ICM Test 3: Peds Cardiology

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ICM Test 3: Peds Cardiology
2012-12-17 18:06:23
Peds Cardiology

Peds Cardiology
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  1. CHD occurs in how many births
  2. Critical CHD (death, cardiac catherization, surgery) occurs in how many births?
  3. Grades of cardiac murmurs
  4. Barely audible
    Grade 1
  5. Soft readily heard
    Grade 2
  6. Moderatly loud, no thrill
    Grade 3
  7. Loud murmur w/ thrill
    Grade 4
  8. Heard w/o complete contact of stethoscope
    Grade 5
  9. Heard w/o stethoscope on chest wall
    Grade 6
  10. 4 causes of Systolic Ejection Murmurs
    • Aortic Stenosis
    • Pulmonic Stenosis
    • Flow murmurs/Stills murmurs
    • ASD
  11. Systolic Murmurs:  Holosystolic or regurgitant murmurs
    • VSD
    • Tricuspid/Mitral Regurgitation
  12. Diastolic murmurs:  Regurgitant-decrescendo
    • Aortic insufficiency
    • Pulmonic insufficiency
    • Starts w/ high frequency and decreases in frequency and intensity as pressure gradient causes regurgitant flow decreases
    • Begins w/ S2 and continues slightly beyond S1
  13. Diastolic Murmurs
    • Diastolic Flow murmur-early (flow)
    • Mitral Stenosis
    • Tricuspid Stenosis
  14. Early diastole low frequency low intensity, no significant pressure gradient
    Tricuspid stenosis
  15. Continuous Murmur:  Venous hum
    • Most common
    • Normal but turbulen flow at confluence of innonimate veins entering SVC
    • Best heard at upper riht sternal border in sitting position
    • Changes w/ turning of head and may disappear when supine
  16. Continuous murmur with a pressure gradient between AO and PA
  17. Where are PDAs best heard?
    Left upper sternal border (not positional)
  18. Arterial pulse waveform showing alternating strong and weak beats.  Almost always indicates left ventricular systolic impairment; poor prognosis.
    Pulsus Anternans
  19. Pulsus anternans almost always indicates
    Left ventricular systolic impairment
  20. Exaggeration of the normal variation during inspiration, in which the blood pressure declines as one inhales and increases as one exhales
    Pulsus paradoxus
  21. Pulsus paradoxus indicates
    • Cardiac tamponade
    • Pericarditis
    • Chronic sleep apnea
    • Croup
    • Obstructive lung disease
  22. Can detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse
    Pulsus paradoxus
  23. Metabolic Syndrome Cardiac Risk Factors
    • Obesity
    • Dyslipidemia
    • Diabetes
    • HTN
  24. Diminished or absent femoral pulses
    Coarctation of the aorta
  25. Bounding or water hammer pulses
    Aortic regurgitation
  26. Narrowing of the aorta
    Coarctation of the aorta
  27. Is coarctation more common in boys or girls?
  28. Coarctation is very common in what syndrome
    Turner Syndrome
  29. Coarctation typically occurs where?
    After the left subclavian artery
  30. Clinical Presentation of CHD in Neonate (Timing and Symptoms depend on)
    • Anatomic defect
    • In utero effects (if any)
    • Physiologic changes- transitional circulation, closure of the ductus arteriosus, fall in pulmonary vascular resistance
  31. Minimal symptoms that present within first 2-3 days of life; duct dependent pulmonary blood flow
  32. Presents within first 2 wks of life; duct-dependent systemic blood flow
    CHF/Circulatory Collapse/ Shock
  33. Hyperoxia Test:  pO2 <100
    Cyanotic CHD likely
  34. Hyperoxia Test:  100-250
    Cyanotic CHD possible
  35. Hyperoxia Test:  pO2 > 250
    Cyanotic disease unlikely
  36. Neonatal emergency, urgent intervention required
    Failed hyperoxia test
  37. Conotruncal defect that has a microdeletion 22
    Truncus Arteriosus
  38. Clinical syndrome in which the heart is unable to perform its pump function to meet metabolic demands of the body
    Congestive Heart Failure
  39. 2 things that result in CHF
    • 1)  increased demaned volume or pressure overload
    • 2)  normal demand but increased ability; inflammatory or metabolic disease
  40. After 2 day, the neonate who presents w/ circulatory collapse in the first few weeks of life has
    Duct dependent systemic blood flow until proben otherwise. (Coarctation of the aorta, Interrupted aortic arch, Critical aortic stenosis, hypoplastic left heart syndrome)
  41. Hypoplastic left heart syndrome
  42. Erb's point
    3rd left intercostal point, hear aortic valve murmurs
  43. PMI is found
    Lateral heart border, usually just inside the mid-clavicular line
  44. 4th intercostal space
    Straddles the atria
  45. 5th important marker
    Most inferior portion of left ventricle
  46. ERBs is where what murmurs are best heard
  47. 4th intercostal space
    tricuspid valve
  48. 5th intercostal space
  49. Heart Sound:  Closing event of mitral and tricuspid valves
  50. Heart Sound:  Closing event of aortic and pulmonic valves
  51. S4 is only with contraction of what?
  52. Heart Sound:  Occurs during end of rapid ventricular filling
  53. Another word for S2
  54. Decreased compliance of the corresponding ventricle
    Diastolic stiffness (S4)
  55. Heart sound indicates systolic dysfunction/systolic failure
  56. Summation sound
    S3 + S4
  57. Diastolic sound- S3 or summation sound
  58. Clicks during systole
    Systolic gallop
  59. Pseudohypertension
    Osler's hypertension
  60. Characteristic Pulse:  Late and weak
    Pulsus tardus et parvus
  61. Characteristic Pulses:  Water hammer
    Corrigan's Pulse
  62. Characteristic Pulses:  Twice beating
    Pulsus bisferiens
  63. Characteristic Pulses:  Two heartbeats close together by a bigeminus
    Pulsus bigeminus
  64. Characteristic Pulses:  Aortic insufficiency and stenosis together
    Pulsus Bisferiens
  65. 3 things that commonly have Pulses paradoxus
    COPD, apnea, tamponade
  66. Pulsus alternans is common in
    heart failure
  67. Allen's Test for functioning Palmar Arch
    Massage blood out of palm, occlude radial and ulnar artery into hand.  Ensures that there are superficial and deep palmar artery arch overlap
  68. Kussmaul's Sign
    Jugular venous distention on inspiration
  69. How do you convert cm of blood to mmHg
    Multiply by 0.7.
  70. Noise from an artery or vein
  71. Noise from the heart
  72. Bruit or murmur you feel
  73. Innocent or abnormal murmur
    Systolic murmur
  74. Abnormal murmur
    Diastolic murmur
  75. Innocent murmurs are usually soft, and most due to flow across _______. Common in ____.
    Pulmonic outflow tract

    Children, during fever, anemia, pregnancy or any state w/ increased cardiac output.

    Normal respiratory response of the second heart sound.
  76. Often equated w/ obstruction at aortic or pulmonic valve
    Ejection Murmur
  77. Diamond Shaped
    Ejection murmur (start quiet, get loud, get quiet again)
  78. Causes all murmurs
    Ejection , either forward or backward
  79. Cardinal Symptoms of Aortic Stenosis
    • Dyspnea
    • Angina pectoris
    • Syncope
  80. Heyde's Syndrome
    Intestinal bleeding associated with aortic stenosis
  81. Gallavardin phenomenon
    Found in aortic stenosis (separation of sounds)
  82. Absent or weak A2
    Calcification of cusps
  83. Which comes first in an S2 split
    Aortic (Anatomy before Physiology)
  84. S1 sound is not due to closure of valve
    It is due to events that bring about the closure
  85. In moderate to severe aortic stenosis you will hear
  86. Sawing wood murmur, usually grade 2-3 intensity
    Aortic Stenosis, absent in tight stenosis
  87. Name 2 sounds common in aortic stenosis
    S4, aortic diastolic murmur
  88. Sign found in patient's with Tricuspid regurgitation
    Carvallo's sign
  89. Pansystolic murmur becomes loud in inspiration
    Carvallo's sign= tricuspid regurgitation (differs it from mitral regurgitation)
  90. Thrill w/ murmur that begins early and masks S1 and extends well beyond S2
  91. Machinery-like murmur
  92. Holosystolic
    Mitral regurg., Tricuspid regurg., VSD
  93. Diamond-shaped murmurs
    Aortic or pulmonic stenosis
  94. High pitched diastolic murmur in Erb's area
    Aortic regurgitation
  95. de Musset's head bobbing
    Duroziez's to and fro femoral bruit
    Traube's pistol shot sound
    Aortic regurgitation
  96. Aortic regurgitation that mimics mitral stenosis
    Austin Flint murmur
  97. Where is Aortic regurgitation best heard
    Right sternal edge
  98. Common cause of Aortic regurgitation
    Rheumtic (congenital, degenerative)
  99. Aortic root disorders that lead to an enlarged aorta and aortic regurgitation
    Cusp rupture (Marfan's, Syphilis)
  100. 4 Stages of Valsalva's Maneuver
    • Stage 1:  LV transient stroke volume & BP increase (4-5 seconds)
    • Stage 2:  LV stroke volume falls - BP falls- heart rate speeds (CO = SV * HR)
    • Stage 3:  Release- blood sucked back in to the lungs- compensatory overshoot of BP- HR falls
    • Stage 4:  Return to baselin
  101. Murmurs that increase during Valsalva's Maneuver
    Murmurs of hypertrophic cardiomyopathy and mitral valve prolapse
  102. Valsalva's maneuver:
    Heart rate _______
    Stroke volume is _____
    • Increases contractility
    • Decreased
  103. Murmurs that decrease during Valsalva's maneuver
    Aortic and pulmonary stenosis
  104. Barlow's Syndrome
    Mitral Valve Prolapse
  105. Mid-systolic click
    Mitral valve prolapse
  106. Regurgitation in an individual with floppy mitral valve.  3rd sound and diastolic flow murmur indicating severe regurgitation
    Barlow's Syndrome
  107. Loose jointed/ hypermobility is indicative of
    Mitral Valve Prolapse
  108. Ehler's Danlos
    Mitral Valve Prolapse
  109. Ejection sound and preserved second sound (A2) reflect mobility of the valve despite severe stenosis
    Congenital bicuspid valve (Pulsus parvus et tardus)
  110. Fixed S2=
    Wide S2 splitting=
    • Fixed S2= ASD
    • Wide S2 splitting= normal in inspiration, abnormal in expiration