Cardiology Practice Questions

Q: A child with Down syndrome presents with heart failure and a systolic murmur. What is the most likely cardiac lesion?

Atrioventricular septal defect. ***Atrioventricular septal defect*** - This is the **most common cardiac lesion** in children with Down syndrome, accounting for approximately 40-50% of defects. - It involves a defect in both the **atrial and ventricular septa** and often an abnormality of the **atrioventricular valves**, leading to significant shunting and early heart failure. *Ventricular septal defect* - While a common congenital heart defect, isolated **ventricular septal defects (VSDs)** are less frequently associated with Down syndrome compared to AVSDs. - A VSD alone would typically present as a harsh **systolic murmur** but may not cause early heart failure unless very large. *Atrial septal defect* - An **atrial septal defect (ASD)** is also a common congenital heart defect, but it is typically asymptomatic in early childhood and less likely to cause heart failure immediately. - The murmur associated with an ASD is usually a **systolic ejection murmur** at the upper left sternal border due to increased pulmonary flow, not necessarily a pansystolic murmur. *Patent ductus arteriosus* - A **patent ductus arteriosus (PDA)** can cause heart failure, but it is less common as the primary lesion in children with Down syndrome compared to AVSD. - The characteristic murmur of a PDA is a continuous **"machinery-like" murmur** rather than a purely systolic murmur as described.

Q: Which symptom is not typically associated with Kawasaki disease?

Hearing loss. ***Hearing loss*** - While various complications can arise from Kawasaki disease, **sensorineural hearing loss** is not a typical manifestation or diagnostic criterion. - Hearing loss is more commonly associated with conditions like **bacterial meningitis** or certain genetic syndromes, which are distinct from Kawasaki disease. *Coronary artery aneurysms* - **Coronary artery aneurysms** are a very serious and common complication of **untreated** or severe Kawasaki disease, leading to potential long-term cardiac issues. - This symptom is a major concern in the management of affected children due to the risk of **myocardial infarction** and future cardiac events. *Strawberry tongue* - **Strawberry tongue** (red, swollen, and bumpy tongue) is a characteristic mucosal change seen in Kawasaki disease, often appearing during the acute phase. - This finding is one of the key diagnostic criteria, reflecting the widespread **inflammation** associated with the illness. *Prolonged fever* - **Prolonged fever** (lasting at least five days) is the hallmark diagnostic criterion for Kawasaki disease, indicating a systemic inflammatory response. - The fever is typically **high-spiking** and unresponsive to antipyretics, driving the need for prompt evaluation and treatment.

Q: A 5-year-old child presents with shortness of breath, hepatomegaly, and elevated jugular venous pressure. What is the most likely diagnosis?

Congestive heart failure. ***Congestive heart failure*** - The combination of **shortness of breath**, **hepatomegaly**, and **elevated jugular venous pressure** in a 5-year-old child are classic signs of fluid overload due to **congestive heart failure**. - **Hepatomegaly** and **elevated jugular venous pressure** indicate systemic venous congestion, while **shortness of breath** points to pulmonary edema, common manifestations of heart failure. *Asthma* - While asthma can cause **shortness of breath**, it does not typically present with **hepatomegaly** or **elevated jugular venous pressure**. - Asthma is characterized by **bronchospasm** and airway inflammation, often with a history of recurrent wheezing. *Cystic fibrosis* - **Cystic fibrosis** primarily affects the respiratory and digestive systems, leading to chronic lung disease, malabsorption, and growth failure. - While it can cause **respiratory distress** due to mucus plugging, it is not typically associated with **acute hepatomegaly** or **elevated jugular venous pressure** as primary signs in this manner. *Pericarditis* - **Pericarditis** involves inflammation of the pericardium and can cause chest pain, fever, and sometimes **pericardial effusion**. - While severe pericardial effusion can lead to **cardiac tamponade** and elevated JVP, it is less likely to cause isolated hepatomegaly without other classic signs of chest pain or friction rub.

Q: A newborn exhibits cyanosis, tachypnea, and a murmur. Which diagnostic test would most accurately identify the underlying cardiac anomaly?

Echocardiogram. ***Echocardiogram*** - An **echocardiogram** provides a real-time, detailed view of the **heart's structure and function**, allowing for direct visualization of cardiac anomalies, blood flow patterns, and chamber sizes. - It is a **non-invasive** and highly accurate method for diagnosing congenital heart diseases, making it the most suitable initial diagnostic test for a newborn with cyanosis, tachypnea, and a murmur. *Chest X-ray (CXR)* - A CXR can show **cardiac silhouette size** and **pulmonary vascular markings**, which might suggest a cardiac anomaly but does not provide details on specific structural defects. - It is often used as an initial screening tool but lacks the resolution to accurately identify the underlying cardiac anomaly. *Electrocardiogram* - An **ECG** evaluates the **electrical activity of the heart**, detecting arrhythmias, chamber enlargement, and myocardial ischemia. - While it can provide clues about cardiac stress or hypertrophy, it cannot visualize the anatomical structure of the heart or precisely identify specific congenital anomalies. *Cardiac catheterization (invasive)* - **Cardiac catheterization** is an **invasive procedure** that provides very detailed information on blood pressures and oxygen saturation within the heart chambers, and can also be therapeutic. - However, due to its invasiveness and associated risks, it is typically reserved for cases where echocardiography is inconclusive, for pre-surgical planning, or for therapeutic interventions, not as the primary diagnostic tool in a neonate with suspected congenital heart disease.

Q: A 2-month-old infant presents with tachypnea and a harsh systolic murmur best heard over the left sternal border. Which congenital heart defect is most likely?

Ventricular septal defect. ***Ventricular septal defect*** - A **harsh systolic murmur** heard best at the **left sternal border** is a classic finding in VSD due to blood shunting from the left to the right ventricle. - **Tachypnea in an infant** with VSD often indicates **pulmonary overcirculation** and developing heart failure due to the significant left-to-right shunt. *Tetralogy of Fallot* - This condition typically presents with **cyanosis** and a **crescendo-decrescendo systolic ejection murmur** heard at the upper left sternal border due to right ventricular outflow tract obstruction. - While tachypnea can occur, the characteristic **cyanotic spells** (tet spells) and absence of a harsh VSD murmur make it less likely. *Atrial septal defect* - An ASD typically causes a **systolic ejection murmur** at the **pulmonic area** (second intercostal space, left sternal border) due to increased flow across the pulmonic valve, not a harsh murmur at the left sternal border. - Significant respiratory distress like tachypnea is less common in infancy unless there are other associated defects or severe pulmonary hypertension. *Coarctation of the aorta* - This defect presents with **blood pressure differences** between the upper and lower extremities and often a **systolic murmur** heard in the back or left infraclavicular area. - While it can cause heart failure symptoms including tachypnea, the murmur description and location are not typical for coarctation.

Q: A 3-year-old child presents with frequent upper respiratory infections, and a continuous murmur is noted on examination. What is the most probable diagnosis?

Patent ductus arteriosus. ***Patent ductus arteriosus*** - A **continuous murmur** is the classic auscultatory finding for a PDA, often described as a "machinery-like" murmur. - Frequent **upper respiratory infections** can be a symptom of increased pulmonary blood flow due to a PDA, leading to recurrent infections and lung congestion. *Atrial septal defect* - An ASD typically presents with a **systolic ejection murmur** over the pulmonic area, due to increased flow across the pulmonic valve, not a continuous murmur. - While it can lead to recurrent respiratory infections due to pulmonary overcirculation, the characteristic murmur is different. *Ventricular septal defect* - A VSD primarily causes a **holosystolic murmur** best heard at the lower left sternal border. - It does not produce a continuous murmur, though large VSDs can also lead to increased pulmonary blood flow and frequent infections. *Pulmonary stenosis* - Pulmonary stenosis results in a **systolic ejection murmur** best heard at the upper left sternal border, often with a thrill. - It is a right-sided obstructive lesion and does not typically present with frequent upper respiratory infections as a primary symptom.

Q: A newborn exhibits cyanosis, tachypnea, and a single second heart sound with no murmur. Which condition is most consistent with this presentation?

Transposition of the great arteries. ***Transposition of the great arteries*** - This condition presents with **severe cyanosis from birth** because the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, creating parallel circulations. - The **single, loud S2** occurs because the aorta is anterior and the aortic valve closure is prominent. - In **simple TGA with intact ventricular septum**, there is often **no murmur** as there is no significant obstruction or shunt aside from necessary mixing through the foramen ovale or ductus arteriosus. - This is a **cyanotic emergency** requiring urgent intervention (prostaglandin E1 to maintain ductal patency). *Tetralogy of Fallot* - While TOF does cause **cyanosis** and can have a **single S2** (due to diminished pulmonary component from severe pulmonic stenosis), it characteristically presents with a **harsh systolic ejection murmur** from right ventricular outflow tract obstruction. - The **absence of a murmur** makes TOF unlikely, as the stenotic pulmonary valve typically produces an audible murmur. *Total anomalous pulmonary venous return* - TAPVR causes **cyanosis** due to obligatory right-to-left shunting at the atrial level. - However, it typically presents with **murmurs** from increased flow across the tricuspid and/or pulmonary valves, and often has signs of **pulmonary congestion** or venous obstruction. - The cardiac examination usually reveals more findings than just a single S2. *Atrial septal defect* - ASD is an **acyanotic lesion** causing left-to-right shunting, so severe cyanosis in a newborn would not be expected. - The characteristic finding is a **fixed, widely split S2** (not single S2) due to delayed pulmonary valve closure. - A **soft systolic murmur** at the upper left sternal border from increased pulmonary flow is typical.

Q: A 6-year-old child presents with signs of congestive heart failure. An echocardiogram shows a complete atrioventricular septal defect. Which syndrome is most commonly associated with this congenital heart defect?

Down syndrome. **Down syndrome** - **Complete atrioventricular septal defect (AVSD)**, also known as endocardial cushion defect, is the most common and classic congenital heart defect seen in children with **Down syndrome (Trisomy 21)**. - It accounts for approximately 40-50% of the congenital heart diseases found in individuals with Down syndrome, often leading to early signs of **congestive heart failure**. *Turner syndrome* - **Turner syndrome (45, XO)** is most commonly associated with **coarctation of the aorta** and **bicuspid aortic valve**. - While other heart defects can occur, an atrioventricular septal defect is not the most common or characteristic finding. *Noonan syndrome* - **Noonan syndrome** is frequently associated with **pulmonary stenosis** (especially dysplastic pulmonary valve) and **hypertrophic cardiomyopathy**. - **AVSD** is not a common cardiac anomaly in patients with Noonan syndrome. *DiGeorge syndrome* - **DiGeorge syndrome** (22q11.2 deletion syndrome) is typically linked to defects involving the **conotruncal region** of the heart, such as **truncus arteriosus**, **interrupted aortic arch**, and **tetralogy of Fallot**. - An atrioventricular septal defect is not the primary cardiac anomaly associated with this syndrome.

Q: In a child with suspected rheumatic fever, which finding is considered a major criterion according to the modified Jones criteria?

Erythema marginatum. ***Erythema marginatum*** - **Erythema marginatum** is a characteristic migratory rash that is one of the five major criteria in the modified Jones criteria for diagnosing **acute rheumatic fever (ARF)**. - Its presence, particularly with other minor criteria or evidence of a preceding **Group A Streptococcus (GAS)** infection, significantly increases the likelihood of ARF. *Arthralgia* - **Arthralgia**, or joint pain, is a **minor criterion** in the modified Jones criteria, not a major one. - While common in ARF, it lacks the specificity and diagnostic weight of arthritis (a major criterion) or other major manifestations. *Increased ESR* - An **increased erythrocyte sedimentation rate (ESR)** is a **minor criterion** indicating systemic inflammation, which is common in ARF but not specific to it. - It reflects a general inflammatory response rather than a particular manifestation of the disease. *Fever* - **Fever** is a **minor criterion** in the modified Jones criteria, reflecting the acute inflammatory nature of rheumatic fever. - It is a non-specific symptom that can be present in numerous infectious and inflammatory conditions.

Question 1

A child with Down syndrome presents with heart failure and a systolic murmur. What is the most likely cardiac lesion?

Accepted Answer

Atrioventricular septal defect

Answer

Ventricular septal defect

Answer

Atrial septal defect

Answer

Patent ductus arteriosus

Question 2

Which symptom is not typically associated with Kawasaki disease?

Accepted Answer

Hearing loss

Answer

Strawberry tongue

Answer

Prolonged fever

Answer

Coronary artery aneurysms

Question 3

A child with Tetralogy of Fallot presents with cyanosis. Which imaging modality is essential for surgical planning?

Accepted Answer

Echocardiography

Answer

Chest X-ray

Answer

CT scan

Answer

MRI

Question 4

A 5-year-old child presents with shortness of breath, hepatomegaly, and elevated jugular venous pressure. What is the most likely diagnosis?

Accepted Answer

Congestive heart failure

Answer

Asthma

Answer

Cystic fibrosis

Answer

Pericarditis

Question 5

A newborn exhibits cyanosis, tachypnea, and a murmur. Which diagnostic test would most accurately identify the underlying cardiac anomaly?

Accepted Answer

Echocardiogram

Answer

Chest X-ray (CXR)

Answer

Electrocardiogram

Answer

Cardiac catheterization (invasive)

Question 6

A 2-month-old infant presents with tachypnea and a harsh systolic murmur best heard over the left sternal border. Which congenital heart defect is most likely?

Accepted Answer

Ventricular septal defect

Answer

Tetralogy of Fallot

Answer

Atrial septal defect

Answer

Coarctation of the aorta

Question 7

A 3-year-old child presents with frequent upper respiratory infections, and a continuous murmur is noted on examination. What is the most probable diagnosis?

Accepted Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Answer

Ventricular septal defect

Answer

Pulmonary stenosis

Question 8

A newborn exhibits cyanosis, tachypnea, and a single second heart sound with no murmur. Which condition is most consistent with this presentation?

Accepted Answer

Transposition of the great arteries

Answer

Total anomalous pulmonary venous return

Answer

Atrial septal defect

Answer

Tetralogy of Fallot

Question 9

A 6-year-old child presents with signs of congestive heart failure. An echocardiogram shows a complete atrioventricular septal defect. Which syndrome is most commonly associated with this congenital heart defect?

Accepted Answer

Down syndrome

Answer

Turner syndrome

Answer

Noonan syndrome

Answer

DiGeorge syndrome

Question 10

In a child with suspected rheumatic fever, which finding is considered a major criterion according to the modified Jones criteria?

Accepted Answer

Erythema marginatum

Answer

Arthralgia

Answer

Increased ESR

Answer

Fever

Cardiology — MCQs

Cardiology — MCQs

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