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Flashcards in Cardiovascular Disorders Deck (42)
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1

The most common congenital heart defect in children is:
a) tricuspid atresia
b) ventricular septal defect
c) aortic stenosis
d) pulmonary atresia

b) ventricular septal defect

2

The mother of a 4 mo infant reports that he turned blue and seemed to have fast labored breathing after vigorous crying soon after awakening. He "fell asleep" and his color and breathing seemed to improve. On physical exam the lips and mouth appear mildly cyanotic. A systolic murmur is heard best at the left sternal border. VS are normal with normal peripheral pulses. There is no hepatomegaly. A likely diagnosis is:
a) congestive heart failure
b) apnea
c) coactation of the aorta
d) cyanotic spell related to tetralogy of fallot

d) cyanotic spell related to tetralogy of fallot

3

Management of the infant with suspected heart disease and reported cyanotic spell should include:
a) prompt referral to a cardiologist
b) an apnea monitor
c) instructing the parent to keep a diary of the episodes
d) continuous administration of oxygen

a) prompt referral to a cardiologist

4

Chest pain in young children is usually:
a) a symptom of congenital heart disease
b) noncardiac in origin
c) a sign of hypercholestermia
d) a symptom of congestive heart failure

b) noncardiac in origin

5

A common cause of congestive heart failure in the first year of life is:
a) pulmonary stenosis
b) ventricular septal defect
c) rheumatic fever
d) complete heart block

b) ventricular septal defect

6

The least likely physical finding in a 2 month old with congestive heart failure is:
a) tachypnea
b) tachycardia
c) hepatomegaly
d) pedal edema

d) pedal edema

Both tachypnea and tachycardia are initial, general signs of congestive heart failure. Hepatomegaly is a sign of right-sided failure and is found early in children. Pedal edema is less common in children than adults. There must be a 10% increase in body weight for edema to occur, and typically the face and eyelids are noted first.

7

A vibratory systolic murmur is heard between the lower left sternal and the apex in a healthy 4 yo at her preschool physical. The cardiovascular exam is otherwise normal. A likely diagnosis is:
a) venous hum
b) still's murmur
c) transposition of the great arteries
d) rheumatic heart disease

b) still's murmur

8

Characteristics of a venous hum include:
a) a systolic murmur
b) radiation over precordium
c) marked decrease or disappearance of murmur when child is supine
d) heard best at lower left sternal border

c) marked decrease or disappearance of murmur when child is supine

9

Which of the following is true regarding innocent murmurs?
a) the murmur is often holosystolic
b) prompt referral to a cardiologist is indicated
c) a precordial thrill is present
d) the murmur is low intensity grade 1-3

d) the murmur is low intensity grade 1-3

10

SBE prophylaxis is recommended for:
a) all children with congenital heart disease on a daily basis
b) all children with congenital heart disease before dental, GI, and GU procedures
c) children with repaired congenital heart disease with a residual defect at the repair site
d) five years after repair of all congenital heart defects

c) children with repaired congenital heart disease with a residual defect at the repair site

Based on current guidelines SBE prophylaxis is only recommended for children for 6 months after surgical repair and continued if they have residual defect, which would prohibit endothelialization of the surrounding tissue.

11

A 12 yo girl seen at a routine visit has a blood pressure of 140/90. She denies any symptoms. The initial management would include:
a) intravenous pyelogram
b) return for two repeat blood pressure measurements
c) no follow up needed--blood pressure probably related to anxiety
d) diuretic therapy

b) return for two repeat blood pressure measurements

12

A 9 yo boy presents with a fever of 102 and complaints of leg pains. His mother reports that he had an upper respiratory infection with a sore throat approximately 2 weeks ago, which subsided without therapy. On physical exam he has tender, swollen knees bilaterally. His heart rate is 120 and a blowing systolic murmur is heard at the apex. No murmur was noted at a previous well child visit. The most likely diagnosis is:
a) Kawasaki disease
b) rheumatic fever
c) sickle cell anemia
d) viral illness

b) rheumatic fever

symptoms such as new onset murmur associated with the mitral valve and polyarthritis of the joints particularly the knees, ankles, and elbows are two of the major criteria necessary for diagnosing rheumatic fever. Fever and arthralgia are minor criteria.

13

The most useful test for evaluation of suspected acute rheumatic fever is:
a) antistreptolysin-O titer
b) electrocardiogram
c) hemoglobin electrophoresis
d) urinalysis

a) antistreptolysin-O titer

14

The initial attack of acute rheumatic fever is preceded by:
a) a viral illness
b) a group A streptococcal infection
c) exposure to mites
d) exposure to chicken pox

b) a group A streptococcal infection

15

A 3 wo infant has a one day history of irritability, pallor, and poor feeding. He is afebrile. On physical exam his heart rate is 240 while asleep. The most likely diagnosis is:
a) supraventricular tachycardia
b) premature ventricular contractions
c) sinus tachycardia
d) cyanotic heart defect

a) supraventricular tachycardia

16

Congenital complete heart block may be associated with:
a) maternal lupus erythematosus
b) wolff-parkinson-white syndrome
c) maternal myocardial infarction
d) kawasaki disease

a) maternal lupus erythematosus

17

The most common cause of myocarditis is:
a) bacterial
b) viral
c) drug reaction
d) radiation therapy

b) viral

While all of these can potentially cause an inflammatory process of the heart, which may progress to myocarditis, the most common cause is typically viral, with adenovirus, coxsackie B, cytomegalovirus, parvovitus B19, influenza, or respiratory syncytial virus being most frequently identified.

18

Which of the following is not an expected finding in a child with myocarditis?
a) persistent tachycardia
b) history of antecedent "flu-like" illness
c) a gallop rhythm
d) a significant heart murmur

d) a significant heart murmur

Murmurs are soft, less common in myocarditis, and only noted if tricuspid or mitral insufficiency is present. The tachycardia is secondary to the inflammation and neurohormonal responses, and a preceding viral illness is very common. Often a gallop rhythm is noted because of rapid filling of a noncompliant, poorly contractile left ventricle.

19

Hypercholesterolemia in children over 2 years old is defined as a total cholesterol at or above:
a) 100
b) 130
c) 160
d) 200

d) 200

20

A potential childhood risk factor for development of atherosclerotic or coronary heart disease as adults is:
a) obesity
b) tachycardia
c) heart murmur
d) aerobic exercise

a) obesity

21

Which of the following is not likely to cause secondary hypercholesterolemia?
a) nephrotic syndrome
b) hypertension
c) corticosteroids
d) obstructive liver disease

b) hypertension

22

which of the following is a common cause of acquired coronary artery disease during childhood?
a) rheumatic fever
b) hypertension
c) systemic lupus erythematosus
d) kawasaki disease

d) kawasaki disease

23

Kawasaki disease is most common in:
a) neonates
b) children less than 5 years of age
c) children over 6 years of age
d) females

b) children less than 5 years of age

24

A principal clinical feature of Kawasaki disease includes:
a) low grade fever for 24 hours and a puritic rash
b) conjunctivitis with exudate and facial rash
c) arthritis and chorea
d) fever persisting at least 5 days and acute erythema and/or edema of hands and feet

d) fever persisting at least 5 days and acute erythema and/or edema of hands and feet

25

An essential test in the evaluation of a 2 yo being managed for Kawasaki disease is:
a) an echocardiogram
b) electrolytes
c) cholesterol
d) streptococcal antibody titer

a) an echocardiogram

26

A common cause of congestive heart failure in the first year of life is:
a) mild pulmonary stenosis
b) inflammatory heart disease
c) rheumatic fever
d) complete heart block

d) complete heart block

Complete heart block in a young child will lead to a heart rate less than acceptable, which will progress to heart failure as the heart cannot meet the body's metabolic demand.

27

Which of the following may cause volume overload leading to congestive heart failure if not appropriately followed and managed?
a) coarctation of the aorta
b) pulmonary stenosis
c) ventricular septal defect
d) supraventricular tachycardia

c) ventricular septal defect

A VSD with its left-to-right shunting will increase pulmonary blood flow and cause volume overload if large enough.

28

A 4 yo caucasian female presents for a well child check. Her blood pressure by auscultation is 135/80. There is no significant family history of hypertension or heart disease. Besides wanting to repeat the blood pressures for accuracy, what are the potential differential diagnoses?
a) severe coronary artery disease
b) renal artery stenosis and coarctation of the aorta
c) rheumatic fever and ventricular septal defect
d) tetralogy of fallot and coarctation of the aorta

b) renal artery stenosis and coarctation of the aorta

Coarctation of the aorta would present with hypertension in the right upper extremity. Kidney diseases such as renal artery stenosis, congenital renal abnormalities, and renal parenchymal disease are a few of the most common causes of secondary hypertension in children younger than 10 years old.

29

A 10 mo infant presents with a 3 day history of fever, runny nose, and coughing. Per the parent he has not been eating well, and only drinking a few cups of milk and juice over the last 2 days. On examination, he feels very warm, his RR is 45 and his HR is 210. He has no rashes. His abdomen is soft and round. Your initial diagnosis includes:
a) supraventricular tachycardia based on HR; needs immediate transfer
b) congestive heart failure based on HR and RR; needs immediate transfer
c) sinus tachycardia based on clinical history and HR; needs antipyretics and possibly fluids.
c) kawasaki disease based on clinical history and fever; needs transfer for IVIG

c) sinus tachycardia based on clinical history and HR; needs antipyretics and possibly fluids.

30

Which of the following is not a component of metabolic syndrome, a clustering of factors in children shown to be associated with increased risk of coronary artery disease later in life?
a) obesity
b) elevated lipid levels
c) heart murmur
d) elevated fasting glucose level

c) heart murmur