Knowledge Check: Cyanotic Congenital Cardiac Defects
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Question 1 of 10
1. Question
Which of the following is a cause of cyanosis?
Hint
Cyanosis can be either respiratory or cardiac in origin.
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Question 2 of 10
2. Question
You are caring for a 2-day old baby with meconium aspiration syndrome and resultant PPHN (persistent pulmonary hypertension of the newborn). You notice the baby has an oxygen saturation of 95% via probe on the right hand, and an oxygen saturation of 70% via probe on the left foot. Which of the following represents the BEST reason for these findings?
Hint
Babies with PPHN have elevated pulmonary vascular resistance, which results in deoxygenated blood shunting from the pulmonary circulation to the systemic circulation through a connection at the great vessel or atrial level.
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Question 3 of 10
3. Question
Which of the following represents the normal ratio of pulmonary vascular resistance to systemic vascular resistance prior to birth?
Hint
Pulmonary vascular resistance is exceedingly high prior to birth and drops dramatically with the baby’s first few breaths.
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Question 4 of 10
4. Question
Which of the following determines the direction of which blood will shunt through a ventricular septal defect (VSD)?
Hint
The resistance to blood flow out of the ventricles will determine the direction of shunting. Blood will flow out through the vasculature with the lowest resistance.
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Question 5 of 10
5. Question
Which of the following determines the direction of which blood will shunt through an atrial septal defect (ASD)?
Hint
Blood tends to shunt left to right at the atrial level due to the thicker, less compliant wall of the LV compared to the RV.
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Question 6 of 10
6. Question
Which of the following BEST explains why patients with Tetralogy of Fallot present with varying degrees of cyanosis?
Hint
The degree of right to left shunting of blood through the ventricular septal defect in patients with Tetralogy of Fallot is determined by the amount of resistance to blood flow out of the right ventricle.
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Question 7 of 10
7. Question
As a patient’s oxygen consumption increases, what will happen to the patient’s mixed venous oxygen saturation?
Hint
Think about what would happen to the amount of oxygen returning to the systemic circulation if the body’s tissues are utilizing more oxygen.
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Question 8 of 10
8. Question
Which of the following are important in determining the amount of oxygen delivery to the body’s tissues?
Hint
Think of oxygen delivery as the “inflow” to the tissues with mixed venous saturation as the “outflow” from the tissues (i.e. the amount of oxygen remaining after oxygen extraction by tissues).
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Question 9 of 10
9. Question
In babies with single ventricle physiology, increased pulmonary blood flow puts the baby at risk of which ONE of the following?
Hint
Increased Qp:Qs ratios in patients with single ventricle physiology have improved arterial oxygen saturations, but at the expense of less blood flow traveling to the systemic circulation.
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Question 10 of 10
10. Question
You are caring for a patient with cyanotic congenital heart disease with full intracardiac mixing of blood, who has a mixed venous saturation of 50%, a pulmonary venous saturation of 100%, and a Qp:Qs ratio of 2:1. Based on this information, what would you expect the aortic oxygen saturation to be?
Hint
A Qp:Qs ratio of 2:1 implies double the contribution from the pulmonary circulation (as compared to the systemic circulation) of blood mixing within the heart.
