Cardiology Practice Questions

Q: What is true regarding secondary prophylaxis of a 6-year-old child with carditis?

Duration of prophylaxis is until 25 years of age. The secondary prophylaxis of Rheumatic Heart Disease (RHD) is a high-yield topic for NEET-PG, governed by the **Revised Jones Criteria (WHO/AHA guidelines)**. The duration of prophylaxis depends on the severity of the initial episode and the presence of residual valvular damage. ### **Explanation of the Correct Answer** In this case, the child has **Rheumatic Fever with Carditis but no residual valvular disease**. According to the guidelines: * **Carditis present, but no residual heart disease (no valvular damage):** Prophylaxis is required for **10 years or until 25 years of age**, whichever is longer. * Since the child is 6 years old, 10 years would only reach age 16. Therefore, the prophylaxis must continue until the age of **25 years** to ensure adequate protection during the period of highest risk for recurrence. ### **Analysis of Incorrect Options** * **Option A (Lifelong):** This is reserved for patients with **severe valvular disease** or those who have undergone prosthetic valve replacement. * **Option B (18 years):** This does not align with any standard RHD guideline. The minimum age for any carditis case is 25. * **Option C (5 years):** This is the duration for Rheumatic Fever **without carditis** (5 years or until age 21, whichever is longer). ### **High-Yield Clinical Pearls for NEET-PG** | Clinical Scenario | Duration of Prophylaxis | | :--- | :--- | | **RF without Carditis** | 5 years or until 21 years of age | | **RF with Carditis (No Valvular Lesion)** | 10 years or until 25 years of age | | **RF with Carditis + Persistent Valvular Disease** | 10 years or until 40 years of age (sometimes lifelong) | * **Drug of Choice:** Injection **Benzathine Penicillin G** (1.2 million units IM every 3–4 weeks). * **Oral Alternative:** Penicillin V (250 mg BD) or Erythromycin (if allergic to Penicillin).

Q: Which of the following statements regarding Tetralogy of Fallot is incorrect?

The second heart sound (S2) is single.. **Explanation:** In Tetralogy of Fallot (TOF), the **Second Heart Sound (S2) is typically single**. This occurs because the pulmonary component (P2) is either extremely soft or absent due to severe infundibular pulmonary stenosis and the posterior displacement of the hypoplastic pulmonary artery. The audible sound is primarily the aortic component (A2), which may be loud as the aorta is "overriding" and closer to the chest wall. Therefore, Option A is a **correct statement** regarding TOF. **Analysis of other options:** * **Option B (The murmur is loud):** The characteristic murmur in TOF is a loud **ejection systolic murmur** heard at the left mid-to-upper sternal border. It is caused by flow across the right ventricular outflow tract (RVOT) obstruction, not the VSD (which is typically large and non-restrictive). * **Option C (Congestive Cardiac Failure):** This is **incorrect** for TOF. CCF is rare in TOF because the large VSD acts as a "pressure-release valve," allowing the right ventricle to shunt deoxygenated blood into the aorta. The ventricles work at systemic pressures but are not volume-overloaded. If a child with suspected TOF presents with CCF, consider an alternative diagnosis like an associated PDA or Anemia. * **Option D (Cardiomegaly):** This is also **incorrect**. TOF is classically associated with a **normal-sized heart** on X-ray. The "boot-shaped" heart (Coeur en sabot) is due to an upturned apex (RV hypertrophy) and a concave pulmonary segment, not global cardiomegaly. **Clinical Pearls for NEET-PG:** 1. **Cyanotic Spells:** Managed by Knee-chest position, Oxygen, Morphine, and Beta-blockers (Propranolol). 2. **X-ray Finding:** Boot-shaped heart with oligemic lung fields. 3. **ECG:** Right axis deviation and Right Ventricular Hypertrophy (RVH). 4. **Most common cyanotic heart disease** after the first year of life.

Q: Which of the following statements about rheumatic fever is FALSE?

It is a communicable disease.. ### Explanation **Why Option C is the Correct (False) Statement:** Acute Rheumatic Fever (ARF) is **not a communicable disease**. While the inciting event is an infection by Group A Beta-hemolytic Streptococcus (GABS), ARF itself is a **delayed, non-suppurative autoimmune sequela**. It results from "molecular mimicry," where antibodies produced against the streptococcal M-protein cross-react with host tissues (heart, joints, brain). You cannot "catch" rheumatic fever from another person; you can only catch the preceding streptococcal pharyngitis. **Analysis of Other Options:** * **Option A:** ARF is strongly associated with **lower socioeconomic status**. Overcrowding, poor hygiene, and limited access to healthcare increase the transmission of GABS, thereby increasing the incidence of ARF. * **Option B:** ARF typically develops **2–4 weeks following streptococcal pharyngitis**. Notably, it does *not* follow streptococcal skin infections (impetigo), unlike post-streptococcal glomerulonephritis (PSGN), which can follow both. * **Option D:** The peak incidence of ARF is in children aged **5 to 15 years**. It is rare in children under 3 years of age, likely due to a less developed immune response to the GABS antigen. **High-Yield Clinical Pearls for NEET-PG:** * **Jones Criteria:** Diagnosis is clinical, based on Revised Jones Criteria (Major: Joint/Polyarthritis, Carditis, Nodules, Erythema marginatum, Sydenham chorea). * **Most Common Valve Involved:** Mitral valve (Mitral Regurgitation in acute phase; Mitral Stenosis in chronic phase). * **Prophylaxis:** Benzathine Penicillin G is the drug of choice for both primary and secondary prevention. * **Aschoff Bodies:** Pathognomonic histological finding in the myocardium.

Q: A child presents with a history of mental retardation. On examination, findings include dolichocephaly, low-set ears, micrognathia, clenched hands with overlapping fingers, simian crease, and rocker-bottom feet. What is the most common cardiac lesion expected in this patient?

Ventricular Septal Defect (VSD). ### Explanation **Diagnosis: Edwards Syndrome (Trisomy 18)** The clinical presentation described—**dolichocephaly** (prominent occiput), **low-set ears**, **micrognathia**, **clenched hands with overlapping fingers** (2nd and 5th fingers over 3rd and 4th), and **rocker-bottom feet**—is classic for **Edwards Syndrome (Trisomy 18)**. **1. Why VSD is the Correct Answer:** Congenital heart disease (CHD) occurs in over 90% of infants with Edwards Syndrome. Among these, **Ventricular Septal Defect (VSD)** is the most common cardiac lesion. It is frequently associated with polyvalvular disease (involving the mitral or aortic valves). **2. Analysis of Incorrect Options:** * **Atrial Septal Defect (ASD):** While ASDs occur in Edwards Syndrome, they are less frequent than VSDs. ASD (specifically Ostium Primum type) is more characteristically associated with **Down Syndrome (Trisomy 21)**. * **Patent Ductus Arteriosus (PDA):** PDA is common in Edwards Syndrome and is a hallmark of **Congenital Rubella Syndrome**, but it ranks second to VSD in Trisomy 18. * **Pulmonary Stenosis:** This is a component of Tetralogy of Fallot (TOF) or seen in **Noonan Syndrome**, but it is not the primary lesion in Edwards Syndrome. **3. High-Yield Clinical Pearls for NEET-PG:** * **Trisomy 21 (Down):** Most common CHD is **Endocardial Cushion Defect** (AVSD), followed by VSD. * **Trisomy 13 (Patau):** Presents with midline defects (holoprosencephaly, cleft lip/palate, polydactyly). Most common CHD is **VSD**. * **Turner Syndrome (45,XO):** Most common CHD is **Bicuspid Aortic Valve** (most common overall) and **Coarctation of the Aorta** (classic exam answer). * **Williams Syndrome:** Associated with **Supravalvular Aortic Stenosis**. * **DiGeorge Syndrome:** Associated with **Truncus Arteriosus** and interrupted aortic arch.

Q: Ductus arteriosus dependent blood flow is mandatory in all of the following congenital heart diseases EXCEPT:

Truncus arteriosus. **Explanation:** In pediatric cardiology, **ductal-dependent lesions** are congenital heart defects where the patency of the Ductus Arteriosus (DA) is essential for either systemic or pulmonary circulation. **1. Why Truncus Arteriosus is the Correct Answer:** In **Truncus Arteriosus**, a single large vessel arises from both ventricles, supplying the systemic, pulmonary, and coronary circulations. Because there is a common outflow tract, blood can reach the lungs and the body regardless of whether the ductus arteriosus is open or closed. While it is a cyanotic heart disease, it is **not** ductal-dependent for survival. **2. Analysis of Incorrect Options (Ductal-Dependent Lesions):** * **Hypoplastic Left Heart Syndrome (HLHS):** This is a ductal-dependent **systemic** circulation lesion. The left side of the heart cannot support systemic flow; thus, blood must flow from the pulmonary artery through the ductus to the aorta to perfuse the body. * **TGA with Intact Ventricular Septum:** This is a ductal-dependent **mixing** lesion. Since the systemic and pulmonary circulations are in parallel (rather than series), the ductus (or an ASD) is mandatory to allow oxygenated blood to reach the systemic circulation. * **Obliterated (Interrupted) Aortic Arch:** This is a ductal-dependent **systemic** circulation lesion. There is no luminal continuity between the ascending and descending aorta; the lower body is entirely dependent on right-to-left flow through the ductus. **Clinical Pearls for NEET-PG:** * **Management:** Prostaglandin E1 (Alprostadil) infusion is the immediate life-saving treatment to keep the ductus open in these conditions. * **Ductal-dependent Pulmonary flow:** Includes Pulmonary Atresia and Critical Pulmonary Stenosis. * **Ductal-dependent Systemic flow:** Includes HLHS, Critical Coarctation of the Aorta, and Interrupted Aortic Arch.

Q: Which of the following cyanotic heart diseases is associated with left axis deviation and left ventricular hypertrophy?

Tricuspid atresia. **Explanation:** In the context of cyanotic congenital heart disease (CCHD), the presence of **Left Axis Deviation (LAD)** and **Left Ventricular Hypertrophy (LVH)** on an ECG is a classic "high-yield" finding diagnostic of **Tricuspid Atresia**. 1. **Why Tricuspid Atresia is correct:** In Tricuspid Atresia, there is no communication between the right atrium and right ventricle. Blood must flow through an ASD to the left atrium and then into the **Left Ventricle (LV)**. The LV becomes the main pumping chamber for both systemic and pulmonary circulations (via a VSD or PDA), leading to LV volume overload and hypertrophy. The right ventricle is typically hypoplastic, causing the electrical axis to shift leftward. 2. **Why other options are incorrect:** * **Transposition of Great Vessels (TGA):** Typically presents with Right Axis Deviation (RAD) and Right Ventricular Hypertrophy (RVH) because the RV remains the systemic ventricle. * **Truncus Arteriosus:** Usually presents with biventricular hypertrophy or normal axis; it does not characteristically show isolated LAD. * **TAPVC:** Characterized by severe right-sided pressure and volume overload, leading to marked RAD and RVH. **High-Yield Clinical Pearls for NEET-PG:** * **The "LAD + Cyanosis" Duo:** If a neonate is cyanotic and the ECG shows LAD, think **Tricuspid Atresia** or **Tricuspid Stenosis**. * **X-ray finding:** Tricuspid atresia often shows a "Wall-to-Wall" heart or a "sitting duck" appearance (though less specific than the ECG). * **Management:** Requires a staged surgical approach: Blalock-Taussig shunt → Glenn procedure → Fontan procedure.

Q: What is the commonest type of cyanotic heart disease?

Tetralogy of Fallot (TOF). ### Explanation **Correct Answer: C. Tetralogy of Fallot (TOF)** **Why it is correct:** Congenital heart diseases (CHD) are broadly classified into **Acyanotic** (left-to-right shunt) and **Cyanotic** (right-to-left shunt). **Tetralogy of Fallot (TOF)** is the most common cyanotic heart disease beyond the neonatal period. It consists of four classic features: Ventricular Septal Defect (VSD), Overriding of the aorta, Right Ventricular Outflow Tract Obstruction (RVOTO/Pulmonary stenosis), and Right Ventricular Hypertrophy (RVH). The degree of cyanosis in TOF is primarily determined by the severity of the pulmonary stenosis. **Why the other options are incorrect:** * **A, B, and D (ASD, VSD, and PDA):** These are all **Acyanotic** heart diseases characterized by left-to-right shunting. While they are more common overall than cyanotic defects, they do not cause cyanosis unless Eisenmenger syndrome (reversal of shunt) develops later in life. * **VSD** is the overall most common congenital heart disease. * **ASD** is the most common CHD to present in adulthood. **NEET-PG High-Yield Pearls:** * **Most common cyanotic CHD at birth (Neonatal period):** Transposition of the Great Arteries (TGA). * **Most common cyanotic CHD overall (Infancy/Childhood):** Tetralogy of Fallot (TOF). * **X-ray finding in TOF:** "Boot-shaped heart" (Coeur en sabot) due to an upturned apex from RVH and a concave pulmonary segment. * **Management of "Tet Spells":** Knee-chest position (increases systemic vascular resistance), Oxygen, Morphine, and Beta-blockers. * **Most common overall CHD:** Ventricular Septal Defect (VSD).

Q: Which of the following statements about total anomalous pulmonary venous connection is FALSE?

None of the above statements are false.. **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a cyanotic congenital heart disease where all four pulmonary veins fail to connect to the left atrium, instead draining into the right atrium or systemic venous circulation. ### **Explanation of Options:** * **Option A (True):** In TAPVC, the pulmonary veins typically join to form a **common pulmonary venous trunk** (confluence) behind the left atrium. This trunk then drains into the systemic venous system (e.g., via the vertical vein in the supracardiac type). * **Option B (True):** TAPVC is an "obligatory shunt" condition. For survival, an **Atrial Septal Defect (ASD)** or a patent foramen ovale must be present to allow blood to reach the left side of the heart. While it is almost universally present for survival, it is considered an **associated compensatory defect** rather than an intrinsic part of the anomalous connection itself. * **Option C (True):** The **Supracardiac type** (Type I) is the most common. It creates a characteristic "Figure-of-8" or **"Snowman" appearance** on a chest X-ray. This is formed by the dilated vertical vein (left), superior vena cava (right), and the innominate vein (top), sitting above the normal heart shadow. Since all statements (A, B, and C) are medically accurate, **Option D** is the correct choice. ### **High-Yield Clinical Pearls for NEET-PG:** * **Classification (Darling’s):** * **Type I (Supracardiac):** Most common; Snowman sign. * **Type II (Cardiac):** Drains into Coronary Sinus. * **Type III (Infracardiac):** Drains into Portal vein; **most likely to be obstructed**, presenting with early, severe cyanosis and pulmonary edema. * **Clinical Sign:** A quadruple rhythm (fixed split S2 + S3 + S4) is often heard. * **ECG:** Shows Right Axis Deviation (RAD) and Right Ventricular Hypertrophy (RVH).

Question 1

What is true regarding secondary prophylaxis of a 6-year-old child with carditis?

Accepted Answer

Duration of prophylaxis is until 25 years of age

Answer

Duration of prophylaxis is lifelong

Answer

Duration of prophylaxis is until 18 years of age

Answer

Duration of prophylaxis is at least 5 years after onset

Question 2

Which of the following statements regarding Tetralogy of Fallot is incorrect?

Accepted Answer

The second heart sound (S2) is single.

Answer

The murmur of Tetralogy of Fallot is loud.

Answer

Patients with Tetralogy of Fallot will develop congestive cardiac failure in the near future.

Answer

With age, the condition proceeds to cardiomegaly.

Question 3

An 11-day-old neonate presented with difficulty in breathing, poor feeding, and sweating during feeding. On examination, weak femoral pulses, bounding radial pulses, radio-femoral delay, a loud S2, systolic ejection clicks or thrills in the suprasternal notch were noted. A systolic murmur was heard along the left sternal border at the 3rd and 4th intercostal spaces, transmitting to the left infrascapular area and to the neck. Arterial blood gas of the lower limbs revealed severe acidosis compared to the upper limbs, and SpO2 (upper limb) > SpO2 (lower limb). Chest X-ray findings are not specified. Which of the following needs to be given urgently to the neonate to save their life?

Accepted Answer

Prostaglandin E1 (PGE1)

Answer

Prostaglandin E2 (PGE2)

Answer

Prostaglandin F2-alpha (PGF2-alpha)

Answer

Prostaglandin D2 (PGD2)

Question 4

Which of the following statements about rheumatic fever is FALSE?

Accepted Answer

It is a communicable disease.

Answer

It is common in individuals from lower socioeconomic groups.

Answer

It typically develops following streptococcal pharyngitis.

Answer

It is commonly observed in children aged 5 to 15 years.

Question 5

A child presents with a history of mental retardation. On examination, findings include dolichocephaly, low-set ears, micrognathia, clenched hands with overlapping fingers, simian crease, and rocker-bottom feet. What is the most common cardiac lesion expected in this patient?

Accepted Answer

Ventricular Septal Defect (VSD)

Answer

Atrial Septal Defect (ASD)

Answer

Patent Ductus Arteriosus (PDA)

Answer

Pulmonary stenosis

Question 6

What is the most important determinant in Tetralogy of Fallot?

Accepted Answer

Sub-pulmonic stenosis

Answer

Right Ventricular Hypertrophy (RVH)

Answer

Pansystolic murmur

Answer

Enlargement of the heart

Question 7

Ductus arteriosus dependent blood flow is mandatory in all of the following congenital heart diseases EXCEPT:

Accepted Answer

Truncus arteriosus

Answer

Hypoplastic left heart syndrome

Answer

Transposition of the great arteries with intact ventricular septum

Answer

Obliterated aortic arch

Question 8

Which of the following cyanotic heart diseases is associated with left axis deviation and left ventricular hypertrophy?

Accepted Answer

Tricuspid atresia

Answer

Transposition of great vessels

Answer

Truncus arteriosus

Answer

Total anomalous pulmonary venous drainage

Question 9

What is the commonest type of cyanotic heart disease?

Accepted Answer

Tetralogy of Fallot (TOF)

Answer

Atrial Septal Defect (ASD)

Answer

Ventricular Septal Defect (VSD)

Answer

Patent Ductus Arteriosus (PDA)

Question 10

Which of the following statements about total anomalous pulmonary venous connection is FALSE?

Accepted Answer

None of the above statements are false.

Answer

All pulmonary veins enter via a single trunk.

Answer

It is not always associated with septal defects.

Answer

Radiologically, it can present with a figure of 8 appearance.

Cardiology — MCQs

Cardiology — MCQs

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