Cardiology – Set 4

What this deck covers

Cardiology – Set 4 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 paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Blue newborn with a leaky valve murmur
2. Lungs perfused without a pump
3. Blue ventilated newborn with no murmur
4. Milky fluid from the chest drain
5. Breathless 3-week-old, bounding pulses
6. Mother asks about her own medicine
7. Grey and floppy at 60 hours of age
8. Teenager turning blue years later
9. Tooth extraction before heart repair
10. Swollen boy with a clean dipstick
11. Film of a grunting, deeply blue girl
12. Fast rhythm on the evening of surgery
13. Mineral low, hormone low too
14. Fever and a focal fit in a blue boy
15. Film before transfer of a blue baby
16. A hand laid flat on a mottled baby
17. A murmur that vanished with age
18. Worse on the ventilator at 3 days
19. Steady losses from a chest drain
20. Pale baby needing blood before repair
21. Finding a fixable cause of gut loss
22. Why the infusion began at birth
23. Drowsy girl with a weak right side
24. Pinker each day without treatment
25. Is it too late to operate
26. Duct-opening drug brings no benefit
27. Sudden slow pulse on day two
28. Greyer as the monitor reading improves
29. First drugs for a ring-enhancing mass
30. Still failing on diuretics at 4 weeks
31. Parents ask for the hole to be shut
32. Slurred speech at the breakfast table
33. Neck veins with a leaking right valve
34. Vertical vein found at four months
35. Drain still pouring after ten days
36. What the bedside nurse should aim for
37. Limp left side after a stomach bug
38. Headaches and a very high blood count
39. What lies ahead after early repair
40. Three days of a racing pulse
41. Mapping out the operations ahead
42. What the aspirated pus will grow
43. Racing heart that stops abruptly
44. Fever and a rub weeks after surgery
45. Breathless months after venous repair
46. When a new heart is advised instead
47. Keeping a teenager safe for life
48. Mother told the blood count is good
49. Gut losses that defy every medicine
50. Blurred vision and a thick blood count

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Tricuspid atresia, Protein over 30 g/L and pH under 7.2, Inborn error of metabolism, Coeliac disease, Oral cholecalciferol (vitamin D3) alone, Forceful left ventricular apex in the axilla, Thoracic duct ligation within the week, Rise in pulmonary vascular resistance, Exercise test with oxygen saturations, It closes the foramen ovale and blocks atrial mixing, Leave it open; do not close it, Hypercyanotic spells when crying or feeding, Brain abscess, IV adenosine.

Clinical pearls from this deck

• Blue newborn, quiet precordium, gallop and giant P waves: think of the displaced tricuspid valve.
• In a Fontan the lungs are perfused by venous pressure alone, so protect a low pulmonary resistance.
• No murmur, white lungs and no veins entering the left atrium: the pulmonary veins have gone somewhere else.
• Milky fluid after feeds restart: a triglyceride above 1.1 mmol/L and lymphocytes above 80 percent make it chyle.
• Blue, breathless, bounding pulses and a single second sound in the first month: think of one great artery.
• Lithium in pregnancy: think of the tricuspid valve, and offer a fetal echocardiogram.

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.