FINAL EXAM: MCN 552, 2025/2026
WITH CORRECT/ACCURATE ANSWERS
When should the PCP be screening for causes of sudden cardiac
death (SCD)?
any well visit, sports physical, and a c/o chest pain, syncope, or
palpitations
What are the most frequent causes of exercise related SCD?
hypertrophic cardiomyopathy* most common* and
arrhythmogenic right ventricular cardiomyopathy
Also: coronary artery anomalies, aortic dissection rupture
(marfan), Mitral valve prolapse, and aortic stenosis, congenital
electrical cardiac abnormalities (WPW)
EVERY CHILD NEEDS A CARDIOLOGY REFERRAL WHO:
-- has a family hx of SCD
-- inheritable cardiomyopathies
-- marfan syndrome
-- chest pain of concern
-- syncope
-- acquired heart disease (kawasaki)
-- CHD
-- palpitations or rhythm disturbances
What is commotio cordis?
direct blow to the chest that disrupts rhythm of heart (blow during
T wave, triggers VFIB); AED and CPR is the treatment
,First goal of chest pain is to rule out
cardiac causes
What is the most frequent cause of chest pain? Is it bad? Does it
require treatment?
musculoskeletal, originating in the chest wall or chest cage. It is
usually benign and rarely requires treatment.
If there is pain in the chest with exercise then what is that most
likely?
exercise induced bronchospasm
Chest pain that is vague and occurs over many months in a
variety of circumstances may be what?
psychogenic (anxiety or hyperventilation)
Chest pain with syncope, exertional dyspnea, or irregular HR
requires what?
CAREFUL EVAL FOR POSSIBLE CARDIAC CAUSE
Chest pain with cardiac cause typically is described with a specific
hx with details that are consistent from event to event.
true
chest pain described as burning, substernal that worsens with
reclining or with spicy food =
most likely gastrointestinal etiology
chest pain that is sharp or stabbing, lasting several seconds to
minutes, located over the midsternum or infranipple area, and
occurring with nonexertion or deep inspirations =
most likely musculoskeletal.
Chest pain that awakens the patient from sleep =
, most likely organic
point tenderness of one or more costochondral joints exaggerated
by physical activity or deep inspiration suggests what? if its
associated with warmth, swelling or tenderness over joint then its
what?
costochondritis; tietze syndrome
When there is no clear etiology, findings are normal, child appears
well, what is the most important treatment for chest pain?
reassurance
Refer any child to cardiology with:
-chest pain that worsens with exercise
-any pain that suggests angina
-positive findings on exam, ekg, cxr, or concerning personal or
family hx
chest pain with a musculoskeletal cause treatment
NSAIDS
A BP should be done on which children?
every kid over the age of 3
A normal BP in kids less than 13 years is:
systolic/ diastolic BP less than the 90th% for age, sex, and height.
Elevated BP in <13 yo
HTN in <13yo
90-95th% for age, sex, height;
HTN= >95th%
WITH CORRECT/ACCURATE ANSWERS
When should the PCP be screening for causes of sudden cardiac
death (SCD)?
any well visit, sports physical, and a c/o chest pain, syncope, or
palpitations
What are the most frequent causes of exercise related SCD?
hypertrophic cardiomyopathy* most common* and
arrhythmogenic right ventricular cardiomyopathy
Also: coronary artery anomalies, aortic dissection rupture
(marfan), Mitral valve prolapse, and aortic stenosis, congenital
electrical cardiac abnormalities (WPW)
EVERY CHILD NEEDS A CARDIOLOGY REFERRAL WHO:
-- has a family hx of SCD
-- inheritable cardiomyopathies
-- marfan syndrome
-- chest pain of concern
-- syncope
-- acquired heart disease (kawasaki)
-- CHD
-- palpitations or rhythm disturbances
What is commotio cordis?
direct blow to the chest that disrupts rhythm of heart (blow during
T wave, triggers VFIB); AED and CPR is the treatment
,First goal of chest pain is to rule out
cardiac causes
What is the most frequent cause of chest pain? Is it bad? Does it
require treatment?
musculoskeletal, originating in the chest wall or chest cage. It is
usually benign and rarely requires treatment.
If there is pain in the chest with exercise then what is that most
likely?
exercise induced bronchospasm
Chest pain that is vague and occurs over many months in a
variety of circumstances may be what?
psychogenic (anxiety or hyperventilation)
Chest pain with syncope, exertional dyspnea, or irregular HR
requires what?
CAREFUL EVAL FOR POSSIBLE CARDIAC CAUSE
Chest pain with cardiac cause typically is described with a specific
hx with details that are consistent from event to event.
true
chest pain described as burning, substernal that worsens with
reclining or with spicy food =
most likely gastrointestinal etiology
chest pain that is sharp or stabbing, lasting several seconds to
minutes, located over the midsternum or infranipple area, and
occurring with nonexertion or deep inspirations =
most likely musculoskeletal.
Chest pain that awakens the patient from sleep =
, most likely organic
point tenderness of one or more costochondral joints exaggerated
by physical activity or deep inspiration suggests what? if its
associated with warmth, swelling or tenderness over joint then its
what?
costochondritis; tietze syndrome
When there is no clear etiology, findings are normal, child appears
well, what is the most important treatment for chest pain?
reassurance
Refer any child to cardiology with:
-chest pain that worsens with exercise
-any pain that suggests angina
-positive findings on exam, ekg, cxr, or concerning personal or
family hx
chest pain with a musculoskeletal cause treatment
NSAIDS
A BP should be done on which children?
every kid over the age of 3
A normal BP in kids less than 13 years is:
systolic/ diastolic BP less than the 90th% for age, sex, and height.
Elevated BP in <13 yo
HTN in <13yo
90-95th% for age, sex, height;
HTN= >95th%
