Cardiology Practice Questions

Q: Which of the following manifestations of rheumatic fever disappears completely?

Arthritis. **Explanation:** The correct answer is **Arthritis**. In Acute Rheumatic Fever (ARF), the arthritis is typically a **migratory polyarthritis** involving large joints (knees, ankles, elbows, wrists). The hallmark of this manifestation is that it is **exquisitely responsive to salicylates** and, most importantly, it **leaves no residual deformity**. It resolves completely within weeks, making it the most transient major manifestation. **Analysis of Options:** * **Carditis (Option A):** This is the most serious manifestation and the only one that can lead to **permanent chronic damage**, specifically Rheumatic Heart Disease (RHD). It can result in lifelong valvular scarring (most commonly the mitral valve). * **Chorea (Option B):** Sydenham’s chorea (St. Vitus dance) is a delayed manifestation. While it usually resolves, it can persist for several months and may occasionally recur. It does not leave "permanent" damage like carditis, but arthritis is the classic textbook answer for "disappearing completely" without sequelae. * **Subcutaneous Nodules (Option D):** These are firm, painless nodules over bony prominences. While they eventually disappear, they are strongly associated with severe carditis and are not the defining "reversible" feature compared to the dramatic resolution of arthritis. **High-Yield Clinical Pearls for NEET-PG:** * **Jones Criteria:** Arthritis is the most common major manifestation, while Carditis is the most specific/serious. * **Salicylate Response:** If a patient suspected of ARF does not show dramatic improvement in joint pain within 48–72 hours of starting Aspirin, the diagnosis of ARF should be reconsidered. * **Jaccoud Arthropathy:** A rare, non-erosive chronic joint deformity that can occur after repeated episodes of ARF, but the standard teaching remains that rheumatic arthritis is non-deforming.

Q: What is the characteristic murmur differentiating Patent Ductus Arteriosus (PDA) from Atrial Septal Defect (ASD)?

Continuous murmur in PDA. **Explanation:** The hallmark of **Patent Ductus Arteriosus (PDA)** is a **continuous machinery-type murmur**, best heard at the left infraclavicular area. This occurs because the pressure in the aorta remains higher than the pressure in the pulmonary artery during both systole and diastole, resulting in a continuous left-to-right shunt. In contrast, an **Atrial Septal Defect (ASD)** typically presents with a **midsystolic flow murmur** (due to increased flow across the pulmonary valve) and a characteristic **fixed, wide splitting of S2**. **Analysis of Options:** * **Option D (Correct):** The continuous nature of the murmur is the pathognomonic clinical feature that distinguishes PDA from most other simple congenital heart defects like ASD or VSD. * **Option A & B (Incorrect):** A wide split of S2 and delayed P2 are classic findings in **ASD**, not PDA. In PDA, the S2 is often obscured by the loud continuous murmur, or there may be "paradoxical splitting" if the shunt is large enough to delay aortic closure. * **Option C (Incorrect):** Accentuation of S1 is typically associated with Mitral Stenosis. In ASD, the S1 is usually normal or split, but not specifically "accentuated" as a differentiating feature from PDA. **High-Yield Clinical Pearls for NEET-PG:** * **PDA Murmur:** Also known as **Gibson’s murmur**. * **ASD S2:** The "Fixed Wide Split S2" in ASD occurs because the respiratory variations in venous return are equalized between the two atria. * **Management:** Indomethacin or Ibuprofen (NSAIDs) are used to close a PDA in preterms; Prostaglandin E1 (Alprostadil) is used to keep it open in duct-dependent lesions. * **Pulse:** PDA is associated with a **bounding pulse** and wide pulse pressure due to diastolic runoff into the pulmonary artery.

Q: What is the most frequent chromosomal abnormality found in individuals with congenital heart defects?

Trisomy 21. **Explanation:** **Trisomy 21 (Down Syndrome)** is the most common chromosomal abnormality associated with congenital heart defects (CHD). Approximately **40–50%** of children with Down Syndrome are born with a cardiac malformation. The most characteristic lesion is the **Atrioventricular Septal Defect (AVSD)**, specifically the endocardial cushion defect. Due to the high prevalence of Down Syndrome in the general population compared to other trisomies, it remains the leading genetic contributor to CHD. **Analysis of Incorrect Options:** * **Trisomy 13 (Patau Syndrome):** While ~80% of these infants have CHD (most commonly VSD, ASD, or PDA), the condition is much rarer and associated with high neonatal mortality, making it less frequent overall than Trisomy 21. * **Trisomy 18 (Edwards Syndrome):** Similar to Trisomy 13, over 90% have CHD (typically VSD or Polyvalvular disease), but the low live-birth prevalence makes it a less frequent cause than Trisomy 21. * **Monosomy X (Turner Syndrome):** Associated with CHD in about 25–30% of cases. The classic lesion is **Bicuspid Aortic Valve** (most common) or **Coarctation of the Aorta**. **High-Yield Clinical Pearls for NEET-PG:** * **Most common CHD in Down Syndrome:** AVSD (Endocardial cushion defect). * **Most common CHD in Turner Syndrome:** Bicuspid Aortic Valve (Note: Coarctation is the most common *obstructive* lesion). * **Noonan Syndrome:** Associated with **Pulmonary Stenosis** and Hypertrophic Cardiomyopathy. * **DiGeorge Syndrome (22q11.2 deletion):** Associated with Conotruncal anomalies (Truncus Arteriosus, Tetralogy of Fallot). * **Williams Syndrome:** Associated with **Supravalvular Aortic Stenosis**.

Q: Which congenital heart disease is associated with decreased pulmonary blood flow?

Ebstein's anomaly. **Explanation:** Congenital Heart Diseases (CHD) are broadly classified into cyanotic and acyanotic types. Cyanotic CHDs are further subdivided based on pulmonary blood flow (PBF). **Why Ebstein’s Anomaly is Correct:** Ebstein’s anomaly is characterized by the downward displacement of the tricuspid valve leaflets into the right ventricle, leading to "atrialization" of the right ventricle. This results in a very small functional right ventricle and significant tricuspid regurgitation. Consequently, the right heart fails to pump adequate blood into the pulmonary artery, leading to **decreased pulmonary blood flow**. It is a classic example of cyanotic CHD with decreased PBF (along with Tetralogy of Fallot and Tricuspid Atresia). **Why Other Options are Incorrect:** * **Truncus Arteriosus:** A single large vessel arises from both ventricles, supplying both systemic and pulmonary circulations. This leads to **increased pulmonary blood flow** due to the low resistance in the pulmonary vascular bed. * **TAPVC:** All pulmonary veins drain into the right atrium instead of the left. This creates a massive left-to-right shunt, resulting in **increased pulmonary blood flow**. * **Complete TGA:** The aorta arises from the right ventricle and the pulmonary artery from the left. While there is "parallel circulation," the pulmonary circuit typically receives **increased blood flow** unless there is associated pulmonary stenosis. **High-Yield Clinical Pearls for NEET-PG:** * **Ebstein’s Anomaly:** Associated with maternal **Lithium** intake. Look for "Box-shaped" heart on X-ray and "multiple clicks" on auscultation. * **Increased PBF Cyanotic CHD (The 3 Ts):** **T**ransposition of Great Arteries, **T**otal Anomalous Pulmonary Venous Connection, **T**runcus Arteriosus. * **Decreased PBF Cyanotic CHD:** **T**etralogy of Fallot, **T**ricuspid Atresia, **E**bstein’s Anomaly.

Q: A 16-year-old male presents for a physical examination before joining a football team. His elder brother died suddenly during football practice. The patient has a loud systolic murmur on chest auscultation. Which of the following findings would NOT be consistent with hypertrophic cardiomyopathy?

Murmur radiating to the neck. **Explanation:** Hypertrophic Cardiomyopathy (HCM) is a common cause of sudden cardiac death in young athletes. The murmur in HCM is caused by dynamic Left Ventricular Outflow Tract (LVOT) obstruction. **Why Option B is the Correct Answer:** Radiation of a systolic murmur to the neck (carotids) is a classic feature of **Valvular Aortic Stenosis (AS)**. In HCM, the obstruction occurs below the valve (sub-valvular); therefore, the murmur typically radiates to the lower left sternal border or the apex, but **not** to the carotids. **Analysis of Incorrect Options:** * **Option A (Crescendo-decrescendo systolic murmur):** This is the characteristic sound of HCM. It is caused by the systolic anterior motion (SAM) of the mitral valve hitting the hypertrophied septum, creating turbulence. * **Option C (Brisk carotid upstroke):** In HCM, the initial ejection of blood is rapid, leading to a brisk or "jerky" pulse (often called a *pulsus bisferiens*). This contrasts with the *pulsus parvus et tardus* (weak and late) seen in valvular AS. * **Option D (Increase with Valsalva/Standing):** These maneuvers decrease venous return (preload). In HCM, a smaller ventricular volume allows the septum and mitral valve to come closer together, worsening the obstruction and **increasing** the murmur intensity. **NEET-PG High-Yield Pearls:** * **Dynamic Murmur:** HCM and MVP are the only two murmurs that **increase** with Valsalva and Standing (decreased preload). * **Handgrip/Squatting:** These increase afterload/preload, which increases LV volume and **decreases** the HCM murmur. * **Inheritance:** Autosomal Dominant, most commonly involving mutations in the **Beta-myosin heavy chain** or Myosin-binding protein C. * **Drug of Choice:** Beta-blockers (to increase diastolic filling time). Avoid Digoxin and Diuretics.

Q: Wide split S2 occurs in which of the following conditions?

Atrial septal defect (ASD). ### Explanation The second heart sound (S2) is produced by the closure of the semilunar valves (Aortic - A2 and Pulmonary - P2). A **wide split S2** occurs when there is a delay in the closure of the pulmonary valve (P2) or early closure of the aortic valve (A2). **Why ASD is the correct answer:** In **Atrial Septal Defect (ASD)**, there is a left-to-right shunt, which increases the blood volume in the right atrium and right ventricle. This chronic volume overload leads to prolonged ejection time from the right ventricle, delaying the closure of the pulmonary valve (P2). Notably, ASD is characterized by a **"Wide and Fixed" split S2**, because the respiratory variations in venous return are balanced by reciprocal changes in the shunt volume, keeping the split interval constant. **Analysis of Incorrect Options:** * **Ventricular Septal Defect (VSD):** While a large VSD can cause a wide split S2 due to increased RV stroke volume, it is typically **variable** (changes with respiration), unlike the classic fixed split of ASD. * **Mitral Stenosis:** This condition usually presents with a loud S1 and an **Opening Snap**. It does not typically cause a wide split S2; in fact, if pulmonary hypertension develops, S2 may become narrowly split or single but loud (P2). * **Coarctation of the Aorta:** This is a left-sided obstructive lesion. It does not delay P2 and therefore does not cause a wide split S2. **High-Yield Clinical Pearls for NEET-PG:** * **Fixed Wide Split S2:** Pathognomonic for ASD. * **Reverse (Paradoxical) Split S2:** Seen in conditions that delay A2 (e.g., Left Bundle Branch Block, Aortic Stenosis). The split narrows during inspiration. * **Narrow Split S2:** Seen in Pulmonary Hypertension (due to early P2 closure from high back pressure). * **Soft/Absent P2:** Seen in Tetralogy of Fallot (TOF) or severe Pulmonary Stenosis.

Question 1

A 25-year-old male diagnosed with Atrial Septal Defect (ASD) presents with a murmur similar to Mitral Regurgitation (MR) on examination and an ECG showing left axis deviation of 40 degrees. What is the most likely underlying condition?

Accepted Answer

Floppy Mitral Valve

Answer

Transposition of the Great Arteries (TGA)

Answer

Ostium Secundum Atrial Septal Defect

Answer

Ostium Primum Atrial Septal Defect

Question 2

Which of the following manifestations of rheumatic fever disappears completely?

Accepted Answer

Arthritis

Answer

Carditis

Answer

Chorea

Answer

Subcutaneous nodules

Question 3

What is the characteristic murmur differentiating Patent Ductus Arteriosus (PDA) from Atrial Septal Defect (ASD)?

Accepted Answer

Continuous murmur in PDA

Answer

Delayed P2 in PDA

Answer

Wide split of S2 in PDA

Answer

Accentuation of S1 in ASD

Question 4

What is the most frequent chromosomal abnormality found in individuals with congenital heart defects?

Accepted Answer

Trisomy 21

Answer

Trisomy 13

Answer

Trisomy 18

Answer

Monosomy X

Question 5

What is the emergency treatment for Transposition of the Great Vessels (TGV)?

Accepted Answer

Balloon septostomy

Answer

Oxygen

Answer

Ventilation

Answer

Digoxin

Question 6

Which congenital heart disease is associated with decreased pulmonary blood flow?

Accepted Answer

Ebstein's anomaly

Answer

Truncus arteriosus

Answer

Total anomalous pulmonary venous connection (TAPVC)

Answer

Complete transposition of the great arteries (TGA)

Question 7

A 16-year-old male presents for a physical examination before joining a football team. His elder brother died suddenly during football practice. The patient has a loud systolic murmur on chest auscultation. Which of the following findings would NOT be consistent with hypertrophic cardiomyopathy?

Accepted Answer

Murmur radiating to the neck

Answer

A crescendo-decrescendo systolic murmur

Answer

Brisk carotid upstroke

Answer

Increase in murmur intensity during Valsalva maneuver or standing

Question 8

All of the following statements about Kawasaki disease are true except?

Accepted Answer

Coronary artery aneurysm is seen in 25% of patients.

Answer

It is the most common immune-mediated vasculitis in children.

Answer

Intravenous immunoglobulin is indicated only in patients with coronary artery aneurysms.

Answer

Skin, mucus membranes, and lymph nodes are involved.

Question 9

Wide split S2 occurs in which of the following conditions?

Accepted Answer

Atrial septal defect (ASD)

Answer

Ventricular septal defect (VSD)

Answer

Mitral stenosis

Answer

Coarctation of the aorta

Question 10

The severity of cyanosis in Fallot's tetralogy physiology is best determined by which factor?

Accepted Answer

Degree of pulmonary stenosis

Answer

Size of the ventricular septal defect (VSD)

Answer

Degree of aortic overriding

Answer

Degree of right ventricular hypertrophy (RVH)

Cardiology — MCQs

Cardiology — MCQs

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