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An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs?
- A. Blood is circulated through the lungs again, causing pulmonary circulatory congestion.
- B. Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia.
- C. Blood is shunted past cardiac arteries, causing myocardial hypoxia.
- D. Blood is circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.
Correct Answer: A
Rationale: When PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation.
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Functional causes of opening Snap (either due to swift opening of AV valve or due to excess flow across the valve) is seen in all, except
- A. Mitral regurgitation
- B. Ventricular septal defect
- C. Atrial septal defect
- D. First degree AV block
Correct Answer: D
Rationale: First degree AV block is not typically associated with an opening snap.
Regarding IUGR:
- A. GH deficiency is a recognised complication in later life
- B. Abdominal circumference measured by USG is a diagnostic parameter
- C. Perinatal morbidity is higher in asymmetric IUGR
- D. Nutritional factor is the commonest cause of IUGR in the UK
Correct Answer: B
Rationale: Abdominal circumference measured by ultrasound is a key diagnostic parameter for intrauterine growth restriction (IUGR).
It is reasonable to suspect child abuse in the following situations:
- A. 6-month old with a large scalp bruise
- B. 7-year-old girl who is found masturbating
- C. 2-year old with multiple bruises of different ages over the shins
- D. 3-month old with failure to thrive
Correct Answer: A
Rationale: The correct answer is A because a large scalp bruise in a 6-month-old is highly suspicious for abuse. The other options (b-e) are less indicative of abuse.
Which of the following features favor a diagnosis of restrictive cardiomyopathy over constrictive pericarditis?
- A. Elevated pulmonary artery pressures
- B. Normal BNP levels
- C. Annulus reversus
- D. Ventricular interdependence
Correct Answer: A
Rationale: Restrictive cardiomyopathy is associated with elevated pulmonary artery pressures
A previously well 3½-month-old presents with poor feeding, diaphoresis during feeding, and poor growth. Vital signs reveal respirations of 70, pulse of 175, and blood pressure of 90/65 mm Hg in the upper and lower extremities. The cardiac examination reveals a palpable parasternal lift and a systolic thrill. A grade 4 holosystolic murmur and a mid-diastolic rumble are noted. The chest radiograph reveals cardiomegaly. The most likely diagnosis is
- A. cardiomyopathy
- B. myocarditis
- C. VSD
- D. coarctation of the aorta
Correct Answer: C
Rationale: The presentation suggests a large ventricular septal defect (VSD) causing significant left-to-right shunting and heart failure.