MCN 552 FINAL EXAM QUESTIONS & ANSWERS
In fetal circulation, oxygenation of blood occurs in the ___ , not the ___ - Answers -
placenta; lungs
The foramen ovale is an opening in the septum and allows a portion of blood flow from
the ___ to the ___ - Answers - RA; LA
A patent ductus arteriosis (PDA) provides a connection between the ____ and the ____,
which then bypasses the fetal lungs - Answers - pulmonary artery; aorta
What is the process the PDA / Foramen Ovale closing? - Answers - As the child starts
breathing for the first time, pulmonary blood flow increases... the increase in oxygen
saturday will begin the process of closing the PDA, and as the pressure in the L side of
the heart becomes greater, the Foramen ovale closes.
When does PDA close normally - Answers - First few hours to days of life
When do shunt murmurs or sx of CHF typically show up? why? - Answers - 6-8weeks of
life; pulmonary vascular resistance drops gradually and shunting to the pulmonary bed
increases
A strong brachial pulse/ weak femoral pulse would be: - Answers - Coarctation of the
aorta
In healthy children, BP should be measured annually beginning at ___ years, unless
they have _____, then BP should be measured at every appointment. - Answers - 3;
obesity, renal disease, diabetes, or known aortic arch disease
Some children with conditions that are associated with CHD have obvious stigmata
such as: - Answers - -Down syndrome
-Marfan syndrome (unusually tall with an arm span wider than the head to toe height)
-Turner syndrome (webbed neck, prominent ears)
-Fetal alcohol spectrum disorder (microcephaly and pinched fascies)
A complete heart block (congenital) is associated with - Answers - maternal systemic
lupus
What is the best indicator of cyanosis in a baby? - Answers - the tongue
What could be a sign of CHF in an infant? - Answers - edema around the eyes
Is scoliosis associated with CHD? - Answers - yes
S1 is louder at the _______ - Answers - apex
,s2 is loudest at the ____ - Answers - base/ upper left sternal border (pulmonic region)
Down syndrome is associated with which CHD? - Answers - -AV canal
-VSD, ASD, PDA
-TOF
Marfan syndrome is associated with which CHD? - Answers - Mitral valve prolapse
Aortic root dilation
Neurofibromitosis is associated with which CHD? - Answers - Pulmonic stenosis
Coarctation of the aorta
Fetal alcohol syndrome is associated with which CHD? - Answers - -VSD, PDA, ASD
-TOF
80% of children have which type of murmur? - Answers - functional or innocent murmur
Cardiac assessment: physical exam includes - Answers - VS, palpation of pulses,
palpation of all 5 areas (aortic, pulmonic, tricuspid, mitral, Erbs point), auscultation
Where is the apical pulse located? - Answers - 4th IC space just the L of the mid-
clavicular line
What is normal sinus arrhythmia ? - Answers - normal variation in HR where the HR will
increase during inspiration and decrease during exhalation
A bounding pulse can be a sign of - Answers - PDA or Aortic Insufficiency
A weak/ thready pulse can be a sign of - Answers - CHF or an obstructive lesion (Aortic
stenosis)
All murmurs may be intensified by - Answers - factors that increase cardiac output like
anemia
fever
exercise
Significant defects may not have a murmur why? - Answers - because there may not be
turbulent blood flow (like from a large VSD)
Describing a heart murmur - Answers - GRADE/ Intensity
Timing with cardiac cycle
Location on chest/ where its loudest
Radiations/ transmissions
Quality
Duration
,Pitch
Innocent murmur - Answers - grade I-III
changes with position
may vary in loudness / presence
increase with cardiac output (fever etc)
musical or vibratory in quality, sometimes blowing
systolic in timing
short duration
best heard in LLSB or pulmonic area
rarely transmitted
may disappear with valsalva maneuver
normal vital signs
normal ECG
good health status
Possible pathologic murmur - Answers - Assoc with CHD
Diastolic murmur
Systolic murmur with thrill
Pansystolic murmur or holosystolic
Continous murmurs that cant be suppressed
Systolic clicks
Opening snaps
Fixed splitting of second heart sound (not with BBB)
Accentuate S2
S4 Gallop**
Not positional
Grade III or IV
Harsh quality
A sickle cell patient may have a loud murmur due to being _____ - Answers - Anemic
PCP management for CHD - Answers - -Adequate Nutrition
-Psychosocial development/ functioning
-Preventative vaccines: delay live vaccines till 6 months after cardiac bypass or
exposure to RBC or plasma, RSV prophylaxis, other vaccines on time
-Prevent avoidable complications
-Prevent infective endocarditis: prophylaxis for dental, be on high alert for suspicious sx
after procedures (fever, petechiae), children with CHD have more gingival inflammatory
conditions
-Optimal fitness
-Optimal neurodevelopment
When should the PCP refer to cardiology? - Answers - -if there is any suspected cardiac
disease or unsure of findings
, -a child with a murmur who is doing well should be referred in timely but not urgent
manner
-suggestive cardiac disease:
>sats < 95
>sx of CHF
>a murmur that is difficult to differentiate In the presence of poor growth / development
>an older child with dizziness, chest pain with exertion, arrhythmia, dyspnea, syncope,
signs of CHF, or abnormal VS
Congestive heart failure - Answers - A progressive condition that reflects weakening of
the heart, common in many children with CHD
Symptoms of CHF vary with ___ and ___ of cardiac problem - Answers - age; root
CHF can occur in children with structurally normal hearts due to - Answers -
cardiomyopathy, arrhythmias, ischemia, toxins, or infections
Which groups of children are most likely to get CHF? - Answers - those with excessive
left to right shunting through unrepaired defects
S/sx of CHF in an infant - Answers - -tachypnea/ tachycardia
-rales or wheezing
-cardiomegaly, hepatomegaly
-periorbital edema
-poor feeding/ tires easily
-poor wt gain
-diaphoresis
S/sx of CHF in a child/ teen - Answers - -T/T
-rales or wheezing
-cardiomegaly/ hepatomegaly
-orthopnea
-SOB or dyspnea with exertion
-peripheral edema
-poor growth and development
CHF: treatment goal - Answers - --Remove accumulated fluid/ sodium
--Improve cardiac function (increase contractility and decrease afterload)
--Decrease cardiac demands
--Improve tissue oxygenation and decrease oxygen consumption
MEDS: Digoxin and Diuretics
When should the PCP be screening for causes of sudden cardiac death (SCD)? -
Answers - any well visit, sports physical, and a c/o chest pain, syncope, or palpitations
In fetal circulation, oxygenation of blood occurs in the ___ , not the ___ - Answers -
placenta; lungs
The foramen ovale is an opening in the septum and allows a portion of blood flow from
the ___ to the ___ - Answers - RA; LA
A patent ductus arteriosis (PDA) provides a connection between the ____ and the ____,
which then bypasses the fetal lungs - Answers - pulmonary artery; aorta
What is the process the PDA / Foramen Ovale closing? - Answers - As the child starts
breathing for the first time, pulmonary blood flow increases... the increase in oxygen
saturday will begin the process of closing the PDA, and as the pressure in the L side of
the heart becomes greater, the Foramen ovale closes.
When does PDA close normally - Answers - First few hours to days of life
When do shunt murmurs or sx of CHF typically show up? why? - Answers - 6-8weeks of
life; pulmonary vascular resistance drops gradually and shunting to the pulmonary bed
increases
A strong brachial pulse/ weak femoral pulse would be: - Answers - Coarctation of the
aorta
In healthy children, BP should be measured annually beginning at ___ years, unless
they have _____, then BP should be measured at every appointment. - Answers - 3;
obesity, renal disease, diabetes, or known aortic arch disease
Some children with conditions that are associated with CHD have obvious stigmata
such as: - Answers - -Down syndrome
-Marfan syndrome (unusually tall with an arm span wider than the head to toe height)
-Turner syndrome (webbed neck, prominent ears)
-Fetal alcohol spectrum disorder (microcephaly and pinched fascies)
A complete heart block (congenital) is associated with - Answers - maternal systemic
lupus
What is the best indicator of cyanosis in a baby? - Answers - the tongue
What could be a sign of CHF in an infant? - Answers - edema around the eyes
Is scoliosis associated with CHD? - Answers - yes
S1 is louder at the _______ - Answers - apex
,s2 is loudest at the ____ - Answers - base/ upper left sternal border (pulmonic region)
Down syndrome is associated with which CHD? - Answers - -AV canal
-VSD, ASD, PDA
-TOF
Marfan syndrome is associated with which CHD? - Answers - Mitral valve prolapse
Aortic root dilation
Neurofibromitosis is associated with which CHD? - Answers - Pulmonic stenosis
Coarctation of the aorta
Fetal alcohol syndrome is associated with which CHD? - Answers - -VSD, PDA, ASD
-TOF
80% of children have which type of murmur? - Answers - functional or innocent murmur
Cardiac assessment: physical exam includes - Answers - VS, palpation of pulses,
palpation of all 5 areas (aortic, pulmonic, tricuspid, mitral, Erbs point), auscultation
Where is the apical pulse located? - Answers - 4th IC space just the L of the mid-
clavicular line
What is normal sinus arrhythmia ? - Answers - normal variation in HR where the HR will
increase during inspiration and decrease during exhalation
A bounding pulse can be a sign of - Answers - PDA or Aortic Insufficiency
A weak/ thready pulse can be a sign of - Answers - CHF or an obstructive lesion (Aortic
stenosis)
All murmurs may be intensified by - Answers - factors that increase cardiac output like
anemia
fever
exercise
Significant defects may not have a murmur why? - Answers - because there may not be
turbulent blood flow (like from a large VSD)
Describing a heart murmur - Answers - GRADE/ Intensity
Timing with cardiac cycle
Location on chest/ where its loudest
Radiations/ transmissions
Quality
Duration
,Pitch
Innocent murmur - Answers - grade I-III
changes with position
may vary in loudness / presence
increase with cardiac output (fever etc)
musical or vibratory in quality, sometimes blowing
systolic in timing
short duration
best heard in LLSB or pulmonic area
rarely transmitted
may disappear with valsalva maneuver
normal vital signs
normal ECG
good health status
Possible pathologic murmur - Answers - Assoc with CHD
Diastolic murmur
Systolic murmur with thrill
Pansystolic murmur or holosystolic
Continous murmurs that cant be suppressed
Systolic clicks
Opening snaps
Fixed splitting of second heart sound (not with BBB)
Accentuate S2
S4 Gallop**
Not positional
Grade III or IV
Harsh quality
A sickle cell patient may have a loud murmur due to being _____ - Answers - Anemic
PCP management for CHD - Answers - -Adequate Nutrition
-Psychosocial development/ functioning
-Preventative vaccines: delay live vaccines till 6 months after cardiac bypass or
exposure to RBC or plasma, RSV prophylaxis, other vaccines on time
-Prevent avoidable complications
-Prevent infective endocarditis: prophylaxis for dental, be on high alert for suspicious sx
after procedures (fever, petechiae), children with CHD have more gingival inflammatory
conditions
-Optimal fitness
-Optimal neurodevelopment
When should the PCP refer to cardiology? - Answers - -if there is any suspected cardiac
disease or unsure of findings
, -a child with a murmur who is doing well should be referred in timely but not urgent
manner
-suggestive cardiac disease:
>sats < 95
>sx of CHF
>a murmur that is difficult to differentiate In the presence of poor growth / development
>an older child with dizziness, chest pain with exertion, arrhythmia, dyspnea, syncope,
signs of CHF, or abnormal VS
Congestive heart failure - Answers - A progressive condition that reflects weakening of
the heart, common in many children with CHD
Symptoms of CHF vary with ___ and ___ of cardiac problem - Answers - age; root
CHF can occur in children with structurally normal hearts due to - Answers -
cardiomyopathy, arrhythmias, ischemia, toxins, or infections
Which groups of children are most likely to get CHF? - Answers - those with excessive
left to right shunting through unrepaired defects
S/sx of CHF in an infant - Answers - -tachypnea/ tachycardia
-rales or wheezing
-cardiomegaly, hepatomegaly
-periorbital edema
-poor feeding/ tires easily
-poor wt gain
-diaphoresis
S/sx of CHF in a child/ teen - Answers - -T/T
-rales or wheezing
-cardiomegaly/ hepatomegaly
-orthopnea
-SOB or dyspnea with exertion
-peripheral edema
-poor growth and development
CHF: treatment goal - Answers - --Remove accumulated fluid/ sodium
--Improve cardiac function (increase contractility and decrease afterload)
--Decrease cardiac demands
--Improve tissue oxygenation and decrease oxygen consumption
MEDS: Digoxin and Diuretics
When should the PCP be screening for causes of sudden cardiac death (SCD)? -
Answers - any well visit, sports physical, and a c/o chest pain, syncope, or palpitations
