Cardiology Practice Questions

Q: A 10 year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity is measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis is:

Coarctation of aorta. ***Coarctation of aorta*** - The combination of **severe hypertension in the upper extremities** (200/140 mm Hg), **impalpable femoral pulses**, and seizures in a 10-year-old boy is highly suggestive of **aortic coarctation**. - Aortic coarctation causes a **pressure gradient** across the narrowed aorta, leading to high pressure proximal to the coarctation (upper body) and low pressure distal to it (lower body). *Renal parenchymal disease* - While renal parenchymal disease can cause **hypertension**, it typically does not present with **differential blood pressures** between upper and lower extremities or absent femoral pulses. - The hypertension in renal disease is usually due to **fluid overload** and **renin-angiotensin-aldosterone system activation**. *Takayasu arteritis* - Takayasu arteritis is a form of **large vessel vasculitis** that can affect the aorta and its branches, leading to differential pulses and hypertension. - However, it more commonly affects **young adult women** (typically 10-40 years old) and often presents with systemic symptoms like **fever, malaise**, and **arterial bruits**, which are not mentioned here. *Grand mal seizures* - Grand mal seizures are a neurological symptom, not a diagnosis of the underlying cause. - While **severe hypertension** from any cause can lead to seizures (hypertensive encephalopathy), this option does not explain the specific cardiovascular findings of **differential blood pressure** and **impalpable femoral pulses**.

Q: A 7 year old child with a known history of rheumatic heart disease presents with a 3 weeks history of fever with palpitations. Most likely cause is:

Staphylococcal endocarditis. **Staphylococcal endocarditis** - Children with **rheumatic heart disease** are at increased risk for **infective endocarditis** due to pre-existing valvular damage. - The symptoms of **fever** and **palpitations** over 3 weeks in a child with a predisposing cardiac condition are highly suggestive of subacute bacterial endocarditis, with *Staphylococcus* being a common pathogen. *Kawasaki's disease* - **Kawasaki's disease** is characterized by fever for at least 5 days, along with specific criteria such as **conjunctivitis**, **oral changes**, **rash**, and **lymphadenopathy**, which are not mentioned here. - Although it can cause cardiac complications like **coronary artery aneurysms**, it does not typically present with palpitations in the context of pre-existing rheumatic heart disease. *None of the options* - This option is incorrect because **Staphylococcal endocarditis** is a highly plausible diagnosis given the clinical presentation. - The combination of **rheumatic heart disease**, prolonged fever, and palpitations strongly points towards a specific cardiac infection. *Collagen vascular disease* - **Collagen vascular diseases** like SLE or juvenile idiopathic arthritis can present with fever, but **palpitations** in a child with pre-existing **rheumatic heart disease** is less specific for these conditions. - These diseases typically have other systemic manifestations, such as **arthralgia**, **rash**, or **organ involvement**, which are not described.

Q: What is the most common type of congenital cyanotic heart disease?

TOF. ***TOF*** - **Tetralogy of Fallot** is the most common **cyanotic congenital heart disease**, characterized by four key defects leading to right-to-left shunting and reduced pulmonary blood flow. - The combination of **pulmonary stenosis**, **ventricular septal defect (VSD)**, **overriding aorta**, and **right ventricular hypertrophy** causes cyanosis. *ASD* - **Atrial septal defect (ASD)** is typically an **acyanotic congenital heart disease**, as blood usually shunts from the left atrium to the right atrium due to pressure differences. - While it can lead to pulmonary hypertension over time, it's not the most common cyanotic lesion. *PDA* - **Patent ductus arteriosus (PDA)** is generally an **acyanotic congenital heart disease** where blood shunts from the aorta to the pulmonary artery, increasing pulmonary blood flow. - Cyanosis may occur in specific complex scenarios, but it is not commonly classified as a primary cyanotic defect. *VSD* - **Ventricular septal defect (VSD)** is the **most common congenital heart defect overall** but is primarily an **acyanotic lesion**, causing left-to-right shunting. - Cyanosis in VSD usually only occurs in advanced stages with **Eisenmenger syndrome**, which is not the typical presentation.

Q: Which of the following clinical findings is most suggestive of congenital heart disease?

Diastolic murmur. ***Diastolic murmur*** - A **diastolic murmur** is almost always pathological and is a strong indicator of underlying structural heart disease, including **congenital heart defects**. - These murmurs reflect abnormal blood flow during the **diastolic phase** of the cardiac cycle, often due to stenotic atrioventricular valves or regurgitant semilunar valves. *Abnormal blood pressure* - While certain congenital heart diseases (e.g., **coarctation of the aorta**) can cause abnormal blood pressure, it is not a universally specific or most suggestive finding for the broad category of **congenital heart disease**. - Many other conditions, both cardiac and non-cardiac, can lead to abnormal blood pressure readings. *Systolic murmur grade I or II* - A **soft, low-grade systolic murmur** (Grade I or II) is often **physiologic** or innocent, especially in children, and does not necessarily indicate structural heart disease. - Many healthy individuals can have an innocent systolic murmur due to normal blood flow dynamics. *Abnormal electrocardiogram* - An **abnormal ECG** can suggest various cardiac issues, including congenital heart disease, but it is not as direct or specific as a diastolic murmur for initial clinical suspicion. - ECG abnormalities can be non-specific or related to acquired conditions, and a normal ECG does not rule out all forms of congenital heart disease.

Q: The risk of recurrence of congenital heart disease for subsequent pregnancies in families with one affected child is:

2-6%. ***2-6%*** - The recurrence risk for **congenital heart disease (CHD)** in subsequent pregnancies after one affected child is generally cited as **2-6%**, reflecting an increased familial predisposition. - This risk is higher than the general population risk but still relatively low, primarily due to the complex, multifactorial etiology of most CHDs. *10-12%* - A **10-12% recurrence risk** is generally too high for most common congenital heart defects, which are typically multifactorial. - Such a high risk might be seen in specific **syndromic forms** of CHD (e.g., genetic aneuploidies or single gene defects), but not for isolated CHD in general. *1%* - A **1% recurrence risk** is comparable to the general population incidence of congenital heart disease (approximately 0.8-1%). - This value does not adequately reflect the established **increased risk for siblings** of an affected child, which is known to be higher than the background population risk. *0.80%* - **0.80%** represents the approximate **general population incidence** of congenital heart disease in live births without a prior affected sibling. - This figure does not account for the **increased familial risk** that exists once one child in a family is already affected.

Q: Which of the following cyanotic congenital heart disease is associated with increased risk of chest infections?

Truncus arteriosus. ***Truncus arteriosus*** - This condition involves a single great artery overriding a **ventricular septal defect**, leading to mixed systemic and pulmonary blood flow. - The **unrestricted pulmonary blood flow** results in **pulmonary hypertension** and edema, making the lungs vulnerable to frequent infections. *Tetralogy of Fallot* - Characterized by **reduced pulmonary blood flow** due to **pulmonary stenosis**, which typically protects the lungs from overload. - While patients can experience complications, an increased risk of frequent chest infections due to pulmonary overcirculation is not a primary feature. *Tricuspid atresia* - Involves the absence of the **tricuspid valve**, leading to mixing of blood in the atria and systemic circulation of deoxygenated blood. - Pulmonary blood flow can be reduced or normal, but severe pulmonary overcirculation leading to recurrent chest infections is not a hallmark. *None of the options* - This option is incorrect because **Truncus arteriosus** is indeed strongly associated with an increased risk of chest infections.

Q: An x-ray performed on a newborn infant shows enlargement of the left ventricle and left atrium as well as dilatation of the aorta. Echocardiographic studies demonstrate volume-overloading of the left ventricle. Cardiac auscultation reveals the presence of a continuous "machinery" murmur. Which of the following is the most likely diagnosis?

Patent ductus arteriosus. ***Patent ductus arteriosus*** - The classic **continuous "machinery" murmur** heard on auscultation is pathognomonic for a PDA, resulting from continuous blood flow from the aorta to the pulmonary artery. - The **left ventricle and left atrial enlargement** and **aortic dilatation** with **left ventricular volume overloading** are consistent with the increased blood return to the left heart due to the left-to-right shunt through the PDA. *Atrial septal defect* - While an ASD can cause left atrial enlargement, it primarily causes **right ventricular volume overload** due to shunting into the right atrium, not left ventricular volume overload or aortic dilatation. - The murmur associated with an ASD is typically a **systolic ejection murmur** over the pulmonic area due to increased flow across the pulmonary valve, not a continuous machinery murmur. *Tetralogy of Fallot* - This is a **cyanotic congenital heart disease** characterized by four defects: ventricular septal defect, pulmonic stenosis, overriding aorta, and right ventricular hypertrophy. - Auscultation typically reveals a **systolic ejection murmur** reflecting the pulmonic stenosis, and the condition presents with **cyanosis** and clubbing, which are not mentioned here. *Pulmonic stenosis* - Isolated pulmonic stenosis would primarily cause **right ventricular hypertrophy** and possibly right atrial enlargement due to increased resistance to outflow from the right ventricle. - The murmur is typically a **systolic ejection murmur** at the upper left sternal border with a thrill, and it would not cause left ventricular volume overload or a continuous machinery murmur.

Q: Which X-ray finding is more characteristic of ASD compared to VSD?

Normal LA. ***Normal LA*** - In an uncomplicated **atrial septal defect (ASD)**, blood shunts from the left atrium to the right atrium, decompressing the left atrium. - This decompression results in a **normal-sized left atrium** on chest X-ray, distinguishing it from conditions with **left ventricular overload**. *Enlarged LA* - An **enlarged left atrium (LA)** is more characteristic of conditions causing **left-sided volume or pressure overload**, such as **ventricular septal defect (VSD)** with significant left-to-right shunt. - In VSD, blood shunts from the left ventricle to the right ventricle, increasing **pulmonary blood flow** and pressure, ultimately leading to LA enlargement. *Aortic shadow* - The **aortic shadow** on X-ray reflects the size and position of the aorta, and while some cardiac conditions can affect it, changes in its size are not a primary distinguishing feature between ASD and VSD. - A subtle **aortic knuckle** may be seen, but it does not differentiate the two defects. *Pulmonary Congestion* - While both ASD and VSD can cause increased **pulmonary blood flow**, **pulmonary congestion** (interstitial or alveolar edema) is more likely to be prominent in a **large VSD** due to the higher pressure shunt. - ASD typically leads to **pulmonary arterial hypertension** over time, but less frank congestion unless there's associated left-sided heart failure.

Q: Most specific cardiac anomaly seen in baby born to Diabetic Mother

Transposition of Great arteries. ***Transposition of Great arteries*** - **Transposition of the great arteries (TGA)** is the most specific congenital heart defect associated with infants born to mothers with **pre-gestational diabetes**. - Poor glycemic control in the first trimester of pregnancy is a significant risk factor for the development of TGA. *Ventricular septal defect* - **Ventricular septal defect (VSD)** is the most common congenital heart defect overall, but it is not specific to diabetic mothers, as its occurrence is common in the general population. - While VSDs can occur in infants of diabetic mothers, they are less characteristic of this population compared to TGA. *Heart blocks* - **Congenital heart blocks** are most commonly associated with **maternal autoimmune diseases**, such as Systemic Lupus Erythematosus (SLE), due to the transplacental transfer of anti-Ro/SSA and anti-La/SSB antibodies. - They are not a specific cardiac anomaly linked to maternal diabetes. *Tetralogy of Fallot* - **Tetralogy of Fallot** is a complex congenital heart defect involving four anomalies, but it is not specifically or disproportionately linked to maternal diabetes compared to other congenital heart defects. - Its etiology is multifactorial, with genetic and environmental factors playing roles.

Q: Normal QRS duration at 1 year of age is

0.04-0.08 seconds. ***0.04-0.08 seconds*** - In children aged 1 year, the **normal QRS duration** typically falls within this range. - A QRS duration wider than this range at 1 year of age would suggest a **ventricular conduction abnormality** if other parameters are normal too. *0.04-0.09 seconds* - While **0.04 seconds** is within the normal lower limit, **0.09 seconds** is slightly prolonged for a 1-year-old. - A QRS duration of 0.09 seconds typically falls into the category of **borderline prolongation** in a 1-year-old child. *0.06-0.09 seconds* - The lower limit of **0.06 seconds** is higher than the generally accepted lowest normal value for a 1-year-old, potentially missing shorter, normal QRS durations. - An upper limit of **0.09 seconds** is considered mildly prolonged for this age group, suggesting a possible **conduction delay**. *0.03-0.07 seconds* - The lower limit of **0.03 seconds** is shorter than the generally accepted lowest normal value, which is usually around 0.04 seconds. - While **0.07 seconds** is within the normal range, this option's lower limit is too restricted and the upper limit may not capture all normal variations.

Question 1

A 10 year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity is measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis is:

Accepted Answer

Coarctation of aorta

Answer

Renal parenchymal disease

Answer

Takayasu arteritis

Answer

Grand mal seizures

Question 2

A 7 year old child with a known history of rheumatic heart disease presents with a 3 weeks history of fever with palpitations. Most likely cause is:

Accepted Answer

Staphylococcal endocarditis

Answer

Kawasaki's disease

Answer

None of the options

Answer

Collagen vascular disease

Question 3

What is the most common type of congenital cyanotic heart disease?

Accepted Answer

TOF

Answer

ASD

Answer

PDA

Answer

VSD

Question 4

Which of the following clinical findings is most suggestive of congenital heart disease?

Accepted Answer

Diastolic murmur

Answer

Abnormal blood pressure

Answer

Systolic murmur grade I or II

Answer

Abnormal electrocardiogram

Question 5

The risk of recurrence of congenital heart disease for subsequent pregnancies in families with one affected child is:

Accepted Answer

2-6%

Answer

10-12%

Answer

1%

Answer

0.80%

Question 6

Which of the following cyanotic congenital heart disease is associated with increased risk of chest infections?

Accepted Answer

Truncus arteriosus

Answer

Tetralogy of Fallot

Answer

Tricuspid atresia

Answer

None of the options

Question 7

An x-ray performed on a newborn infant shows enlargement of the left ventricle and left atrium as well as dilatation of the aorta. Echocardiographic studies demonstrate volume-overloading of the left ventricle. Cardiac auscultation reveals the presence of a continuous "machinery" murmur. Which of the following is the most likely diagnosis?

Accepted Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Answer

Tetralogy of Fallot

Answer

Pulmonic stenosis

Question 8

Which X-ray finding is more characteristic of ASD compared to VSD?

Accepted Answer

Normal LA

Answer

Enlarged LA

Answer

Aortic shadow

Answer

Pulmonary Congestion

Question 9

Most specific cardiac anomaly seen in baby born to Diabetic Mother

Accepted Answer

Transposition of Great arteries

Answer

Ventricular septal defect

Answer

Heart blocks

Answer

Tetralogy of Fallot

Question 10

Normal QRS duration at 1 year of age is

Accepted Answer

0.04-0.08 seconds

Answer

0.04-0.09 seconds

Answer

0.06-0.09 seconds

Answer

0.03-0.07 seconds

Cardiology — MCQs

Cardiology — MCQs

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