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Pediatric Emergency MCQ No 23

Question 23

The following are common signs of heart failure in infancy
A. Intercostal retraction.
B. Basal crepitations.
C. Tachycardia.
D. Raised JVP.
E. Enlarged liver.

Answer & Comments:
•ACE
•Comments:
–Intercostals induction and tachypnoea (60-100 respiration/ minute), tachycardia >120-140 bpm, are common.
–Hepatomegaly is a reliable indicator of effectiveness of therapy and is common.
–Frank pulmonary oedema is uncommon and raised JVP, though useful in older children is not a reliable clinical sign in infants.

Pediatric Emergency MCQ No 22

Question 22

In suspected acute rheumatic fever the following indicate carditis:
A. An ESR of 120 mm in one hour.
B. Short apical soft systolic bruit.
C. Strong cardiac impulse at the apex, which is displaced laterally.
D. Sinus arrhythmia.
E. Erythema nodosum.
ANSWER & COMMENTS:
•C
•Comments:
–The confirmation of rheumatic carditis solely depends on the findings of mitral and or aortic incompetence.

Pediatric Emergency MCQ No 21

Question 21
In a heart transplant recipient, each of the following statements is true EXCEPT
A.Sinus tachycardia at rest can be normal
B.The effect of atropine is exaggerated in the denervated heart
C.The response to -adrenergic drugs is normal or increased
D.The ECG is often read as atrial fibrillation or flutter
E.The patient will be immuno-suppressed for life

ANSWER & COMMENTS:
•B
•Comments:
–Atropine has no effect on the denervated heart because it acts by blocking actions of the vagus nerve.
–The response to catecholamines may be increased by upregulation of receptors in the denervated heart.
–The resting heart rate is usually between 90 and 100 beats per minute.
–The ECG often displays multiple P waves, from both the new heart and a residual portion of the original atria.
–Life long immuno-suppression is mandatory to prevent rejection.

Pediatric Emergency MCQ No 20

Question 20

Sudden cardiac death in an adoloscent can occur in
A.Wolf-Parkinson- White Syndrome.
B.Severe Aortic Stenosis.
C.Long QT syndrome.
D.Atrial septal defect.
E.Familial hypercholestolemia.

ANSWER & COMMENTS:
•ABC
•Comments:
–In WPW fast AF may rapidly deteriorate into VF.
–In severe AS and Long QT there may be VT.

Pediatric Emergency MCQ No 19

Question 19
The following are associated with sudden death in childhood:
A.Aortic stenosis.
B.Primary pulmonary hypertension.
C.Atrioventricular septal defect.
D.Fallot's tetralogy.
E.Cardiomyopathy.

ANSWER & COMMENTS:
•A,B,D,E
•Comments:
–Sudden death may be caused by tricyclic antidepressants, haemosiderosis, SIDS, metabolic disorders such as MCAD, child abuse, trauma, hyperthermia, asthma, meningitis/septicaemia, bacterial endocarditis, pertussis, cholera, RSV, gastro-oesophageal reflux, Reye Syndrome, unrecognised diaphragmatic hernia, upper respiratory obstruction, pulmonary thromboembolism, prolonged QT Syndrome, aortic stenosis, mitral valve prolapse, aspiration, anomalous right coronary artery or left coronary artery, Tetralogy of Fallot, pulmonary atresia intact septum, tricuspid atresia, transposition of the great arteries, arrhythmia, coronary artery disease in Hurler's Syndrome, calcinosis of the coronary arteries, viral myocarditis, primary cardiomyopathy, hypertrophic cardiomyopathy, Marfan's Syndrome, achondroplasia secondary to cervical cord compression, and volatile substance abuse.

pediatric emergency MCQ-No18

Question 18

Echocardiographic evidence of tamponade includes which of the following?
A.Pericardial effusion >1 cm in largest diameter.
B.Pericardial effusion with left ventricular collapse.
C.Pericardial effusion with right ventricular collapse.
D.Pericardial fluid collection.

Answer & Comments
•C
Comments:
–Although not always seen, right-sided collapse (decreased filling) due to pericardial effusion is evidence of tamponade.
–Presence of pericardial fluid does not equate to tamponade, while the absence of fluid does exclude the diagnosis.