Cardiology Practice Questions

Q: In which of the following conditions is the left atrium not enlarged?

Atrial septal defect. **Explanation:** The key to understanding chamber enlargement in congenital heart disease lies in the **direction of the shunt** and the **volume of blood** returning to specific chambers. **1. Why Atrial Septal Defect (ASD) is the correct answer:** In a typical secundum ASD, blood shunts from the Left Atrium (LA) to the Right Atrium (RA) due to higher compliance of the right ventricle. While the RA and RV become volume-overloaded and enlarged, the **LA does not enlarge** because it constantly decompresses itself into the RA. In fact, the LA may even be small or normal in size. **2. Why the other options are incorrect:** * **Ventricular Septal Defect (VSD):** Blood shunts from the LV to the RV, goes to the lungs, and returns via the pulmonary veins to the **LA**. This increased venous return causes LA and LV enlargement (Left-sided volume overload). * **Patent Ductus Arteriosus (PDA) & Aortopulmonary (AP) Window:** These are "Great Vessel" shunts. Blood shunts from the Aorta to the Pulmonary Artery, travels through the lungs, and returns to the **LA and LV**. Both conditions lead to LA enlargement. **Clinical Pearls for NEET-PG:** * **Rule of Thumb:** Any shunt that increases pulmonary blood flow will enlarge the **Left Atrium**, *except* for ASD and Total Anomalous Pulmonary Venous Connection (TAPVC). * **Radiological Sign:** On a lateral chest X-ray, LA enlargement is best seen as posterior displacement of the esophagus (if barium swallow is used) or the "double atrial shadow" on a PA view. * **ASD Triad:** Enlarged RA, Enlarged RV, and prominent pulmonary arteries with a **normal-sized LA**.

Q: Pulmonary blood flow is increased in all of the following conditions except:

Tetralogy of Fallot (TOF). **Explanation:** The fundamental concept behind this question is the classification of Congenital Heart Diseases (CHD) into **Acyanotic (Left-to-Right shunts)** and **Cyanotic (Right-to-Left shunts)**, and further sub-classifying them based on pulmonary blood flow. **Why Tetralogy of Fallot (TOF) is the correct answer:** TOF is a cyanotic CHD characterized by four features: VSD, Overriding of aorta, Right Ventricular Hypertrophy, and **Pulmonary Stenosis (PS)**. The pulmonary stenosis acts as a physical obstruction to the outflow of blood from the right ventricle to the lungs. Consequently, blood is shunted right-to-left across the VSD, leading to **decreased pulmonary blood flow** and a "boot-shaped" heart with oligemic lung fields on X-ray. **Analysis of Incorrect Options:** * **ASD & VSD:** These are acyanotic CHDs with left-to-right shunting. Because pressure is higher on the left side of the heart, blood flows back into the right side and is recirculated through the lungs, leading to **increased pulmonary blood flow**. * **TGA:** Although TGA is a cyanotic CHD, it is characterized by **increased pulmonary blood flow**. In TGA, the two circulations are in parallel; the lungs receive a massive volume of blood because there is no outflow obstruction, often leading to early congestive heart failure. **NEET-PG High-Yield Pearls:** * **Cyanotic CHD with Decreased Flow:** TOF, Tricuspid Atresia, Ebstein Anomaly. * **Cyanotic CHD with Increased Flow:** TGA, TAPVC, Truncus Arteriosus, Single Ventricle. * **X-ray Findings:** TOF (Boot-shaped heart/Coeur en sabot), TGA (Egg-on-a-string appearance), TAPVC (Snowman/Figure-of-8 appearance). * **Most common cyanotic CHD:** TOF (overall), but TGA is the most common cyanotic CHD presenting in the *neonatal* period.

Q: Which of the following is not a feature of Sydenham's chorea?

Seizures. **Explanation:** **Sydenham’s Chorea** (also known as St. Vitus’ Dance) is a major Jones criterion for **Acute Rheumatic Fever (ARF)**. It results from molecular mimicry where antibodies against Group A Streptococcus cross-react with the **basal ganglia** (specifically the caudate and putamen). **Why Seizures is the correct answer:** Seizures are **not** a feature of Sydenham’s Chorea. The pathology is localized to the basal ganglia, affecting motor control and emotional regulation, but it does not involve the cerebral cortex in a way that triggers epileptiform activity. If a patient with suspected ARF presents with seizures, clinicians should investigate alternative diagnoses like systemic lupus erythematosus (SLE) or viral encephalitis. **Analysis of Incorrect Options:** * **Hypotonia:** This is a classic finding. Patients often exhibit "milkmaid’s grip" (rhythmic squeezing) and "pendular knee jerks" due to significant muscle hypotonia. * **Unintelligible speech:** Dysarthria is common. The involuntary movements affect the muscles of phonation and the tongue (often resulting in the "darting tongue" or "harlequin tongue" sign), making speech jerky and difficult to understand. * **Emotional lability:** This is frequently the earliest symptom. Children often exhibit inappropriate crying, laughing, or irritability (pediatric autoimmune neuropsychiatric disorders) before the onset of motor chorea. **NEET-PG High-Yield Pearls:** * **Latent Period:** It has the longest latent period of all ARF features (1–6 months after infection). * **Gender:** More common in females and prepubertal children. * **Clinical Signs:** Look for "Pronator sign" (palms turn outward when arms are raised) and "Milkmaid's grip." * **Treatment:** Usually self-limiting; severe cases are treated with **haloperidol**, valproic acid, or phenobarbital. Corticosteroids may hasten recovery.

Q: All of the following features are seen in Kawasaki disease except?

Exudative conjunctivitis. **Explanation:** Kawasaki Disease (KD) is an acute, febrile, medium-vessel vasculitis that primarily affects children under 5 years of age. The diagnosis is clinical, based on the presence of high-grade fever for ≥5 days plus at least 4 out of 5 classic criteria. **Why "Exudative Conjunctivitis" is the correct answer:** In Kawasaki disease, the ocular involvement is characteristically **bilateral, non-exudative conjunctival injection** (sparing the limbus). The absence of discharge or "pus" is a key clinical differentiator from viral or bacterial conjunctivitis. Therefore, the presence of exudate points away from a diagnosis of KD. **Analysis of Incorrect Options:** * **Coronary Artery Aneurysms (A):** This is the most serious complication of KD, occurring in 20-25% of untreated cases. It typically develops in the subacute phase (weeks 2–4). * **Red Strawberry Tongue (B):** This is a classic manifestation of oropharyngeal changes, which also include cracked, erythematous lips and diffuse pharyngeal hyperemia. * **Cervical Lymphadenopathy (D):** This is usually unilateral, non-fluctuant, and involves at least one node >1.5 cm in diameter. It is often the least common of the five clinical criteria. **NEET-PG High-Yield Pearls:** * **Mnemonic (CRASH and Burn):** **C**onjunctivitis (non-exudative), **R**ash (polymorphous), **A**denopathy (cervical), **S**trawberry tongue, **H**and/foot changes (edema/desquamation), and **Burn** (Fever >5 days). * **Treatment:** IVIG (2g/kg) + High-dose Aspirin. IVIG is most effective when given within the first 10 days to prevent coronary aneurysms. * **Lab Findings:** Elevated ESR/CRP, thrombocytosis (after week 1), and sterile pyuria.

Q: Which of the following statements is true regarding Tetralogy of Fallot?

There is an association with DiGeorge syndrome.. **Explanation:** **Tetralogy of Fallot (TOF)** is the most common cyanotic congenital heart disease (CHD) beyond infancy. It consists of four components: VSD, overriding of the aorta, pulmonary stenosis (infundibular), and right ventricular hypertrophy. **Why Option D is Correct:** TOF is strongly associated with chromosomal microdeletions, most notably **22q11.2 deletion (DiGeorge syndrome)**. Approximately 15-25% of TOF patients have this deletion. DiGeorge syndrome presents with the "CATCH-22" mnemonic: Cardiac defects (TOF/Truncus), Abnormal facies, Thymic hypoplasia (T-cell deficiency), Cleft palate, and Hypocalcemia. **Analysis of Incorrect Options:** * **Option A:** Cyanosis in TOF is typically **not present at birth**. It usually appears between 3–6 months of age as the infundibular stenosis progresses. If a neonate is cyanotic on day one, think of Transposition of the Great Arteries (TGA). * **Option B:** A **right-sided aortic arch** is seen in approximately **25%** of TOF cases, not 50%. While high-yield, 50% is an overestimation. * **Option C:** During a "Tet spell" (cyanotic spell), the murmur actually becomes **softer or disappears**. This is because the spell is caused by an acute increase in right-to-left shunting due to near-total obstruction of the right ventricular outflow tract (RVOT); thus, flow across the pulmonary valve **decreases**. **High-Yield Clinical Pearls for NEET-PG:** * **X-ray finding:** "Boot-shaped heart" (Coeur en sabot) due to an upturned apex (RVH) and concave pulmonary segment. * **ECG:** Shows Right Axis Deviation and RVH. * **Management of Tet Spell:** Knee-chest position (increases systemic vascular resistance), Oxygen, Morphine, and Beta-blockers (Propranolol). * **Most important prognostic factor:** The severity of pulmonary stenosis.

Q: In Transposition of the Great Arteries (TGA), what is the relative position of the aorta to the pulmonary artery?

Anterior and right to the pulmonary artery. **Explanation:** In **Transposition of the Great Arteries (TGA)**, specifically the most common form known as **d-TGA** (dextro-TGA), the embryological defect lies in the failure of the conotruncal septum to spiral. Instead of the normal spiral development, the septum grows straight. This results in the aorta arising from the morphological right ventricle and the pulmonary artery arising from the morphological left ventricle. **Why Option D is correct:** In d-TGA, the aorta is displaced **anteriorly** and typically to the **right** of the pulmonary artery. This spatial relationship is a hallmark of the condition and is easily visualized on an echocardiogram or CT scan. **Analysis of Incorrect Options:** * **Options A & B (Posterior):** In a normal heart, the aorta is posterior and to the right of the pulmonary artery. Therefore, any "posterior" position of the aorta is characteristic of normal anatomy, not TGA. * **Option C (Anterior and left):** This describes **l-TGA** (levo-TGA or Congenitally Corrected TGA), where the ventricles are also switched (ventricular inversion). While the aorta is anterior, it lies to the left of the pulmonary artery. **High-Yield Clinical Pearls for NEET-PG:** * **Chest X-ray Finding:** The narrow vascular pedicle and globular heart shape create the classic **"Egg-on-a-string"** appearance. * **Survival:** TGA is an **incompatible-with-life** cyanotic heart disease unless there is a shunting lesion (PDA, VSD, or ASD) to allow mixing of the parallel circulations. * **Management:** The initial medical management is **PGE1 infusion** to keep the ductus arteriosus open. The definitive surgical treatment of choice is the **Arterial Switch Operation (Jatene Procedure)**, ideally performed in the first 2 weeks of life.

Q: All are manifestations of Kawasaki disease, except:

Thrombocytopenia. **Explanation:** Kawasaki Disease (KD) is an acute, multisystem, febrile vasculitis of unknown etiology that primarily affects medium-sized arteries, most notably the coronary arteries. **Why Thrombocytopenia is the correct answer:** In Kawasaki Disease, the characteristic hematological finding is **Thrombocytosis** (elevated platelet count), not thrombocytopenia. Platelet counts typically begin to rise during the subacute phase (after the 10th day of illness) and can exceed 1 million/mm³. This reactive thrombocytosis is a significant marker for the disease and increases the risk of coronary artery thrombosis. **Analysis of other options:** * **A. Conjunctival congestion:** This is a classic diagnostic criterion. It is typically bilateral, non-exudative (bulbar), and spares the limbus. * **C. Aneurysm of coronary artery:** This is the most serious complication of KD, occurring in up to 25% of untreated cases. It usually develops in the subacute phase. * **D. Enlarged lymph nodes:** Cervical lymphadenopathy (usually >1.5 cm and unilateral) is one of the five primary clinical diagnostic criteria. **NEET-PG High-Yield Pearls:** * **Diagnostic Criteria (CRASH and Burn):** **C**onjunctivitis, **R**ash, **A**denopathy, **S**trawberry tongue (and oral changes), **H**and/foot changes (edema/desquamation), and **Burn** (High-grade fever for ≥5 days). * **Treatment:** High-dose IVIG (2g/kg) and Aspirin. IVIG is most effective when given within the first 10 days to prevent coronary aneurysms. * **Echo Schedule:** Perform at diagnosis, at 2 weeks, and at 6–8 weeks. * **Incomplete KD:** Suspect in infants with prolonged fever and fewer than 4 criteria; check ESR/CRP and Platelets.

Q: Which of the following syndromes is best associated with congenital heart disease?

Holt Oram syndrome. **Explanation:** **Holt-Oram Syndrome (Correct Answer):** Also known as **Heart-Hand Syndrome**, this is an autosomal dominant condition caused by a mutation in the **TBX5 gene**. It is characterized by the co-occurrence of upper limb deformities (most commonly a triphalangeal or absent thumb and radial dysplasia) and congenital heart defects. The most frequent cardiac association is an **Atrial Septal Defect (ASD)** of the ostium secundum type, followed by Ventricular Septal Defects (VSD). **Analysis of Incorrect Options:** * **Lesch-Nyhan Syndrome:** An X-linked recessive disorder caused by a deficiency of the enzyme HGPRT. It presents with hyperuricemia, gout, and characteristic self-mutilating behavior, but is not typically associated with structural heart disease. * **Rasmussen Syndrome:** A rare, progressive neurological inflammatory disease (chronic focal encephalitis) characterized by intractable seizures and hemiparesis. It has no cardiac involvement. * **LEOPARD Syndrome:** Now often referred to as **Noonan Syndrome with Multiple Lentigines**. While it *does* involve the heart (most commonly hypertrophic cardiomyopathy or pulmonary stenosis), Holt-Oram is the "classic" textbook association for a syndrome defined by the heart-limb axis in NEET-PG contexts. **Clinical Pearls for NEET-PG:** * **Holt-Oram:** Remember the "Hand-Heart" link. If a question mentions a "thumb deformity + murmur," think Holt-Oram. * **TBX5 Gene:** High-yield genetic association. * **ASD:** The most common cardiac lesion in this syndrome (specifically Secundum type). * **LEOPARD Mnemonic:** **L**entigines, **E**CG conduction defects, **O**cular hypertelorism, **P**ulmonary stenosis, **A**bnormal genitalia, **R**etardation of growth, and **D**eafness.

Question 1

The severity of cyanosis in Fallot's tetralogy physiology is best determined by which factor?

Accepted Answer

Degree of pulmonary stenosis

Answer

Size of the ventricular septal defect (VSD)

Answer

Degree of aortic overriding

Answer

Degree of right ventricular hypertrophy (RVH)

Question 2

In which of the following conditions is the left atrium not enlarged?

Accepted Answer

Atrial septal defect

Answer

Ventricular septal defect

Answer

Aortopulmonary window

Answer

Patent ductus arteriosus

Question 3

Pulmonary blood flow is increased in all of the following conditions except:

Accepted Answer

Tetralogy of Fallot (TOF)

Answer

Atrial septal defect (ASD)

Answer

Ventricular septal defect (VSD)

Answer

Transposition of great arteries (TGA)

Question 4

Which of the following is not a feature of Sydenham's chorea?

Accepted Answer

Seizures

Answer

Hypotonia

Answer

Unintelligible speech

Answer

Emotional lability

Question 5

All of the following features are seen in Kawasaki disease except?

Accepted Answer

Exudative conjunctivitis

Answer

Coronary artery aneurysms

Answer

Red strawberry tongue

Answer

Cervical lymphadenopathy

Question 6

Which of the following statements is true regarding Tetralogy of Fallot?

Accepted Answer

There is an association with DiGeorge syndrome.

Answer

Cyanosis is often present in the first few days of life.

Answer

There is a right-sided aortic arch in about 50% of cases.

Answer

The murmur becomes softer during a cyanotic spell as flow through the pulmonary valve is increased.

Question 7

In Transposition of the Great Arteries (TGA), what is the relative position of the aorta to the pulmonary artery?

Accepted Answer

Anterior and right to the pulmonary artery

Answer

Posterior and left to the pulmonary artery

Answer

Posterior and right to the pulmonary artery

Answer

Anterior and left to the pulmonary artery

Question 8

All are manifestations of Kawasaki disease, except:

Accepted Answer

Thrombocytopenia

Answer

Conjunctival congestion

Answer

Aneurysm of coronary artery

Answer

Enlarged lymph nodes

Question 9

Which of the following syndromes is best associated with congenital heart disease?

Accepted Answer

Holt Oram syndrome

Answer

Lesch-Nyhan syndrome

Answer

Rasmussen syndrome

Answer

LEOPARD syndrome

Question 10

Which of the following drug combinations is used in a patient with tetralogy of Fallot?

Accepted Answer

Morphine, sodium bicarbonate, and propranolol

Answer

Digoxin, furosemide, and oxygen

Answer

Atenolol with direct current cardioversion

Answer

Captopril with aminophylline

Cardiology — MCQs

Cardiology — MCQs

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