Congenital Heart Disease Quiz
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Questions and Answers

What is the primary complication associated with a ventricular septal defect (VSD)?

  • Right ventricular dilation (correct)
  • Aortic stenosis
  • Pulmonary atresia
  • Patent ductus arteriosus
  • Which factor is not commonly associated with the etiology of congenital heart disease?

  • Genetic predisposition
  • Exposure to radiation
  • Maternal diabetes
  • Obesity in infants (correct)
  • In which type of cyanotic heart disease does pulmonary plethora occur?

  • Atrial septal defect
  • Aortic coarctation
  • Fallot's tetralogy
  • Transposition of great arteries (correct)
  • What is the classification of congenital heart diseases without shunt?

    <p>Aortic stenosis and pulmonary stenosis</p> Signup and view all the answers

    Which respiratory disorder is characterized by inflammation of the bronchioles?

    <p>Bronchiolitis</p> Signup and view all the answers

    What is a common trigger for anoxic spells in patients with pulmonary stenosis?

    <p>Physical exertion</p> Signup and view all the answers

    Which of the following is a complication associated with chronic hypoxia?

    <p>Growth retardation</p> Signup and view all the answers

    What is the recommended immediate treatment for anoxic spells?

    <p>Knee-chest position</p> Signup and view all the answers

    What is the main cause of acute rheumatic fever?

    <p>Autoimmune reaction to GABHS</p> Signup and view all the answers

    In which phase of rheumatic fever does the onset of symptoms occur?

    <p>Phase 3, onset of acute rheumatic fever</p> Signup and view all the answers

    What specific treatment approach may be utilized for patients with pulmonary stenosis?

    <p>Total surgical correction</p> Signup and view all the answers

    What could result from untreated brain anoxia due to pulmonary complications?

    <p>Cerebral infarction</p> Signup and view all the answers

    Which statement about acute rheumatic fever is correct?

    <p>Both boys and girls aged 5-10 are equally affected.</p> Signup and view all the answers

    What is the most common cause of acute bronchiolitis in infants?

    <p>Respiratory syncytial virus (RSV)</p> Signup and view all the answers

    During the pathogenesis of bronchiolitis, which sequence of events leads to hypercapnia?

    <p>Viral invasion -&gt; Bronchiolar wall edema -&gt; Gas exchange defect</p> Signup and view all the answers

    Which symptom is most commonly associated with acute bronchiolitis in infants?

    <p>History of exposure to respiratory syncytial virus</p> Signup and view all the answers

    What distinguishes bronchiolitis from asthma in a clinical setting?

    <p>Age of presentation and fever</p> Signup and view all the answers

    What diagnostic method is primarily used to confirm RSV in cases of acute bronchiolitis?

    <p>Nasopharyngeal aspirate for RSV antibodies</p> Signup and view all the answers

    What is a common complication associated with acute bronchiolitis?

    <p>Viral myocarditis</p> Signup and view all the answers

    What treatment is considered effective for easing bronchial edema in acute bronchiolitis?

    <p>Nebulized hypertonic saline</p> Signup and view all the answers

    Which of the following is NOT typically part of the treatment for acute bronchiolitis?

    <p>Antiviral medication for all patients</p> Signup and view all the answers

    Signup and view all the answers

    Study Notes

    Respiratory System Infections: Acute Bronchiolitis

    • Definition: Inflammation obstructing small airways (bronchioles) during the first two years of life, peaking at 6 months.
    • Etiology: Respiratory syncytial virus (RSV) is most common (80%). Other causes include para influenza virus, adenovirus, and measles virus.
    • Pathogenesis: Viral invasion of bronchioles causes inflammation and edema. Partial blockage leads to airflow without outflow, hyperinflation, and defective gas exchange with CO2 retention (hypercapnia) and decreased PaO2 (hypoxia).
    • Symptoms: History of adult respiratory syncytial virus exposure, fever, rhinitis for 2-3 days, cough, and shortness of breath with wheezing.
    • Signs: Respiratory distress (tachypnea, retractions, grunting, cyanosis), and auscultatory findings (diffuse wheezing, diminished air entry, fine crepitations).
    • Complications: Respiratory failure, heart failure (viral myocarditis), dehydration, metabolic acidosis, and secondary bacterial infection.
    • Diagnosis: Chest X-ray showing hyperinflation, and nasopharyngeal aspirate for RSV antibodies.
    • Differential Diagnosis: Bronchial asthma can be difficult to distinguish, but age of onset, presence of fever, and lack of personal or family asthma history are major differentiators.
    • Treatment: Humidified oxygen, IV fluids, nasogastric tube, nebulized hypertonic saline, and bronchodilators. Possible use of steroids and antibiotics (only for secondary bacterial infection).
    • Prophylaxis: For high-risk groups (premature, congenital heart disease), consider RSV antibodies but only given to high-risk groups.

    Pneumonia

    • Definition: Inflammation of lung tissue with alveolar consolidation.

    • Leading cause of death in children under 5 globally.

    • Can be primary illness or complication of another condition.

    • Classification (Anatomical):

      • Lobar Pneumonia: Large segment or all of a lung lobe involved, bilateral involvement is possible/two lungs affected.
      • Bronchopneumonia: Involves terminal bronchioles becoming plugged with exudate, consolidated patches of nearby lung.
      • Interstitial Pneumonia: Inflammatory process confined to alveolar walls and surrounding tissues/ peribronchial/interlobular tissues.
    • Classification (Etiological):

      • Bacterial: Includes pneumococci, streptococci and staphylococci, hemophilus influenza
      • Non-bacterial: Includes viral (RSV), mycoplasma, parasitic, and fungal.
    • Pathological Changes: Starts with inflammation, leading to congestion (alveolar wall edema and accumulation of phagocytes), thickening of alveolar walls, decreased gas exchange, hypoxia, and acidosis. Exudates transform into pus, leading to consolidation and crepitation (heard during auscultation).

    • Clinical picture: Includes fever, cough, shortness of breath and chest findings of dullness/fine crepitations upon percussion/auscultation.

    • Diagnosis: Use Complete Blood Count (CBC), increased WBC count suggesting bacterial infection and lymphocytosis suggesting viral infection. C-Reactive Protein (+ve in bacterial & -ve in viral pneumonia). Chest X-ray and culture of blood, sputum or bronchial aspirate used for confirmation.

    • Treatment: General treatment includes hospitalization, oxygen, IV fluids, and control of fever. Appropriate antibiotics given if bacterial infection suspected.

    Cardiovascular Disorders in Children

    • Classification includes Congenital (A) cyanotic heart disease (with shunt, without shunt) and (B) cyanotic heart disease (With pulmonary oligeamia, With pulmonary plethora)
    • (Acquired) heart disease (Acute rheumatic fever).
    • Congenital Heart Diseases:
      • Etiology: Maternal rubella during pregnancy, alcohol consumption during pregnancy, diabetes, and exposure to radiation during pregnancy.
      • Ventricular Septal Defect (VSD):
        • Blood shunted from the left ventricle to the right, leading to right ventricle dilation.
        • Excess blood passes to the pulmonary artery, causing pulmonary artery dilation and lung plethora.
        • Types: (Small VSD) often in the muscular part of the septum or (Big VSD) often in the membranous part of the septum.
      • Tetralogy of Fallot (TOF):
        • Commonest cyanotic heart disease
        • Pulmonary stenosis, VSD, and overriding aorta, and hypertrophy of right ventricle.
        • Venous return to the right to the right atrium; right ventricle to VSD to aorta.
        • Blood bypasses the lungs causing decreased blood flow to the lungs/ resulting in lung oligeamia.
    • Acute Rheumatic Fever (A.R.F):
      • An inflammatory disease of connective tissues involving the joints and heart.
      • Incidence: More common in children between 5-10 years of age, with high rates in developing countries due to overcrowding.
      • Etiology: Autoimmune response to group A-beta hemolytic streptococcal (GABHS) infection, which cause upper respiratory tract infections (pharyngitis)
    • Pathophysiology: R.F. has three phases; GABHS infection, asymptomatic phase, and acute R.F. onset.

    Jaundice in Newborns

    • Definition: Yellowish discoloration due to bilirubin accumulation in skin and mucus membranes.
    • Pathogenesis: Bilirubin produced from heme breakdown, transported in the blood with albumin to the liver. Conjugation in the liver results in water-soluble forms that are excreted in bile and urine.
    • Types:
      • Physiological Jaundice: Most common, due to increased red blood cells lifespan and immature glucuronyl transferase enzyme.
      • Pathological Jaundice: Unconjugated hyperbilirubinemia (due to hemolytic conditions like Rh and ABO incompatibility, or non-immune conditions such as infection or G6PD deficiency). Conjugated hyperbilirubinemia (liver dysfunction) which include hepatocellular and biliary conditions.
    • Treatment: Phototherapy(exposure to blue light converts bilirubin to water-soluble forms). Blood Exchange (Removal of an infant's blood and replacement with donor blood).
    • Complications: Bilirubin-induced neurologic dysfunction (BIND), characterized by acute and chronic forms, leading to potential brain damage, cerebral palsy, hearing loss. Kernicterus: yellowish staining of stem nuclei and cerebellum.

    Diarrhea

    • Definition: Increased stool frequency and fluidity compared to normal.

    • Classification:

      • Acute Diarrhea: Sudden onset, often self-limiting (usually within 14 days), with or without dehydration.
      • Chronic Diarrhea: Persistent diarrhea lasting longer than 14 days.
    • Causes:

      • Infection: Bacteria (Salmonella, Shigella), Viruses (Rotavirus), or Parasites (Giardia).
      • Dietary: Introduction of new foods, overfeeding, osmotic diarrhea (excess sugar).
      • Medications: Antibiotics and laxatives.
        -- Non Infectious causes: Associated conditions include infections, urinary or upper respiratory tract infections, otitis media, or dietary issues like overfeeding new foods, or reinstituting new food products too quickly following a diarrheal episode and some cases of osmotic diarrhea and dietary intolerance.
    • Complications: Dehydration, malnutrition, or severe diarrhea cases if not taken care of.

    Urinary Tract Infection (UTI)

    • Definition: Bacterial invasion of the kidneys or urinary tract.
      • Upper UTI (pyelonephritis) occurs when the kidneys are affected -Lower UTI refers to infections of the lower urinary tract including the bladder (cystitis) and urethra.
    • Presentation: Non-specific (General), Common signs and symptoms in children experiencing UTI may include fever, changes in urination pattern, pain and discomfort associated with the abdominal region, pain or burning sensation when urinating, and in babies a change in feeding habits and behaviour as a whole.
    • Causes: Enterococci and Gram-Negative bacilli such as strains of E.coli, Proteus, Klebsiella, and Pseudomonas
    • Diagnosis: Urine cultures used to identify responsible bacteria.
    • Treatment: Appropriate antibiotics according to antibiotic sensitivity testing; Treatment duration usually 7-10 days.

    Dehydration

    • Definition: Excessive loss of water and electrolytes (through vomiting or diarrhea).

    • Assessment: Severity assessment based on signs and symptoms like, skin pinch check, dehydration and signs of dehydration (restlessness, sunken eyes, extreme thirst).

    • Treatment: Rehydration strategies based on severity of dehydration, including oral rehydration solutions(ORS), intravenous fluids, and other treatment strategies appropriate to the presenting needs and situation.

    Nephrotic Syndrome

    • Definition: Characterized by edema, hypoproteinemia (low protein levels in the blood), and hyperlipidemia (high lipid levels in the blood), often resulting from glomerular damage and protein loss in the urine.
    • Presentation: Edema (swelling in extremities, abdomen, face); normal blood pressure initially.
    • Diagnosis: Urine examination to check protein levels. Blood test to evaluate total protein, albumin and cholesterol levels.
    • Treatment: Corticosteroids usually the first line therapy.
    • Relapse: Monitoring for relapses (periodic urine checks). Antibiotics and supportive treatment are used for infections.

    Endocrine System: Hypothyroidism

    • Definition: Deficiency in thyroid hormone production (T3 & T4).
    • Etiology: Categorized as Primary (thyroid), Central (hypothalamic-pituitary), or acquired (autoimmune).
    • Classification: Primary is a thyroid defect itself. Central refers to a defect in the hypothalamus or pituitary.
    • Presentation: Symptoms vary by age. Neonates may experience prolonged jaundice, feeding difficulties, and poor growth; in infancy/childhood may show slow growth, delayed development, and other symptoms. Older children may develop other changes such as menometrorrhagia (or galactorrhea if related to Prolactin).
    • Diagnosis: Lab testing of thyroid hormone levels (T3 and T4) and thyroid-stimulating hormone (TSH). Ultrasound examination can sometimes identify relevant nodules or enlargement. Bone age testing helpful with childhood presentation.
    • Treatment: Levothyroxine, a thyroid hormone replacement. Therapy is lifelong. Complications related to severe hypothyroidism include multiple organs issues.

    Nutritional Disorders: Rickets

    • Definition: Nutritional deficiency disease, characterized by inadequate bone mineralization due to insufficient vitamin D, calcium, or phosphorus.
    • Types:
      • Nutritional Rickets: Prolonged breastfeeding, exclusively breastfeeding without supplementation, exposure to UV sunlight, inadequate dietary calcium intake and/or vitamin D intake, etc,
      • Non-Nutritional Rickets: Genetic disorder, medication induced issues, chronic diseases. (Inherited), hypophosphatemia/ hypocalcaemia or renal tubular acidosis.
    • Presentation: Children may show delayed growth, bone deformities (bowed legs, rachitic rosary), delayed dentition, and other skeletal changes.
    • Diagnosis: Blood tests (vitamin D, calcium, phosphorus) and X-rays (bone structures/age.)
    • Treatment: Vitamin D supplementation (oral) and correction/control of underlying issues (or disease states).

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    Description

    Test your knowledge on congenital heart diseases and their complications with this quiz. Explore various aspects of ventricular septal defects and their etiology. Additionally, understand different classifications and related respiratory disorders.

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