Cardiology Practice Questions

Q: Cyanosis is NOT present in which of the following conditions?

Coarctation of the aorta (COA). **Explanation:** The core concept in pediatric cardiology is distinguishing between cyanotic and acyanotic heart diseases. **Coarctation of the Aorta (CoA)** is classified as an **acyanotic** obstructive heart defect. It involves a localized narrowing of the aorta, typically near the ductus arteriosus. While it causes a pressure gradient (higher BP in upper limbs, lower in lower limbs), it does not involve a right-to-left shunt of deoxygenated blood into the systemic circulation; therefore, central cyanosis is absent. **Analysis of Incorrect Options:** * **TGA:** A classic cyanotic heart disease ("Cyanotic 5 Ts"). It involves parallel circulations where deoxygenated blood is pumped directly back to the body, causing profound early cyanosis. * **PDA with Pulmonary Hypertension:** While a simple PDA is acyanotic (left-to-right shunt), severe pulmonary hypertension can reverse the shunt (right-to-left), leading to **differential cyanosis** (cyanosis in the lower limbs but not the upper limbs). This is known as Eisenmenger syndrome. * **Ebstein’s Anomaly:** This involves the downward displacement of the tricuspid valve. It often presents with an atrial septal defect (ASD) and massive right-sided heart failure, leading to a right-to-left shunt and cyanosis. **NEET-PG High-Yield Pearls:** * **CoA Hallmark:** "Radio-femoral delay" and rib notching (3rd–8th ribs) on X-ray. * **Differential Cyanosis:** Pathognomonic for PDA with reversal of shunt (Eisenmenger’s). * **Reverse Differential Cyanosis:** Seen in TGA with PDA and Pre-ductal CoA. * **Ebstein’s Anomaly:** Associated with maternal **Lithium** intake and "Box-shaped" heart on X-ray.

Q: Which of the following is included in the modified Jones criteria for the diagnosis of acute rheumatic fever?

Erythema Marginatum. Acute Rheumatic Fever (ARF) is a multisystem inflammatory disease following a Group A Streptococcal (GAS) pharyngitis. The diagnosis is clinical, based on the **Modified Jones Criteria** (revised by AHA in 2015). Even in established rheumatic heart disease, diagnosis requires evidence of preceding GAS infection [1]. **Why Erythema Marginatum is Correct:** Erythema Marginatum is one of the **five Major Criteria** for ARF. It is a distinctive, evanescent, non-pruritic, pink erythematous rash with pale centers and rounded/serpiginous margins, typically found on the trunk and proximal extremities (never the face). **Analysis of Incorrect Options:** * **A. Oral Ulcers:** These are characteristic of Systemic Lupus Erythematosus (SLE) or Behçet’s disease, not ARF. * **B. Malar Rash:** This "butterfly rash" is a classic feature of SLE [2]. In contrast, ARF does not typically involve facial rashes. * **D. Nail Telangiectasia:** These are vascular changes seen in connective tissue diseases like Dermatomyositis or Scleroderma. **High-Yield Clinical Pearls for NEET-PG:** * **Jones Criteria Mnemonic (Major):** **J♥NES** * **J** - Joints (Migratory Polyarthritis) * **♥** - Carditis (Pancarditis; Valvulitis is most common) [1] * **N** - Nodules (Subcutaneous) * **E** - Erythema Marginatum * **S** - Sydenham Chorea (St. Vitus Dance) * **Minor Criteria:** Fever, Polyarthralgia, prolonged PR interval, and elevated ESR/CRP. * **Requirement:** 2 Major OR 1 Major + 2 Minor criteria, **PLUS** evidence of preceding GAS infection (ASO titer or Positive Throat Culture) [1]. * **Exception:** Chorea or indolent carditis can be diagnostic of ARF without meeting other criteria or proving prior infection [1].

Q: What is the most common congenital heart disease associated with Edward's syndrome?

Ventricular Septal Defect. **Explanation:** **Edward’s Syndrome (Trisomy 18)** is the second most common autosomal trisomy after Down syndrome. Congenital Heart Disease (CHD) is present in over 90% of these patients and is a major contributor to high neonatal mortality. **Why Ventricular Septal Defect (VSD) is correct:** **Ventricular Septal Defect (VSD)** is the most common cardiac anomaly associated with Edward’s syndrome. It typically presents as a large perimembranous or muscular defect. While multiple defects often coexist in these patients, VSD remains the most frequent finding in clinical and pathological studies. **Analysis of Incorrect Options:** * **A. Atrial Septal Defect (ASD):** While ASDs (specifically ostium secundum) are common in Trisomy 18, they occur less frequently than VSDs. * **C. Patent Ductus Arteriosus (PDA):** PDA is frequently seen in Edward’s syndrome, often in combination with VSD or ASD, but it is not the primary or most common lesion. * **D. Tetralogy of Fallot (TOF):** TOF is more classically associated with **DiGeorge Syndrome** (22q11 deletion) and Down syndrome, though it can occasionally occur in Trisomy 18. **High-Yield Clinical Pearls for NEET-PG:** * **Trisomy 18 (Edward’s) Mnemonic:** Remember **"E"** for **E**ighteen and **E**dward’s. * **Key Features:** Clenched fists with overlapping fingers (2nd and 5th digits over 3rd and 4th), Rocker-bottom feet, Micrognathia, and low-set malformed ears. * **Comparison:** * **Down Syndrome (Trisomy 21):** Most common CHD is **Atrioventricular Septal Defect (AVSD)** / Endocardial Cushion Defect. * **Patau Syndrome (Trisomy 13):** Most common CHD is **VSD** (similar to Edward's), but often associated with Dextrocardia. * **Turner Syndrome:** Most common is **Bicuspid Aortic Valve** (overall) and **Coarctation of Aorta**.

Q: Which of the following can cause recurrent pulmonary infection?

Tetralogy of Fallot (TOF). The correct answer is **Tetralogy of Fallot (TOF)**. While this question appears to be a clinical cardiology query, it is frequently categorized under Neuroanatomy/Embryology in NEET-PG due to the developmental origins of the heart and the associated complications involving the central nervous system. **Why TOF is the correct answer:** Tetralogy of Fallot is a **cyanotic** heart disease characterized by a right-to-left shunt. In TOF, blood bypasses the pulmonary circulation (where it is normally filtered by the pulmonary capillary bed). This allows bacteria and septic emboli from the systemic circulation to enter the arterial system directly. These emboli often lodge in the brain, leading to **Brain Abscesses**. Clinically, these patients present with "recurrent pulmonary infections" (often misdiagnosed) or chronic hypoxia leading to polycythemia, which increases blood viscosity and further predisposes them to cerebral infarction and subsequent infection. **Analysis of Incorrect Options:** * **VSD and ASD:** These are typically **acyanotic** (left-to-right shunt) conditions. While they cause increased pulmonary blood flow (leading to frequent lower respiratory tract infections), they do not bypass the pulmonary filter, making brain abscesses or systemic embolic infections much less common compared to TOF. * **Recurrent LVF:** This leads to pulmonary edema and congestive changes but does not provide a structural mechanism for right-to-left shunting of septic emboli. **NEET-PG High-Yield Pearls:** * **Most common cause of Brain Abscess in children:** Cyanotic Heart Disease (specifically TOF). * **The "Filter" Concept:** The lungs act as a physiological filter for venous bacteria; any right-to-left shunt (TOF, Eisenmenger syndrome) bypasses this, increasing the risk of CNS infections. * **TOF Components:** Pulmonary stenosis, Right ventricular hypertrophy, Overriding of aorta, and VSD.

Q: Peripheral pulmonic stenosis may be seen in all of the following conditions EXCEPT:

Cytomegalovirus (CMV) infection. **Explanation:** Peripheral Pulmonic Stenosis (PPS) refers to the narrowing of the pulmonary artery branches. It is a classic finding in specific genetic and infectious syndromes, but it is **not** associated with Cytomegalovirus (CMV) infection. **Why Option D is Correct:** While **Congenital CMV** is the most common intrauterine infection, its primary clinical manifestations are neurological and systemic (e.g., microcephaly, periventricular calcifications, sensorineural hearing loss, and petechiae). Unlike Rubella, CMV does not typically cause structural cardiac defects like PPS. **Why the Other Options are Incorrect:** * **Williams Syndrome (Option A):** Caused by a microdeletion on chromosome 7q11.23 (elastin gene). It is characteristically associated with **Supravalvular Aortic Stenosis** and peripheral pulmonic stenosis. * **Alagille Syndrome (Option B):** An autosomal dominant disorder (JAG1 mutation) characterized by paucity of interlobular bile ducts. PPS is the most common cardiovascular manifestation (seen in ~70% of cases), often occurring alongside Tetralogy of Fallot. * **Congenital Rubella Syndrome (Option C):** Classically presents with the triad of Cataracts, Sensorineural deafness, and Cardiac defects. The most common cardiac lesions are **Patent Ductus Arteriosus (PDA)** and peripheral pulmonic stenosis. **High-Yield Clinical Pearls for NEET-PG:** * **Williams Syndrome:** Look for "Elfin facies," hypercalcemia, and an outgoing "cocktail party" personality. * **Alagille Syndrome:** Look for "butterfly vertebrae," posterior embryotoxon in the eye, and cholestatic jaundice. * **Auscultation:** PPS presents as a systolic ejection murmur heard best at the upper left sternal border, radiating to the axilla and back. * **CMV vs. Rubella:** Remember—**R**ubella causes **R**ight-sided/Arterial lesions (PPS, PDA), while **C**MV causes **C**alcifications (Periventricular).

Q: Truncus arteriosus is most commonly associated with which of the following conditions?

DiGeorge Syndrome. **Explanation:** **Truncus Arteriosus** is a cyanotic congenital heart disease where a single great vessel fails to divide into the aorta and pulmonary artery due to the failure of the **conotruncal ridges** to fuse. This developmental process is heavily dependent on **neural crest cell migration**. **Why DiGeorge Syndrome is correct:** DiGeorge Syndrome (22q11.2 deletion syndrome) is characterized by the defective development of the 3rd and 4th pharyngeal pouches. Since neural crest cells contribute to both the pharyngeal pouches and the cardiac outflow tract, there is a strong association. Approximately **30-35%** of patients with Truncus Arteriosus have DiGeorge Syndrome. Conversely, Truncus Arteriosus is the most specific cardiac defect associated with this syndrome (along with Interrupted Aortic Arch Type B). **Why other options are incorrect:** * **Turner’s Syndrome (45, XO):** Most commonly associated with **Bicuspid Aortic Valve** (most common) and **Coarctation of the Aorta** (pre-ductal). * **Down’s Syndrome (Trisomy 21):** Most commonly associated with **Endocardial Cushion Defects** (Atrioventricular Septal Defects/AVSD). * **Klinefelter’s Syndrome (47, XXY):** Not typically associated with specific structural congenital heart defects; it is primarily a primary hypogonadism disorder. **High-Yield Clinical Pearls for NEET-PG:** * **CATCH-22 Mnemonic for DiGeorge:** **C**ardiac defects (Truncus), **A**bnormal facies, **T**hymic hypoplasia (T-cell deficiency), **C**left palate, **H**ypocalcemia (due to parathyroid hypoplasia). * **Chest X-ray:** Truncus arteriosus often presents with a "sitting duck" appearance or a right-sided aortic arch (seen in 25% of cases). * **Treatment:** Early surgical repair is mandatory to prevent irreversible pulmonary hypertension.

Question 1

A 2-year-old known case of Rheumatic Heart Disease presents with a 3-week history of fever, hematuria, and palpitations. What is the most likely diagnosis?

Accepted Answer

Staphylococcal endocarditis

Answer

Streptococcal endocarditis

Answer

Collagen vascular disease

Answer

Reactivation

Question 2

Cyanosis is NOT present in which of the following conditions?

Accepted Answer

Coarctation of the aorta (COA)

Answer

Transposition of the great arteries (TGA)

Answer

Patent ductus arteriosus (PDA) with pulmonary hypertension

Answer

Ebstein's anomaly

Question 3

A newborn male, normal at birth, started developing cyanosis. On auscultation, a continuous murmur was audible. The child was put on supplemental oxygen but no improvement was noted; rather, the oxygen saturation of the neonate kept falling further. The pediatrician on call made a provisional diagnosis of a duct-dependent lesion. What is the next line of management?

Accepted Answer

Administer PGE1

Answer

Administer prostaglandin inhibitor

Answer

Administer PGG2

Answer

Take the baby to the OR immediately for surgical management of the defect

Question 4

Which of the following is included in the modified Jones criteria for the diagnosis of acute rheumatic fever?

Accepted Answer

Erythema Marginatum

Answer

Oral ulcer

Answer

Malar rash

Answer

Nail telangiectasia

Question 5

Essential criteria for Tetralogy of Fallot includes all, EXCEPT:

Accepted Answer

Valvular stenosis

Answer

Infundibular stenosis

Answer

Overriding of aorta

Answer

Right ventricular hypertrophy

Question 6

What is the most common congenital heart disease associated with Edward's syndrome?

Accepted Answer

Ventricular Septal Defect

Answer

Atrial Septal Defect

Answer

Patent Ductus arteriosus

Answer

Tetralogy of Fallot

Question 7

An infant presents with a double aortic arch. What is the likely diagnosis?

Accepted Answer

Congenital anomalies of the heart and great vessels (CATCH 22)

Answer

DiGeorge syndrome

Answer

Velo-cardio-facial syndrome

Answer

All of the above

Question 8

Which of the following can cause recurrent pulmonary infection?

Accepted Answer

Tetralogy of Fallot (TOF)

Answer

Ventricular Septal Defect (VSD)

Answer

Recurrent Left Ventricular Failure (LVF)

Answer

Atrial Septal Defect (ASD)

Question 9

Peripheral pulmonic stenosis may be seen in all of the following conditions EXCEPT:

Accepted Answer

Cytomegalovirus (CMV) infection

Answer

Williams syndrome

Answer

Alagille syndrome

Answer

Rubella syndrome

Question 10

Truncus arteriosus is most commonly associated with which of the following conditions?

Accepted Answer

DiGeorge Syndrome

Answer

Turner's syndrome

Answer

Klinefelter's syndrome

Answer

Down's syndrome

Cardiology — MCQs

Cardiology — MCQs

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