Cardiology Practice Questions

Q: Which of the following can cause recurrent pulmonary infection?

Tetralogy of Fallot (TOF). The correct answer is **Tetralogy of Fallot (TOF)**. While this question appears to be a clinical cardiology query, it is frequently categorized under Neuroanatomy/Embryology in NEET-PG due to the developmental origins of the heart and the associated complications involving the central nervous system. **Why TOF is the correct answer:** Tetralogy of Fallot is a **cyanotic** heart disease characterized by a right-to-left shunt. In TOF, blood bypasses the pulmonary circulation (where it is normally filtered by the pulmonary capillary bed). This allows bacteria and septic emboli from the systemic circulation to enter the arterial system directly. These emboli often lodge in the brain, leading to **Brain Abscesses**. Clinically, these patients present with "recurrent pulmonary infections" (often misdiagnosed) or chronic hypoxia leading to polycythemia, which increases blood viscosity and further predisposes them to cerebral infarction and subsequent infection. **Analysis of Incorrect Options:** * **VSD and ASD:** These are typically **acyanotic** (left-to-right shunt) conditions. While they cause increased pulmonary blood flow (leading to frequent lower respiratory tract infections), they do not bypass the pulmonary filter, making brain abscesses or systemic embolic infections much less common compared to TOF. * **Recurrent LVF:** This leads to pulmonary edema and congestive changes but does not provide a structural mechanism for right-to-left shunting of septic emboli. **NEET-PG High-Yield Pearls:** * **Most common cause of Brain Abscess in children:** Cyanotic Heart Disease (specifically TOF). * **The "Filter" Concept:** The lungs act as a physiological filter for venous bacteria; any right-to-left shunt (TOF, Eisenmenger syndrome) bypasses this, increasing the risk of CNS infections. * **TOF Components:** Pulmonary stenosis, Right ventricular hypertrophy, Overriding of aorta, and VSD.

Q: Peripheral pulmonic stenosis may be seen in all of the following conditions EXCEPT:

Cytomegalovirus (CMV) infection. **Explanation:** Peripheral Pulmonic Stenosis (PPS) refers to the narrowing of the pulmonary artery branches. It is a classic finding in specific genetic and infectious syndromes, but it is **not** associated with Cytomegalovirus (CMV) infection. **Why Option D is Correct:** While **Congenital CMV** is the most common intrauterine infection, its primary clinical manifestations are neurological and systemic (e.g., microcephaly, periventricular calcifications, sensorineural hearing loss, and petechiae). Unlike Rubella, CMV does not typically cause structural cardiac defects like PPS. **Why the Other Options are Incorrect:** * **Williams Syndrome (Option A):** Caused by a microdeletion on chromosome 7q11.23 (elastin gene). It is characteristically associated with **Supravalvular Aortic Stenosis** and peripheral pulmonic stenosis. * **Alagille Syndrome (Option B):** An autosomal dominant disorder (JAG1 mutation) characterized by paucity of interlobular bile ducts. PPS is the most common cardiovascular manifestation (seen in ~70% of cases), often occurring alongside Tetralogy of Fallot. * **Congenital Rubella Syndrome (Option C):** Classically presents with the triad of Cataracts, Sensorineural deafness, and Cardiac defects. The most common cardiac lesions are **Patent Ductus Arteriosus (PDA)** and peripheral pulmonic stenosis. **High-Yield Clinical Pearls for NEET-PG:** * **Williams Syndrome:** Look for "Elfin facies," hypercalcemia, and an outgoing "cocktail party" personality. * **Alagille Syndrome:** Look for "butterfly vertebrae," posterior embryotoxon in the eye, and cholestatic jaundice. * **Auscultation:** PPS presents as a systolic ejection murmur heard best at the upper left sternal border, radiating to the axilla and back. * **CMV vs. Rubella:** Remember—**R**ubella causes **R**ight-sided/Arterial lesions (PPS, PDA), while **C**MV causes **C**alcifications (Periventricular).

Q: Truncus arteriosus is most commonly associated with which of the following conditions?

DiGeorge Syndrome. **Explanation:** **Truncus Arteriosus** is a cyanotic congenital heart disease where a single great vessel fails to divide into the aorta and pulmonary artery due to the failure of the **conotruncal ridges** to fuse. This developmental process is heavily dependent on **neural crest cell migration**. **Why DiGeorge Syndrome is correct:** DiGeorge Syndrome (22q11.2 deletion syndrome) is characterized by the defective development of the 3rd and 4th pharyngeal pouches. Since neural crest cells contribute to both the pharyngeal pouches and the cardiac outflow tract, there is a strong association. Approximately **30-35%** of patients with Truncus Arteriosus have DiGeorge Syndrome. Conversely, Truncus Arteriosus is the most specific cardiac defect associated with this syndrome (along with Interrupted Aortic Arch Type B). **Why other options are incorrect:** * **Turner’s Syndrome (45, XO):** Most commonly associated with **Bicuspid Aortic Valve** (most common) and **Coarctation of the Aorta** (pre-ductal). * **Down’s Syndrome (Trisomy 21):** Most commonly associated with **Endocardial Cushion Defects** (Atrioventricular Septal Defects/AVSD). * **Klinefelter’s Syndrome (47, XXY):** Not typically associated with specific structural congenital heart defects; it is primarily a primary hypogonadism disorder. **High-Yield Clinical Pearls for NEET-PG:** * **CATCH-22 Mnemonic for DiGeorge:** **C**ardiac defects (Truncus), **A**bnormal facies, **T**hymic hypoplasia (T-cell deficiency), **C**left palate, **H**ypocalcemia (due to parathyroid hypoplasia). * **Chest X-ray:** Truncus arteriosus often presents with a "sitting duck" appearance or a right-sided aortic arch (seen in 25% of cases). * **Treatment:** Early surgical repair is mandatory to prevent irreversible pulmonary hypertension.

Q: Right axis deviation is seen in all of the following conditions except?

Tricuspid atresia. **Explanation:** The key to answering this question lies in understanding the hemodynamic consequences of congenital heart defects on ventricular dominance. **Why Tricuspid Atresia is the Correct Answer:** In **Tricuspid Atresia**, there is no communication between the right atrium and the right ventricle. This leads to an obligatory right-to-left shunt (via an ASD) and a hypoplastic right ventricle. Consequently, the left ventricle handles the entire systemic and pulmonary venous return, leading to **Left Ventricular Hypertrophy (LVH)**. On an ECG, this manifests as **Left Axis Deviation (LAD)**. In a cyanotic neonate, the presence of LAD is a classic, high-yield diagnostic hallmark for Tricuspid Atresia. **Analysis of Incorrect Options:** * **Ventricular Septal Defect (VSD):** Large VSDs cause left-to-right shunting, leading to pulmonary hypertension and eventual right ventricular hypertrophy (RVH), which results in **Right Axis Deviation (RAD)**. * **Pulmonary Atresia:** This condition causes significant pressure overload on the right side of the heart (unless the septum is intact and the RV is hypoplastic), typically leading to **RAD**. * **Atrial Septal Defect (ASD):** ASDs cause a volume overload of the right ventricle, leading to RVH and a characteristic **RAD** with an RSR' pattern in V1 (incomplete RBBB). **NEET-PG High-Yield Pearls:** 1. **Cyanotic Heart Disease + LAD:** Think **Tricuspid Atresia** or **AV Canal Defect (ECD)**. 2. **Cyanotic Heart Disease + RAD:** Think **Tetralogy of Fallot (TOF)** or **Transposition of the Great Arteries (TGA)**. 3. **ASD ECG Triad:** RAD, Right Bundle Branch Block (RBBB), and Right Ventricular Hypertrophy.

Q: Which congenital cyanotic heart disease is characterized by Left Ventricular hypertrophy and Left atrial enlargement?

Tricuspid atresia. **Explanation:** **Tricuspid Atresia** is the correct answer because it is the only common cyanotic congenital heart disease (CCHD) characterized by **Left Axis Deviation (LAD)** and **Left Ventricular Hypertrophy (LVH)** on ECG. 1. **Why it is correct:** In Tricuspid Atresia, there is no communication between the right atrium and right ventricle. Blood must flow through an ASD/Patent Foramen Ovale to the left atrium (causing **LA enlargement**) and then into the left ventricle. Since the left ventricle handles the entire systemic and pulmonary venous return, it undergoes compensatory **hypertrophy**. The right ventricle is typically hypoplastic, leading to the classic "Left Axis Deviation" on ECG—a high-yield finding for NEET-PG. 2. **Why incorrect options are wrong:** * **Coarctation of Aorta:** This is an acyanotic heart disease. While it causes LVH due to increased afterload, it does not typically present with cyanosis in the neonatal period unless associated with other complex shunts. * **Ebstein’s Anomaly:** Characterized by "giant" right atrium and right ventricular dysfunction. The ECG typically shows Right Bundle Branch Block (RBBB) and tall "Himalayan" P waves, not LVH. * **Transposition of Great Arteries (TGA):** Typically presents with Right Ventricular Hypertrophy (RVH) and right axis deviation because the RV acts as the systemic pump. **High-Yield Clinical Pearls for NEET-PG:** * **The "Left Axis" Rule:** If a cyanotic neonate has Left Axis Deviation on ECG, the diagnosis is **Tricuspid Atresia** until proven otherwise. * **Chest X-ray:** Shows a "sitting duck" or "boot-shaped" heart (due to RV hypoplasia) with oligemic lung fields. * **Associated Defect:** A VSD or PDA is necessary for pulmonary blood flow and survival.

Q: Which of the following is a FALSE feature regarding Atrial Septal Defect (ASD)?

Murmur presents early in the course of disease.. **Explanation:** In Atrial Septal Defect (ASD), the pressure gradient between the left and right atria is minimal. Consequently, the blood flow across the defect is laminar and does not produce a "shunt murmur." This is a critical distinction from Ventricular Septal Defect (VSD), where high-pressure gradients produce early murmurs. **Why Option B is the Correct (False) Statement:** The murmur in ASD is **not** due to the shunt itself, but due to the increased volume of blood passing through the valves. It takes time for the right ventricle to become compliant enough to handle the large volume load. Therefore, the characteristic murmurs of ASD (Ejection Systolic Murmur and Mid-diastolic Murmur) typically appear **later in childhood**, usually after 2–3 years of age, rather than early in the neonatal period. **Analysis of Other Options:** * **Option A (True):** Increased pulmonary blood flow (pulmonary plethora) leads to structural changes in pulmonary vasculature, eventually causing pulmonary hypertension (though this usually takes decades in ASD). * **Option C (True):** The increased blood flow across the **Tricuspid valve** (relative tricuspid stenosis) creates a low-pitched **mid-diastolic murmur**, best heard at the lower left sternal border. * **Option D (True):** As mentioned, the pressure difference between atria is too low to generate a murmur; thus, a "shunt murmur" is absent. **High-Yield Clinical Pearls for NEET-PG:** * **Characteristic Sign:** Wide, fixed split S2 (due to delayed closure of the pulmonary valve). * **Most Common Type:** Ostium Secundum (75%). * **ECG Findings:** Right axis deviation and RSR' pattern in V1 (incomplete RBBB). * **Ejection Systolic Murmur (ESM):** Heard in the pulmonary area due to increased flow across the pulmonary valve (relative pulmonary stenosis).

Q: A 9-month-old infant accidentally ingests an unknown quantity of digitalis. What is the most important noncardiac manifestation of toxicity in this infant?

Vomiting. **Explanation:** **Digitalis (Digoxin) toxicity** is a high-yield topic in pediatric cardiology. In infants and children, the clinical presentation differs slightly from adults, making it crucial to distinguish between cardiac and noncardiac signs. **1. Why Vomiting is the Correct Answer:** **Vomiting** is the most common and often the earliest **noncardiac** manifestation of digitalis toxicity in infants. It occurs due to the direct stimulation of the **Chemoreceptor Trigger Zone (CTZ)** in the area postrema of the medulla. Other common gastrointestinal symptoms include nausea and anorexia. In an infant, poor feeding is a frequent surrogate for these symptoms. **2. Analysis of Incorrect Options:** * **Fever (A):** Digitalis toxicity does not typically cause fever. It is more likely to cause neurological or gastrointestinal symptoms. * **Dizziness (B):** While dizziness can occur in older children or adults, it is difficult to assess in a 9-month-old infant and is not the primary diagnostic sign. * **Visual disturbances (D):** Classic "yellow-green halos" (xanthopsia) are a hallmark of digoxin toxicity in **adults**. However, these are nearly impossible to document in infants and are rarely the presenting feature in this age group. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most Common Cardiac Manifestation:** In children, the most common cardiac sign is **sinus bradycardia** or **prolonged PR interval**. In adults, ventricular ectopy is more common. * **Electrolyte Interaction:** **Hypokalemia**, hypomagnesemia, and hypercalcemia predispose a patient to digoxin toxicity. * **ECG Changes:** Look for the "reverse tick" or "scooped" ST-segment depression (Digoxin effect). * **Management:** The definitive treatment for severe toxicity (arrhythmias or hyperkalemia) is **Digoxin-specific Fab fragments (Digibind).**

Q: A cyanotic newborn is suspected of having congenital heart disease. The newborn has an increased left ventricular impulse and a holosystolic murmur along the left sternal border. The ECG shows left-axis deviation and left ventricular hypertrophy (LVH). Which of the following is the most likely diagnosis?

Tricuspid atresia. **Explanation:** The clinical presentation of a cyanotic newborn with **Left Axis Deviation (LAD)** and **Left Ventricular Hypertrophy (LVH)** on ECG is a classic "spotter" for **Tricuspid Atresia**. **Why Tricuspid Atresia is correct:** In Tricuspid Atresia, there is no communication between the right atrium and right ventricle. Systemic venous return must pass through an ASD/PFO to the left atrium and then into a dominant left ventricle. This leads to: 1. **LVH:** The left ventricle handles both systemic and pulmonary venous return. 2. **LAD:** Due to the hypoplastic right ventricle and structural conduction changes, the QRS axis shifts to the left (usually -30° to -90°). 3. **Holosystolic Murmur:** Usually represents a VSD, which is necessary for blood to reach the pulmonary circulation. **Why other options are incorrect:** * **Transposition of the Great Arteries (TGA):** Typically presents with Right Axis Deviation (RAD) and RVH. The "egg-on-a-string" appearance is seen on X-ray. * **Truncus Arteriosus:** Usually presents with increased pulmonary blood flow and biventricular hypertrophy, but the axis is typically normal or rightward. * **Tetralogy of Fallot (TOF):** The most common cyanotic heart disease, but it characteristically shows **RAD and RVH** due to right ventricular outflow obstruction and a boot-shaped heart. **High-Yield Clinical Pearls for NEET-PG:** * **Cyanotic Heart Disease + LAD =** Tricuspid Atresia (most common) or AV Canal Defect. * **ECG in Cyanotic Newborns:** Most cyanotic lesions (TOF, TGA, TAPVC) cause RAD/RVH because the right heart is under pressure. Tricuspid Atresia is the notable exception. * **X-ray finding:** Tricuspid atresia often shows a "wall-to-wall" heart or decreased pulmonary vascular markings.

Question 1

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

Question 2

Which of the following can cause recurrent pulmonary infection?

Accepted Answer

Tetralogy of Fallot (TOF)

Answer

Ventricular Septal Defect (VSD)

Answer

Recurrent Left Ventricular Failure (LVF)

Answer

Atrial Septal Defect (ASD)

Question 3

Peripheral pulmonic stenosis may be seen in all of the following conditions EXCEPT:

Accepted Answer

Cytomegalovirus (CMV) infection

Answer

Williams syndrome

Answer

Alagille syndrome

Answer

Rubella syndrome

Question 4

Truncus arteriosus is most commonly associated with which of the following conditions?

Accepted Answer

DiGeorge Syndrome

Answer

Turner's syndrome

Answer

Klinefelter's syndrome

Answer

Down's syndrome

Question 5

Right axis deviation is seen in all of the following conditions except?

Accepted Answer

Tricuspid atresia

Answer

Ventricular septal defect (VSD)

Answer

Pulmonary atresia

Answer

Atrial septal defect (ASD)

Question 6

Which congenital cyanotic heart disease is characterized by Left Ventricular hypertrophy and Left atrial enlargement?

Accepted Answer

Tricuspid atresia

Answer

Coarctation of Aorta

Answer

Ebstein's anomaly

Answer

Transposition of great arteries

Question 7

Which of the following is a FALSE feature regarding Atrial Septal Defect (ASD)?

Accepted Answer

Murmur presents early in the course of disease.

Answer

Pulmonary plethora leads to pulmonary hypertension.

Answer

Flow murmur is present, leading to a mid-diastolic murmur.

Answer

Shunt murmur is absent.

Question 8

Which of the following is the most common sustained tachyarrhythmia in children?

Accepted Answer

Supraventricular tachycardia

Answer

Ventricular tachycardia

Answer

Atrial flutter

Answer

Atrial fibrillation

Question 9

A 9-month-old infant accidentally ingests an unknown quantity of digitalis. What is the most important noncardiac manifestation of toxicity in this infant?

Accepted Answer

Vomiting

Answer

Fever

Answer

Dizziness

Answer

Visual disturbances

Question 10

A cyanotic newborn is suspected of having congenital heart disease. The newborn has an increased left ventricular impulse and a holosystolic murmur along the left sternal border. The ECG shows left-axis deviation and left ventricular hypertrophy (LVH). Which of the following is the most likely diagnosis?

Accepted Answer

Tricuspid atresia

Answer

Transposition of the great arteries

Answer

Truncus arteriosus

Answer

Tetralogy of Fallot

Cardiology — MCQs

Cardiology — MCQs

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