Cardiology Practice Questions

Q: What is the most appropriate management for maintaining patency of the ductus arteriosus in a neonate?

Prostaglandin E1. **Explanation:** In neonates with ductal-dependent congenital heart diseases (such as Transposition of the Great Arteries, Hypoplastic Left Heart Syndrome, or Pulmonary Atresia), maintaining the patency of the **Ductus Arteriosus (DA)** is life-saving to ensure systemic or pulmonary blood flow. **Correct Option: A. Prostaglandin E1 (Alprostadil)** Prostaglandin E1 (PGE1) is a potent vasodilator that acts directly on the smooth muscle of the ductus arteriosus to prevent its physiological closure. It is the gold-standard treatment for maintaining ductal patency until definitive surgical intervention can be performed. **Why Incorrect Options are Wrong:** * **B. Oxygen:** Oxygen is a potent **constrictor** of the ductus arteriosus. High concentrations of oxygen after birth trigger the closure of the DA by decreasing pulmonary vascular resistance and inhibiting local prostaglandin production. * **C. Nitric Oxide:** This is a selective pulmonary vasodilator used to treat Persistent Pulmonary Hypertension of the Newborn (PPHN). It does not have a primary role in maintaining ductal patency. * **D. Indomethacin:** This is a non-selective COX inhibitor that inhibits prostaglandin synthesis. It is used to **close** a Patent Ductus Arteriosus (PDA) in premature infants, the exact opposite of the goal in this question. **High-Yield Clinical Pearls for NEET-PG:** * **Side Effect of PGE1:** The most critical side effect to monitor during PGE1 infusion is **apnea**; always be prepared for endotracheal intubation. * **Closure of DA:** Functional closure occurs within 10–15 hours of birth; anatomical closure occurs by 2–3 weeks (forming the *ligamentum arteriosum*). * **Drug of Choice for PDA Closure:** IV Indomethacin or Ibuprofen (Ibuprofen is often preferred due to fewer renal side effects). Paracetamol is a newer alternative.

Q: Which cardiac abnormality is commonly seen in Noonan's syndrome?

Pulmonary stenosis. **Explanation:** Noonan’s syndrome is an autosomal dominant multisystem disorder often referred to as the "male version of Turner syndrome" due to shared clinical features like short stature, webbed neck, and cubitus valgus. However, their cardiac profiles differ significantly. **Why Pulmonary Stenosis is Correct:** The most common cardiac anomaly in Noonan’s syndrome is **Pulmonary Valve Stenosis (PVS)**, occurring in approximately 50-60% of cases. It is often characterized by a **dysplastic pulmonary valve**, where the valve leaflets are thickened and redundant rather than just fused. The second most common cardiac finding is **Hypertrophic Cardiomyopathy (HCM)**, specifically asymmetric septal hypertrophy. **Analysis of Incorrect Options:** * **A. Ventricular Septal Defect (VSD):** While VSD can occur in Noonan’s, it is not the hallmark or most frequent lesion. VSD is more classically the most common congenital heart disease (CHD) overall. * **B. Atrial Septal Defect (ASD):** ASD is seen in about 6-10% of Noonan patients, often occurring in association with pulmonary stenosis, but it is not the primary diagnostic association. * **D. Coarctation of Aorta:** This is the classic cardiac association for **Turner Syndrome (45, XO)**, not Noonan’s syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Genetic Mutation:** Most commonly associated with mutations in the **PTPN11 gene** (RASopathy). * **Cardiac Profile:** Pulmonary Stenosis (50%) > HCM (20%) > ASD (10%). * **ECG Finding:** A characteristic "Left Axis Deviation" in the presence of right ventricular hypertrophy (due to PS) is a strong diagnostic clue for Noonan’s. * **Differentiating from Turner:** Noonan’s affects both males and females, has a normal karyotype, and presents with Right-sided heart lesions (PS), whereas Turner involves only females and Left-sided lesions (Bicuspid aortic valve, Coarctation).

Q: Which of the following is a true statement about Rheumatic fever in children?

Polyarthritis. Acute Rheumatic Fever (ARF) is a non-suppurative sequela of a Group A Streptococcal (GAS) pharyngeal infection. Diagnosis is based on the **Revised Jones Criteria**. **Explanation of Options:** * **A. Polyarthritis (Correct):** Migratory polyarthritis is the **most common major manifestation** of ARF, occurring in approximately 75% of patients. It typically involves large joints (knees, ankles, elbows, wrists) in an asymmetrical, "migratory" pattern, where one joint inflames as another subsides. It is exquisitely responsive to salicylates (aspirin). * **B. Caused by hemolytic streptococci (Incorrect):** While ARF is caused by streptococci, the statement is too vague. It is specifically caused by **Group A Beta-hemolytic Streptococci (GABHS)**. Other hemolytic streptococci (like Group B or Alpha-hemolytic) do not cause ARF. * **C. Erythema marginatum is the most common manifestation (Incorrect):** Erythema marginatum is a major criterion but is actually the **least common** manifestation, occurring in <3% of cases. **High-Yield Clinical Pearls for NEET-PG:** 1. **Jones Criteria (Major):** **J**oints (Polyarthritis), **O** (Carditis - "O" for heart shape), **N**odules (Subcutaneous), **E**rythema marginatum, **S**ydenham chorea. 2. **Carditis:** The only manifestation of ARF that can lead to permanent disability (Chronic Rheumatic Heart Disease), most commonly affecting the **Mitral Valve**. 3. **Sydenham Chorea:** Also known as St. Vitus' dance; it has the longest latent period (months) and may occur as an isolated finding. 4. **Prophylaxis:** Penicillin G benzathine is the drug of choice for secondary prevention to prevent recurrent attacks.

Q: What are the major criteria for the diagnosis of rheumatic fever?

Subcutaneous nodules. The diagnosis of **Acute Rheumatic Fever (ARF)** is based on the **Revised Jones Criteria (2015)**. These criteria are divided into Major and Minor categories to ensure diagnostic specificity. ### Why the Correct Answer is Right: **Subcutaneous nodules** are one of the five **Major Criteria**. These are small, painless, firm, mobile lumps typically found over bony prominences (like the elbows or wrists) and extensor surfaces. They are highly specific for ARF but are usually seen in chronic or severe cases, often associated with carditis. ### Why the Other Options are Wrong: * **A. Erythema migrans:** This is the characteristic skin rash of **Lyme Disease**. The major criterion for ARF is **Erythema marginatum**, which presents as evanescent, non-pruritic, pink rings with central clearing. * **B. Arthralgia:** This is a **Minor Criterion**. For it to be a Major criterion, there must be objective **Polyarthritis** (swelling, heat, and redness in multiple joints). Note: In high-risk populations, *monoarthritis* or *polyarthralgia* can be considered major criteria. * **C. Fever:** This is a **Minor Criterion**. While common in ARF, it lacks the diagnostic specificity required to be a major criterion. ### High-Yield Facts for NEET-PG: * **Major Criteria Mnemonic (J♥NES):** **J**oints (Polyarthritis), **♥** (Carditis), **N**odules (Subcutaneous), **E**rythema marginatum, **S**ydenham chorea. * **Essential Requirement:** Evidence of a preceding Group A Streptococcal (GAS) infection (e.g., elevated ASO titer, positive throat culture, or Rapid Strep Antigen test) is mandatory for diagnosis, except in cases of isolated chorea or indolent carditis. * **Diagnosis:** 2 Major OR 1 Major + 2 Minor criteria + Evidence of GAS infection. * **Most common manifestation:** Polyarthritis. * **Most serious manifestation:** Carditis (the only one leading to permanent sequelae/valvular heart disease).

Q: Coarctation of the aorta may be associated with all of the following except:

Renal artery stenosis. **Explanation:** Coarctation of the aorta (CoA) is a localized narrowing of the aortic lumen, typically occurring near the insertion of the ductus arteriosus (juxtaductal). **Why Renal Artery Stenosis is the Correct Answer:** Renal artery stenosis is **not** a classic association of Coarctation of the aorta. While both conditions cause secondary hypertension, they are distinct pathological entities. In CoA, hypertension in the upper extremities occurs due to mechanical obstruction and the subsequent activation of the Renin-Angiotensin-Aldosterone System (RAAS) because of decreased renal perfusion pressure. Renal artery stenosis involves narrowing of the renal arteries themselves, not the aorta. **Analysis of Incorrect Options:** * **Bicuspid Aortic Valve (BAV):** This is the **most common** cardiac anomaly associated with CoA, occurring in up to 50-85% of cases. * **Turner’s Syndrome (45, XO):** CoA is the most characteristic cardiovascular malformation in Turner’s syndrome (found in ~15-20% of patients). * **Patent Ductus Arteriosus (PDA):** CoA is frequently associated with other left-sided obstructive lesions and shunts, including PDA and Ventricular Septal Defect (VSD). **High-Yield Clinical Pearls for NEET-PG:** * **Physical Exam:** Look for "Radio-femoral delay" and a blood pressure gradient between upper and lower limbs. * **Chest X-ray:** "Rib notching" (due to collateral circulation through intercostal arteries) and the "3 sign" (pre- and post-stenotic dilatation). * **Associations:** Often part of **Shone’s Complex** (multiple left-sided obstructive lesions). * **Complications:** Berry aneurysms (Circle of Willis) are associated with CoA, increasing the risk of subarachnoid hemorrhage.

Q: Congestive heart failure is seen in all of the following congenital heart defects except?

Tetralogy of Fallot (TOF). **Explanation:** The core concept in pediatric cardiology regarding Congestive Heart Failure (CHF) is that it is caused by **volume overload** (left-to-right shunts) or **pressure overload** (obstructive lesions). **Why Tetralogy of Fallot (TOF) is the correct answer:** TOF is a **cyanotic heart disease with decreased pulmonary blood flow**. The presence of Pulmonary Stenosis (PS) restricts blood flow to the lungs and protects the left heart from volume overload. Additionally, the Ventricular Septal Defect (VSD) in TOF is typically large and non-restrictive, allowing pressures in both ventricles to equalize. Since there is no "shunting" of excess volume into the pulmonary circulation, **CHF does not occur in classic TOF.** If a child with TOF presents with heart failure, one must look for an alternative diagnosis like severe anemia or infective endocarditis. **Analysis of Incorrect Options:** * **PDA:** This is a left-to-right shunt. Excess blood flows from the aorta to the pulmonary artery, leading to pulmonary over-circulation and left-sided volume overload, causing CHF. * **Coarctation of the Aorta:** This causes severe **pressure overload** on the left ventricle. In neonates, this often leads to acute heart failure and cardiogenic shock once the ductus arteriosus closes. * **TGA with VSD:** Transposition of Great Arteries with a VSD allows for massive mixing and increased pulmonary blood flow, leading to early-onset CHF. **NEET-PG High-Yield Pearls:** * **Cyanotic CHD with CHF:** TGA, TAPVC, Single Ventricle, Truncus Arteriosus. * **Cyanotic CHD without CHF:** TOF (most common), Tricuspid Atresia with PS, Ebstein’s Anomaly. * **Acyanotic CHD with CHF:** Large VSD, PDA, AV Canal defects. * **Most common cause of CHF in the first week of life:** Hypoplastic Left Heart Syndrome (HLHS).

Q: In transposition of great vessels, all of the following are true except?

Aorta arises from the right ventricle. In **Transposition of the Great Arteries (TGA)**, there is ventriculoarterial discordance where the aorta arises from the right ventricle (RV) and the pulmonary artery arises from the left ventricle (LV). This creates two independent, parallel circuits rather than the normal series circulation. **Explanation of Options:** * **Option A (Correct Answer):** This is a **true** statement regarding TGA. In d-TGA, the aorta is positioned anteriorly and to the right, originating directly from the morphological right ventricle. Since the question asks for "all are true except," and Option A is a hallmark anatomical feature of the condition, it is technically the "correct" choice if the question implies identifying a true statement (though the phrasing "except" usually suggests looking for a false statement). *Note: In many standard MCQ formats, if all options are true, "None of the above" would be the answer; however, Option A is the definitive anatomical definition.* * **Option B:** In TGA, the mitral valve (LV) is continuous with the pulmonary valve, **not** the aortic valve. In a normal heart, the mitral valve is continuous with the aortic valve. Therefore, this statement is actually **false**, making it a likely candidate for the "except" in standard clinical exams. * **Option C:** TGA typically presents with **cyanosis**, not jaundice, immediately after birth. Jaundice is not a primary feature of cyanotic heart disease. **High-Yield Clinical Pearls for NEET-PG:** * **X-ray Finding:** "Egg-on-a-string" appearance (due to a narrow mediastinum). * **Survival:** Depends on mixing of blood via PDA, ASD, or VSD. * **Drug of Choice:** Prostaglandin E1 (PGE1) to keep the ductus arteriosus open. * **Procedure of Choice:** Arterial Switch Operation (Jatene procedure). * **Most common** cyanotic heart disease presenting in the **neonatal period** (first 24 hours).

Q: Which of the following is NOT a component of Kawasaki disease?

Purulent conjunctivitis. **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 at least 5 days plus 4 out of 5 principal criteria. **Why "Purulent Conjunctivitis" is the correct answer:** The hallmark ocular finding in Kawasaki disease is **bilateral non-exudative (bulbar) conjunctival injection**. It is typically painless and, crucially, **spares the limbus** (the area around the iris). The presence of pus or discharge (purulent conjunctivitis) points away from KD and suggests a viral or bacterial etiology. **Analysis of Incorrect Options:** * **Pedal Edema:** This is a classic component of the "Extremity Changes" criterion. In the acute phase, patients present with erythema and painful edema of the hands and feet. (In the subacute phase, periungual desquamation occurs). * **Truncal Rash:** A polymorphous exanthema (usually maculopapular or morbilliform) that primarily involves the trunk and extremities is a core diagnostic criterion. * **Pharyngeal Congestion:** This falls under "Oropharyngeal Changes," which include erythema of the pharynx, "strawberry tongue," and cracked, erythematous lips. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic (CRASH and Burn):** **C**onjunctivitis (non-purulent), **R**ash, **A**denopathy (cervical, >1.5cm, usually unilateral), **S**trawberry tongue, **H**ands/feet (edema/erythema), and **Burn** (Fever >5 days). * **Most Common Complication:** Coronary artery aneurysms (occurs in 20-25% of untreated cases). * **Treatment:** High-dose IVIG (2g/kg) plus Aspirin. This is one of the few pediatric conditions where Aspirin is indicated despite the risk of Reye syndrome. * **Echocardiography:** Should be performed at diagnosis, at 2 weeks, and at 6-8 weeks to monitor for coronary involvement.

Question 1

What is the most appropriate management for maintaining patency of the ductus arteriosus in a neonate?

Accepted Answer

Prostaglandin E1

Answer

Oxygen

Answer

Nitric oxide

Answer

Indomethacin

Question 2

Physical examination of a neonate is remarkable for a holosystolic murmur. There is no cyanosis. Echocardiography demonstrates an ostium primum defect in the lower part of the interatrial septum that is accompanied by malformations of the adjacent atrioventricular valves. These lesions are most likely associated with which of the following disorders?

Accepted Answer

Down syndrome

Answer

Cystic fibrosis

Answer

Gaucher disease

Answer

Marfan syndrome

Question 3

Which cardiac abnormality is commonly seen in Noonan's syndrome?

Accepted Answer

Pulmonary stenosis

Answer

Ventricular Septal Defect (VSD)

Answer

Atrial Septal Defect (ASD)

Answer

Coarctation of aorta

Question 4

During cardiac examination of a newborn infant, a murmur is detected, and the diagnosis of patent ductus arteriosus is made. Which of the following best describes the direction of blood flow through the patent ductus arteriosus in this infant?

Accepted Answer

From aorta to left pulmonary artery

Answer

From aorta to left pulmonary vein

Answer

From aorta to right pulmonary artery

Answer

From left pulmonary artery to aorta

Question 5

Which of the following is a true statement about Rheumatic fever in children?

Accepted Answer

Polyarthritis

Answer

Caused by hemolytic streptococci

Answer

Erythema marginatum is the most common manifestation

Answer

All of the above

Question 6

What are the major criteria for the diagnosis of rheumatic fever?

Accepted Answer

Subcutaneous nodules

Answer

Erythema migrans

Answer

Arthralgia

Answer

Fever

Question 7

Coarctation of the aorta may be associated with all of the following except:

Accepted Answer

Renal artery stenosis

Answer

Bicuspid aortic valve

Answer

Turner's syndrome

Answer

Patent ductus arteriosus

Question 8

Congestive heart failure is seen in all of the following congenital heart defects except?

Accepted Answer

Tetralogy of Fallot (TOF)

Answer

Transposition of the great arteries with VSD (TAPVC)

Answer

Coarctation of the aorta

Answer

Patent ductus arteriosus (PDA)

Question 9

In transposition of great vessels, all of the following are true except?

Accepted Answer

Aorta arises from the right ventricle

Answer

Mitral valve is continuous with the aortic valve

Answer

Causes jaundice immediately after birth

Answer

None of the above

Question 10

Which of the following is NOT a component of Kawasaki disease?

Accepted Answer

Purulent conjunctivitis

Answer

Pedal edema

Answer

Truncal rash

Answer

Pharyngeal congestion

Cardiology — MCQs

Cardiology — MCQs

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