Cardiology Practice Questions

Q: A newborn baby is readmitted to the hospital with hypoxia and upon testing is found to have pulmonary stenosis, dextraposition of the aorta, interventricular septal defect, and hypertrophy of the right ventricle. Which of the following is best described by these symptoms?

Tetralogy of Fallot. **Explanation:** The clinical presentation described is the classic anatomical quartet of **Tetralogy of Fallot (TOF)**, which is the most common cyanotic congenital heart disease (CHD) presenting after the neonatal period. **1. Why Tetralogy of Fallot is Correct:** TOF is defined by four specific structural defects resulting from the anterior and cephalad deviation of the infundibular (outflow tract) septum: * **Pulmonary Stenosis:** Usually infundibular, determining the degree of cyanosis. * **Right Ventricular Hypertrophy (RVH):** A result of the heart pumping against high pressure (pulmonary obstruction). * **Overriding Aorta (Dextraposition):** The aorta sits over the ventricular septal defect. * **Ventricular Septal Defect (VSD):** Typically a large, non-restrictive malalignment defect. **2. Why Other Options are Incorrect:** * **ASD:** An acyanotic CHD involving a hole in the interatrial septum; it does not feature ventricular hypertrophy or aortic malposition. * **PDA:** An acyanotic CHD characterized by a persistent connection between the aorta and pulmonary artery, typically presenting with a continuous "machinery" murmur. * **Aortic Stenosis:** An obstructive lesion of the left heart; while it causes left ventricular hypertrophy, it does not involve VSDs or pulmonary stenosis. **3. NEET-PG High-Yield Pearls:** * **X-ray Finding:** "Boot-shaped heart" (*Coeur en sabot*) due to an upturned apex (RVH) and concave pulmonary segment. * **Clinical Feature:** **"Tet Spells"** (hypercyanotic episodes) occur during crying or feeding. Management involves the **knee-chest position** to increase systemic vascular resistance. * **Murmur:** The murmur in TOF is due to **pulmonary stenosis** (ejection systolic), not the VSD. * **ECG:** Shows Right Axis Deviation and RVH.

Q: Squatting attacks and polycythemia are features of?

Cyanotic heart disease. **Explanation:** The presence of **squatting attacks** and **polycythemia** is a hallmark of **Cyanotic Heart Disease (CHD)**, specifically those with decreased pulmonary blood flow like **Tetralogy of Fallot (TOF)**. 1. **Why Cyanotic Heart Disease is correct:** * **Squatting Attacks:** In TOF, squatting increases systemic vascular resistance (SVR) by kinking the femoral arteries. This increase in SVR reduces the right-to-left shunt across the VSD, forcing more blood into the pulmonary artery, thereby improving oxygenation. * **Polycythemia:** Chronic hypoxemia triggers the kidneys to release erythropoietin, stimulating the bone marrow to produce more red blood cells. This compensatory erythrocytosis (polycythemia) increases the oxygen-carrying capacity but also increases blood viscosity. 2. **Why other options are incorrect:** * **Acyanotic Heart Disease:** These conditions (e.g., VSD, ASD, PDA) involve left-to-right shunts. Patients are not typically hypoxic at rest and do not require squatting to improve oxygenation. * **Eisenmenger Syndrome:** While this involves cyanosis due to a reversed shunt, squatting is not a characteristic clinical feature. These patients have fixed pulmonary hypertension, and squatting does not significantly alleviate their pathophysiology. * **Lutembacher Syndrome:** This is a specific combination of an **Atrial Septal Defect (ASD)** and **Mitral Stenosis**. It is primarily an acyanotic condition unless complications arise. **High-Yield Clinical Pearls for NEET-PG:** * **Boot-shaped heart** (Coeur en sabot) on X-ray is classic for TOF. * **Hypercyanotic spells (Tet spells)** are managed by the knee-chest position, oxygen, morphine, and beta-blockers (Propranolol). * **Complications of Polycythemia:** Increased risk of cerebral venous thrombosis and brain abscesses in children with CHD. * **Clubbing** is another common feature of chronic cyanotic heart disease.

Q: What vascular anomaly is most associated with severe tracheobronchial anomalies?

Pulmonary artery sling. **Explanation:** The correct answer is **Pulmonary Artery Sling (Option C)**. This anomaly occurs when the left pulmonary artery (LPA) originates from the right pulmonary artery instead of the main pulmonary trunk. To reach the left lung, the LPA courses between the trachea and the esophagus, forming a "sling" around the right mainstem bronchus and distal trachea. **Why it is the correct answer:** Unlike other vascular rings, a pulmonary artery sling is uniquely associated with **"Ring-Sling Complex."** In approximately 50% of cases, it is associated with intrinsic tracheobronchial abnormalities, most notably **complete tracheal rings** (O-shaped rings instead of C-shaped), leading to long-segment tracheal stenosis. This makes it the vascular anomaly with the highest morbidity regarding the airway. **Why other options are incorrect:** * **Double Aortic Arch (Option B):** While this is the most common cause of a symptomatic vascular ring and causes significant extrinsic compression of both the trachea and esophagus, it is generally *not* associated with intrinsic tracheobronchial cartilage anomalies. * **Right Aortic Arch with Left Subclavian (Option A):** This often forms a ring via a left-sided ligamentum arteriosum. While it causes compression, it lacks the embryological association with primary airway malformations seen in pulmonary artery slings. **High-Yield Clinical Pearls for NEET-PG:** * **Barium Swallow Finding:** Pulmonary artery sling is the *only* vascular anomaly that causes an **anterior indentation** on the esophagus (as it passes between the trachea and esophagus). * **Clinical Presentation:** Presents with "stridor since birth," wheezing, and respiratory distress that does not improve with neck extension. * **Imaging:** Echocardiography is the initial screening tool, but CT/MRI is the gold standard for visualizing the airway-vessel relationship.

Q: Strawberry tongue is a clinical sign seen in which of the following conditions?

Kawasaki disease. **Explanation:** **Strawberry tongue** is a classic clinical sign characterized by a bright red, swollen tongue with prominent, enlarged fungiform papillae. It is a hallmark feature of **Kawasaki Disease (KD)**, a medium-vessel vasculitis that primarily affects children under five years of age. In KD, the strawberry tongue is part of the "Oropharyngeal changes" diagnostic criteria, which also includes cracked, erythematous lips and diffuse pharyngeal injection. **Analysis of Options:** * **Kawasaki Disease (Correct):** It presents with the "CRASH and Burn" mnemonic (Conjunctivitis, Rash, Adenopathy, Strawberry tongue/lips, Hand/foot edema, and high-grade Fever). * **Wegener Granulomatosis (Granulomatosis with Polyangiitis):** Typically presents with a "Strawberry Gingivitis" (friable, granular gums), not a strawberry tongue. It primarily affects the upper/lower respiratory tract and kidneys. * **Phenytoin Toxicity:** Classically associated with **Gingival Hyperplasia** (overgrowth of gums), not lingual changes. * **Polyarteritis Nodosa (PAN):** A systemic vasculitis that affects medium-sized arteries but lacks the specific mucocutaneous features (like strawberry tongue) seen in KD. **Clinical Pearls for NEET-PG:** 1. **Differential Diagnosis for Strawberry Tongue:** Besides Kawasaki Disease, it is also seen in **Scarlet Fever** (caused by Group A Streptococcus) and **Toxic Shock Syndrome**. 2. **White vs. Red Strawberry Tongue:** In Scarlet Fever, it starts as a "White Strawberry Tongue" (white coat with red papillae) and progresses to "Red Strawberry Tongue" by day 4-5. 3. **KD Complication:** The most dreaded complication is **Coronary Artery Aneurysms**. Treatment involves IVIG and high-dose Aspirin.

Q: The overall heart size in tetralogy of Fallot is usually:

Normal or relatively small. **Explanation:** In **Tetralogy of Fallot (TOF)**, the overall heart size is typically **normal or relatively small**. This is a high-yield distinction from other cyanotic congenital heart diseases. **Why the correct answer is right:** The hallmark of TOF is the combination of a large ventricular septal defect (VSD) and right ventricular outflow tract obstruction (RVOTO/Pulmonary Stenosis). Because the pulmonary stenosis limits the amount of blood entering the lungs, there is no pulmonary over-circulation. Furthermore, the VSD is "non-restrictive," allowing the right ventricle (RV) to decompress into the aorta. While the RV undergoes **concentric hypertrophy** to handle the pressure, it does not typically undergo significant dilatation. This results in the classic **"Coeur-en-sabot" (boot-shaped heart)** on X-ray, where the apex is tilted upward by the hypertrophied RV, but the total cardiothoracic ratio remains within normal limits. **Why the incorrect options are wrong:** * **Options A, C, and D:** These are incorrect because TOF is a "cyanotic heart disease with **decreased** pulmonary blood flow." Marked or moderate cardiomegaly is usually seen in conditions with **increased** pulmonary blood flow (e.g., large VSD, PDA, or TGA) or valvular regurgitation, where the heart chambers must dilate to accommodate volume overload. **High-Yield Clinical Pearls for NEET-PG:** * **X-ray Findings:** Boot-shaped heart, narrow vascular pedicle (due to pulmonary hypoplasia), and **oligemic lung fields** (decreased pulmonary markings). * **Right-sided Aortic Arch:** Seen in approximately 25% of TOF cases. * **The "Shunt" Rule:** If a cyanotic child has a **large** heart on X-ray, think of Transposition of the Great Arteries (TGA) or Ebstein’s Anomaly, not TOF. * **Murmur:** The murmur in TOF is due to **pulmonary stenosis**, not the VSD. A softer murmur during a "Tet spell" indicates worsening obstruction.

Q: A child has Transposition of the Great Arteries. What maternal condition should be investigated?

Diabetes mellitus. **Explanation:** **1. Why Diabetes Mellitus is Correct:** Maternal pregestational diabetes mellitus is a well-established and potent risk factor for congenital heart disease (CHD) in the offspring. Hyperglycemia during the period of organogenesis (the first 8 weeks of gestation) acts as a teratogen, disrupting the normal development of the heart. While diabetes is associated with various defects (most commonly Ventricular Septal Defects and Hypertrophic Cardiomyopathy), **Transposition of the Great Arteries (TGA)** is specifically and strongly associated with maternal diabetes. The metabolic derangements lead to abnormal looping and septation of the conotruncal region. **2. Why Other Options are Incorrect:** * **Maternal Pregnancy-Induced Hypertension (PIH) & Hypertension:** Chronic or gestational hypertension is more commonly associated with placental insufficiency, intrauterine growth restriction (IUGR), and prematurity, rather than specific structural cardiac malformations like TGA. * **Thyroid Disease:** Maternal thyroid dysfunction (hypo- or hyperthyroidism) is primarily linked to fetal growth issues, goiter, or neurodevelopmental delays, but it is not a recognized risk factor for TGA. **3. Clinical Pearls for NEET-PG:** * **Most Common CHD in Infants of Diabetic Mothers (IDM):** Ventricular Septal Defect (VSD). * **Most Characteristic/Specific CHD in IDM:** Transposition of the Great Arteries (TGA). * **Hypertrophic Cardiomyopathy (HCM):** IDMs often present with transient subaortic septal hypertrophy, which usually resolves spontaneously after birth. * **TGA Presentation:** Presents as "Early, Deep Cyanosis" in a newborn. On X-ray, it shows the classic **"Egg-on-a-string"** appearance. * **Management:** Prostaglandin E1 (to keep the ductus open) followed by the **Arterial Switch Operation (Jatene procedure)**, which is the treatment of choice.

Q: Which of the following statements is false regarding Atrial Septal Defect?

It typically involves a right-to-left shunt.. **Explanation:** **1. Why Option B is the correct (False) statement:** Atrial Septal Defect (ASD) is an **acyanotic** congenital heart disease. Under normal physiological conditions, the pressure in the left atrium is higher than in the right atrium. Therefore, blood flows from the left atrium to the right atrium, resulting in a **left-to-right shunt**. A right-to-left shunt only occurs if pulmonary hypertension develops (Eisenmenger syndrome), which is a late complication. **2. Analysis of other options:** * **Option A:** **Ostium secundum** is indeed the most common type of ASD (75% of cases), located in the region of the fossa ovalis. * **Option C:** ASD is frequently associated with other anomalies. Specifically, **Sinus Venosus ASD** is classically associated with partial or total anomalous pulmonary venous connection (TAPVC/PAPVC). * **Option D:** CCF is **very rare** in children with ASD because the right ventricle is highly compliant and can handle the volume overload for decades. Symptoms usually manifest in the 3rd or 4th decade of life. **Clinical Pearls for NEET-PG:** * **Auscultation:** Characterized by a **Wide, Fixed Split S2** (due to delayed closure of the pulmonary valve) and a mid-systolic flow murmur at the pulmonary area. * **ECG Findings:** Right axis deviation and **RSR' pattern** (incomplete RBBB) in lead V1 are high-yield diagnostic clues. * **Lutembacher Syndrome:** The combination of ASD and acquired Mitral Stenosis. * **Paradoxical Embolism:** A unique complication where a systemic venous embolus crosses the ASD to cause a stroke.

Question 1

A newborn baby is readmitted to the hospital with hypoxia and upon testing is found to have pulmonary stenosis, dextraposition of the aorta, interventricular septal defect, and hypertrophy of the right ventricle. Which of the following is best described by these symptoms?

Accepted Answer

Tetralogy of Fallot

Answer

Atrial septal defect (ASD)

Answer

Patent ductus arteriosus (PDA)

Answer

Aortic stenosis

Question 2

A patient with a ventricular septal defect (VSD) develops pulmonary hypertension. Which of the following findings will be present?

Accepted Answer

Initial resolution of symptoms

Answer

Ejection systolic murmur in the pulmonary area

Answer

Clubbing

Answer

Palpable A2

Question 3

A 4-month-old infant with Tetralogy of Fallot presents with fever and loose stools. Which of the following is compatible with the diagnosis of Tetralogy spells?

Accepted Answer

Inability to hear a murmur

Answer

Oxygen saturation < 70% in room air

Answer

Hepatomegaly

Answer

S3 gallop rhythm

Question 4

Squatting attacks and polycythemia are features of?

Accepted Answer

Cyanotic heart disease

Answer

Acyanotic heart disease

Answer

Eisenmenger syndrome

Answer

Lutembacher syndrome

Question 5

What vascular anomaly is most associated with severe tracheobronchial anomalies?

Accepted Answer

Pulmonary artery sling

Answer

Right aortic arch, left subclavian artery

Answer

Double aortic arch

Answer

All of the above

Question 6

A Carey Coomb's murmur heard in a child with multiple joint pains is suggestive of?

Accepted Answer

Rheumatic fever

Answer

Infective endocarditis

Answer

Rheumatoid arthritis

Answer

Libman-Sack's endocarditis

Question 7

Strawberry tongue is a clinical sign seen in which of the following conditions?

Accepted Answer

Kawasaki disease

Answer

Wegener granulomatosis

Answer

Phenytoin toxicity

Answer

Polyarteritis nodosa

Question 8

The overall heart size in tetralogy of Fallot is usually:

Accepted Answer

Normal or relatively small

Answer

Markedly enlarged

Answer

Slightly enlarged

Answer

Moderately enlarged

Question 9

A child has Transposition of the Great Arteries. What maternal condition should be investigated?

Accepted Answer

Diabetes mellitus

Answer

Maternal pregnancy-induced hypertension

Answer

Hypertension

Answer

Thyroid disease

Question 10

Which of the following statements is false regarding Atrial Septal Defect?

Accepted Answer

It typically involves a right-to-left shunt.

Answer

Ostium secundum is the most common type.

Answer

It may be associated with Total Anomalous Pulmonary Venous Connection (TAPVC).

Answer

Congestive Cardiac Failure (CCF) is very rare.

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?