Cardiology Practice Questions

Q: A child with fever for 6 days, strawberry tongue, conjunctival congestion with peeling of skin. What will be the treatment option for this child?

IVIG. ***IVIG*** - The constellation of **fever for 6 days (prolonged fever)**, **strawberry tongue**, **conjunctival congestion**, and **peeling skin** is highly indicative of **Kawasaki disease**. - **Intravenous immunoglobulin (IVIG) 2 g/kg as a single infusion** is the cornerstone of treatment for Kawasaki disease to reduce the risk of **coronary artery aneurysms** (from ~25% to <5%). - IVIG should be administered within **10 days of fever onset** for maximum efficacy. - **High-dose aspirin** (80-100 mg/kg/day) is given concurrently until the fever subsides, then switched to low-dose aspirin (3-5 mg/kg/day) for antiplatelet effect. *Antibiotics* - Kawasaki disease is a **vasculitis**, not a bacterial infection, so antibiotics are ineffective. - While other conditions like scarlet fever can present with strawberry tongue, the prolonged fever and other classic Kawasaki features differentiate it. *Steroids* - While steroids can reduce inflammation, they are **not the primary treatment** for Kawasaki disease and are typically used in conjunction with IVIG in **refractory cases** or for IVIG-resistant disease. - **Monotherapy with steroids** is not recommended for acute Kawasaki disease due to potential for increased aneurysm risk. *Antipyretics* - **Antipyretics** like acetaminophen can help manage the fever symptomatically. - However, they **do not treat the underlying vasculitis** or prevent the serious cardiac complications of Kawasaki disease. - Note: **NSAIDs like ibuprofen should be avoided** when high-dose aspirin is being used due to risk of drug interactions.

Q: Which of the following congenital heart disease has equal saturation in all heart chambers?

Total anomalous pulmonary venous circulation. ***Total anomalous pulmonary venous circulation*** - In this condition, all **pulmonary veins drain abnormally** into the systemic venous circulation, mixing oxygenated and deoxygenated blood before it reaches the left atrium. - This complete mixing results in **equal oxygen saturation** throughout all four heart chambers and the great arteries, as there is a single common mixing chamber. *Tetralogy of Fallot* - This condition involves **four defects**: pulmonary stenosis, ventricular septal defect (VSD), overriding aorta, and right ventricular hypertrophy, leading to right-to-left shunting. - Oxygen saturations would be **lower in the systemic circulation** and aorta compared to the pulmonary circulation (if measurable), but not equal across all chambers due to deoxygenated blood mixing in the systemic flow. *Transposition of great arteries* - Characterized by the **aorta arising from the right ventricle** and the pulmonary artery from the left ventricle, creating two parallel circulations. - Without mixing lesions (like a VSD or patent foramen ovale), the systemic circulation would be severely desaturated and the pulmonary circulation fully saturated, resulting in **highly disparate saturations** between chambers. *Tricuspid atresia* - Involves the **absence of a tricuspid valve**, preventing blood flow from the right atrium to the right ventricle, necessitating an atrial septal defect (ASD) or patent foramen ovale (PFO) for survival. - Blood from the right atrium goes directly to the left atrium, and then via a VSD to the pulmonary artery, leading to **different saturations** in the systemic and pulmonary circulations and not equal saturation in all chambers.

Q: Most common cardiac abnormality in Noonan syndrome is:-

Pulmonary stenosis. ***Pulmonary stenosis*** - **Valvular pulmonary stenosis**, particularly a dysplastic pulmonary valve, is the **most common cardiac defect** found in individuals with Noonan syndrome. - This condition can lead to an obstruction of blood flow from the right ventricle into the **pulmonary artery**. *Atrial septal defect* - While **atrial septal defects (ASDs)** can occur in Noonan syndrome, they are less common than pulmonary stenosis. - ASDs are characterized by a hole in the septum separating the two upper chambers of the heart. *Tetralogy of Fallot* - **Tetralogy of Fallot** is a complex congenital heart defect involving four specific abnormalities, which is not the most common cardiac finding in Noonan syndrome. - It is typically associated with a different set of genetic syndromes or occurs sporadically. *Ventricular septal defect* - **Ventricular septal defects (VSDs)** are also observed in some cases of Noonan syndrome but are less prevalent than pulmonary stenosis. - VSDs involve a hole in the wall separating the heart's lower two chambers.

Q: A 3-year-old boy is brought by his parents to the emergency department because they are concerned that he has had a high fever for several days. On examination, the boy has conjunctival and oral erythema. He has palpable cervical lymphadenopathy and erythema of his palms and soles. What is a potential life-threatening complication of this disorder?

Aneurysm of the coronary arteries. ***Aneurysm of the coronary arteries*** - The classic presentation of prolonged fever, **conjunctival and oral erythema**, cervical lymphadenopathy, and erythema of the palms and soles is highly suggestive of **Kawasaki disease**. - **Coronary artery aneurysms** are the most serious and potentially life-threatening complication of Kawasaki disease, especially if left untreated. *Dissection of the thoracic aorta* - This is a rare event in children and is not typically associated with Kawasaki disease. - Thoracic aortic dissection often presents with **sudden, severe chest pain** radiating to the back and is seen more commonly in adults with conditions like uncontrolled hypertension or connective tissue disorders. *Rupture of a berry aneurysm* - **Berry aneurysms** are typically found in the cerebral circulation and their rupture leads to subarachnoid hemorrhage. - While they can occur in children, they are not a characteristic complication of Kawasaki disease. *Aneurysm of the abdominal aorta* - Aneurysms of the abdominal aorta are rare in children and are not directly associated with Kawasaki disease. - These are typically seen in older adults due to **atherosclerosis** or in some genetic syndromes.

Q: Cyanotic heart disease with left axis deviation is:

Tricuspid atresia. ***Tricuspid atresia*** - **Tricuspid atresia** is a **cyanotic congenital heart disease** characterized by the absence of a tricuspid valve, leading to a single ventricle physiology. - The characteristic **ECG finding** in tricuspid atresia is **left axis deviation**, often with left ventricular hypertrophy, which is somewhat counterintuitive given the right-sided lesion. *TAPVC* - **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a **cyanotic heart disease** where all four pulmonary veins drain into the systemic venous circulation. - While cyanotic, it typically presents with a **right axis deviation** and **right ventricular hypertrophy** on ECG, not left axis deviation. *Ebstein anomaly* - **Ebstein anomaly** involves the downward displacement of the septal and posterior leaflets of the tricuspid valve into the right ventricle, often leading to **cyanosis**. - ECG findings are usually characterized by **right atrial enlargement** and **right bundle branch block**, not left axis deviation. *TGA* - **Transposition of the Great Arteries (TGA)** is a **cyanotic heart disease** where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. - ECG typically shows **right axis deviation** and **right ventricular hypertrophy**, reflecting the increased workload of the right ventricle pumping into the high-pressure aortic circuit.

Q: All of the following are acyanotic congenital heart diseases except _________

Tetralogy of fallot. ***Tetralogy of Fallot*** - This is a **cyanotic heart disease** due to the combination of four heart defects, leading to a **right-to-left shunt** and deoxygenated blood entering the systemic circulation [1]. - The four defects include a large **ventricular septal defect (VSD)**, **pulmonary stenosis**, an **overriding aorta**, and **right ventricular hypertrophy** [1]. *PDA* - A **patent ductus arteriosus (PDA)** allows blood to flow from the aorta to the pulmonary artery, creating a **left-to-right shunt**, which typically results in an acyanotic condition [3]. - While it can lead to complications like pulmonary hypertension, it does not usually cause cyanosis unless severe pulmonary hypertension develops (Eisenmenger syndrome). *VSD* - A **ventricular septal defect (VSD)** involves an opening between the ventricles, typically causing **left-to-right shunting** [2]. - This increased blood flow to the lungs defines it as an **acyanotic** condition because oxygenated blood from the left side is rerouted to the lungs. *ASD* - An **atrial septal defect (ASD)** is a hole in the septum separating the atria, usually leading to a **left-to-right shunt** from the left atrium to the right atrium [4]. - The increased blood flow to the right side of the heart and lungs makes it an **acyanotic** condition, as oxygenated blood continues to be delivered systemically.

Q: Commonest cause of heart failure in infancy is:

Congenital heart disease. **Congenital heart disease** - **Congenital heart defects** are the leading cause of heart failure in infancy due to structural abnormalities that impair normal cardiac function and blood flow. - Conditions like **ventricular septal defects (VSDs)**, **atrial septal defects (ASDs)**, and **patent ductus arteriosus (PDA)** can lead to volume overload or pressure overload, resulting in heart failure. *Cardiomyopathy* - While a cause of heart failure, **cardiomyopathy** is less common than congenital heart disease in infancy. - It involves primary myocardial dysfunction, which can be genetic, metabolic, or idiopathic. *Rheumatic fever* - **Rheumatic fever** is a post-streptococcal inflammation that can affect the heart, but it is rare in infancy and more typically seen in older children and adolescents. - Its incidence has also significantly decreased in developed countries due to improved hygiene and antibiotic use. *Myocarditis* - **Myocarditis**, often virally induced, can cause heart failure in infants but is less frequent than congenital heart defects. - It involves inflammation of the heart muscle, leading to impaired contractility.

Q: Most common cause of Acquired Complete Heart Block in children is

Cardiac Surgery. ***Cardiac Surgery*** - **Cardiac surgery** for congenital heart disease is the **most common cause** of acquired complete heart block in children, occurring in approximately **1-3% of congenital heart surgeries**. - High-risk procedures include **VSD repair**, **AV canal defect repair**, **tetralogy of Fallot correction**, and surgeries involving the **ventricular septum** near the AV node and bundle of His. - The conduction system may be damaged during surgical manipulation, leading to **immediate or delayed post-operative complete heart block**. - If the block persists beyond **7-10 days post-surgery**, permanent pacemaker implantation is typically required. *Myocarditis* - **Myocarditis** can cause varying degrees of AV block, including complete heart block, particularly following **viral infections** (e.g., Coxsackie virus, adenovirus). - However, complete heart block in myocarditis is **less common** than post-surgical cases in the pediatric population. - Most cases of myocarditis-related conduction disturbances are **transient** and resolve with treatment of the underlying inflammation. *Acute Rheumatic Fever* - **Acute Rheumatic Fever (ARF)** typically causes **first-degree AV block** (prolonged PR interval) as part of rheumatic carditis. - Complete heart block is **rare** in ARF; the carditis more commonly leads to **valvular damage** (mitral and aortic regurgitation) rather than complete AV dissociation. *Drug overdose* - Overdose of **cardiac depressants** (beta-blockers, calcium channel blockers, digoxin) can cause complete heart block. - This is an **acute toxicological cause** and relatively uncommon compared to post-surgical heart block in children. - Treatment involves supportive care, antidotes when available, and temporary pacing if needed.

Q: Which of the following is a defining feature of Tetralogy of Fallot?

Ventricular septal defect. ***Ventricular septal defect*** - A **ventricular septal defect (VSD)** is one of the four cardinal features of **Tetralogy of Fallot**, along with pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. - The VSD in Tetralogy of Fallot is typically **large** and **non-restrictive**, allowing a **right-to-left shunt** due to increased right ventricular pressure from pulmonary stenosis, resulting in cyanosis. - Cyanotic spells (tet spells) occur when there is increased right-to-left shunting due to dynamic worsening of RVOT obstruction. *Atrial septal defect* - An **atrial septal defect (ASD)** is a communication between the atria and is not a defining feature of Tetralogy of Fallot. - While ASDs can occur in conjunction with other congenital heart defects, they are not part of the classic tetralogy. *Mitral valve prolapse* - **Mitral valve prolapse** is a condition where the mitral valve leaflets bulge into the left atrium during systole, and it is not a congenital heart defect associated with Tetralogy of Fallot. - It is a common valvular abnormality that usually develops later in life or can be present congenitally but is unrelated to the pathophysiology of Tetralogy of Fallot. *Patent ductus arteriosus* - A **patent ductus arteriosus (PDA)** is a persistent opening between the aorta and pulmonary artery, which normally closes shortly after birth. - While a PDA can be present in some cases of congenital heart disease, it is not one of the four defects that comprise Tetralogy of Fallot.

Q: Which of the following cardiac lesions is least likely to occur in Congenital Rubella syndrome?

ASD. ***ASD*** - While **atrial septal defects (ASDs)** can occur in congenital heart disease, they are **rarely associated with congenital rubella syndrome**. - The classic cardiac defects linked to congenital rubella are related to persistent fetal circulation structures or underdeveloped outflow tracts. *VSD* - **Ventricular septal defects (VSDs)** are among the **most common congenital heart defects** and can be associated with congenital rubella syndrome. - Rubella infection can interfere with septal development, leading to these **shunt lesions**. *Pulmonary Stenosis* - **Pulmonary artery stenosis**, particularly **peripheral pulmonary artery stenosis**, is a **characteristic cardiovascular anomaly** in congenital rubella syndrome. - The rubella virus can affect the development of the pulmonary arteries and valves. *PDA* - **Patent ductus arteriosus (PDA)** is the **most common cardiac lesion** seen in congenital rubella syndrome due to the virus's interference with ductal closure. - The infection leads to abnormal development and persistence of the communication between the aorta and pulmonary artery.

Question 1

A child with fever for 6 days, strawberry tongue, conjunctival congestion with peeling of skin. What will be the treatment option for this child?

Accepted Answer

IVIG

Answer

Antibiotics

Answer

Steroids

Answer

Antipyretics

Question 2

Which of the following congenital heart disease has equal saturation in all heart chambers?

Accepted Answer

Total anomalous pulmonary venous circulation

Answer

Tetralogy of Fallot

Answer

Transposition of great arteries

Answer

Tricuspid atresia

Question 3

Most common cardiac abnormality in Noonan syndrome is:-

Accepted Answer

Pulmonary stenosis

Answer

Atrial septal defect

Answer

Tetralogy of Fallot

Answer

Ventricular septal defect

Question 4

A 3-year-old boy is brought by his parents to the emergency department because they are concerned that he has had a high fever for several days. On examination, the boy has conjunctival and oral erythema. He has palpable cervical lymphadenopathy and erythema of his palms and soles. What is a potential life-threatening complication of this disorder?

Accepted Answer

Aneurysm of the coronary arteries

Answer

Dissection of the thoracic aorta

Answer

Rupture of a berry aneurysm

Answer

Aneurysm of the abdominal aorta

Question 5

Cyanotic heart disease with left axis deviation is:

Accepted Answer

Tricuspid atresia

Answer

TAPVC

Answer

Ebstein anomaly

Answer

TGA

Question 6

All of the following are acyanotic congenital heart diseases except _________

Accepted Answer

Tetralogy of fallot

Answer

PDA

Answer

VSD

Answer

ASD

Question 7

Commonest cause of heart failure in infancy is:

Accepted Answer

Congenital heart disease

Answer

Cardiomyopathy

Answer

Rheumatic fever

Answer

Myocarditis

Question 8

Most common cause of Acquired Complete Heart Block in children is

Accepted Answer

Cardiac Surgery

Answer

Acute Rheumatic Fever

Answer

Drug overdose

Answer

Myocarditis

Question 9

Which of the following is a defining feature of Tetralogy of Fallot?

Accepted Answer

Ventricular septal defect

Answer

Atrial septal defect

Answer

Mitral valve prolapse

Answer

Patent ductus arteriosus

Question 10

Which of the following cardiac lesions is least likely to occur in Congenital Rubella syndrome?

Accepted Answer

ASD

Answer

VSD

Answer

Pulmonary Stenosis

Answer

PDA

Cardiology — MCQs

Cardiology — MCQs

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