Septal Defects and the Persistent Duct – 18 Board-Style Cases with Answers

What this deck covers

Septal Defects and the Persistent Duct in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. Loud, and she is thriving
2. Sweating through every feed
3. The quieter of the two
4. Nothing wrong at the first check
5. A second noise lower down
6. Nothing bothers her at all
7. Not one for the catheter
8. Bounding, and still on the machine
9. Still there at three
10. The noise that went away
11. Fainter after a year
12. Booked ahead of the others
13. A stroke at fourteen
14. Big on the right, nothing seen
15. Feeding him before theatre
16. Not quite silent afterwards
17. Back on the pitch, and when
18. Time is on his side

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: A large communication between the ventricles, The second infant is anaemic, Narrowing of the mitral valve, Refer for closure during the preschool years, It needs an operation rather than a device, Scan the heart and treat the duct, Refer for catheter closure, Spontaneous closure of the hole, Resistance in the lung circulation has risen, Energy-dense feeds and a diuretic while he waits, A small leak at the edge of the patch, It will most likely shut by itself.

Clinical pearls from this deck

• Loud means a small hole with a big pressure drop. Quiet is what should worry you.
• Breathless, sweaty, not growing, saturation normal. The lungs are being flooded, not bypassed.
• The loud one is usually the well one. Never grade severity by volume.
• Nothing on day one proves nothing. The six-week check is where the shunt appears.
• The systolic murmur says there is a shunt. The diastolic rumble says it is big.
• In this lesion, waiting for symptoms means waiting thirty years too long.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all Cardiology Board Questions case decks · pediatric reference values.