Cardiology Practice Questions

Q: Which of the following is a component of Tetralogy of Fallot?

Ventricular Septal Defect (VSD). **Explanation:** Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. It is characterized by four classic anatomical components resulting from the **anterior and cephalad deviation of the infundibular (outflow tract) septum**. 1. **Why Option A is Correct:** **Ventricular Septal Defect (VSD)** is one of the four cardinal features. It is typically a large, non-restrictive malalignment defect located in the membranous septum. The other three components are **Right Ventricular Outflow Tract Obstruction (RVOTO)** (usually infundibular stenosis), **Overriding of the Aorta**, and **Right Ventricular Hypertrophy (RVH)**. 2. **Why Other Options are Incorrect:** * **Option B (Left Ventricular Hypertrophy):** In TOF, the right ventricle faces high pressure due to pulmonary stenosis and the systemic pressure transmitted through the VSD. This leads to **Right Ventricular Hypertrophy**, not left. The left ventricle is often normal or small in size. * **Option C (Left Axis Deviation):** Due to the dominance of the right ventricle, the ECG in TOF characteristically shows **Right Axis Deviation (RAD)** and RVH. Left Axis Deviation is a classic finding in Tricuspid Atresia or AV Canal Defects, making it a high-yield "negative" finding for TOF. **High-Yield Clinical Pearls for NEET-PG:** * **X-ray Finding:** "Boot-shaped heart" (Coeur en sabot) due to an upturned apex (RVH) and a concave pulmonary segment. * **Management:** Squatting increases systemic vascular resistance (SVR), reversing the right-to-left shunt and improving oxygenation during "Tet spells." * **Murmur:** The murmur in TOF is due to **pulmonary stenosis** (crescendo-decrescendo systolic ejection murmur), NOT the VSD. A softer murmur indicates a more severe spell.

Q: Turner syndrome is associated with which of the following?

Coarctation of the aorta. **Explanation:** **Turner Syndrome (45, XO)** is a common chromosomal abnormality in females characterized by short stature, webbed neck, and gonadal dysgenesis. **1. Why Coarctation of the Aorta is Correct:** Approximately 25–30% of patients with Turner syndrome have congenital heart defects. The most classic and frequently tested association is **Coarctation of the Aorta (pre-ductal)**, occurring in about 10–15% of cases. The underlying mechanism is related to lymphatic obstruction during fetal development, which alters hemodynamics and leads to narrowing of the aortic arch. Additionally, **Bicuspid Aortic Valve (BAV)** is the single most common cardiac anomaly (up to 30%) in these patients. **2. Analysis of Incorrect Options:** * **B. Aortic Dissection:** While patients with Turner syndrome are at a significantly increased risk for aortic dissection (due to hypertension and BAV), it is a *complication* or a late sequela rather than the primary congenital association. * **C. Aortic Regurgitation:** This may occur secondary to a Bicuspid Aortic Valve or aortic root dilation, but it is not the primary diagnostic association for the syndrome. * **D. Pulmonic Stenosis:** This is classically associated with **Noonan Syndrome** (often called "Male Turner" due to similar phenotypic features) rather than Turner syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cardiac anomaly:** Bicuspid Aortic Valve (BAV). * **Most classic/specific association:** Coarctation of the Aorta. * **Karyotype:** 45, XO is the most common; however, mosaicism (45,X/46,XX) can occur. * **Differentiating Noonan vs. Turner:** Noonan syndrome affects both sexes, features **Pulmonic Stenosis**, and usually has a normal karyotype. * **Screening:** All girls diagnosed with Turner syndrome must undergo an initial **Echocardiogram or Cardiac MRI** to screen for aortic root dilation.

Q: In a 5-year-old child, instead of the physiological splitting of the second heart sound (S2) which is expected only during inspiration, a wide and fixed split of S2 is heard during both inspiration and expiration. A wide fixed split of the second heart sound can be seen in all of the following EXCEPT?

Ventricular septal defect. ***Ventricular septal defect*** - In a **Ventricular septal defect (VSD)**, the split of S2 is **wide but mobile**, meaning it still intensifies during inspiration and narrows during expiration. - While VSD causes a delay in **pulmonary valve (P2)** closure due to increased right-sided volume, it does not equalize the pressure/volume between atria needed for a **fixed split**. *Atrial septal defect* - This is the classic cause of a **wide fixed split S2** because the left-to-right shunt equalizes volume between both atria during the entire respiratory cycle. - The constant volume overload in the right ventricle ensures that the **pulmonary component (P2)** is always delayed by the same amount, regardless of respiration. *Right bundle branch block* - **Right bundle branch block (RBBB)** causes a wide split of S2 because electrical activation of the right ventricle is delayed, resulting in a late **P2**. - Although it may vary slightly, it is a primary differential for **persistent splitting** that is often perceived as wide and relatively fixed in clinical practice. *Total anomalous pulmonary venous connection* - **TAPVC** results in all pulmonary veins draining into the right heart, creating a significant **right-sided volume overload**. - This hemodynamically mimics a large **atrial septal defect**, resulting in a **wide fixed split S2** because respiratory cycles do not significantly change the right ventricular filling.

Q: Which NSAID is most commonly used in Rheumatic fever?

Aspirin. **Explanation:** **Aspirin (Acetylsalicylic acid)** remains the drug of choice for the management of arthritis and carditis without cardiomegaly or heart failure in Acute Rheumatic Fever (ARF). The underlying medical concept is its potent anti-inflammatory action, which provides dramatic relief of joint pain and swelling, typically within 24–48 hours. In ARF, Aspirin is used at anti-inflammatory doses (75–100 mg/kg/day in children) rather than standard analgesic doses. **Analysis of Incorrect Options:** * **Indomethacin:** While a potent NSAID, it is primarily used in pediatrics for the closure of Patent Ductus Arteriosus (PDA) and is not the first-line agent for ARF. * **Phenylbutazone:** This drug is rarely used in modern practice due to its severe side effect profile, including bone marrow suppression (aplastic anemia). * **Rofecoxib:** This is a selective COX-2 inhibitor. These are generally avoided in children and have been associated with increased cardiovascular risks in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Response:** If a patient with suspected Rheumatic arthritis does not respond to Aspirin within 48–72 hours, the diagnosis of ARF should be reconsidered. * **Steroids vs. NSAIDs:** Corticosteroids (Prednisolone) are indicated only when there is **severe carditis** (manifesting as cardiomegaly, CHF, or 3rd-degree heart block). * **Monitoring:** Long-term high-dose Aspirin requires monitoring for **salicylism** (tinnitus, hyperventilation) and awareness of **Reye’s Syndrome** if the child contracts Influenza or Varicella.

Q: A 3-month-old infant is diagnosed with a deletion at the 22q11 chromosome. A routine cardiovascular examination reveals severe congenital cardiac malformation. Which of the following malformations will most likely be associated with 22q11 syndrome?

Tetralogy of Fallot and truncus arteriosus. **Explanation:** The patient presents with **DiGeorge Syndrome (22q11.2 deletion syndrome)**, characterized by the mnemonic **CATCH-22**: **C**ardiac defects, **A**bnormal facies, **T**hymic hypoplasia (T-cell deficiency), **C**left palate, and **H**ypocalcemia (due to parathyroid hypoplasia). **Why Option A is Correct:** The 22q11 deletion results in the maldevelopment of the **3rd and 4th pharyngeal pouches**. This leads to defects in the **neural crest cells**, which are essential for the septation of the **outflow tract (conotruncus)** of the heart. Consequently, "conotruncal" or "cyanotic" heart defects are most common. **Tetralogy of Fallot (TOF)** is the most frequent, followed by **Truncus Arteriosus** and Interrupted Aortic Arch (Type B). **Why Other Options are Incorrect:** * **Option B (TGA):** While a cyanotic defect, TGA is not classically associated with 22q11 syndrome; it is more commonly associated with maternal diabetes. * **Option C (ASD/VSD):** These are common isolated defects or associated with Down Syndrome (Trisomy 21), particularly endocardial cushion defects (AVSD). * **Option D (Coarctation of the aorta):** This is the hallmark cardiac association for **Turner Syndrome (45, XO)**. **High-Yield Clinical Pearls for NEET-PG:** * **Most common defect in DiGeorge:** Tetralogy of Fallot. * **Most specific defect for DiGeorge:** Interrupted Aortic Arch (Type B) or Truncus Arteriosus. * **Immunology Link:** Patients have recurrent viral/fungal infections due to T-cell deficiency (absent thymic shadow on X-ray). * **Metabolic Link:** Seizures in the neonatal period may occur due to hypocalcemia (hypoparathyroidism).

Q: A 2-month-old baby with central cyanosis presented with specific findings on chest X-ray and ECG. What is the most probable underlying diagnosis?

Ebstein anomaly. ***Ebstein anomaly*** - Presents with **central cyanosis** in infants due to **tricuspid valve displacement** causing right-to-left shunting through atrial septal defect. - Classic chest X-ray shows **massive cardiomegaly** with **box-shaped heart** and ECG reveals **tall P waves**, **RBBB**, and **Wolff-Parkinson-White pattern**. *Tetralogy of Fallot* - While it causes **central cyanosis**, chest X-ray typically shows **boot-shaped heart** with decreased pulmonary vascularity, not massive cardiomegaly. - ECG shows **right ventricular hypertrophy** without the characteristic **WPW pattern** seen in Ebstein anomaly. *Hypoplastic left heart syndrome* - Causes **severe cyanosis** and heart failure in neonates, but chest X-ray shows **pulmonary edema** and **left atrial enlargement**. - ECG demonstrates **right axis deviation** and **right ventricular hypertrophy** without the massive cardiomegaly pattern. *Coarctation of the aorta* - Typically presents with **differential cyanosis** (lower body) rather than central cyanosis in infants. - Chest X-ray may show **rib notching** in older children and **left ventricular enlargement**, not the box-shaped massive cardiomegaly.

Q: What is the most common heart abnormality in children?

Ventricular septal defect. **Explanation:** **Ventricular Septal Defect (VSD)** is the most common congenital heart disease (CHD) in children, accounting for approximately **25–30%** of all cardiac malformations. It involves a hole in the interventricular septum, leading to a left-to-right shunt. While many small VSDs (especially muscular types) close spontaneously in early childhood, they remain the most frequently diagnosed abnormality at birth. **Analysis of Options:** * **Atrial Septal Defect (ASD):** While common, it is less frequent than VSD in children. However, it is the most common CHD diagnosed in **adults** because it often remains asymptomatic until later in life. * **Tetralogy of Fallot (TOF):** This is the most common **cyanotic** heart disease after infancy (beyond one year of age). Transposition of the Great Arteries (TGA) is the most common cyanotic CHD at birth. * **Total Anomalous Pulmonary Venous Connection (TAPVC):** This is a rare cyanotic heart disease characterized by pulmonary veins draining into the right atrium instead of the left. **High-Yield Clinical Pearls for NEET-PG:** * **Most common type of VSD:** Membranous (Perimembranous) VSD. * **Most common CHD overall:** VSD. * **Most common CHD in Down Syndrome:** Atrioventricular Septal Defect (AVSD/Endocardial cushion defect). * **Most common CHD in Turner Syndrome:** Bicuspid Aortic Valve (followed by Coarctation of Aorta). * **Most common CHD in Congenital Rubella:** Patent Ductus Arteriosus (PDA). * **Auscultation:** VSD typically presents with a harsh **pansystolic murmur** best heard at the left lower sternal border.

Q: According to the American Heart Association & World Heart Federation 2015 criteria, low risk for acute rheumatic fever is defined as an incidence of less than which of the following per 100,000 school-aged children per year?

2. ### Explanation The classification of populations into "low risk" or "moderate-to-high risk" for Acute Rheumatic Fever (ARF) is crucial because the diagnostic criteria (Jones Criteria) differ based on this risk profile. **1. Why Option B is Correct:** According to the **2015 Revised Jones Criteria** (endorsed by the American Heart Association and the World Heart Federation), a population is defined as **low risk** if: * The incidence of ARF is **< 2 per 100,000 school-aged children (ages 5–14 years)** per year, **OR** * The prevalence of Rheumatic Heart Disease (RHD) is **≤ 1 per 1,000 population** per year (at any age). In low-risk populations, the diagnostic criteria are stricter to avoid overdiagnosis. In moderate-to-high risk populations (incidence ≥ 2 per 100,000), the criteria are expanded (e.g., monoarthritis and polyarthralgia are accepted as major and minor criteria, respectively). **2. Why Other Options are Incorrect:** * **Option A (1):** While 1 per 1,000 is the threshold for RHD prevalence, it is not the threshold for ARF incidence. * **Options C & D (0.1 and 0.01):** These values are far too low. While developed nations have seen a massive decline in ARF, the standardized epidemiological cutoff remains at 2 per 100,000. **3. High-Yield NEET-PG Pearls:** * **Jones Criteria 2015 Update:** The most significant change was the stratification of criteria based on risk (Low vs. Moderate/High). * **Major Criteria for Low Risk:** Carditis (clinical or subclinical), Polyarthritis, Chorea, Erythema marginatum, and Subcutaneous nodules. * **Major Criteria for Moderate/High Risk:** Includes the above, but also accepts **Monoarthritis** or **Polyarthralgia**. * **Subclinical Carditis:** Echocardiographic evidence of valvulitis is now considered a "Major" criterion even if a murmur is absent (in all risk groups). * **India's Status:** India is considered a **Moderate-to-High risk** zone for ARF/RHD.

Question 1

Which of the following is a component of Tetralogy of Fallot?

Accepted Answer

Ventricular Septal Defect (VSD)

Answer

Left Ventricular Hypertrophy

Answer

Left Axis Deviation

Answer

All of the above

Question 2

In a 12-year-old boy, which of the following is the best statement regarding aortic valve stenosis?

Accepted Answer

The patient should be restricted from competitive sports.

Answer

The patient does not need endocarditis prophylaxis.

Answer

ECG demonstrates right ventricular hypertrophy.

Answer

The aortic valve is probably calcified.

Question 3

Turner syndrome is associated with which of the following?

Accepted Answer

Coarctation of the aorta

Answer

Aortic dissection

Answer

Aortic regurgitation

Answer

Pulmonic stenosis

Question 4

In a 5-year-old child, instead of the physiological splitting of the second heart sound (S2) which is expected only during inspiration, a wide and fixed split of S2 is heard during both inspiration and expiration. A wide fixed split of the second heart sound can be seen in all of the following EXCEPT?

Accepted Answer

Ventricular septal defect

Answer

Atrial septal defect

Answer

Right bundle branch block

Answer

Total anomalous pulmonary venous connection

Question 5

Which NSAID is most commonly used in Rheumatic fever?

Accepted Answer

Aspirin

Answer

Indomethacin

Answer

Phenylbutazone

Answer

Rofecoxib

Question 6

A 4-year-old child presents with high fever, a toxic appearance, eruptions on the trunk and proximal extremities, bilateral bulbar conjunctivitis without discharge, fissured-crusted red lips, and limb edema making walking difficult. She also has desquamation in the perineum and fingertips, along with cervical adenopathy. What is the most likely diagnosis?

Accepted Answer

Kawasaki syndrome

Answer

Polyarteritis nodosa (PAN)

Answer

Henoch-Schönlein purpura (HSP)

Answer

Erythema infectiosum

Question 7

A 3-month-old infant is diagnosed with a deletion at the 22q11 chromosome. A routine cardiovascular examination reveals severe congenital cardiac malformation. Which of the following malformations will most likely be associated with 22q11 syndrome?

Accepted Answer

Tetralogy of Fallot and truncus arteriosus

Answer

Transposition of the great arteries

Answer

Atrial septal and ventricular septal defects

Answer

Coarctation of the aorta

Question 8

A 2-month-old baby with central cyanosis presented with specific findings on chest X-ray and ECG. What is the most probable underlying diagnosis?

Accepted Answer

Ebstein anomaly

Answer

Tetralogy of Fallot

Answer

Hypoplastic left heart syndrome

Answer

Coarctation of the aorta

Question 9

What is the most common heart abnormality in children?

Accepted Answer

Ventricular septal defect

Answer

Atrial septal defect

Answer

Tetralogy of Fallot

Answer

Total anomalous pulmonary venous connection

Question 10

According to the American Heart Association & World Heart Federation 2015 criteria, low risk for acute rheumatic fever is defined as an incidence of less than which of the following per 100,000 school-aged children per year?

Accepted Answer

2

Answer

1

Answer

0.1

Answer

0.01

Cardiology — MCQs

Cardiology — MCQs

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