Pediatric Examination and Board Review (6 page)

Keane JF, Fyler DC, Lock JE, eds.
Nadas’ Pediatric Cardiology.
2nd ed. Philadelphia, PA: Hanley and Belfus; 2006.

Park M, ed.
Pediatric Cardiology for Practitioners.
5th ed. St. Louis, MO: Mosby; 2007.

CASE 2: A 10-YEAR-OLD BOY WITH PALPITATIONS

A 10-year-old boy presents to the clinic with a history of intermittent episodes of palpitations occurring 1 time per month. The episodes are not associated with exercise or activity, last for several minutes, and resolve spontaneously. There is no significant past medical history, no new medications, and no dizziness or syncope. A 12-lead ECG, performed while he is asymptomatic, is normal.

SELECT THE ONE BEST ANSWER

1.
Which test would best help to evaluate the etiology of this patient’s palpitations?

(A) echocardiogram

(B) chest radiograph

(C) event recorder monitor

(D) exercise stress test

(E) tilt table test

Match the ECG rhythm strips in questions 2 through 5 to one of the findings below.

(A) premature atrial contractions

(B) premature ventricular contractions

(C) sinus tachycardia

(D) sinus arrhythmia

2.
Figure 2-1
shown below

FIGURE 2-1.

3.
Figure 2-2
shown below

FIGURE 2-2.

4.
Figure 2-3
shown below

FIGURE 2-3.

5.
Figure 2-4
shown below

FIGURE 2-4.

6.
What is the most likely cause of supraventricular tachycardia in the patient whose history was presented above?

(A) a concealed accessory bypass tract causing orthodromic, reciprocating tachycardia

(B) AV node reentry tachycardia

(C) ectopic atrial tachycardia

(D) atrial flutter

(E) atrial fibrillation

7.
What is an appropriate acute therapy for symptomatic orthodromic, reciprocating tachycardia?

(A) DC cardioversion

(B) IV adenosine

(C) vagal maneuvers

(D) all of the above

(E) none of the above

8.
Which of the following agents is considered firstline therapy for chronic control of orthodromic, reciprocating tachycardia?

(A) propafenone

(B) atenolol

(C) sotalol

(D) amiodarone

(E) flecainide

9.
What would be the most appropriate acute therapy for symptomatic ectopic atrial tachycardia?

(A) DC cardioversion

(B) IV adenosine

(C) vagal maneuvers

(D) IV esmolol

(E) none of the above

10.
A child with supraventricular tachycardia (SVT) is found to have a resting ECG rhythm strip shown in
Figure 2-5
. What is the diagnosis?

(A) sinus tachycardia

(B) ventricular preexcitation

(C) ventricular tachycardia

(D) sinus rhythm

(E) sinus arrhythmia

FIGURE 2-5.

11.
Which statement is true regarding the diagnosis of Wolff-Parkinson-White (WPW) syndrome?

(A) there is an increased risk of sudden cardiac death

(B) there is an increased risk of ectopic atrial tachycardia

(C) there is an increased risk of tachycardiainduced cardiomyopathy

(D) there is no risk of atrial fibrillation

(E) there is no increased risk for associated structural heart disease

12.
Which of the following agents is considered firstline therapy for chronic control of orthodromically, reciprocating tachycardia associated with ventricular preexcitation (WPW syndrome)?

(A) digoxin

(B) verapamil

(C) propranolol

(D) amiodarone

(E) flecainide

FIGURE 2-6.

13.
A 10-year-old child experiences palpitations associated with dizziness when standing. He has had one episode of syncope following standing in school. What is the most common etiology of syncope in this age group?

(A) seizures

(B) cardiac disease

(C) hypoglycemia

(D) neurocardiogenic (vasovagal)

(E) cardiac arrhythmia

14.
Which of the following features would suggest neurocardiogenic syncope?

(A) urinary incontinence during episodes of syncope

(B) auditory aura preceding episode of syncope

(C) transient right arm paralysis following episode of syncope

(D) symptoms of dizziness, blurred vision, diaphoresis preceding syncope