Cardiology Practice Questions

Q: In Transposition of the Great Arteries (TGA), what is the relative position of the aorta to the pulmonary artery?

Anterior and right to the pulmonary artery. **Explanation:** In **Transposition of the Great Arteries (TGA)**, specifically the most common form known as **d-TGA** (dextro-TGA), the embryological defect lies in the failure of the conotruncal septum to spiral. Instead of the normal spiral development, the septum grows straight. This results in the aorta arising from the morphological right ventricle and the pulmonary artery arising from the morphological left ventricle. **Why Option D is correct:** In d-TGA, the aorta is displaced **anteriorly** and typically to the **right** of the pulmonary artery. This spatial relationship is a hallmark of the condition and is easily visualized on an echocardiogram or CT scan. **Analysis of Incorrect Options:** * **Options A & B (Posterior):** In a normal heart, the aorta is posterior and to the right of the pulmonary artery. Therefore, any "posterior" position of the aorta is characteristic of normal anatomy, not TGA. * **Option C (Anterior and left):** This describes **l-TGA** (levo-TGA or Congenitally Corrected TGA), where the ventricles are also switched (ventricular inversion). While the aorta is anterior, it lies to the left of the pulmonary artery. **High-Yield Clinical Pearls for NEET-PG:** * **Chest X-ray Finding:** The narrow vascular pedicle and globular heart shape create the classic **"Egg-on-a-string"** appearance. * **Survival:** TGA is an **incompatible-with-life** cyanotic heart disease unless there is a shunting lesion (PDA, VSD, or ASD) to allow mixing of the parallel circulations. * **Management:** The initial medical management is **PGE1 infusion** to keep the ductus arteriosus open. The definitive surgical treatment of choice is the **Arterial Switch Operation (Jatene Procedure)**, ideally performed in the first 2 weeks of life.

Q: All are manifestations of Kawasaki disease, except:

Thrombocytopenia. **Explanation:** Kawasaki Disease (KD) is an acute, multisystem, febrile vasculitis of unknown etiology that primarily affects medium-sized arteries, most notably the coronary arteries. **Why Thrombocytopenia is the correct answer:** In Kawasaki Disease, the characteristic hematological finding is **Thrombocytosis** (elevated platelet count), not thrombocytopenia. Platelet counts typically begin to rise during the subacute phase (after the 10th day of illness) and can exceed 1 million/mm³. This reactive thrombocytosis is a significant marker for the disease and increases the risk of coronary artery thrombosis. **Analysis of other options:** * **A. Conjunctival congestion:** This is a classic diagnostic criterion. It is typically bilateral, non-exudative (bulbar), and spares the limbus. * **C. Aneurysm of coronary artery:** This is the most serious complication of KD, occurring in up to 25% of untreated cases. It usually develops in the subacute phase. * **D. Enlarged lymph nodes:** Cervical lymphadenopathy (usually >1.5 cm and unilateral) is one of the five primary clinical diagnostic criteria. **NEET-PG High-Yield Pearls:** * **Diagnostic Criteria (CRASH and Burn):** **C**onjunctivitis, **R**ash, **A**denopathy, **S**trawberry tongue (and oral changes), **H**and/foot changes (edema/desquamation), and **Burn** (High-grade fever for ≥5 days). * **Treatment:** High-dose IVIG (2g/kg) and Aspirin. IVIG is most effective when given within the first 10 days to prevent coronary aneurysms. * **Echo Schedule:** Perform at diagnosis, at 2 weeks, and at 6–8 weeks. * **Incomplete KD:** Suspect in infants with prolonged fever and fewer than 4 criteria; check ESR/CRP and Platelets.

Q: Which of the following syndromes is best associated with congenital heart disease?

Holt Oram syndrome. **Explanation:** **Holt-Oram Syndrome (Correct Answer):** Also known as **Heart-Hand Syndrome**, this is an autosomal dominant condition caused by a mutation in the **TBX5 gene**. It is characterized by the co-occurrence of upper limb deformities (most commonly a triphalangeal or absent thumb and radial dysplasia) and congenital heart defects. The most frequent cardiac association is an **Atrial Septal Defect (ASD)** of the ostium secundum type, followed by Ventricular Septal Defects (VSD). **Analysis of Incorrect Options:** * **Lesch-Nyhan Syndrome:** An X-linked recessive disorder caused by a deficiency of the enzyme HGPRT. It presents with hyperuricemia, gout, and characteristic self-mutilating behavior, but is not typically associated with structural heart disease. * **Rasmussen Syndrome:** A rare, progressive neurological inflammatory disease (chronic focal encephalitis) characterized by intractable seizures and hemiparesis. It has no cardiac involvement. * **LEOPARD Syndrome:** Now often referred to as **Noonan Syndrome with Multiple Lentigines**. While it *does* involve the heart (most commonly hypertrophic cardiomyopathy or pulmonary stenosis), Holt-Oram is the "classic" textbook association for a syndrome defined by the heart-limb axis in NEET-PG contexts. **Clinical Pearls for NEET-PG:** * **Holt-Oram:** Remember the "Hand-Heart" link. If a question mentions a "thumb deformity + murmur," think Holt-Oram. * **TBX5 Gene:** High-yield genetic association. * **ASD:** The most common cardiac lesion in this syndrome (specifically Secundum type). * **LEOPARD Mnemonic:** **L**entigines, **E**CG conduction defects, **O**cular hypertelorism, **P**ulmonary stenosis, **A**bnormal genitalia, **R**etardation of growth, and **D**eafness.

Q: In a preterm baby with patent ductus arteriosus, which of the following statements is true, EXCEPT?

Narrow pulse pressure. In a Patent Ductus Arteriosus (PDA), blood shunts from the high-pressure aorta to the low-pressure pulmonary artery during both systole and diastole. **Explanation of the Correct Answer:** * **Option A (Narrow pulse pressure):** This is the **incorrect** statement (and thus the correct answer). In PDA, the runoff of blood from the aorta into the pulmonary artery during diastole causes a significant drop in diastolic blood pressure. Conversely, the stroke volume increases to compensate for the left-to-right shunt, maintaining or slightly increasing systolic pressure. This results in a **Wide Pulse Pressure**, not a narrow one. Clinically, this manifests as "bounding pulses" (Water-hammer pulse). **Explanation of Incorrect Options:** * **Option B (Necrotizing enterocolitis):** Large PDAs cause a "ductal steal" phenomenon, diverting blood away from the systemic circulation. Reduced mesenteric perfusion increases the risk of **NEC** in preterm infants. * **Option C (Continuous murmur):** The classic physical finding is a **Gibson’s murmur** (continuous machinery murmur), heard best at the left infraclavicular area. Note: In very small preterms, it may only be systolic initially. * **Option D (Congestive heart failure):** The increased pulmonary venous return leads to volume overload of the left atrium and left ventricle, potentially resulting in **CHF**. **NEET-PG High-Yield Pearls:** * **Drug of Choice:** Intravenous **Indomethacin** or **Ibuprofen** (NSAIDs) are used to close a PDA by inhibiting prostaglandins. Paracetamol is an emerging alternative. * **Maintenance:** If a duct-dependent lesion is present (e.g., Transposition of Great Arteries), **Alprostadil (PGE1)** is given to keep the ductus open. * **Chest X-ray:** Shows cardiomegaly and increased pulmonary vascular markings.

Q: What is the average blood pressure of a 1-year-old child?

95/50 mmHg. **Explanation:** The blood pressure (BP) in children is significantly lower than in adults and increases progressively with age, height, and weight. For a **1-year-old child**, the average (50th percentile) blood pressure is approximately **95/50 mmHg**. **Why Option C is correct:** Blood pressure is determined by cardiac output and systemic vascular resistance. In infants and toddlers, the arterial walls are more compliant and the stroke volume is smaller compared to adults. According to standard pediatric reference charts (like the Nelson Textbook of Pediatrics), the systolic BP at birth is ~60–70 mmHg, rising to ~95 mmHg by age 1, and reaching adult levels by late adolescence. **Analysis of Incorrect Options:** * **Option A (120/80 mmHg):** This is the standard normal BP for a healthy **adult**. In a 1-year-old, this would represent severe Stage 2 hypertension. * **Option B (75/50 mmHg):** This range is more characteristic of a **neonate** (newborn) or an infant under 3 months of age. * **Option D (60/30 mmHg):** This is typical for a **preterm neonate**. In a 1-year-old, this value would indicate profound hypotension or shock. **High-Yield Clinical Pearls for NEET-PG:** * **Formula for Systolic BP (1–10 years):** A quick bedside rule for the 50th percentile systolic BP is **90 + (2 × age in years)**. For a 1-year-old: 90 + 2 = 92 mmHg (closest to 95). * **Hypotension Definition:** In a child aged 1–10 years, systolic BP **< 70 + (2 × age in years)** is considered hypotension. * **Cuff Size:** The most common cause of an erroneous BP reading is incorrect cuff size. The bladder should cover **80–100%** of the arm circumference and **40%** of the arm width. * **Right Arm Preference:** BP should ideally be measured in the right arm to avoid false readings in cases of Coarctation of the Aorta.

Q: All of the following are included in Jones major criteria except?

Lymphadenopathy. The **Jones Criteria** are used for the clinical diagnosis of **Acute Rheumatic Fever (ARF)**, a non-suppurative sequela of Group A Streptococcal (GAS) pharyngitis. ### **Explanation of the Correct Answer** **A. Lymphadenopathy:** This is the correct answer because it is **not** part of the Jones Criteria. While lymphadenopathy may occur during the initial streptococcal throat infection, it is not a diagnostic feature of the subsequent autoimmune inflammatory process that defines Rheumatic Fever. ### **Analysis of Incorrect Options (Major Criteria)** The mnemonic **"J♥NES"** helps recall the Major Criteria: * **B. Polyarthritis (J - Joints):** Migratory polyarthritis involving large joints is the most common major manifestation. * **D. Pancarditis (♥ - Carditis):** Inflammation affecting the endocardium, myocardium, and pericardium. It is the only manifestation that can lead to chronic valvular heart disease. * **C. Sydenham's chorea (N - Nodes/Neurological):** Characterized by rapid, purposeless movements; it is a late manifestation. * **Erythema Marginatum (E):** A pink, evanescent, non-pruritic macular rash with serpiginous borders. * **Subcutaneous Nodules (S):** Small, painless, firm lumps typically found over bony prominences. ### **High-Yield Clinical Pearls for NEET-PG** 1. **Diagnosis Requirement:** For a primary episode, diagnosis requires **2 Major** OR **1 Major + 2 Minor** criteria, plus evidence of a preceding GAS infection (e.g., elevated ASO titer). 2. **Minor Criteria:** Include fever, arthralgia, prolonged PR interval on ECG, and elevated acute phase reactants (ESR/CRP). 3. **Most Common Valve Involved:** Mitral valve (Mitral Regurgitation in acute phase; Mitral Stenosis in chronic phase). 4. **Aschoff Bodies:** Pathognomonic histological finding in the myocardium consisting of Anitschkow cells ("caterpillar cells").

Q: All of the following may occur in Noonan's syndrome except?

Infertility in females. **Explanation:** Noonan’s syndrome is an **autosomal dominant** multisystem disorder often referred to as the "Male Turner Syndrome" due to phenotypic similarities. It is primarily caused by mutations in the **RAS-MAPK signaling pathway** (most commonly the **PTPN11 gene**). **Why "Infertility in females" is the correct answer:** Unlike Turner Syndrome (45,XO), where streak ovaries lead to primary infertility, females with Noonan’s syndrome (usually 46,XX) typically have **normal ovarian function and are fertile**. In contrast, **males** with Noonan’s syndrome often suffer from infertility due to gonadal dysfunction associated with bilateral cryptorchidism. **Analysis of incorrect options:** * **Hypertrophic Cardiomyopathy (HCM):** This is a classic association. While Pulmonary Stenosis (dysplastic valve) is the most common cardiac lesion, HCM occurs in approximately 20-30% of cases. * **Cryptorchidism:** Undescended testes are seen in up to 80% of affected males, frequently leading to impaired spermatogenesis. * **Autosomal dominant transmission:** Noonan’s syndrome follows an AD pattern, though many cases arise from *de novo* mutations. **High-Yield Clinical Pearls for NEET-PG:** * **Karyotype:** Usually normal (46,XY or 46,XX). * **Cardiac Profile:** Pulmonary Valve Stenosis (most common) > HCM > ASD. * **Facial Features:** Low-set ears, hypertelorism, downward-slanting palpebral fissures, and webbed neck. * **Hematology:** Increased risk of bleeding diathesis (Factor XI deficiency) and Juvenile Myelomonocytic Leukemia (JMML). * **Triad for Diagnosis:** Short stature, characteristic facies, and congenital heart disease.

Q: What is the most common cause of heart block in infants?

Surgery for congenital heart disease. **Explanation:** The most common cause of heart block in infants and children is **iatrogenic injury during surgery for congenital heart disease (CHD)**. During corrective procedures for defects like Ventricular Septal Defects (VSD), Atrioventricular Canal Defects, or Tetralogy of Fallot, the conduction system (specifically the Bundle of His) is anatomically close to the surgical site. Sutures or mechanical trauma during the repair can lead to transient or permanent complete heart block. **Analysis of Options:** * **A. Systemic Lupus Erythematosus (SLE):** This is the most common cause of **congenital** (in-utero) complete heart block due to the transplacental passage of maternal anti-Ro (SSA) and anti-La (SSB) antibodies. However, in the overall pediatric population, post-surgical causes are statistically more frequent. * **C. Viral Myocarditis:** While myocarditis can cause arrhythmias and conduction delays due to myocardial inflammation, it is a less common cause of permanent heart block compared to surgical trauma. * **D. Rheumatic Fever:** This typically presents in older children (school-age) rather than infants. While it characteristically causes a **first-degree heart block** (prolonged PR interval), it rarely progresses to complete heart block in the acute phase. **High-Yield Clinical Pearls for NEET-PG:** * **Congenital Heart Block:** Strongly associated with maternal **SLE**; 100% of these infants have mothers with anti-Ro/SSA antibodies. * **Post-Surgical Block:** If a heart block persists for more than **7–10 days** after cardiac surgery, a permanent pacemaker is usually indicated. * **Most common site of injury:** The Bundle of His, especially during VSD closure.

Question 1

In Transposition of the Great Arteries (TGA), what is the relative position of the aorta to the pulmonary artery?

Accepted Answer

Anterior and right to the pulmonary artery

Answer

Posterior and left to the pulmonary artery

Answer

Posterior and right to the pulmonary artery

Answer

Anterior and left to the pulmonary artery

Question 2

All are manifestations of Kawasaki disease, except:

Accepted Answer

Thrombocytopenia

Answer

Conjunctival congestion

Answer

Aneurysm of coronary artery

Answer

Enlarged lymph nodes

Question 3

Which of the following syndromes is best associated with congenital heart disease?

Accepted Answer

Holt Oram syndrome

Answer

Lesch-Nyhan syndrome

Answer

Rasmussen syndrome

Answer

LEOPARD syndrome

Question 4

Which of the following drug combinations is used in a patient with tetralogy of Fallot?

Accepted Answer

Morphine, sodium bicarbonate, and propranolol

Answer

Digoxin, furosemide, and oxygen

Answer

Atenolol with direct current cardioversion

Answer

Captopril with aminophylline

Question 5

In a preterm baby with patent ductus arteriosus, which of the following statements is true, EXCEPT?

Accepted Answer

Narrow pulse pressure

Answer

Necrotizing enterocolitis

Answer

Continuous murmur

Answer

Congestive heart failure

Question 6

What is the average blood pressure of a 1-year-old child?

Accepted Answer

95/50 mmHg

Answer

120/80 mmHg

Answer

75/50 mmHg

Answer

60/30 mmHg

Question 7

All of the following are included in Jones major criteria except?

Accepted Answer

Lymphadenopathy

Answer

Polyarthritis

Answer

Sydenham's chorea

Answer

Pancarditis

Question 8

All of the following may occur in Noonan's syndrome except?

Accepted Answer

Infertility in females

Answer

Hypertrophic cardiomyopathy

Answer

Cryptorchidism

Answer

Autosomal dominant transmission

Question 9

What is the most common cause of heart block in infants?

Accepted Answer

Surgery for congenital heart disease

Answer

Systemic lupus erythematosus (SLE)

Answer

Viral myocarditis

Answer

Rheumatic fever

Question 10

Pulmonary blood flow is decreased in which of the following conditions?

Accepted Answer

Tetralogy of Fallot

Answer

Ebstein's anomaly

Answer

Common atrium

Answer

Transposition of the great arteries with intact ventricular septum

Cardiology — MCQs

Cardiology — MCQs

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