Cardiology — Prometric Style Questions, Set 3

What this deck covers

Cardiology – Prometric Style Questions, Set 3 in 50 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 50 cases, in order

1. Breathless, then fainted running
2. The murmur faded, then he went blue
3. Needing more oxygen than last month
4. Collapse during suctioning
5. When the pressure falls on testing
6. Grey on day four, one small chamber
7. Why the neck veins stand up
8. Coughing up a cast of the airway
9. Bluer each year, normal echo
10. Can he stop the blood thinner
11. Noisy breathing, eased by extension
12. High in the arm, low in the leg
13. Indented in front, not behind
14. Painful belly after the repair
15. Bread sticks, camera normal
16. Quiet heart, full neck veins
17. Toxic child with fluid round the heart
18. Veins that rise on breathing in
19. The third bout of the same pain
20. Fluid found on a routine scan
21. A rate of 48 from the first day
22. Two collapses on the pitch
23. Paced, but never speeds up
24. Three jolts in front of the television
25. Diathermy with nothing underneath
26. Grandmother’s tablets, slow pulse
27. Why the adenosine did nothing
28. Stops breathing on the drip
29. Slow, flat, and low on sugar
30. A twisting rhythm on two drugs
31. The heart in a boy who cannot walk
32. Breathless with a normal haemoglobin
33. Vegetations on both sides of the valve
34. Breathless on day three of feeding
35. A cold leg in a swollen child
36. Fainted in the pool, cousin drowned
37. Collapsed at night with a fever
38. A QRS that keeps getting wider
39. A tall R in V1 at six weeks
40. Found on a school sports trace
41. Maximal treatment, still going down
42. Not himself, six weeks on
43. Falling function, no warning symptom
44. Nodes and a mass a year later
45. Failing on the waiting list
46. More beats than P waves after theatre
47. Cool toes with a normal pressure
48. The drain turned milky with feeds
49. Cannot come off the ventilator
50. Oxygen where it should not be

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Exercise-induced asthma with deconditioning, A pulmonary artery sling, Urgent echocardiography and pericardial drainage, An implantable cardioverter defibrillator, Begin nocturnal non-invasive ventilation, Brugada syndrome, Phrenic nerve injury with diaphragmatic paralysis.

Clinical pearls from this deck

• Exertional syncope in pulmonary hypertension is not a faint. It is the right ventricle failing to keep up, and it changes the prognosis.
• In an unrepaired large shunt, a murmur getting quieter is bad news. The gradient is disappearing because the pressures have equalised.
• In chronic lung disease of prematurity the direction of travel is the diagnosis. Needing more oxygen than last month is an echocardiogram, not a bigger cylinder.
• Pressure down and venous pressure up together points right. In the first day after repairing a big shunt, assume a pulmonary hypertensive crisis.
• Vasoreactivity testing exists to find the few children who may take a calcium channel blocker safely, and to protect everyone else from it.
• The three stages exist to work around one missing ventricle. Each one waits for pulmonary resistance to fall a little further.

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 case decks · pediatric reference values.