Cardiology Practice Questions

Q: Child presents with strawberry tongue, fever for 5 days, cracked lips, Periungual peeling of the skin and bulbar congestion. Which of the following cardiac lesions will be seen in this child?

Mitral regurgitation. ***Mitral regurgitation*** - The constellation of symptoms (strawberry tongue, fever, cracked lips, periungual peeling, bulbar congestion) is highly characteristic of **Kawasaki disease**. - **Coronary artery aneurysms** and **mitral regurgitation** are common cardiac complications of Kawasaki disease due to inflammation affecting the heart valves and coronary arteries. *Mitral stenosis* - Mitral stenosis is less common in acute Kawasaki disease and is more typically a long-term complication of rheumatic fever or a congenital anomaly. - The acute inflammatory nature of Kawasaki disease is more likely to cause valvular insufficiency (regurgitation) rather than narrowing (stenosis). *Tricuspid stenosis* - Tricuspid stenosis is a relatively rare valvular lesion and is not typically associated with Kawasaki disease. - Inflammatory conditions like Kawasaki disease primarily affect the left-sided heart valves and coronary arteries. *Pulmonary regurgitation* - While pulmonary regurgitation can occur congenitally or due to pulmonary hypertension, it is not a direct or common cardiac complication of Kawasaki disease. - Kawasaki disease primarily targets the systemic vasculature and coronary arteries, leading to problems like mitral regurgitation.

Q: A 1-week-old neonate presents with anoxic spells and single S2. CXR shows all except:

Pulmonary plethora. ***Pulmonary plethora*** - Pulmonary plethora, or **increased pulmonary vascular markings**, indicates increased blood flow to the lungs, which is not characteristic of Tetralogy of Fallot as it involves **pulmonary outflow obstruction**. - Tetralogy of Fallot leads to **decreased pulmonary blood flow**, resulting in **pulmonary oligemia** (reduced vascular markings) on CXR. *Boot-shaped heart* - This is a classic radiographic finding in **Tetralogy of Fallot** due to **right ventricular hypertrophy** and an upturned cardiac apex caused by **pulmonary hypoplasia**. - The image appears to show early signs of a boot-shaped heart (Coeur en sabot), consistent with the clinical picture of a cyanotic neonate with anoxic spells. *Right-sided aortic arch* - A **right-sided aortic arch** is seen in approximately 25% of patients with Tetralogy of Fallot and is a recognized associated anomaly. - While not universally present, its occurrence is significant enough to be considered a feature of the condition, making it a possible finding. *Right ventricular hypertrophy* - **Right ventricular hypertrophy** is one of the four defining features of **Tetralogy of Fallot** (together with ventricular septal defect, pulmonary stenosis, and an overriding aorta). - While not always directly visible as an enlarged chamber on a CXR, its presence is inferred by the **boot-shaped heart** configuration and the physiological adaptations to pulmonary outflow obstruction.

Q: A 3-year-old child presents with the clinical features shown in the image. What is the most likely diagnosis?

Kawasaki disease. ***Kawasaki disease*** * The image displays classic signs of **Kawasaki disease**, including **bilateral conjunctivitis without exudates** (top left), **erythema of the palms and soles with desquamation** (top right), **cervical lymphadenopathy** (bottom left, indicated by swelling in the neck region), and a **strawberry tongue** (bottom right). * These clinical features, especially in a young child, are diagnostic for **Kawasaki disease**, which is a vasculitis affecting medium-sized arteries, most notably the coronary arteries. *Scarlet fever* * While **scarlet fever** can cause a **strawberry tongue** and a rash, the rash is typically a **fine, sandpaper-like rash** that blanches with pressure, not usually characterized by the distinct palm/sole erythema and desquamation seen in the image. * **Conjunctivitis** is not a prominent feature of scarlet fever, and the lymphadenopathy is typically less pronounced and may be tender. *Kikuchi disease* * **Kikuchi disease** (histiocytic necrotizing lymphadenitis) primarily presents with **cervical lymphadenopathy, fever**, and often rash, but it does **not typically involve conjunctivitis or changes in the hands, feet, or tongue** as dramatically depicted. * It is a self-limiting condition of unknown etiology, distinct from the systemic vasculitis of Kawasaki disease. *Rosai-Dorfman disease* * **Rosai-Dorfman disease** (sinus histiocytosis with massive lymphadenopathy) is characterized by **massive, painless lymphadenopathy**, particularly cervical, with fever and other systemic symptoms. * However, it does **not present with the specific mucocutaneous findings** of conjunctivitis, strawberry tongue, or characteristic hand/foot changes seen in the images indicative of Kawasaki disease.

Q: A 1-year-old child with CHD is on heart failure treatment. The ECG shows all except:

Heart rate of 60 bpm approximately. ***Heart rate of 60 bpm approximately*** - The ECG rhythm is irregular; however, the predominant rhythm shows a normal heart rate for a 1-year-old child. A heart rate of 60 bpm would be considered **bradycardia** in an infant, where the normal heart rate ranges from 100-160 bpm. - The calculated heart rate from the provided ECG strip is approximately 100-120 bpm (counting 10 small squares between R waves, which corresponds to 1500/100 = 150 bpm, or 15 small squares, hence 1500/15 = 100 bpm if the duration between two consecutive R waves is 15 small squares on the ECG graph). *Ventricular bigeminy* - The ECG shows a regular QRS complex followed by a premature ventricular contraction (PVC), which is then followed by another regular QRS complex, fitting the pattern of **ventricular bigeminy**. - This pattern can be observed as the wide, bizarre QRS complexes interspersed between normal beats. *ST depression* - The ST-segment, which is the interval between the end of the QRS complex and the beginning of the T wave, appears to be **depressed**, particularly in the leads shown (V3 and V6). - This finding can indicate **myocardial ischemia** or strain, commonly seen in heart failure. *U wave* - A **U wave** is a small deflection immediately following the T wave, typically positive and best seen in V2-V3. - These waves are visible on this ECG, often prominent when there's hypokalemia or digitalis toxicity, which is plausible in a child on heart failure treatment.

Q: The given ECG of a neonate born to a mother with SLE shows?

Complete heart block. ***Complete heart block*** - The ECG demonstrates **complete dissociation** between the P waves (atrial activity) and the QRS complexes (ventricular activity). The atrial rate is faster than the ventricular rate, and there is no consistent relationship between P waves and QRS complexes. - In a neonate of a mother with SLE, **congenital complete heart block** is a well-known complication due to transplacental transfer of maternal antibodies (anti-Ro/SSA and anti-La/SSB) that damage the atrioventricular (AV) node. *Mobitz I heart block* - This type of heart block (also known as **Wenckebach phenomenon**) is characterized by a **progressive prolongation of the PR interval** until a P wave is eventually not conducted, leading to a dropped QRS complex. - The ECG provided does not show a gradual lengthening of the PR interval; rather, it shows a complete lack of conduction between atria and ventricles. *Mobitz II heart block* - In Mobitz II block, there is a **fixed PR interval** for conducted beats, but some P waves are **intermittently blocked** without prior PR prolongation. - The ECG in the question shows no consistent PR interval whatsoever, as P waves and QRS complexes are completely dissociated. *Sick sinus syndrome* - This condition involves a malfunction of the **sinoatrial node**, leading to a variety of rhythm disturbances such as sinus bradycardia, sinus arrest, or *tachycardia-bradycardia syndrome*. - While it can cause bradycardia, it does not typically present with the **P-QRS dissociation** characteristic of advanced AV block seen in the ECG.

Q: Which one of the following is a cyanotic congenital heart disease?

Tetralogy of Fallot. ***Tetralogy of Fallot*** - This condition is characterized by **four distinct heart defects** that result in **right-to-left shunting** of unoxygenated blood into the systemic circulation, leading to cyanosis. - The four defects are **ventricular septal defect**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy**. *Patent ductus arteriosus* - This is an **acyanotic heart defect** where there is a persistent opening between the aorta and pulmonary artery, leading to a **left-to-right shunt**, increasing pulmonary blood flow. - It does not typically cause cyanosis unless there is severe pulmonary hypertension leading to shunt reversal (Eisenmenger syndrome). *Ventricular septal defect* - This is also primarily an **acyanotic heart defect** where a hole exists between the ventricles, causing a **left-to-right shunt** of oxygenated blood. - Cyanosis would only occur in severe cases with significant pulmonary hypertension and shunt reversal (Eisenmenger syndrome). *Atrial septal defect* - This is an **acyanotic heart defect** involving an opening between the atria, usually resulting in a **left-to-right shunt** of oxygenated blood into the right atrium. - It rarely causes cyanosis unless there are significant complications like pulmonary hypertension with shunt reversal.

Q: A 15-year-old patient presents with joint swelling, a pan-systolic murmur, negative rheumatoid factor (RF), and elevated ESR. The patient also reports a recent history of sore throat and exhibits subcutaneous nodules and erythema marginatum on physical examination. What is the most likely diagnosis?

Acute rheumatic fever. **Acute rheumatic fever** - The combination of **joint swelling**, a recent **sore throat**, **pan-systolic murmur** (indicating carditis), **subcutaneous nodules**, and **erythema marginatum** meets the **Jones criteria** for acute rheumatic fever [1]. - An **elevated ESR** is a common inflammatory marker, and a **negative rheumatoid factor** helps differentiate it from other rheumatic conditions. - Carditis often presents with new or changed murmurs, such as a soft systolic murmur due to mitral regurgitation [1]. Acute rheumatic carditis is also a principal cause of valve regurgitation [2]. *Seronegative rheumatoid arthritis* - This typically presents with chronic inflammatory arthritis, but lacks specific features like **carditis** or characteristic skin rashes like **erythema marginatum** and **subcutaneous nodules**. - While it has a negative RF, the acute presentation with a preceding sore throat points away from chronic arthropathy. *Juvenile idiopathic arthritis* - This is a diagnosis of exclusion for chronic arthritis in children under 16, lacking acute rheumatic fever's hallmark cardiac involvement, **subcutaneous nodules**, or **erythema marginatum**. - While it can cause joint swelling and elevated ESR, the constellation of symptoms strongly points to an acute systemic illness. *Ankylosing spondylitis* - This primarily affects the **axial skeleton** (spine and sacroiliac joints) and is characterized by back pain and stiffness, predominantly in young adults. - It does not typically present with a **pan-systolic murmur**, **subcutaneous nodules**, or **erythema marginatum**, and is rarely seen in 15-year-old patients with this acute presentation.

Q: Which of the following cyanotic heart diseases cause increased pulmonary blood flow? 1. Ebstein anomaly 2. Tetralogy of Fallot 3. Transposition of the great arteries (TGA) 4. Total anomalous pulmonary venous communication (TAPVC) Select the correct combination:

3,4. ***3,4 (TGA and TAPVC)*** - **Transposition of the great arteries (TGA)** involves two parallel circulations with the aorta arising from the right ventricle and pulmonary artery from the left ventricle. Mixing occurs through defects (ASD, VSD, or PDA), leading to **pulmonary overcirculation** as oxygenated blood recirculates through the lungs. - **Total anomalous pulmonary venous connection (TAPVC)** results in all pulmonary veins draining into the systemic venous circulation (typically right atrium). This causes **increased volume load on the right heart** and subsequently increased pulmonary blood flow, with obligatory mixing at the atrial level. *1,2 (Ebstein and ToF)* - Both conditions cause **decreased pulmonary blood flow**. - **Ebstein anomaly** involves apical displacement of the tricuspid valve with "atrialization" of the right ventricle, causing tricuspid regurgitation and right-to-left shunting through an ASD/PFO. - **Tetralogy of Fallot** features right ventricular outflow tract obstruction (pulmonary stenosis) as its defining feature, causing reduced pulmonary blood flow. *2,4* - Incorrect combination: **Tetralogy of Fallot causes decreased pulmonary blood flow** due to RVOT obstruction, not increased. *1,4* - Incorrect combination: **Ebstein anomaly causes decreased pulmonary blood flow**, not increased.

Q: Which of the following is considered a minor clinical finding suggestive of congenital heart disease?

Abnormal 2nd heart sound. ***Abnormal 2nd heart sound*** - An abnormal (loud, soft, split, or single) **second heart sound (S2)** is a minor clinical finding that can suggest congenital heart disease (CHD). - This reflects abnormalities in the **pulmonary** or **aortic valve closure**, common in various CHDs. *Low BP* - **Low blood pressure** is a general sign of circulatory compromise and is not a specific or minor clinical finding for congenital heart disease itself. - It might indicate severe heart failure or shock, which are major, late-stage complications of CHD, rather than an early suggestive sign. *Systolic murmur grade-3* - A **systolic murmur of grade 3 or higher** is generally considered a **major clinical finding** and often indicates significant structural heart disease. - Minor findings are typically less intense or specific signs that still warrant further investigation. *Diastolic murmur* - The presence of **any diastolic murmur** is considered a **major clinical finding** that is highly suggestive of significant heart disease, as it often implies structural valve abnormalities or abnormal blood flow during diastole. - This is not a "minor" finding as it virtually always indicates pathology.

Question 1

Choose the TRUE statement regarding the disease depicted in the images below:

Accepted Answer

Intravenous immunoglobulin (IVIG) and aspirin are the mainstays of treatment

Answer

Antibiotics should be started immediately to prevent cardiac complications

Answer

Corticosteroids are the first-line treatment for this condition

Answer

NSAIDs other than aspirin are preferred to reduce inflammatory response

Question 2

Child presents with strawberry tongue, fever for 5 days, cracked lips, Periungual peeling of the skin and bulbar congestion. Which of the following cardiac lesions will be seen in this child?

Accepted Answer

Mitral regurgitation

Answer

Mitral stenosis

Answer

Tricuspid stenosis

Answer

Pulmonary regurgitation

Question 3

A 1-week-old neonate presents with anoxic spells and single S2. CXR shows all except:

Accepted Answer

Pulmonary plethora

Answer

Boot-shaped heart

Answer

Right-sided aortic arch

Answer

Right ventricular hypertrophy

Question 4

A 3-year-old child presents with the clinical features shown in the image. What is the most likely diagnosis?

Accepted Answer

Kawasaki disease

Answer

Scarlet fever

Answer

Kikuchi disease

Answer

Rosai-Dorfman disease

Question 5

A 1-year-old child with CHD is on heart failure treatment. The ECG shows all except:

Accepted Answer

Heart rate of 60 bpm approximately

Answer

Ventricular bigeminy

Answer

ST depression

Answer

U wave

Question 6

The given ECG of a neonate born to a mother with SLE shows?

Accepted Answer

Complete heart block

Answer

Mobitz I heart block

Answer

Mobitz II heart block

Answer

Sick sinus syndrome

Question 7

Which one of the following is a cyanotic congenital heart disease?

Accepted Answer

Tetralogy of Fallot

Answer

Patent ductus arteriosus

Answer

Ventricular septal defect

Answer

Atrial septal defect

Question 8

A 15-year-old patient presents with joint swelling, a pan-systolic murmur, negative rheumatoid factor (RF), and elevated ESR. The patient also reports a recent history of sore throat and exhibits subcutaneous nodules and erythema marginatum on physical examination. What is the most likely diagnosis?

Accepted Answer

Acute rheumatic fever

Answer

Seronegative rheumatoid arthritis

Answer

Juvenile idiopathic arthritis

Answer

Ankylosing spondylitis

Question 9

Which of the following cyanotic heart diseases cause increased pulmonary blood flow?

1. Ebstein anomaly
2. Tetralogy of Fallot
3. Transposition of the great arteries (TGA)
4. Total anomalous pulmonary venous communication (TAPVC)

Select the correct combination:

Accepted Answer

3,4

Answer

1,2

Answer

2,4

Answer

1,4

Question 10

Which of the following is considered a minor clinical finding suggestive of congenital heart disease?

Accepted Answer

Abnormal 2nd heart sound

Answer

Low BP

Answer

Systolic murmur grade-3

Answer

Diastolic murmur

Cardiology — MCQs

Cardiology — MCQs

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