Cardiology Practice Questions

Q: Which of the following is FALSE regarding Kawasaki disease?

Unilateral, suppurative cervical lymphadenopathy. **Explanation:** Kawasaki Disease (KD) is an acute, self-limiting systemic medium-vessel vasculitis. The diagnosis is clinical, based on the presence of high-grade fever for ≥5 days along with specific diagnostic criteria. **Why Option D is False:** While **unilateral cervical lymphadenopathy** (usually >1.5 cm) is a classic diagnostic criterion for KD, it is characteristically **non-suppurative**. If a lymph node is fluctuant or draining pus (suppurative), it points toward a bacterial etiology (like *Staphylococcus aureus* lymphadenitis) rather than Kawasaki disease. **Analysis of Other Options:** * **Option A (Strawberry tongue):** This is a classic finding of oral mucosal involvement in KD, caused by the sloughing of filiform papillae and hypertrophy of fungiform papillae. * **Option B (Periungual desquamation):** This is a hallmark of the **subacute phase** (occurring 2–3 weeks after fever onset). Skin peeling begins under the fingernails and toenails. * **Option C (Self-limiting febrile illness):** KD is indeed self-limiting; the fever and acute inflammation usually resolve even without treatment. However, treatment (IVIG) is mandatory to prevent the serious complication of coronary artery aneurysms. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Complication:** Coronary artery aneurysms (occurs in 20–25% of untreated cases). * **Treatment of Choice:** High-dose **IVIG** (2g/kg) plus **Aspirin**. (Note: This is one of the few pediatric conditions where Aspirin is indicated despite the risk of Reye syndrome). * **Cardiac Screening:** Echocardiography should be performed at diagnosis, at 2 weeks, and at 6–8 weeks. * **Incomplete Kawasaki:** Suspect in infants with prolonged fever and fewer than 4 criteria; check ESR/CRP and Echo.

Q: All are features of Kawasaki disease, except?

Peak incidence at age > 5 years. **Explanation:** Kawasaki Disease (KD) is an acute, self-limiting systemic medium-vessel vasculitis. It is the leading cause of acquired heart disease in children in developed nations. **Why Option A is the correct answer (The "Except"):** The peak incidence of Kawasaki Disease is in children **younger than 5 years** (specifically between 6 months and 2 years of age). It is rare in infants under 3 months or children older than 8 years. Therefore, "Peak incidence at age > 5 years" is factually incorrect. **Why other options are incorrect (Features of KD):** * **Option B (Coronary Artery Aneurysm):** This is the most serious complication, occurring in 20–25% of untreated cases. It typically develops in the subacute phase. * **Option C (Enlarged Lymph Nodes):** Cervical lymphadenopathy (usually >1.5 cm and unilateral) is one of the five classic diagnostic criteria. * **Option D (Fever):** High-grade, spiking fever lasting for at least 5 days is the mandatory hallmark for diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria (CRASH and Burn):** **C**onjunctivitis (bilateral, non-purulent), **R**ash (polymorphous), **A**denopathy (cervical), **S**trawberry tongue (and oral mucosal changes), **H**ands/feet (edema/erythema/desquamation), and **Burn** (Fever ≥ 5 days). * **Treatment:** High-dose **IVIG** (2g/kg) and **Aspirin**. IVIG is most effective if given within the first 10 days to prevent coronary aneurysms. * **Incomplete Kawasaki:** Common in infants; requires high clinical suspicion as they are at high risk for aneurysms despite not meeting all criteria. * **Echo:** Should be performed at diagnosis, at 2 weeks, and 6–8 weeks.

Q: The child shown below is suffering from a congenital heart disease. Which congenital heart defect is most commonly seen in these children?

Atrioventricular septal defect. ***Atrioventricular septal defect*** - **Endocardial cushion defects** (AVSD) are the most common congenital heart disease in **Down syndrome**, occurring in approximately **40-45%** of cases. - Results from incomplete fusion of the **endocardial cushions**, leading to defects in both the atrial and ventricular septum with **common atrioventricular valve**. *Patent ductus arteriosus* - More commonly associated with **prematurity** and **maternal rubella infection** rather than Down syndrome. - Characterized by persistent connection between the **aorta and pulmonary artery**, causing a **continuous "machinery" murmur**. *Atrial septal defect* - While seen in Down syndrome, it's less frequent than **AVSD** in this population. - More commonly associated with **Holt-Oram syndrome** and presents with a **fixed split S2** heart sound. *Ventricular septal defect* - Though **VSD is the most common CHD overall** in the general population, it's not the predominant defect in Down syndrome. - Typically presents with a **holosystolic murmur** at the left sternal border and may cause **failure to thrive**.

Q: A neonate has recurrent attacks of abdominal pain, restless irritability, and diaphoresis on feeding. Cardiac auscultation reveals a nonspecific murmur. The neonate is believed to be at risk for myocardial infarction. What is the likely diagnosis?

Anomalous coronary artery. **Explanation:** The clinical presentation describes **ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery)**, also known as **Bland-White-Garland Syndrome**. **1. Why the Correct Answer is Right:** In ALCAPA, the left coronary artery arises from the pulmonary artery instead of the aorta. As pulmonary vascular resistance drops after birth, the left ventricle receives deoxygenated blood at low pressure. Eventually, blood flows retrograde from the right coronary artery to the pulmonary artery (coronary steal). This leads to **myocardial ischemia**, especially during exertion like **feeding**. The "abdominal pain," irritability, and diaphoresis are classic signs of **infantile angina**. Without intervention, these infants are at high risk for myocardial infarction and heart failure. **2. Why Incorrect Options are Wrong:** * **ASD & VSD:** These are left-to-right shunts. While they can cause tachypnea and failure to thrive, they do not typically cause episodic, angina-like pain or early myocardial infarction. * **Tetralogy of Fallot (TOF):** Presents with cyanosis and "Tet spells" (hyperpnea and cyanosis), not typically isolated diaphoresis and irritability mimicking angina during feeding. **3. High-Yield Clinical Pearls for NEET-PG:** * **ECG Findings:** Pathological **Q-waves** in leads I, aVL, and V4–V6 (anterolateral infarct pattern). * **Chest X-ray:** Significant cardiomegaly due to left ventricular dysfunction. * **Management:** Surgical reimplantation of the anomalous artery into the aorta is the definitive treatment. * **Key Differentiator:** If a neonate presents with symptoms of **congestive heart failure + ECG evidence of infarction**, always suspect ALCAPA.

Q: Which of the following congenital heart diseases is associated with cyanosis, except?

Atrial septal defect with mitral stenosis. ### Explanation The core concept in pediatric cardiology is distinguishing between **Cyanotic Congenital Heart Disease (CCHD)** and **Acyanotic Congenital Heart Disease**. **Why Option D is Correct:** **Atrial Septal Defect (ASD) with Mitral Stenosis** is clinically known as **Lutembacher Syndrome**. In this condition, the mitral stenosis increases left atrial pressure, which further augments the **left-to-right shunt** through the ASD. Since oxygenated blood is moving from the left side to the right side of the heart, there is no mixing of deoxygenated blood into the systemic circulation; hence, the patient remains **acyanotic**. **Why the Other Options are Incorrect:** * **A. Complete Transposition of the Great Arteries (TGA):** This is a classic CCHD where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, creating two parallel circuits. Cyanosis is inevitable and severe. * **B. Single Ventricle:** This represents a "common mixing" lesion. Whether or not pulmonic stenosis is present, deoxygenated systemic venous return and oxygenated pulmonary venous return mix in a single chamber before being pumped to the body, causing cyanosis. * **C. Hypoplastic Left Heart Syndrome (HLHS):** This is a critical CCHD where the left-sided structures are underdeveloped. Systemic perfusion depends on the ductus arteriosus, and mixing of blood occurs at the atrial level, leading to cyanosis. **NEET-PG High-Yield Pearls:** * **Lutembacher Syndrome:** Defined as the combination of acquired Mitral Stenosis (usually rheumatic) and a congenital ASD (usually Secundum type). * **The 5 T’s of Cyanotic Heart Disease:** TGA, Tetralogy of Fallot, Truncus Arteriosus, Tricuspid Atresia, and Total Anomalous Pulmonary Venous Return (TAPVC). * **Admixture Lesions:** Single ventricle and HLHS are categorized as "mixing lesions" which always present with some degree of arterial desaturation.

Q: A 5-year-old boy is referred to a pediatric cardiologist after a check-up at his GP revealed he had a murmur consistent with aortic regurgitation. What is the MOST likely cause of this defect?

Ventricular septal defect. **Explanation:** The correct answer is **Ventricular Septal Defect (VSD)**. While aortic regurgitation (AR) is classically associated with rheumatic heart disease in adults, in a pediatric patient with a congenital VSD, it occurs due to the **Venturi effect**. Subpulmonic (doubly committed) or perimembranous VSDs located just below the aortic valve create a high-velocity jet. This creates negative pressure that "sucks" the right coronary cusp of the aortic valve into the defect (valve prolapse), leading to progressive aortic regurgitation. This is a high-yield association for NEET-PG known as the **Laubry-Pezzi syndrome**. **Analysis of Incorrect Options:** * **Atrial Septal Defect (ASD):** ASDs typically present with a fixed splitting of the second heart sound (S2) and a systolic ejection murmur over the pulmonary area; they do not cause AR. * **Rheumatic Fever:** While a leading cause of acquired valvular disease (Mitral Regurgitation > Aortic Regurgitation), it is less common in a 5-year-old compared to the mechanical complications of a congenital VSD in this age group. * **Cardiomyopathy:** Dilated cardiomyopathy may cause functional mitral or tricuspid regurgitation due to annular stretching, but it is not a primary cause of isolated AR in children. **Clinical Pearls for NEET-PG:** * **Most common type of VSD:** Perimembranous. * **VSD + AR:** Most commonly seen in **Subpulmonic (Supracristal) VSDs**. * **Indication for Surgery:** The presence of even mild aortic valve prolapse or AR in a child with VSD is a strong indication for early surgical closure to prevent permanent valve damage.

Q: Which congenital heart disease most commonly causes death within the first week of life?

Hypoplastic left ventricle. **Explanation:** **Hypoplastic Left Heart Syndrome (HLHS)** is the most common cause of death from congenital heart disease (CHD) in the first week of life. In HLHS, the left side of the heart (mitral valve, left ventricle, and aorta) is severely underdeveloped. The systemic circulation becomes entirely dependent on the **Ductus Arteriosus (PDA)**. As the ductus begins to close physiologically within the first few days of life, the systemic perfusion fails, leading to rapid circulatory collapse, metabolic acidosis, and death if not intervened upon immediately. **Analysis of Incorrect Options:** * **Ventricular Septal Defect (VSD):** While it is the most common CHD overall, it rarely causes symptoms or death in the first week. Symptoms of heart failure typically appear at 4–6 weeks as pulmonary vascular resistance drops. * **Tetralogy of Fallot (TOF):** This is the most common *cyanotic* CHD after infancy. However, neonates are usually stable at birth unless there is severe pulmonary atresia. Death in the first week is rare. * **Ebstein’s Anomaly:** While it can cause severe right-sided failure and cyanosis in neonates, it is significantly less common than HLHS and is not the leading cause of early neonatal mortality. **High-Yield Clinical Pearls for NEET-PG:** * **Most common CHD overall:** VSD. * **Most common Cyanotic CHD (overall):** Tetralogy of Fallot. * **Most common Cyanotic CHD (at birth/neonatal period):** Transposition of the Great Arteries (TGA). * **Ductal-dependent lesions:** HLHS, Coarctation of Aorta, and TGA require Prostaglandin E1 (Alprostadil) to maintain ductal patency for survival.

Question 1

Which of the following is FALSE regarding Kawasaki disease?

Accepted Answer

Unilateral, suppurative cervical lymphadenopathy

Answer

Strawberry tongue

Answer

Periungual desquamation

Answer

Self-limiting febrile illness

Question 2

All are features of Kawasaki disease, except?

Accepted Answer

Peak incidence at age > 5 years

Answer

Aneurysm of coronary artery

Answer

Enlarged lymph nodes

Answer

Fever

Question 3

The child shown below is suffering from a congenital heart disease. Which congenital heart defect is most commonly seen in these children?

Accepted Answer

Atrioventricular septal defect

Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Answer

Ventricular septal defect

Question 4

All of the following are congenital heart diseases with oligemic lung fields except?

Accepted Answer

Transposition of the great arteries (TGA)

Answer

Tricuspid atresia

Answer

Ebstein's anomaly

Answer

Mitral regurgitation

Question 5

A 7-day-old baby presents to the emergency department with unconsciousness, cyanosis, and an oxygen saturation of 85%. What is the most likely diagnosis?

Accepted Answer

Transposition of the Great Arteries (TGA)

Answer

Tetralogy of Fallot

Answer

Total Anomalous Pulmonary Venous Connection (TAPVC)

Answer

Patent Ductus Arteriosus (PDA)

Question 6

A neonate has recurrent attacks of abdominal pain, restless irritability, and diaphoresis on feeding. Cardiac auscultation reveals a nonspecific murmur. The neonate is believed to be at risk for myocardial infarction. What is the likely diagnosis?

Accepted Answer

Anomalous coronary artery

Answer

Atrial Septal Defect (ASD)

Answer

Ventricular Septal Defect (VSD)

Answer

Tetralogy of Fallot (TOF)

Question 7

Which of the following congenital heart diseases is associated with cyanosis, except?

Accepted Answer

Atrial septal defect with mitral stenosis

Answer

Complete transposition of the great arteries

Answer

Single ventricle with or without pulmonic stenosis

Answer

Hypoplastic left heart

Question 8

A 5-year-old boy is referred to a pediatric cardiologist after a check-up at his GP revealed he had a murmur consistent with aortic regurgitation. What is the MOST likely cause of this defect?

Accepted Answer

Ventricular septal defect

Answer

Atrial septal defect

Answer

Rheumatic fever

Answer

Cardiomyopathy

Question 9

A two-year-old boy presents with episodes of becoming dusky. On examination, there was central cyanosis and clubbing. There was no pallor, edema, or respiratory distress. The heart was normal sized with a parasternal heave. A systolic thrill was palpable over the left middle sternal border. The first heart sound was normal, and only the aortic component was audible in the second heart sound. The liver was not enlarged. What is the likely diagnosis?

Accepted Answer

Tetralogy of Fallot

Answer

Congenital methemoglobinemia

Answer

Eisenmenger syndrome

Answer

Aortic stenosis

Question 10

Which congenital heart disease most commonly causes death within the first week of life?

Accepted Answer

Hypoplastic left ventricle

Answer

Ventricular septal defect (VSD)

Answer

Tetralogy of Fallot (TOF)

Answer

Ebstein's anomaly

Cardiology — MCQs

Cardiology — MCQs

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