Med Quizzes

Neonatal Shock & Heart Failure

Mouse: Drag each finding into the correct diagnosis. Keyboard: 1–9 to pick up, A–D to place. ? hotkeys / cheatsheet

Keyboard Shortcuts

Key	Action
1 - 9	Pick up finding by position in bank
Click	Pick up / deselect
A - D	Place held finding into zone
Tab	Cycle through zones
Enter	Drop into focused zone
Bksp	Return held finding to bank
Esc	Cancel / close modal
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Neonatal Heart Disease Cheatsheet

Key Concept: Strong brachial + weak femoral pulses = coarctation of aorta. HLHS = all pulses weak equally. VSD = holosystolic murmur + equal pulses. TGA = profound cyanosis + single loud S2 + egg-on-string CXR. All duct-dependent lesions: start PGE1 immediately.

Diagnosis	Key Features
Coarctation of Aorta	Strong upper extremity pulses + weak/absent lower extremity pulses Blood pressure differential: arm > leg Duct-dependent systemic circulation (lower body) Presents days 1-7 as ductus closes NO murmur (or soft ejection murmur) Symptoms worse with feeds Treat immediately with prostaglandin E1 Surgical repair or balloon angioplasty
VSD	Holosystolic (pansystolic) murmur at left lower sternal border Left-to-right shunt → pulmonary overcirculation Failure to thrive (from increased metabolic demand) Usually presents weeks to months (after PVR drops) Equal brachial and femoral pulses Rales from pulmonary edema Palpable thrill if large
HLHS	Hypoplastic left heart + ascending aorta ALL pulses weak (not differential — no upper/lower discrepancy) Ductal-dependent systemic circulation Profound shock when PDA closes Single S2 (only pulmonic component) Norwood procedure (staged palliation) Often detected prenatally on anatomy scan
TGA	Parallel circulations: aorta from RV, PA from LV Profound cyanosis from birth O2 does NOT improve with 100% FiO2 (parallel circuits) Single loud S2 No significant murmur Egg-on-string CXR (narrow mediastinum) PGE1 + balloon atrial septostomy (Rashkind) → arterial switch (Jatene)

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Neonatal Shock & Heart Failure

Findings Bank

A Coarctation of Aorta

B VSD

C HLHS

D TGA