Cardiology Practice Questions

Q: An 8-month-old female child presented to the emergency department with a heart rate of 220/minute and features of congestive heart failure. Her heart rate returned to normal after administering intravenous adenosine. What is the most likely diagnosis?

Paroxysmal supraventricular tachycardia. ***Paroxysmal supraventricular tachycardia*** - **Paroxysmal supraventricular tachycardia (PSVT)** is a common cause of **tachyarrhythmia** in infants and typically responds well to **adenosine**, which transiently blocks the AV node. - The presentation of a heart rate of **220/minute** in an 8-month-old, along with signs of congestive heart failure, is characteristic of PSVT. *Atrial flutter* - While atrial flutter can cause a rapid heart rate, it often presents with a characteristic **sawtooth pattern** on ECG and may less consistently respond to adenosine with complete rhythm conversion. - Typically, the ventricular rate in atrial flutter is a fraction of the atrial rate (e.g., 2:1 or 3:1 block), which might be high but not always resolve completely with adenosine. *Atrial fibrillation* - **Atrial fibrillation** is rare in infants without significant structural heart disease and usually presents with an **irregularly irregular rhythm**, which is not explicitly mentioned. - Although adenosine can slow the ventricular response, it generally does not convert atrial fibrillation back to sinus rhythm. *Ventricular tachycardia* - **Ventricular tachycardia** is generally less common than PSVT in infants and is often associated with more severe underlying cardiac pathology or poorer hemodynamic stability. - While adenosine can sometimes terminate certain types of VT, it is typically used cautiously and is less effective than in PSVT.

Q: The heart lesion not found in Congenital Rubella infection is –

ASD. ***Atrial Septal Defect (ASD)*** - **ASD is NOT a typical cardiac manifestation** of congenital rubella syndrome and is generally not reported as part of the classic cardiovascular anomalies. - The characteristic cardiac defects in congenital rubella involve **persistent fetal structures** (PDA) and **pulmonary outflow abnormalities** (peripheral and valvular pulmonary stenosis). - Among the options listed, **ASD** is the lesion least associated with congenital rubella infection. *Ventricular Septal Defect (VSD)* - **VSD is also not a classic feature** of congenital rubella syndrome, though isolated case reports exist. - However, compared to ASD, **VSD has slightly more literature support** as an occasional finding. - The defect involves the **interventricular septum**. *Pulmonary Stenosis (PS)* - **Peripheral pulmonary artery stenosis** is one of the most characteristic cardiovascular anomalies in congenital rubella syndrome (found in ~50-60% of cardiac cases). - Involves narrowing of the **branch pulmonary arteries**, often multiple sites. - **Pulmonary valve stenosis** is also commonly seen. *Patent Ductus Arteriosus (PDA)* - **PDA is the most common cardiac defect** in congenital rubella syndrome, occurring in up to 80% of affected infants with heart disease. - Represents failure of the **ductus arteriosus** to close after birth. - Part of the classic triad: **PDA + peripheral PS + pulmonary valve stenosis**.

Q: Which of the following does not complicate into CHF –

Tetralogy of Fallot. ***Tetralogy of Fallot*** - This condition is characterized by **right-to-left shunting** due to a large ventricular septal defect (VSD) and right ventricular outflow tract obstruction, leading to **cyanosis** rather than heart failure. - The right ventricular hypertrophy and pulmonary stenosis in Tetralogy of Fallot actually **protect the pulmonary circulation** from volume overload, thus reducing the risk of CHF. *Patent ductus arteriosus* - A PDA causes a **left-to-right shunt** from the aorta to the pulmonary artery, increasing pulmonary blood flow and leading to **pulmonary hypertension** and eventually **left ventricular volume overload**, which can lead to CHF. - The continuous flow through the PDA can cause **volume overload** on the left ventricle and a subsequent increase in cardiac work leading to heart failure. *Transposition of great vessels* - In TGV, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, creating **two parallel circulations**. Complete TGV without a septal defect is incompatible with life. - If a VSD is present, it can lead to **volume overload** of the left ventricle and pulmonary hypertension, increasing the risk of CHF. *Coarctation of aorta* - This is a narrowing of the aorta, typically distal to the left subclavian artery, causing **increased afterload** on the left ventricle. - The increased workload and pressure overload on the left ventricle can lead to **left ventricular hypertrophy** and ultimately **heart failure**.

Q: A child presented with headache, dizziness, intermittent claudication with occasional dyspnea. The most probable diagnosis is:

Coarctation of aorta. ***Coarctation of aorta*** - **Coarctation of the aorta** presents with upper extremity hypertension and lower extremity hypotension. - This pressure difference typically causes symptoms such as **headache**, **dizziness**, and **intermittent claudication** in the legs. *PDA* - A **patent ductus arteriosus (PDA)** typically presents with a continuous murmur and, if large, signs of heart failure or pulmonary hypertension. - While it can cause dyspnea, **headache, dizziness, and claudication** are not defining symptoms. *TOF* - **Tetralogy of Fallot (TOF)** is characterized by cyanosis, exertional dyspnea, and "tet spells." - It does not typically cause **headaches, dizziness, or claudication** in the absence of severe complications. *ASD* - An **atrial septal defect (ASD)** is often asymptomatic until adulthood or presents with mild symptoms like fatigue or dyspnea with exertion. - It is not associated with **headache, dizziness, or intermittent claudication**.

Q: True statement about Rheumatic fever in children -

Polyarthritis is the most common major manifestation. ***Polyarthritis is the most common major manifestation*** - **Polyarthritis** is a migratory inflammation of large joints, typically affecting more than one joint simultaneously or in quick succession, and is indeed the most frequent major manifestation of acute rheumatic fever in children. - It affects about **60-80%** of children with episodes of rheumatic fever, usually resolving without permanent joint damage. *MC valve involvement is Aortic* - The **mitral valve** is the most commonly affected heart valve in rheumatic fever, experiencing damage in 50-70% of cases [1]. - While the aortic valve can be involved, it is less common than mitral valve involvement, with tricuspid and pulmonary valves being affected least frequently. *Caused by Group A beta-hemolytic streptococci* - Acute rheumatic fever is an **autoimmune inflammatory process** that occurs as a sequela of an untreated or inadequately treated infection with Group A Streptococcus (GAS), not directly caused by the bacteria [1]. - The immune response to GAS (specifically *Streptococcus pyogenes*) leads to **molecular mimicry**, where antibodies mistakenly attack host tissues, primarily the heart, joints, brain, and skin [2]. *Erythema marginatum is the most common manifestation* - **Erythema marginatum** is a rare rash associated with rheumatic fever, characterized by red rings or crescent-shaped lesions with clear centers, primarily seen on the trunk and proximal extremities. - It is one of the **minor manifestations** and occurs in less than 5% of cases, making it far from the most common overall manifestation (major or minor).

Q: Uncommon finding in congestive cardiac failure in a newborn -

Pedal edema. ***Pedal edema*** - While **edema** can occur in newborns with **congestive heart failure (CHF)**, it is less common to see isolated **pedal edema** compared to older children or adults. - In newborns, fluid retention often manifests as **generalized edema** or **periorbital edema** due to less developed lymphatic drainage and different fluid distribution. *Tachycardia* - **Tachycardia** (increased heart rate) is a **very common** and significant finding in newborns with **CHF** as the heart attempts to maintain cardiac output. - It is an early compensatory mechanism in response to decreased pump function. *Tachypnoea* - **Tachypnoea** (increased respiratory rate) is a **common symptom** of **CHF** in newborns due to pulmonary congestion and increased effort of breathing. - The lungs become stiff and less compliant, leading to faster, shallow breathing. *Hepatomegaly* - **Hepatomegaly** (enlarged liver) is a **frequent and diagnostically important sign** of **right-sided heart failure** in newborns due to venous congestion. - The liver acts as a reservoir, and its enlargement often indicates increased systemic venous pressure.

Q: A 41/2- year-old girl always had to wear warm socks even is summer season. On physical examination, it was noticed that she had high blood pressure and her femoral pulse was weak as compared to radial and carotid pulse. a chest radiograph showed remarkable notching of ribs along with their lower borders. This was due to -

Coarctation of aorta. ***Coarctation of aorta*** - This condition is characterized by a **narrowing of the aorta**, typically at or near the ductus arteriosus. - The classic findings of a **weak femoral pulse** compared to radial/carotid, **hypertension**, and **rib notching** (due to dilated intercostal arteries supplying collateral circulation) are highly indicative of coarctation of the aorta. *Raynaud's disease* - This is a condition causing **vasospasm of small arteries and arterioles**, leading to pallor, cyanosis, and redness, primarily in the fingers and toes, often triggered by cold or stress. - It does not involve **hypertension**, **weak femoral pulses**, or **rib notching**. *Femoral artery thrombosis* - This condition would cause **ischemia and pain** in the affected leg, and a **weak or absent femoral pulse** on one side. - However, it would not explain the **generalized hypertension** or the characteristic **rib notching** seen in this patient. *Takayasu's arteritis* - This is a **granulomatous vasculitis** primarily affecting the aorta and its major branches, leading to narrowing or occlusion. - While it can cause **absent pulses** and hypertension, it is less common in this age group and **rib notching** is not a typical feature.

Q: One month old baby is referred for failure to thrive. On examination there are features of congestive cardiac failure. Femoral pulses are feeble compared to brachial pulses. The likely diagnosis is

Coarctation of aorta. ***Coarctation of aorta*** - **Coarctation of the aorta** is characterized by a narrowing of the aorta, leading to reduced blood flow to the lower body. This explains the **feeble femoral pulses** compared to the **brachial pulses**. - Presentation in a **one-month-old infant** with **congestive cardiac failure** suggests **critical coarctation** that becomes symptomatic when the **ductus arteriosus closes** (typically in first few weeks of life), suddenly increasing afterload on the left ventricle. - The increased workload on the heart upstream from the coarctation results in signs of **congestive cardiac failure** and contributes to **failure to thrive** in infants. - The **pulse discrepancy** (weak femoral vs normal/bounding brachial) is the **pathognomonic finding** for coarctation. *Congenital aortic stenosis* - **Congenital aortic stenosis** would typically present with a **systolic ejection murmur** and symptoms related to reduced cardiac output, but usually *without* a significant difference in pulse strength between upper and lower extremities. - While it can cause **congestive cardiac failure** and **failure to thrive**, the classic **pulse discrepancy** is absent. *Congenital aorto-iliac disease* - While **aorto-iliac disease** can cause diminished femoral pulses, it is exceedingly **rare as a congenital condition** presenting with heart failure in an infant. - It would typically affect blood supply to the legs more directly, but less likely to cause the global heart failure symptoms seen in this case. *Patent ductus arteriosus* - A **patent ductus arteriosus (PDA)** results in a **continuous murmur** and can cause **congestive cardiac failure** and **failure to thrive** due to left-to-right shunting. - However, PDA typically presents with **bounding pulses** or **widened pulse pressure**, not feeble femoral pulses that differ significantly from brachial pulses.

Q: A neonate is diagnosed with pentalogy of Fallot. She may have the following lesions:

TOF + ASD. ***TOF + ASD*** - The "pentalogy of Fallot" is an atypical variant of the more common **tetralogy of Fallot (TOF)** that includes an additional cardiac anomaly. - The fifth lesion in pentalogy of Fallot is typically an **atrial septal defect (ASD)** or, less commonly, a **patent foramen ovale (PFO)**, adding to the four classic TOF lesions (ventricular septal defect, pulmonary stenosis, overriding aorta, right ventricular hypertrophy). *TOF + COA* - **Coarctation of the aorta (COA)** is a narrowing of the aorta that, when present alongside TOF, does not constitute the pentalogy of Fallot. - While both are congenital heart defects, COA is a distinct lesion not typically included in the definition of pentalogy of Fallot. *TOF + PDA* - A **patent ductus arteriosus (PDA)** is a persistent connection between the aorta and pulmonary artery that usually closes shortly after birth. - While it can coexist with TOF, a PDA is not considered the fifth lesion that defines the pentalogy of Fallot. *TOF + Polysplenia* - **Polysplenia** is a heterotaxy syndrome characterized by multiple small spleens and is associated with complex congenital heart disease, but it is an *extracardiac* anomaly. - The "pentalogy of Fallot" specifically refers to 5 *intracardiac* or *great vessel* abnormalities.

Q: What is the most common congenital heart defect in newborns with Down syndrome?

AV canal defect. ***AV canal defect*** - An **atrioventricular septal defect (AVSD)**, also known as an **AV canal defect**, is the **most common congenital heart defect** in newborns with Down syndrome, accounting for **40-45%** of cardiac defects - This defect involves a **hole in the center of the heart** where the atria and ventricles meet, often affecting both the **mitral and tricuspid valves** (complete AVSD) - The defect results from failure of endocardial cushion development during embryonic life *VSD* - A **ventricular septal defect (VSD)** is the **second most common** CHD in Down syndrome, occurring in approximately **30-35%** of cases - VSDs involve a hole in the **interventricular septum**, leading to left-to-right shunting - While common, it is less frequent than AVSD in this population *ASD* - An **atrial septal defect (ASD)** is also seen in Down syndrome but is **less frequent** than both AVSD and VSD - ASDs are holes in the **interatrial septum**, often leading to volume overload of the right heart - Secundum ASD is the most common type overall, but AVSD remains more prevalent in Down syndrome *Tetralogy of Fallot* - **Tetralogy of Fallot (TOF)** is a complex cyanotic heart defect that can occur in Down syndrome but is **much less common** than AVSD - TOF consists of four components: **VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy** - While TOF is an important differential, it is not the most prevalent defect in this population

Question 1

An 8-month-old female child presented to the emergency department with a heart rate of 220/minute and features of congestive heart failure. Her heart rate returned to normal after administering intravenous adenosine. What is the most likely diagnosis?

Accepted Answer

Paroxysmal supraventricular tachycardia

Answer

Atrial flutter

Answer

Atrial fibrillation

Answer

Ventricular tachycardia

Question 2

The heart lesion not found in Congenital Rubella infection is –

Accepted Answer

ASD

Answer

VSD

Answer

PS

Answer

PDA

Question 3

Which of the following does not complicate into CHF –

Accepted Answer

Tetralogy of Fallot

Answer

Patent ductus arteriosus

Answer

Transposition of great vessels

Answer

Coarctation of aorta

Question 4

A child presented with headache, dizziness, intermittent claudication with occasional dyspnea. The most probable diagnosis is:

Accepted Answer

Coarctation of aorta

Answer

PDA

Answer

TOF

Answer

ASD

Question 5

True statement about Rheumatic fever in children -

Accepted Answer

Polyarthritis is the most common major manifestation

Answer

MC valve involvement is Aortic

Answer

Caused by Group A beta-hemolytic streptococci

Answer

Erythema marginatum is the most common manifestation

Question 6

Uncommon finding in congestive cardiac failure in a newborn -

Accepted Answer

Pedal edema

Answer

Tachycardia

Answer

Tachypnoea

Answer

Hepatomegaly

Question 7

A 41/2- year-old girl always had to wear warm socks even is summer season. On physical examination, it was noticed that she had high blood pressure and her femoral pulse was weak as compared to radial and carotid pulse. a chest radiograph showed remarkable notching of ribs along with their lower borders. This was due to -

Accepted Answer

Coarctation of aorta

Answer

Raynaud's disease

Answer

Femoral artery thrombosis

Answer

Takayasu's arteritis

Question 8

One month old baby is referred for failure to thrive. On examination there are features of congestive cardiac failure. Femoral pulses are feeble compared to brachial pulses. The likely diagnosis is

Accepted Answer

Coarctation of aorta

Answer

Congenital aortic stenosis

Answer

Congenital aorto-iliac disease

Answer

Patent ductus arteriosus

Question 9

A neonate is diagnosed with pentalogy of Fallot. She may have the following lesions:

Accepted Answer

TOF + ASD

Answer

TOF + COA

Answer

TOF + PDA

Answer

TOF + Polysplenia

Question 10

What is the most common congenital heart defect in newborns with Down syndrome?

Accepted Answer

AV canal defect

Answer

Tetralogy of Fallot

Answer

VSD

Answer

ASD

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?