Cardiology Practice Questions

Q: Drug of choice for the treatment of Kawasaki disease is

Intravenous Immunoglobulin. ***Intravenous Immunoglobulin*** - **Intravenous Immunoglobulin (IVIG)**, in combination with aspirin, is the cornerstone of therapy for acute Kawasaki disease. - It works by modulating the immune system and reducing inflammation, thereby preventing serious complications like **coronary artery aneurysms**. *Steroids* - While steroids can reduce inflammation, they are generally considered **second-line therapy** in Kawasaki disease, often used in cases unresponsive to IVIG. - Routine initial use of steroids alone is not the drug of choice due to the proven efficacy of IVIG in preventing **coronary artery pathology**. *Low molecular weight Heparin* - **Low molecular weight heparin** is an anticoagulant used to prevent or treat **thrombosis**. - It is not indicated for the primary treatment of the acute inflammatory phase of Kawasaki disease, though it may be used in specific situations if **coronary artery thrombosis** develops. *Aspirin* - **Aspirin** is an essential part of Kawasaki disease treatment, used initially at high doses for its anti-inflammatory effects and later at low doses for its **antiplatelet properties**. - However, aspirin is always administered **in conjunction with IVIG** as the primary treatment to reduce the risk of coronary artery complications.

Q: An infant previously diagnosed with a large muscular VSD comes to the office with complaints from the mother of fatigue and poor feeding over the past month. You note the child has not gained weight since the previous visit 2 months ago. The child is apathetic, tachypneic, and has wheezes and crackles on lung auscultation. What is the most likely cardiac diagnosis based on this patient's presentation?

Congestive heart failure. ***Congestive heart failure*** - The infant's symptoms of **fatigue**, **poor feeding**, **no weight gain**, **apathy**, **tachypnea**, and **wheezes/crackles** are classic signs of **congestive heart failure** in an infant. - A **large muscular VSD** can lead to significant left-to-right shunting, causing **pulmonary overcirculation** and symptoms of heart failure. *Congenital heart block* - This condition involves an abnormality in the heart's electrical conduction system, leading to a **slow heart rate (bradycardia)**. - While it can cause fatigue, it typically doesn't present with respiratory symptoms like **tachypnea** and **rales** unless profound bradycardia leads to heart failure. *Prolonged QT syndrome* - This is an **electrical disorder** that can cause **arrhythmias** and sudden cardiac death, often presenting with syncope or seizures. - It does not typically manifest with the signs of **pulmonary congestion** (wheezes, crackles) or feeding difficulties seen in this infant. *Hypertrophic cardiomyopathy* - This condition involves thickening of the heart muscle, leading to **outflow obstruction** and diastolic dysfunction. - While it can cause symptoms of poor feeding and fatigue, the prominent respiratory symptoms like **tachypnea** and **crackles** are more indicative of pulmonary venous congestion secondary to a large shunt.

Q: Clinical manifestations of large VSD in children typically appear at:

2 months. ***2 months*** - **Large ventricular septal defects (VSDs)** manifest clinically around **6 to 8 weeks (2 months) of age** because the **pulmonary vascular resistance (PVR)** decreases significantly around this time. - As PVR falls, increased **left-to-right shunting** occurs, leading to pulmonary overcirculation and symptoms like **tachypnea, poor feeding, and growth failure**. *2 days* - At **2 days of age**, PVR is still **elevated**, minimizing **left-to-right shunting** through a VSD, so symptoms are usually absent. - Significant symptoms from large left-to-right shunts due to congenital heart disease are uncommon in the **immediate postnatal period**. *2 weeks* - At **2 weeks of age**, PVR is still **relatively high**, and the decrease is not yet sufficient to cause significant symptomatic **pulmonary overcirculation** from a large VSD. - Clinical manifestations typically become evident when PVR has dropped considerably lower, around the 6-8 week mark. *6 months* - While symptoms would certainly be present at **6 months**, the typical onset of symptoms for a large VSD with significant left-to-right shunting occurs **earlier**, around 2 months of age. - By 6 months, if untreated, infants with large VSDs would likely have well-established signs of **heart failure** and **pulmonary hypertension**.

Q: Tetralogy of Fallot (TOF) includes all of the following components except:

ASD. ***ASD*** - While an **atrial septal defect (ASD)** can be present in some complex congenital heart diseases, it is **not considered a primary component of Tetralogy of Fallot** [1]. - The four classic components of **TOF** are **ventricular septal defect (VSD)**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy (RVH)** [1]. *VSD* - A **ventricular septal defect (VSD)** is a **mandatory component** of Tetralogy of Fallot, allowing for mixing of oxygenated and deoxygenated blood [1]. - It's typically a **large, subaortic defect** that enables the overriding aorta to receive blood from both ventricles [1]. *Pulmonary stenosis* - **Pulmonary stenosis** (obstruction of blood flow from the right ventricle to the pulmonary artery) is a **key component** determining the severity of Tetralogy of Fallot [1]. - The degree of **pulmonary stenosis** dictates the amount of right-to-left shunting and the clinical manifestation of **cyanosis** [1]. *RVH* - **Right ventricular hypertrophy (RVH)** develops as a compensatory mechanism due to the increased workload on the right ventricle from the **pulmonary stenosis** and the **VSD** [1]. - It is a **consequence** of the increased pressure required to eject blood past the stenotic pulmonary valve and into the systemic circulation through the VSD [1].

Q: A one month old infant with a congenital cardiac lesion shows increased sweating during feeding. Which of the following is the sure sign of congestive cardiac failure in this infant?

Liver enlargement. ***Liver enlargement*** - **Hepatomegaly** is a **cardinal sign** of **congestive cardiac failure** in infants due to venous congestion and fluid retention. - The infant's immature lymphatic system and pliable chest wall make other signs less reliable, while the liver quickly reflects increased systemic venous pressure. *JVP* - **Jugular venous pressure (JVP)** is notoriously difficult to assess accurately in infants due to their short necks and poorly developed neck muscles. - Therefore, it is **not a reliable indicator** of congestive cardiac failure in this age group. *Basal crepitations* - **Basal crepitations**, indicating pulmonary edema, can be a sign but are often subtle and can also be present in other respiratory conditions prevalent in infants. - The infant's small lung fields and rapid respiratory rate make the detection of crepitations challenging and less specific than liver enlargement. *Pedal oedema* - **Pedal edema** is less common in infants with congestive heart failure because they tend to retain fluid in the **extracellular space**, leading to generalized edema rather than localized peripheral swelling. - The distribution of fluid retention in infants often manifests as puffiness around the eyes or generalized anasarca rather than prominent pedal edema.

Q: A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :

SVT. **SVT** - A heart rate of 250/min in a 3-4 month old infant, along with a **narrow QRS complex ( 0.09-0.10 sec in adults, proportionally less in infants) because the impulse originates in the ventricles. - The patient's QRS complex is **narrow (<0.07 sec)**, ruling out typical VT. *PSVT with block* - **Paroxysmal supraventricular tachycardia (PSVT) with block** would still present with a rapid atrial rate, and while there might be block to the ventricles, the dominant rhythm would stem from supraventricular activity causing narrow QRS, but the term "with block" usually implies some degree of AV nodal block which would lead to a ventricular rate slower than the atrial rate, unlike the observed 250/min. - The absence of P waves makes identification of a specific "block" pattern difficult, and the high ventricular rate favors a direct conduction rather than a blocked rhythm limiting ventricular response. *Sinus tachycardia* - **Sinus tachycardia** is usually characterized by discernible **P waves** preceding each QRS complex and a heart rate that typically doesn't exceed 220 bpm in infants unless under extreme physiological stress. - A heart rate of 250/min is generally above the physiological limit for sinus tachycardia in infants, and the **absence of P waves** further distinguishes it from sinus tachycardia.

Q: Ductus dependent blood flow is required for all of these congenital heart diseases except:

Persistent truncus arteriosus. ***Persistent truncus arteriosus*** - In **persistent truncus arteriosus**, there is a single great artery overriding a ventricular septal defect, supplying both systemic and pulmonary circulation. **Ductus arteriosus** closure does not critically compromise blood flow to either system. - Pulmonary blood flow is often increased in truncus arteriosus, so a patent ductus is not necessary for pulmonary circulation, nor is it essential for systemic circulation as the single trunk directly supplies the aorta. *Pulmonary stenosis* - Severe **pulmonary stenosis** in neonates can restrict blood flow to the lungs, making a **patent ductus arteriosus** essential for pulmonary blood flow via a right-to-left shunt if the stenosis is critical. - Without the **ductus arteriosus**, severe hypoxemia and acidosis can develop due to insufficient oxygenation. *Hypoplastic left heart syndrome* - In **hypoplastic left heart syndrome**, the left ventricle and aorta are underdeveloped, making the **ductus arteriosus** crucial for systemic blood flow from the right ventricle. - Its closure would severely impair blood supply to the body, leading to circulatory collapse and death. *TGA with intact ventricular septum* - With **transposition of the great arteries (TGA)** and an **intact ventricular septum**, systemic and pulmonary circulations are parallel rather than in series. - A **patent ductus arteriosus** is necessary to allow mixing of oxygenated and deoxygenated blood to sustain life.

Q: Not true about Kawasaki disease is

Thrombocytopenia. ***Thrombocytopenia*** - **Kawasaki disease** typically presents with **thrombocytosis** (elevated platelet count), especially during the subacute phase, as an inflammatory response. - **Thrombocytopenia** (low platelet count) is generally not seen in Kawasaki disease and would suggest an alternative diagnosis. *Posterior cervical lymphadenopathy* - **Cervical lymphadenopathy** is a common diagnostic criterion for Kawasaki disease, often unilateral and **anterior**. - While **posterior cervical lymphadenopathy** is less typical, lymph node involvement is a key feature, making this a plausible (though not the most common) manifestation. *Erythema* - **Erythema** (redness) is a common dermatological finding in Kawasaki disease, often presenting as a polymorphous rash on the trunk and extremities. - It can also manifest as **erythema of the lips and oral mucosa**, including a "strawberry tongue," or **redness and swelling of the hands and feet**. *Conjunctivitis* - **Bilateral non-exudative conjunctivitis** is one of the classic diagnostic criteria for Kawasaki disease. - The eyes appear red without pus or discharge, differentiating it from bacterial conjunctivitis.

Q: The most common cause of Blue baby syndrome

Tetralogy of Fallot. **Tetralogy of Fallot** - **Tetralogy of Fallot (TOF)** is the most common cyanotic congenital heart defect, often presenting as "blue baby syndrome" due to **right-to-left shunting** of unoxygenated blood. - This condition involves **four key defects**: a large ventricular septal defect (VSD), pulmonary stenosis, overriding aorta, and right ventricular hypertrophy, which collectively lead to cyanosis. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect but typically causes a left-to-right shunt, leading to **acyanotic** heart disease, not cyanosis. - While a large VSD can sometimes be part of a more complex cyanotic defect, in isolation, it usually does not cause a "blue baby." *Cardiac Ischemia* - **Cardiac ischemia** refers to reduced blood flow to the heart muscle, most commonly seen in adults due to **coronary artery disease**. - It is not a congenital condition and does not typically present as "blue baby syndrome" in infants. *None of the options* - This option is incorrect because **Tetralogy of Fallot** is indeed the most common cause of "blue baby syndrome."

Q: The commonest mode of inheritance of congenital heart disease is

Multifactorial. ***Multifactorial*** - **Congenital heart disease (CHD)** is primarily caused by a combination of genetic predispositions and environmental factors [1]. - This **multifactorial inheritance** means that while genes play a role in susceptibility, specific environmental triggers during fetal development are also crucial [1], [4]. *Autosomal recessive* - This mode of inheritance is associated with conditions that only manifest if an individual inherits two copies of a **mutated gene**, one from each parent. - While some rare forms of CHD can be autosomal recessive, it is not the most common inheritance pattern for the majority of cases. *Sex-linked dominant* - **Sex-linked dominant** disorders are caused by mutations on the X chromosome and affect males and females differently, with affected fathers passing the trait to all their daughters but no sons. - This pattern is not typically observed as the primary mode of inheritance for general CHD. *Autosomal dominant* - In **autosomal dominant inheritance**, only one copy of an altered gene is needed for the condition to manifest [2]. - While certain syndromes associated with CHD can be autosomal dominant (e.g., Marfan syndrome), it is not the most frequent mode of inheritance for isolated CHD [3].

Question 1

Drug of choice for the treatment of Kawasaki disease is

Accepted Answer

Intravenous Immunoglobulin

Answer

Steroids

Answer

Low molecular weight Heparin

Answer

Aspirin

Question 2

An infant previously diagnosed with a large muscular VSD comes to the office with complaints from the mother of fatigue and poor feeding over the past month. You note the child has not gained weight since the previous visit 2 months ago. The child is apathetic, tachypneic, and has wheezes and crackles on lung auscultation. What is the most likely cardiac diagnosis based on this patient's presentation?

Accepted Answer

Congestive heart failure

Answer

Congenital heart block

Answer

Prolonged QT syndrome

Answer

Hypertrophic cardiomyopathy

Question 3

Clinical manifestations of large VSD in children typically appear at:

Accepted Answer

2 months

Answer

2 days

Answer

2 weeks

Answer

6 months

Question 4

Tetralogy of Fallot (TOF) includes all of the following components except:

Accepted Answer

ASD

Answer

VSD

Answer

Pulmonary stenosis

Answer

RVH

Question 5

A one month old infant with a congenital cardiac lesion shows increased sweating during feeding. Which of the following is the sure sign of congestive cardiac failure in this infant?

Accepted Answer

Liver enlargement

Answer

JVP

Answer

Basal crepitations

Answer

Pedal oedema

Question 6

A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :

Accepted Answer

SVT

Answer

VT

Answer

PSVT with block

Answer

Sinus tachycardia

Question 7

Ductus dependent blood flow is required for all of these congenital heart diseases except:

Accepted Answer

Persistent truncus arteriosus

Answer

Pulmonary stenosis

Answer

Hypoplastic left heart syndrome

Answer

TGA with intact ventricular septum

Question 8

Not true about Kawasaki disease is

Accepted Answer

Thrombocytopenia

Answer

Posterior cervical lymphadenopathy

Answer

Erythema

Answer

Conjunctivitis

Question 9

The most common cause of Blue baby syndrome

Accepted Answer

Tetralogy of Fallot

Answer

VSD

Answer

Cardiac Ischemia

Answer

None of the options

Question 10

The commonest mode of inheritance of congenital heart disease is

Accepted Answer

Multifactorial

Answer

Autosomal recessive

Answer

Sex-linked dominant

Answer

Autosomal dominant

Cardiology — MCQs

Cardiology — MCQs

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