Cardiac Evaluation and Diagnostics — MCQs
A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :
A 2-week-old girl is found to have a harsh murmur along the left sternal border. The parents report that the baby gets "bluish" when she cries or drinks from her bottle. Echocardiogram reveals a congenital heart defect associated with pulmonary stenosis, ventricular septal defect, dextroposition of the aorta, and right ventricular hypertrophy. What is the appropriate diagnosis?
MRI is superior in all of the following conditions except
A child presented at 10 weeks with recurrent episode of pneumonia and failure to thrive. X-ray shows cardiomegaly & pulmonary plethora. What is the diagnosis?
A one month old infant with a congenital cardiac lesion shows increased sweating during feeding. Which of the following is the sure sign of congestive cardiac failure in this infant?
Most common cardiac anomaly associated with Turner's syndrome among the following is
Most common cardiac anomaly in Turner syndrome: CMC (Vellore) 07; CMC (Ludhiana) 13; UPSC 14
Which of the following is part of the classic triad of congenital rubella syndrome?
Most common cardiac abnormality in Noonan syndrome is:-
Most common type of TAPVC is -
Cardiac Evaluation and Diagnostics Indian Medical PG Practice Questions and MCQs
Question 1: A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :
- A. VT
- B. PSVT with block
- C. SVT (Correct Answer)
- D. Sinus tachycardia
Explanation: **SVT** - A heart rate of 250/min in a 3-4 month old infant, along with a **narrow QRS complex (<0.07 sec)**, is highly indicative of **supraventricular tachycardia (SVT)**. - The **absence of visible P waves** suggests that the atrial activity is either too rapid to be clearly distinguished or is retrograde and hidden within the QRS complex. *VT* - **Ventricular tachycardia (VT)** is characterized by **wide QRS complexes** (typically >0.09-0.10 sec in adults, proportionally less in infants) because the impulse originates in the ventricles. - The patient's QRS complex is **narrow (<0.07 sec)**, ruling out typical VT. *PSVT with block* - **Paroxysmal supraventricular tachycardia (PSVT) with block** would still present with a rapid atrial rate, and while there might be block to the ventricles, the dominant rhythm would stem from supraventricular activity causing narrow QRS, but the term "with block" usually implies some degree of AV nodal block which would lead to a ventricular rate slower than the atrial rate, unlike the observed 250/min. - The absence of P waves makes identification of a specific "block" pattern difficult, and the high ventricular rate favors a direct conduction rather than a blocked rhythm limiting ventricular response. *Sinus tachycardia* - **Sinus tachycardia** is usually characterized by discernible **P waves** preceding each QRS complex and a heart rate that typically doesn't exceed 220 bpm in infants unless under extreme physiological stress. - A heart rate of 250/min is generally above the physiological limit for sinus tachycardia in infants, and the **absence of P waves** further distinguishes it from sinus tachycardia.
Question 2: A 2-week-old girl is found to have a harsh murmur along the left sternal border. The parents report that the baby gets "bluish" when she cries or drinks from her bottle. Echocardiogram reveals a congenital heart defect associated with pulmonary stenosis, ventricular septal defect, dextroposition of the aorta, and right ventricular hypertrophy. What is the appropriate diagnosis?
- A. Atrial septal defect
- B. Tetralogy of Fallot (Correct Answer)
- C. Coarctation of aorta, postductal
- D. Coarctation of aorta, preductal
Explanation: ***Tetralogy of Fallot*** - The combination of **pulmonary stenosis**, **ventricular septal defect**, **dextroposition of the aorta** (overriding aorta), and **right ventricular hypertrophy** is the classic definition of Tetralogy of Fallot. - The "bluish" episodes (cyanosis) when crying or feeding are characteristic of **tet spells**, indicating right-to-left shunting and reduced pulmonary blood flow, exacerbated by activity. *Atrial septal defect* - An ASD primarily involves a **left-to-right shunt** and typically presents with a **fixed, split S2** and a **pulmonic flow murmur**, usually without cyanosis in infancy. - It does not involve the characteristic four defects seen in this patient, particularly the significant pulmonary stenosis and cyanosis. *Coarctation of aorta, postductal* - **Postductal coarctation** typically presents in older children or adults with **hypertension in the upper extremities** and **diminished or absent femoral pulses**, often without cyanosis. - This condition is a narrowing of the aorta **distal to the ductus arteriosus** and does not involve the four specific intracardiac defects described. *Coarctation of aorta, preductal* - **Preductal coarctation** can present in neonates with **heart failure** and **differential cyanosis** (upper body pink, lower body blue), or signs of shock if the ductus arteriosus closes. - This condition involves a narrowing of the aorta **proximal to the ductus arteriosus** and is not characterized by the four specific tetralogy defects.
Question 3: MRI is superior in all of the following conditions except
- A. Diagnosis of iron overload cardiomyopathy in a pediatric patient with β-thalassemia major and congestive heart failure.
- B. Serial evaluation of liver functions in a 54-year-old female with metastatic carcinoma breast with doxorubicin chemotherapy (Correct Answer)
- C. Diagnosis of aortic coarctation in a 17-year-old female with hypertension and radiofemoral delay on physical examination.
- D. Diagnosis of arrhythmogenic right ventricular cardiomyopathy in a 24-year-old man who survived recent cardiac arrest.
Explanation: ***Serial evaluation of liver functions in a 54-year-old female with metastatic carcinoma breast with doxorubicin chemotherapy*** - While MRI can assess **liver morphology** and some functional parameters, **liver function** is primarily evaluated through **blood tests** (e.g., liver enzymes, bilirubin, albumin). - Regular biochemical tests are more direct and efficient for monitoring liver function during chemotherapy. *Diagnosis of iron overload cardiomyopathy in a pediatric patient with β-thalassemia major and congestive heart failure.* - **Cardiac MRI with T2* mapping** is the gold standard for quantifying myocardial iron deposition, which leads to iron overload cardiomyopathy. - This is crucial for guiding chelation therapy and preventing irreversible heart damage in **thalassemia patients**. *Diagnosis of aortic coarctation in a 17-year-old female with hypertension and radiofemoral delay on physical examination.* - **MRI angiography** provides excellent detailed anatomical imaging of the aorta, including the site, extent, and severity of coarctation, as well as collateral circulation. - This offers a comprehensive assessment that is superior to echocardiography in older children and adults. *Diagnosis of arrhythmogenic right ventricular cardiomyopathy in a 24-year-old man who survived recent cardiac arrest.* - **Cardiac MRI** is highly effective in diagnosing **ARVC** by detecting characteristic findings such as **fibrofatty replacement** in the right ventricular myocardium, wall motion abnormalities, and regional aneurysms. - These features are often difficult to visualize with other imaging modalities.
Question 4: A child presented at 10 weeks with recurrent episode of pneumonia and failure to thrive. X-ray shows cardiomegaly & pulmonary plethora. What is the diagnosis?
- A. VSD (Correct Answer)
- B. TOF
- C. Patent foramen ovale
- D. ASD
Explanation: ***VSD*** - **Ventricular septal defect (VSD)** is the most common cause of this presentation in early infancy (symptoms typically appear at **6-10 weeks** of age). - Large VSDs cause significant **left-to-right shunt** leading to pulmonary overcirculation, resulting in **recurrent pneumonia** and **failure to thrive**. - **Cardiomegaly** (due to volume overload of left atrium and ventricle) and **pulmonary plethora** (increased pulmonary vascular markings) on X-ray are classic findings. - The infant may also present with tachypnea, feeding difficulties, and poor weight gain. *TOF* - **Tetralogy of Fallot (TOF)** is a **cyanotic heart defect** with right-to-left shunt, presenting with cyanosis and hypoxic spells, not recurrent pneumonia. - X-ray shows **boot-shaped heart** and **pulmonary oligemia** (decreased pulmonary vascular markings), not pulmonary plethora. - Does not typically cause failure to thrive in the same manner as acyanotic left-to-right shunt lesions. *Patent foramen ovale* - A **patent foramen ovale (PFO)** is a normal variant in infants and typically remains **asymptomatic**. - Does not cause significant hemodynamic shunting in the absence of elevated right atrial pressure. - Does not cause **cardiomegaly**, **pulmonary plethora**, recurrent pneumonia, or failure to thrive. *ASD* - An **atrial septal defect (ASD)** also causes left-to-right shunt with pulmonary plethora, but the shunt develops **gradually** over time. - ASD typically presents **later in childhood or adulthood** with milder symptoms (fatigue, exercise intolerance) due to lower pressure gradient across atria. - **Recurrent pneumonia and failure to thrive at 10 weeks** are uncommon with isolated ASD, as the hemodynamic changes are less pronounced in early infancy compared to VSD. - When symptomatic in infancy, large ASDs present later (around 6 months to 1 year) rather than at 10 weeks.
Question 5: A one month old infant with a congenital cardiac lesion shows increased sweating during feeding. Which of the following is the sure sign of congestive cardiac failure in this infant?
- A. JVP
- B. Basal crepitations
- C. Liver enlargement (Correct Answer)
- D. Pedal oedema
Explanation: ***Liver enlargement*** - **Hepatomegaly** is a **cardinal sign** of **congestive cardiac failure** in infants due to venous congestion and fluid retention. - The infant's immature lymphatic system and pliable chest wall make other signs less reliable, while the liver quickly reflects increased systemic venous pressure. *JVP* - **Jugular venous pressure (JVP)** is notoriously difficult to assess accurately in infants due to their short necks and poorly developed neck muscles. - Therefore, it is **not a reliable indicator** of congestive cardiac failure in this age group. *Basal crepitations* - **Basal crepitations**, indicating pulmonary edema, can be a sign but are often subtle and can also be present in other respiratory conditions prevalent in infants. - The infant's small lung fields and rapid respiratory rate make the detection of crepitations challenging and less specific than liver enlargement. *Pedal oedema* - **Pedal edema** is less common in infants with congestive heart failure because they tend to retain fluid in the **extracellular space**, leading to generalized edema rather than localized peripheral swelling. - The distribution of fluid retention in infants often manifests as puffiness around the eyes or generalized anasarca rather than prominent pedal edema.
Question 6: Most common cardiac anomaly associated with Turner's syndrome among the following is
- A. Pulmonary stenosis
- B. Aortic stenosis
- C. Ventricular septal defect
- D. Coarctation of Aorta (Correct Answer)
Explanation: ***Coarctation of Aorta*** - **Coarctation of the aorta** is the most common cardiac anomaly observed in individuals with **Turner's syndrome**, affecting approximately 10-20% of patients. - It involves a **narrowing of the aorta**, typically distal to the left subclavian artery, leading to systemic hypertension and reduced blood flow to the lower extremities. *Pulmonary stenosis* - While pulmonary valve anomalies (such as bicuspid pulmonary valve) can occur, **pulmonary stenosis** is not the most common significant cardiac anomaly. - Pulmonary stenosis involves narrowing of the **pulmonary valve**, impeding blood flow from the right ventricle to the pulmonary artery. *Aortic stenosis* - **Aortic stenosis**, involving narrowing of the aortic valve, is less common than coarctation of the aorta in Turner's syndrome. - However, a **bicuspid aortic valve** is a frequent finding, which can predispose to future aortic stenosis or dissection. *Ventricular septal defect* - **Ventricular septal defect (VSD)** is a common congenital heart defect in the general population but is not the most prevalent cardiac anomaly specifically associated with **Turner's syndrome**. - VSD involves a **hole in the septum** separating the left and right ventricles, leading to shunting of blood.
Question 7: Most common cardiac anomaly in Turner syndrome: CMC (Vellore) 07; CMC (Ludhiana) 13; UPSC 14
- A. Bicuspid aortic valve (Correct Answer)
- B. Bifurcation of aorta
- C. Coarctation of aorta
- D. Aortic stenosis
Explanation: ***Bicuspid aortic valve*** - A **bicuspid aortic valve** is the most frequently observed cardiac anomaly in individuals with Turner syndrome, occurring in approximately 15-30% of cases. - This condition involves the **aortic valve** having two leaflets instead of the usual three, which can lead to complications such as **aortic stenosis** or **aortic regurgitation** over time. *Bifurcation of aorta* - **Aortic bifurcation** is a normal anatomical structure where the aorta divides into the common iliac arteries at the level of L4. - This is not a cardiac anomaly, but rather a standard vascular branching pattern. *Coarctation of aorta* - **Coarctation of the aorta** is a narrowing of the aorta, typically near the ductus arteriosus, and is also common in Turner syndrome (occurring in about 10-15%). - Although common, it is **less frequent** than a bicuspid aortic valve. *Aortic stenosis* - **Aortic stenosis** (narrowing of the aortic valve) can be a consequence of a bicuspid aortic valve, but it is not the primary or most common congenital anomaly itself. - The most common **structural defect** that predisposes to aortic stenosis in Turner syndrome is the bicuspid aortic valve.
Question 8: Which of the following is part of the classic triad of congenital rubella syndrome?
- A. Hepatosplenomegaly, mental retardation, deafness
- B. Chorioretinitis, multiorgan failure, pneumonitis
- C. Patent ductus arteriosus (PDA), cataracts, and sensorineural deafness (Correct Answer)
- D. None of the options
Explanation: ***Patent ductus arteriosus (PDA), cataracts, and sensorineural deafness.*** - The classic triad of **congenital rubella syndrome** includes cardiac defects (most commonly **patent ductus arteriosus** or pulmonary artery stenosis), ocular defects (such as **cataracts** or glaucoma), and auditory defects (**sensorineural deafness**). - These specific defects arise from the timing of the rubella virus infection during fetal development, particularly within the first trimester. *Hepatosplenomegaly, mental retardation, deafness* - While **deafness** can be part of congenital rubella syndrome, **hepatosplenomegaly** and **mental retardation** are more commonly associated with other congenital infections like **cytomegalovirus (CMV)** or **toxoplasmosis**, though they can occasionally be seen in severe rubella cases. - These symptoms are not considered part of the *classic triad* which focuses on the most consistently reported and defining defects. *Chorioretinitis, multiorgan failure, pneumonitis* - **Chorioretinitis** is a hallmark feature of **congenital toxoplasmosis** and **CMV infection**, not rubella. - **Multiorgan failure** and **pneumonitis** can occur in severe congenital infections but are not specific to rubella and do not constitute its classic triad. *None of the options* - This option is incorrect because the classic triad for congenital rubella syndrome, consisting of **patent ductus arteriosus**, **cataracts**, and **sensorineural deafness**, is accurately represented in one of the choices.
Question 9: Most common cardiac abnormality in Noonan syndrome is:-
- A. Pulmonary stenosis (Correct Answer)
- B. Atrial septal defect
- C. Tetralogy of Fallot
- D. Ventricular septal defect
Explanation: ***Pulmonary stenosis*** - **Valvular pulmonary stenosis**, particularly a dysplastic pulmonary valve, is the **most common cardiac defect** found in individuals with Noonan syndrome. - This condition can lead to an obstruction of blood flow from the right ventricle into the **pulmonary artery**. *Atrial septal defect* - While **atrial septal defects (ASDs)** can occur in Noonan syndrome, they are less common than pulmonary stenosis. - ASDs are characterized by a hole in the septum separating the two upper chambers of the heart. *Tetralogy of Fallot* - **Tetralogy of Fallot** is a complex congenital heart defect involving four specific abnormalities, which is not the most common cardiac finding in Noonan syndrome. - It is typically associated with a different set of genetic syndromes or occurs sporadically. *Ventricular septal defect* - **Ventricular septal defects (VSDs)** are also observed in some cases of Noonan syndrome but are less prevalent than pulmonary stenosis. - VSDs involve a hole in the wall separating the heart's lower two chambers.
Question 10: Most common type of TAPVC is -
- A. Supracardiac (Correct Answer)
- B. Cardiac
- C. Infracardiac
- D. Multiple
Explanation: ***Supracardiac*** - This is the **most common type** of Total Anomalous Pulmonary Venous Connection (TAPVC), accounting for about 50% of cases. - Pulmonary veins drain into a **common vertical vein** that ascends to connect with the **innominate vein** or superior vena cava. *Cardiac* - In this type, the pulmonary veins drain directly into the **right atrium** or a coronary sinus. - It is relatively less common than the supracardiac type. *Infracardiac* - This is the **least common** and most severe type, where the pulmonary veins drain below the diaphragm, typically into the portal vein, ductus venosus, or inferior vena cava. - It is often associated with **pulmonary venous obstruction**, leading to cyanosis and pulmonary hypertension. *Multiple* - While it is possible to have anomalous drainage sites, **multiple sites** draining into different systemic veins are less common than a single primary site for TAPVC. - TAPVC is typically classified into specific anatomic types rather than 'multiple' as a primary category.
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