Cardiology

Question 1

Egg on a String

Answer 1

CXR for TGA

Question 2

Boot

Answer 2

TOF (RVH)

Question 3

Snowman

Answer 3

TAPVR

Question 4

Giant heart

Answer 4

Ebstein’s Anomaly

Question 5

Two tests for cyanotic heart lesions

Answer 5

Pre-post ductal saturations

Hyperoxia test

Question 6

Hyperoxia test

Answer 6

ABG in room air, then repeated after placed on 100% FiO2 for 10 min - if PaO2 >80, unlikely to be cyanotic congenital heart disease

Question 7

3 sign

Answer 7

Coarctation of Aorta on CXR

Question 8

Signs of PDA

Answer 8

Continuous murmur
Pulmonary edema
Wide pulse pressure
Bounding pulses

Question 9

Risks of PDA in preterm infants

Answer 9

NEC
Renal injury
Myocardial ischemia

Question 10

Components required for PDA closure

Answer 10

Absence of Prostaglandins
Smooth muscle
Platelets

Question 11

Murmur of PDA

Answer 11

Continuous murmur
LUSB
Machine like

Question 12

Treatment of PDAs

Answer 12

Indomethacin - risk of NEC, SIP, bleeding (do not use in thrombocytopenia, IVH, intracranial hypertension)
Ibuprofen - monitor renal function
Acetaminophen -monitor liver function

Question 13

ASD murmur

Answer 13

Systolic ejection murmur
LUSB
Wide fixed split S2

Question 14

Commonest type of ASD

Answer 14

Secundum

Question 15

Natural history of ASD

Answer 15

Most will close spontaneously by 8 years of age

5-10% of patients will develop pulmonary hypertension over time due to increased pulmonary blood flow

Question 16

Types of VSDs

Answer 16

Membranous/peri-membranous (70%)
Muscular (5-20%)
Inlet/AV canal type VSD (5-8%)
Supracristal/infundibular (5-7%)

Question 17

Most common congenital heart disease

Answer 17

Bicuspid aortic valve

Question 18

Most common cyanotic congenital heart disease

Answer 18

TOF

Question 19

VSD murmur

Answer 19

Holosystolic, LLSB

If defect close to aortic or tricuspid valves, can lead to insufficiency and other murmurs

Question 20

Bicuspid aortic valve auscultation

Answer 20

Midsystolic ejection click +/- murmur if stenosis/insufficiency present

Question 21

Late sequelae of BAV (2)

Answer 21

Aortic root dilatation

Aortic dissection

Question 22

Natural history of BAV

Answer 22

Valvular calcification and stenosis
Valvular degradation and insufficiency
Aortic root dilatation/dissection

Question 23

Important long term management/surveillance of BAV

Answer 23

Serial echo - assess aortic root, function of valve

Strict hypertension control

Question 24

Genetic association with CoA

Answer 24

Turner syndrome (30%)

Question 25

Genetic association with TOF

Answer 25

Trisomy 21
22q11
Trisomy 18
Trisomy 13
Alagille syndrome
Holt Oram

Question 26

Developmental problem in TOF

Answer 26

Anterior deviation of infundibular septum

Question 27

Lesions in TOF (4)

Answer 27

Overriding aorta
VSD
RV outflow tract obstruction
RVH

Question 28

Medication options for management of hyper cyanotic spell

Answer 28

Morphine (calm baby)
Propranolol
Phenylephrine (increase SVR and reverse shunt)
Paralysis (last option)

Question 29

Non-medication options for management of hyper cyanotic spell

Answer 29

Comfort
Knee to chest (baby)
Squat (child)
Fluid bolus