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Peds > Murmers/Coartation of aorta > Flashcards

Murmers/Coartation of aorta Flashcards

1
Q
  1. An innocent heart murmur has which of the following characteristics?
    A. occurs late in systole
    B. has localized area of auscultation
    C. becomes softer when the patient moves from supine to standing position
    D. frequently obliterates the second heart sound (S2)
    (Fitzgerald 481)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

C. becomes softer when the patient moves from supine to standing position

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2
Q
  1. The murmur of atrial septal defect is usually:
    A. found in children with symptoms of cardiac disease.
    B. first found on a 2- to 6-month well-baby examination.
    C. found with mitral valve prolapse.
    D. presystolic in timing. (Fitzgerald 481)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

B. first found on a 2- to 6-month well-baby examination.

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3
Q
  1. A Still murmur:
    A. is heard in the presence of cardiac pathology.
    B. has a humming or vibratory quality.
    C. is a reason for denying sports participation clearance.
    D. can become louder when the patient is standing.
    (Fitzgerald 481)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

B. has a humming or vibratory quality.

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4
Q 
Heard in first few days of life; disappears in 2–3 weeks
Benign condition (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation,  5th Edition. F.A. Davis Company, 20170314. VitalBook file.
A

. Newborn murmur

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5
Q

Subsides or disappears when pressure applied to abdomen (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

. Newborn murmur

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6
Q

Grade 1–2/6 early systolic, vibratory, heard best at left lower sternal border (LLSB) with little radiation
Pulses intact, otherwise well neonate (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Newborn murmur

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7
Q 
/Usual onset age 2–6 years; may persist through adolescence
Benign condition (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation,  5th Edition. F.A. Davis Company, 20170314. VitalBook file.
A

Still (vibratory innocent murmur) (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

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8
Q

/Softens or disappears when sitting, when standing, or with Valsalva maneuver
Louder when supine or with fever or tachycardia (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Still (vibratory innocent murmur) (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

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9
Q

/Grade 1–3/6 early systolic ejection, musical or vibratory, short, often buzzing, heard best midway between apex and LLSB (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Still (vibratory innocent murmur) (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

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10
Q

/Grade 1–2/6 systolic ejection, high-pitched, heard best in pulmonic and aortic areas (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Hemic (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

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11
Q

. Heard only in presence of increased cardiac output, such as fever, anemia, stress (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Hemic

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12
Q

Disappears when underlying condition resolves
Usually seen without cardiac disease
Most often heard in children and younger adults with thin chest walls (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Hemic

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13
Q

Disappears when underlying condition resolves
Usually seen without cardiac disease
Most often heard in children and younger adults with thin chest walls (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Venous hum

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14
Q

Disappears in supine position, when jugular vein is compressed
Common after age 3 years (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Venous hum

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15
Q 
Believed to be produced by turbulence in subclavian and jugular veins
Benign condition (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation,  5th Edition. F.A. Davis Company, 20170314. VitalBook file.
A

Venous hum

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16
Q

. Softens or disappears when sitting, when standing, or with Valsalva maneuver
Louder when supine (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Pulmonaryoutflowejection murmur (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

17
Q

. Heard throughout childhood
Benign condition but has qualities similar to murmurs caused by pathological condition such as atrial septal defect (ASD), coarctation of the aorta (COA), pulmonic stenosis (PS) (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Pulmonaryoutflowejection murmur (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

18
Q

. Grade 1–2/6 soft, short, systolic ejection murmur, heard best at LLSB, usually localized (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Pulmonaryoutflowejection murmur (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

19
Q

. Grade 2–4/6 continuous murmur heard best at ULSB and left infraclavicular area (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Patent ductus arteriosus (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

20
Q

. In premature newborns, seen with active precordium; in older children, seen with full pulses (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Patent ductus arteriosus (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

21
Q

. Normal ductus closure occurs by day 4 of life
Often isolated finding but may be seen with COA, ventricular septal defect (VSD)
Accounts for ±12% of all congenital heart disease
Twice as common in girls
In preterm infants <1500 g, rate 20%–60% (Fitzgerald 482-483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Patent ductus arteriosus (Fitzgerald 482)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

22
Q

. Grade 1–3/6 systolic ejection murmur, heard best at ULSB with widely split fixed S2 (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Atrial septal defect (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

23
Q

. Accompanying mid-diastolic murmur heard at fourth intercostal space (ICS) left sternal border (LSB); commonly caused by increased flow across tricuspid valve (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

. Atrial septal defect (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

24
Q

. Two times as common in girls
Child is often entirely well or present with heart failure
Often missed in the first few months of life or even entire childhood
Watch for children with easy fatigability
Cyanosis rare (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Atrial septal defect (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

25
Q

. Grade 2–5/6 regurgitant systolic murmur heard best at LLSB
Occasionally holosystolic, usually localized (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Ventricular septal defect (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

26
Q

. Thrill may be present and a loud P2 with large left-to-right shunt (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Ventricular septal defect (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

27
Q

. Usually without cyanosis
Children with small- to moderate-sized left-to-right shunt without pulmonary hypertension likely to have minimal symptoms
Larger shunts may result in CHF with onset in infancy (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Ventricular septal defect (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

28
Q

. Grade 2–5/6 systolic ejection murmur heard best in upper left sternal border (ULSB) or second right ICS, possibly with paradoxically split S2 (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Aortic stenosis (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

29
Q

. Ejection click at apex, third left ICS, second right ICS
Radiation or thrill to the carotid arteries (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Aortic stenosis (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

30
Q

. More common in boys than girls
In children, usually caused by unicuspid (if noted in infancy) or bicuspid (if noted in childhood) valve
Mild exercise intolerance common (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Aortic stenosis (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

31
Q

. Grade 1–5/6 systolic ejection murmur heard best at ULSB and left interscapular area (on back) (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Coarctation of aorta (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

32
Q

. Weak or absent femoral pulses, hypertension in arms (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Coarctation of aorta (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

33
Q

. Often seen with aortic stenosis (AS), mitral regurgitation (MR)
Presence of dorsalis pedis pulse in child essentially rules out this condition (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Coarctation of aorta

34
Q

. Grade 1–3/6 mid-systolic click followed by late systolic murmur heard best at the apex (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Mitral valve prolapse (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

35
Q

. Murmur heard earlier in systole and often louder with standing or squatting (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Mitral valve prolapse (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

36
Q

. Often with pectus excavatum, straight back (>85%) (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Mitral valve prolapse (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

37
Q

. Grade 2–5/6 heard best at ULSB, ejection click at second left ICS (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Pulmonic valve stenosis (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

38
Q

. Radiates to back S2 can be widely split (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Pulmonic valve stenosis (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

39
Q

. No symptoms with mild to moderate disease
Usually a fusion of valvular cusps
(Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

Pulmonic valve stenosis (Fitzgerald 483)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

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