common congenital cardiac lesions

Question 1

location of a secundum ASD

Answer 1

centre of atrial septum

Question 2

location of primum ASD

Answer 2

parital AVSD

-at crux of heart

Question 3

presenation of ASD

Answer 3

usually asympotmatic in childhood

incidental murmur

later in life may present with breathlessness and arrhythmias

Question 4

managemnt of secundum ASD 2

Answer 4

transcatheter device closure

surgical repair

Question 5

management of primum ASD 1

Answer 5

surgical- needs to be open

Question 6

prognosis of ASD

Answer 6

good long term outlook

Question 7

prevalence of VSD

Answer 7

2/1000 births

Question 8

how can VSDs be classified 2 and then 3

Answer 8

can. be membranous or msucular part of septum

then defined as small, medium or large

Question 9

presentation of small VSD

Answer 9

usually asymptomamtic
-around 80% close spontaneously

Question 10

presentation of large VSD

Answer 10

haemodynamically significant
-can effect left ventircular overload-> ioncreaed pulmonary blood flow and lead to caridac failure

-needs repaired in first 6 months of life

Question 11

if heart failure due to VSD what is mangemnt 3

Answer 11

diuretics

ACE inhibiotrs

maximise nutrion- often with NG feed s

earlier surgery if child continutes to fail to thrive

Question 12

what is a patent ductus arteriosus associated with 2

Answer 12

prematurity

maternal rubella

Question 13

signs on examination of patent ductus arteriosus 2

Answer 13

bounding femoral pulses

continous murmur under left clavicle - subclavicular

Question 14

complications of patent ductus arteriosus 2

Answer 14

heart failure

failure to thrive

Question 15

treatment of patent ductus arteriosus in preterm infants 2

Answer 15

NSAIDs -indomethacin or ibruprofen

surgical ligation if medical management fails

Question 16

treatment of patent ductus arteriosus in older children 1

Answer 16

device occulsion by cardiac catheterisation

Question 17

how does coarctation of aorta present in neonates 3

Answer 17

collapse

cardiac failure

weak/absent femoral pulses

Question 18

coarctation of aorta presentation in older chldren/adults 3

Answer 18

raised BP

absent femoral pulses
or
radio-femoral delay

Question 19

investigation for coarctation of aorta and finding 1

Answer 19

CXR

may show cardiomegaly/ rib notching (in late stages)

Question 20

treatment for coarctation of aorta in infants 1

Answer 20

surgery

Question 21

coarctation of aorta treatment in adults

Answer 21

ballon dilation /stenting

Question 22

commonest neonatal cyanotic condition

Answer 22

transposition of the great arteries

Question 23

presenation of transposition of the great arteries when ductus arteriosus closes 2

Answer 23

effortless tachypneoa

acidotic

*may not have murmur

Question 24

managemnt of transposition of the great arteries 4

Answer 24

CXR- looks like an egg on side

prostaglandin to open arteiral duct

?urgent balloon atrial septostomy (BAS) to increase mixing at atrial level

definitive surgery
-artieral switch- good long term outcome

Question 25

what does tetralogy of Fallot contain

Answer 25

VSD rigt ventricular outflow tract obstruction aortic overide VSD right ventircular hypertorphy

Question 26

spectrum of presentaion of tetralogy of Fallot 3

Answer 26

minimal RVOT obstruction - pink fixed obstruction - may become progresssively cyanosed dynamic obstruction-hypercyanotic spells

Question 27

biochem in tetralogy of Fallot 1

Answer 27

polycythaemia is characterisitc

Question 28

CXR for tetralogy of Fallot

Answer 28

boot shaped heart

Question 29

CXR for transposition of greater arteries

Answer 29

egg on side

Question 30

what is tetralogy of Fallot assoicated with 2

Answer 30

Di george syndrome Downs