Congenital heart disease

Averil Tam
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Averil Tam
Created by Averil Tam over 1 year ago
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Question Answer
TRUE/FALSE? A. A normal physical examination at birth rules out the likelihood of congenital heart disease. False. Ductus dependent lesions in particular may become evident as the ductus arteriosus closes over the first few days of life. Thus a baby discharged from hospital on day one of life may become acutely unwell over the next few days as the duct closes! Other lesions may become apparent over the course of several weeks of life as the pulmonary vascular resistance falls (eg. ventricular septal defect) or as the lesion progresses (eg. Tetralogy of Fallot).
TRUE/FALSE? B. The recurrence risk of congenital heart disease in siblings of an affected child is increased two folds. False. The recurrence risk of congenital heart disease in siblings of an affected child is increased three to four folds.
TRUE/FALSE? C. Babies with a congenital heart disease may not be symptomatic until several weeks of age. True. Depending on the nature of the lesion babies may not be symptomatic until several weeks of age. A normal newborn check thus does not rule out the possibility of congenital heart disease. Repeat cardiac examination when reviewing babies at 6 weeks and thereafter. Consider the possibility of heart disease in the baby with unexplained failure to thrive or with a history of recurrent chest infections.
TRUE/FALSE? D. Innocent murmurs typically have varying intensity upon review at different times. True. Innocent murmurs typically vary in intensity at different clinic visits and may be heightened at times of illness. Children with an innocent murmur have a normal systemic examination; the murmur is ejection systolic and musical in character and not more than grade 2 or 3 in intensity. It generally intensifies with change in posture from lying to sitting up or standing upright. A palpable precordium is always abnormal; consider cardiac pathology as also if the child has facial dysmorphism or failure to thrive or hepatomegaly.
TRUE/FALSE? E. A child with facial dysmorphism and a systolic murmur should be investigated for the possibility of heart disease. True. In children with facial dysmorphism and a systolic murmur consider the possibility of an underlying heart disease although the likelihood of having an innocent heart murmur still exists.
TRUE/FALSE? F. A normal foetal cardiac scan rules out the possibility of congenital heart disease. False. A normal foetal cardiac scan does not exclude the possibility of congenital heart disease. Small defects in particular may be hard to visualise and get missed.
TRUE/FALSE? G. The 2008 guidelines for infective endocarditis prophylaxis for procedures have ruled out the need for prophylaxis for several cardiac lesions that previously mandated prophylaxis. True. As per the 2008 guidelines for infective endocarditis prophylaxis for procedures, only children with cyanotic heart disease, cardiac prosthesis, those who had cardiac surgery in the previous 6 months and some high risk post operative cases are required to undergo infective endocarditis prophylaxis.
TRUE/FALSE? H. Children with acyanotic heart disease are predisposed to paradoxical emboli and brain abscess formation. False. Children with a cyanotic heart disease are predisposed to paradoxical emboli and brain abscess formation. Avoid trying to “flush” blocked cannulas in these children as this may cause a dissemination of emboli. Suspect cerebral abscess in a child with a cyanotic heart disease who complains of headache. These children are also prone to stroke, always guard against dehydration and educate the parents regarding the same.