Intrasession Lecture: Cardiology

Question 1

A 3-year-old has a continuous, low-pitched murmur in the supraclavicular area that goes away when he turns his head. What is this?

Answer 1

Venous hum –a benign finding

Question 2

What differentiates a grade III and IV murmur?

Answer 2

IV has a thrill.

Question 3

Still’s murmurs have what pitch?

Answer 3

Low-pitched

Question 4

Diastolic murmurs are graded ____________.

Answer 4

I to IV

Question 5

Venous hums are heard over which location?

Answer 5

Supraclavicular

Question 6

Benign murmurs are heard best in what condition?

Answer 6

When the child is exerting himself or herself. When the child is lying down.

Question 7

Why do you need to look at the P wave axis?

Answer 7

The P wave should be positive in I, II, and aVF. If it is negative in I and II but positive in aVF, then it indicates that the SA node is not generating the atrial signal.

Question 8

Why does an ASD cause pulmonic ejection murmur?

Answer 8

The increased flow causes a “relative stenosis” in the pulmonic valve (and even the tricuspid valve) leading to a systolic ejection murmur (and sometimes a diastolic rumble, too).

Question 9

What are the three moguls on the patient’s left in a cardiac x-ray?

Answer 9

• Top: ascending aorta
• Middle: pulmonary artery (should be very mild)
• Bottom: left ventricle

Question 10

Pulmonary arterial hypertension causes what lung findings?

Answer 10

Because hypertensive lungs are constricted, the vasculature is less noticeable. Thus, any congestion in the lungs would make PAH less likely as a diagnosis.