Cardiology- Congenital, Valvular, Infectious

Question 1

MC Congenital defect

Answer 1

VSD

Question 2

In VSD a loud murmur means

Answer 2

small defect

Question 3

1 week old infant with FTT
on exam a pansystolic murmur is heard with a palpable thrill
EKG shows possible LA abnl
dx
tx

Answer 3

ECHO demonstrates VSD
symptomatic with diuretics to “buy time”
surgical repair/device closure

Question 4

3 week old female infant with fixed S2 split and systolic ejection murmur

Answer 4

ASD

Question 5

Infant born at 27 weeks gestation has poor feeding. On exam bounding peripheral pulses. A machine like grinding murmur is heard best on LSB
Dx
Tx

Answer 5

PDA
can wait, can try indomethacin if neonate
surgical correction

Question 6

ToF consists of

Answer 6

VSD
Overriding Aorta
Pulmonary Stenosis
RVH

Question 7

Tx of ToF

Answer 7

Surgery always indicated

-temporize with BT shunt until ready for sx

Question 8

MC cyanotic congenital heart diease

Answer 8

ToF

Question 9

Acyanotic shunts are what direction

Answer 9

L to R

Question 10

Cyanotic shunts are what direction

Answer 10

R to L

Question 11

Eisenmenger Syndrome is

Answer 11

reversal of L to R shunt (no big deal) to R to L shunt (cyanotic)
- happens with defect lasts long enough for pulm HTN and RVH to happen which leads to reversal of flow

Question 12

Tx Coarctation of Aorta

Answer 12

simple uncomplicated- balloon angioplasty

otherwise surgical resection

Question 13

systolic crescendo-descrescendo ejection murmur that radiates to the carotids

Answer 13

Aortic Stenosis

Question 14

Nocturnal angina and nocturnal dyspnea with diastolic murmur

Answer 14

Aortic Regurgitation

Question 15

Harsh decrescendo diastolic murmur best at base. De-Musset pulse present

Answer 15

Aortic Regurgitation

Question 16

How to diagnose all the murmurs…

Answer 16

ECHO

Question 17

MCC Aortic regurg

Answer 17

Aortic stenosis

Question 18

Acute aortic regurgitation treatment of choice

Answer 18

vasodilator- sodium nitroprusside

Question 19

MCC mitral stenosis

Answer 19

rheumatic heart disease

Question 20

Pt complaining of dyspnea. Tachycardic on exam with a low pitched diastolic murmur heard best at the apex and associated opening snap

Answer 20

Mitral Stenosis

Question 21

Holosystolic blowing murmur with radiation to the left axilla

Answer 21

Mitral Regurgitation

Question 22

Pt c/o light headedness and pre-syncopal episodes. PMH significant for Marfans. On exam a late systolic click is heard. ECHO shows leaflets in the LA.

Answer 22

Mitral Valve Prolapse

Question 23

MCC of Tricuspid Regurgiation

Answer 23

secondary to RV failure/dilation

Question 24

Soft systolic murmur best at 4th ICS LSP that increases with inspiration.

Answer 24

Tricuspid Regurgitation

Question 25

MCC Tricuspid Stenosis

Answer 25

rheumatic heart disease

Question 26

Pt presents with light headedness. On exam you note JVD and a diastolic murmur at LLSB that increases with inspiration and associated opening snap

Answer 26

Tricuspid Stenosis

Question 27

Valsalva ______ MR & _______ AS

Answer 27

decreases MR | decreases AS

Question 28

Hand grip ______ MR & ________ AS

Answer 28

increases MR | decreases AS

Question 29

MCC myocarditis

Answer 29

Viral: coxsackie, influenza, parvovirus, arbo, etc etc

Question 30

Patho of myocarditis

Answer 30

Inflammatory process with necrosis that involves the myocardium. Can be direct injury by infectious agent, immune reaction, or from drugs.

Question 31

Acute onset CHF pts in young pt with few RF suggests

Answer 31

Myocarditis in ddx

Question 32

First step in dx myocarditis | Gold standard to dx

Answer 32

Cardiac MRI with Gadolinium | Biopsy is gold standard to confirm

Question 33

MC pathogen in endocarditis

Answer 33

Strep viridans

Question 34

MC site of endocarditis

Answer 34

mitral valve

Question 35

MC site of endocarditis in IVDU | MC pathogen in IVDU

Answer 35

Tricuspid valve | Staph aureus

Question 36

HIV/AIDS pts have increased susceptibility to what specific organism in endocarditis

Answer 36

Salmonella

Question 37

Native valve IE RF

Answer 37

``` rheumatic heart congenital heart IVDU poor dental hygiene DM on hemodialysis ```

Question 38

30 M presents with 5 days of fever and night sweats and minor dyspnea. On exam he has splenomegaly and nontender erythematous lesions on palms bilt and R sole. Test of Choice

Answer 38

Blood cultures now! start empiric abx likely get ECHO dx IE

Question 39

How to dx IE

Answer 39

Dukes Criteria: 2 major, 1 maj + minor, 5 minor Major: + b.c. for typical organism + ECHO Minor: predisposing condition (IVDU, rheum) temp >38.0 vasc phenom: Janeway lesions, ICH, arterial emboli Immuno phenom: glomeruloneph, Osler nodes, Roth spots ECHO findings abnormal organism recovered

Question 40

Empiric treatment of infective endocarditis

Answer 40

Vanc + Gentamycin +/- Ceftriaxone

Question 41

MCC pericarditis

Answer 41

Viral- esp coxsackie and echoviruses

Question 42

pleuritic CP relieved when sitting up and leaning forward with friction rub on exam

Answer 42

Pericarditis

Question 43

Classic EKG findings of pericarditis

Answer 43

DIFFUSE ST segment elevation low QRS amplitude PR depression ~electrical alternans (from effusion)

Question 44

Work up of pericardial effusion

Answer 44

ECHO most sensitive to dx | diagnostic/therapeutic Pericardiocentesis/bx often indicated

Question 45

Cholesterol found in pericardial effusion suggests

Answer 45

hypothyroid cause

Question 46

Chylous material found in pericardial effusion suggests

Answer 46

lymphatic obstruction

Question 47

6 y/o M with 5 days of fever presents with stomatitis and cervical LAN. He also has a polymorphous exanthema in which there is desquamation of hands and feet.

Answer 47

Kawasaki Disease

Question 48

Untreated Kawasaki Disease patients are at risk of developing

Answer 48

coronary anuerysm

Question 49

Diagnostic Criteria for Kawasaki Disease

Answer 49

Dx if 4/5: bilat painless conjunctivitis (non exudative) stomatitis cervical LAN polymorphous exanthema extremity changes- redness, swlling hands and feet with desquamation

Question 50

Treatment for Kawasaki Disease

Answer 50

IVIG and high dose ASA

Question 51

Rheumatic Fever caused by

Answer 51

immune response triggered by pharyngeal infection with group A strep

Question 52

Diagnostic Criteria for Rheumatic Fever

Answer 52

``` 2 major, 1 major + 2minor Major: carditis polyarthritis- migratory Sydenham chorea erythema marginatum subQ nodules ``` Minor: polyarthralgias, CRP, prolonged PR, fever, + throat culture, + ASO tier

Question 53

Valve MC affected in rheumatic fever | can lead to___

Answer 53

Mitral | mitral stenosis

Question 54

Tx for rheumatic fever

Answer 54

1.2 mill units PCN G IM then PCN IM q month until 21 y/o