Cardiology Practice Questions

Q: A 2-month-old child, born prematurely, presents with respiratory distress. Cardiac examination reveals increased pulse pressure and a pansystolic murmur best heard in the 2nd left intercostal space. What is the most probable diagnosis?

Patent ductus arteriosus. ### Explanation **Correct Answer: C. Patent ductus arteriosus (PDA)** The clinical presentation of a **premature infant** with respiratory distress, **increased pulse pressure** (bounding pulses), and a murmur in the **2nd left intercostal space** is classic for PDA. * **Pathophysiology:** In PDA, the fetal connection between the pulmonary artery and aorta fails to close. This leads to a left-to-right shunt. The increased stroke volume into the aorta followed by rapid runoff into the pulmonary circulation causes a wide pulse pressure. * **Murmur Characteristics:** While the classic description is a "continuous machinery murmur," in neonates and young infants with high pulmonary vascular resistance, it may present initially as a **systolic murmur** (often pansystolic) at the left upper sternal border. **Why the other options are incorrect:** * **A. Atrial Septal Defect (ASD):** Typically asymptomatic in infancy. It presents with a fixed wide splitting of S2 and a systolic ejection murmur at the left upper sternal border, not a pansystolic murmur or wide pulse pressure. * **B. Ventricular Septal Defect (VSD):** While it presents with a pansystolic murmur, it is best heard at the **lower left sternal border**. It does not typically cause increased pulse pressure. * **D. Tetralogy of Fallot (TOF):** A cyanotic heart disease. The murmur is due to pulmonary stenosis (ejection systolic), and pulse pressure is usually normal or narrow. **NEET-PG High-Yield Pearls:** * **Drug of Choice:** Indomethacin or Ibuprofen (NSAIDs) are used to close a PDA in prematures by inhibiting prostaglandins. * **Prostaglandin E1:** Used to keep the ductus *open* in ductal-dependent cyanotic heart diseases. * **Association:** PDA is strongly associated with **Congenital Rubella Syndrome**. * **Physical Sign:** "Bounding pulses" or "Water-hammer pulses" in a neonate should immediately make you suspect PDA.

Q: All of the following are cyanotic heart diseases, EXCEPT?

Patent Ductus Arteriosus (PDA). **Explanation:** Congenital Heart Diseases (CHD) are broadly classified into **Acyanotic** (Left-to-Right shunt) and **Cyanotic** (Right-to-Left shunt) based on whether deoxygenated blood enters the systemic circulation. **Why PDA is the correct answer:** **Patent Ductus Arteriosus (PDA)** is a classic **Acyanotic CHD**. In a PDA, the high-pressure aorta shunts oxygenated blood back into the lower-pressure pulmonary artery (Left-to-Right shunt). Since oxygenated blood is recirculated to the lungs rather than deoxygenated blood entering the systemic flow, the patient remains "pink" (non-cyanotic) unless complications like Eisenmenger syndrome develop later. **Analysis of Incorrect Options:** * **Tetralogy of Fallot (TOF):** The most common cyanotic CHD after infancy. It involves pulmonary stenosis and a VSD, leading to a Right-to-Left shunt and systemic cyanosis. * **Tricuspid Atresia:** A cyanotic CHD where the absence of the tricuspid valve necessitates an ASD and VSD/PDA for survival. Deoxygenated systemic blood must mix with pulmonary venous blood to reach the left side, causing cyanosis. * **Eisenmenger’s Complex:** This occurs when a long-standing acyanotic shunt (like VSD) causes pulmonary hypertension, leading to a **reversal of shunt** (Right-to-Left). Once the shunt reverses, the patient becomes clinically cyanotic. **High-Yield Clinical Pearls for NEET-PG:** * **The 5 T’s of Cyanotic CHD:** **T**OF, **T**ransposition of Great Arteries (TGA), **T**ricuspid Atresia, **T**runcus Arteriosus, and **T**otal Anomalous Pulmonary Venous Connection (TAPVC). * **PDA Murmur:** Characteristically described as a **"Machinery murmur"** (continuous) heard best at the left infraclavicular area. * **Drug of Choice:** **Indomethacin** or **Ibuprofen** (NSAIDs) are used to close a PDA in prematures; **Alprostadil (PGE1)** is used to keep it open in ductal-dependent cyanotic lesions.

Q: Which of the following conditions is typically not seen in adults?

Kawasaki disease. **Explanation:** The correct answer is **Kawasaki Disease (KD)**. **Why Kawasaki Disease is the correct answer:** Kawasaki Disease is an acute, febrile, medium-vessel vasculitis that is almost exclusively a disease of **young children**. Approximately 85% to 90% of cases occur in children under the age of 5, with a peak incidence between 6 months and 2 years. While rare "adult-onset Kawasaki disease" cases are documented in literature, it is classically defined in pediatric medicine as a childhood condition. In the context of competitive exams like NEET-PG, it is the hallmark "pediatric" vasculitis. **Analysis of Incorrect Options:** * **Henoch-Schönlein Purpura (HSP):** Although it is the most common vasculitis in children, it frequently occurs in adults (often presenting with a more severe clinical course and higher risk of renal complications). * **Susac Syndrome:** This is a rare endotheliopathy characterized by the triad of encephalopathy, branch retinal artery occlusions, and sensorineural hearing loss. It typically affects young adults (ages 20–40), predominantly females. * **Takayasu Arteritis:** Known as "pulseless disease," this large-vessel vasculitis primarily affects the aorta and its branches. It is most commonly seen in young women under the age of 40. **NEET-PG High-Yield Pearls:** * **KD Diagnosis:** Requires Fever for ≥5 days + 4 out of 5 criteria (Conjunctivitis, Rash, Edema/Erythema of hands/feet, Adenopathy, Mucositis/Strawberry tongue). * **Complication:** Coronary artery aneurysms are the most dreaded complication; 2D-Echo is the investigation of choice. * **Treatment:** IVIG (2g/kg) + High-dose Aspirin. Note: This is one of the few instances where Aspirin is used in children despite the risk of Reye’s syndrome.

Q: Cyanosis is NOT present in which of the following conditions?

Coarctation of the aorta (COA). **Explanation:** The core concept in pediatric cardiology is distinguishing between cyanotic and acyanotic heart diseases. **Coarctation of the Aorta (CoA)** is classified as an **acyanotic** obstructive heart defect. It involves a localized narrowing of the aorta, typically near the ductus arteriosus. While it causes a pressure gradient (higher BP in upper limbs, lower in lower limbs), it does not involve a right-to-left shunt of deoxygenated blood into the systemic circulation; therefore, central cyanosis is absent. **Analysis of Incorrect Options:** * **TGA:** A classic cyanotic heart disease ("Cyanotic 5 Ts"). It involves parallel circulations where deoxygenated blood is pumped directly back to the body, causing profound early cyanosis. * **PDA with Pulmonary Hypertension:** While a simple PDA is acyanotic (left-to-right shunt), severe pulmonary hypertension can reverse the shunt (right-to-left), leading to **differential cyanosis** (cyanosis in the lower limbs but not the upper limbs). This is known as Eisenmenger syndrome. * **Ebstein’s Anomaly:** This involves the downward displacement of the tricuspid valve. It often presents with an atrial septal defect (ASD) and massive right-sided heart failure, leading to a right-to-left shunt and cyanosis. **NEET-PG High-Yield Pearls:** * **CoA Hallmark:** "Radio-femoral delay" and rib notching (3rd–8th ribs) on X-ray. * **Differential Cyanosis:** Pathognomonic for PDA with reversal of shunt (Eisenmenger’s). * **Reverse Differential Cyanosis:** Seen in TGA with PDA and Pre-ductal CoA. * **Ebstein’s Anomaly:** Associated with maternal **Lithium** intake and "Box-shaped" heart on X-ray.

Q: Which of the following is included in the modified Jones criteria for the diagnosis of acute rheumatic fever?

Erythema Marginatum. Acute Rheumatic Fever (ARF) is a multisystem inflammatory disease following a Group A Streptococcal (GAS) pharyngitis. The diagnosis is clinical, based on the **Modified Jones Criteria** (revised by AHA in 2015). Even in established rheumatic heart disease, diagnosis requires evidence of preceding GAS infection [1]. **Why Erythema Marginatum is Correct:** Erythema Marginatum is one of the **five Major Criteria** for ARF. It is a distinctive, evanescent, non-pruritic, pink erythematous rash with pale centers and rounded/serpiginous margins, typically found on the trunk and proximal extremities (never the face). **Analysis of Incorrect Options:** * **A. Oral Ulcers:** These are characteristic of Systemic Lupus Erythematosus (SLE) or Behçet’s disease, not ARF. * **B. Malar Rash:** This "butterfly rash" is a classic feature of SLE [2]. In contrast, ARF does not typically involve facial rashes. * **D. Nail Telangiectasia:** These are vascular changes seen in connective tissue diseases like Dermatomyositis or Scleroderma. **High-Yield Clinical Pearls for NEET-PG:** * **Jones Criteria Mnemonic (Major):** **J♥NES** * **J** - Joints (Migratory Polyarthritis) * **♥** - Carditis (Pancarditis; Valvulitis is most common) [1] * **N** - Nodules (Subcutaneous) * **E** - Erythema Marginatum * **S** - Sydenham Chorea (St. Vitus Dance) * **Minor Criteria:** Fever, Polyarthralgia, prolonged PR interval, and elevated ESR/CRP. * **Requirement:** 2 Major OR 1 Major + 2 Minor criteria, **PLUS** evidence of preceding GAS infection (ASO titer or Positive Throat Culture) [1]. * **Exception:** Chorea or indolent carditis can be diagnostic of ARF without meeting other criteria or proving prior infection [1].

Q: What is the most common congenital heart disease associated with Edward's syndrome?

Ventricular Septal Defect. **Explanation:** **Edward’s Syndrome (Trisomy 18)** is the second most common autosomal trisomy after Down syndrome. Congenital Heart Disease (CHD) is present in over 90% of these patients and is a major contributor to high neonatal mortality. **Why Ventricular Septal Defect (VSD) is correct:** **Ventricular Septal Defect (VSD)** is the most common cardiac anomaly associated with Edward’s syndrome. It typically presents as a large perimembranous or muscular defect. While multiple defects often coexist in these patients, VSD remains the most frequent finding in clinical and pathological studies. **Analysis of Incorrect Options:** * **A. Atrial Septal Defect (ASD):** While ASDs (specifically ostium secundum) are common in Trisomy 18, they occur less frequently than VSDs. * **C. Patent Ductus Arteriosus (PDA):** PDA is frequently seen in Edward’s syndrome, often in combination with VSD or ASD, but it is not the primary or most common lesion. * **D. Tetralogy of Fallot (TOF):** TOF is more classically associated with **DiGeorge Syndrome** (22q11 deletion) and Down syndrome, though it can occasionally occur in Trisomy 18. **High-Yield Clinical Pearls for NEET-PG:** * **Trisomy 18 (Edward’s) Mnemonic:** Remember **"E"** for **E**ighteen and **E**dward’s. * **Key Features:** Clenched fists with overlapping fingers (2nd and 5th digits over 3rd and 4th), Rocker-bottom feet, Micrognathia, and low-set malformed ears. * **Comparison:** * **Down Syndrome (Trisomy 21):** Most common CHD is **Atrioventricular Septal Defect (AVSD)** / Endocardial Cushion Defect. * **Patau Syndrome (Trisomy 13):** Most common CHD is **VSD** (similar to Edward's), but often associated with Dextrocardia. * **Turner Syndrome:** Most common is **Bicuspid Aortic Valve** (overall) and **Coarctation of Aorta**.

Question 1

A 2-month-old child, born prematurely, presents with respiratory distress. Cardiac examination reveals increased pulse pressure and a pansystolic murmur best heard in the 2nd left intercostal space. What is the most probable diagnosis?

Accepted Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Answer

Ventricular septal defect

Answer

Tetralogy of Fallot

Question 2

All of the following are cyanotic heart diseases, EXCEPT?

Accepted Answer

Patent Ductus Arteriosus (PDA)

Answer

Tetralogy of Fallot (TOF)

Answer

Tricuspid Atresia

Answer

Eisenmenger's complex

Question 3

Which of the following conditions is typically not seen in adults?

Accepted Answer

Kawasaki disease

Answer

Henoch-Schönlein purpura

Answer

Susac syndrome

Answer

Takayasu arteritis

Question 4

A 2-year-old known case of Rheumatic Heart Disease presents with a 3-week history of fever, hematuria, and palpitations. What is the most likely diagnosis?

Accepted Answer

Staphylococcal endocarditis

Answer

Streptococcal endocarditis

Answer

Collagen vascular disease

Answer

Reactivation

Question 5

Cyanosis is NOT present in which of the following conditions?

Accepted Answer

Coarctation of the aorta (COA)

Answer

Transposition of the great arteries (TGA)

Answer

Patent ductus arteriosus (PDA) with pulmonary hypertension

Answer

Ebstein's anomaly

Question 6

A newborn male, normal at birth, started developing cyanosis. On auscultation, a continuous murmur was audible. The child was put on supplemental oxygen but no improvement was noted; rather, the oxygen saturation of the neonate kept falling further. The pediatrician on call made a provisional diagnosis of a duct-dependent lesion. What is the next line of management?

Accepted Answer

Administer PGE1

Answer

Administer prostaglandin inhibitor

Answer

Administer PGG2

Answer

Take the baby to the OR immediately for surgical management of the defect

Question 7

Which of the following is included in the modified Jones criteria for the diagnosis of acute rheumatic fever?

Accepted Answer

Erythema Marginatum

Answer

Oral ulcer

Answer

Malar rash

Answer

Nail telangiectasia

Question 8

Essential criteria for Tetralogy of Fallot includes all, EXCEPT:

Accepted Answer

Valvular stenosis

Answer

Infundibular stenosis

Answer

Overriding of aorta

Answer

Right ventricular hypertrophy

Question 9

What is the most common congenital heart disease associated with Edward's syndrome?

Accepted Answer

Ventricular Septal Defect

Answer

Atrial Septal Defect

Answer

Patent Ductus arteriosus

Answer

Tetralogy of Fallot

Question 10

An infant presents with a double aortic arch. What is the likely diagnosis?

Accepted Answer

Congenital anomalies of the heart and great vessels (CATCH 22)

Answer

DiGeorge syndrome

Answer

Velo-cardio-facial syndrome

Answer

All of the above

Cardiology — MCQs

Cardiology — MCQs

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