Cardiology Practice Questions

Q: A neonate presents with a congenital heart disease as shown below. Which drug should be started immediately? (Recent NEET Pattern 2016-17)

Alprostadil. ***Alprostadil*** - The image shows a **transposition of the great arteries (TGA)** with the aorta originating from the right ventricle and the pulmonary artery from the left ventricle. In this condition, a patent ductus arteriosus (PDA) is crucial to improve mixing between the parallel circulations in TGA. - **Alprostadil (prostaglandin E1 analog)** is used to keep the **ductus arteriosus patent**, allowing for mixing of blood and improving systemic oxygenation in neonates with ductal-dependent congenital heart defects like severe TGA. *Digoxin* - **Digoxin** is a cardiac glycoside used to improve **cardiac contractility** and control heart rate in certain heart conditions, but it is not the immediate drug of choice for maintaining patency of the ductus arteriosus in TGA. - Its primary role is in managing heart failure symptoms or arrhythmias, not directly addressing the immediate ductal dependency of TGA. *Ivabradine* - **Ivabradine** is a hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker that selectively reduces heart rate by acting on the **sinoatrial node**. - It is used in adults with chronic heart failure or stable angina, and is not indicated for the acute management of congenital heart defects like TGA in neonates. *Propranolol* - **Propranolol** is a non-selective beta-blocker used to reduce heart rate and blood pressure, or to manage conditions like **tetralogy of Fallot spells**. - It does not have any role in maintaining the patency of the ductus arteriosus, which is critical for survival in ductal-dependent congenital heart lesions like TGA.

Q: A child with Down syndrome presents with the finding shown. Which congenital heart disease is most commonly associated with this condition?

Endocardial cushion defect. ***Endocardial cushion defect*** - The image displays a **single palmar crease** (also known as a **simian crease**), which is a dermatological feature associated with, but not diagnostic of, **Down syndrome (Trisomy 21)**. In this clinical context, the patient has a confirmed diagnosis of Down syndrome. - Approximately 40-50% of individuals with Down syndrome have **congenital heart disease**, with **endocardial cushion defects** (also known as atrioventricular septal defects) being the most common type. *Tricuspid atresia* - This is a complex cyanotic congenital heart defect characterized by the **absence of the tricuspid valve**, preventing blood flow from the right atrium to the right ventricle. - While it is a congenital heart defect, it is **not specifically associated with a single palmar crease** or Down syndrome as commonly as endocardial cushion defects. *Double outlet right ventricle* - This is a rare cyanotic congenital heart defect where **both the aorta and pulmonary artery arise primarily from the right ventricle**. - It is not typically associated with specific dermatological signs like a single palmar crease or specifically linked to Down syndrome. *Aortic regurgitation* - This is a condition where the **aortic valve does not close tightly**, causing blood to leak back into the left ventricle during diastole. - Aortic regurgitation is an **acquired or congenital valve defect**, but it is not directly linked to genetic syndromes like Down syndrome or the presence of a single palmar crease.

Q: Child presents with strawberry tongue, fever for 5 days, cracked lips, Periungual peeling of the skin and bulbar congestion. Which of the following cardiac lesions will be seen in this child?

Mitral regurgitation. ***Mitral regurgitation*** - The constellation of symptoms (strawberry tongue, fever, cracked lips, periungual peeling, bulbar congestion) is highly characteristic of **Kawasaki disease**. - **Coronary artery aneurysms** and **mitral regurgitation** are common cardiac complications of Kawasaki disease due to inflammation affecting the heart valves and coronary arteries. *Mitral stenosis* - Mitral stenosis is less common in acute Kawasaki disease and is more typically a long-term complication of rheumatic fever or a congenital anomaly. - The acute inflammatory nature of Kawasaki disease is more likely to cause valvular insufficiency (regurgitation) rather than narrowing (stenosis). *Tricuspid stenosis* - Tricuspid stenosis is a relatively rare valvular lesion and is not typically associated with Kawasaki disease. - Inflammatory conditions like Kawasaki disease primarily affect the left-sided heart valves and coronary arteries. *Pulmonary regurgitation* - While pulmonary regurgitation can occur congenitally or due to pulmonary hypertension, it is not a direct or common cardiac complication of Kawasaki disease. - Kawasaki disease primarily targets the systemic vasculature and coronary arteries, leading to problems like mitral regurgitation.

Q: A 1-week-old neonate presents with anoxic spells and single S2. CXR shows all except:

Pulmonary plethora. ***Pulmonary plethora*** - Pulmonary plethora, or **increased pulmonary vascular markings**, indicates increased blood flow to the lungs, which is not characteristic of Tetralogy of Fallot as it involves **pulmonary outflow obstruction**. - Tetralogy of Fallot leads to **decreased pulmonary blood flow**, resulting in **pulmonary oligemia** (reduced vascular markings) on CXR. *Boot-shaped heart* - This is a classic radiographic finding in **Tetralogy of Fallot** due to **right ventricular hypertrophy** and an upturned cardiac apex caused by **pulmonary hypoplasia**. - The image appears to show early signs of a boot-shaped heart (Coeur en sabot), consistent with the clinical picture of a cyanotic neonate with anoxic spells. *Right-sided aortic arch* - A **right-sided aortic arch** is seen in approximately 25% of patients with Tetralogy of Fallot and is a recognized associated anomaly. - While not universally present, its occurrence is significant enough to be considered a feature of the condition, making it a possible finding. *Right ventricular hypertrophy* - **Right ventricular hypertrophy** is one of the four defining features of **Tetralogy of Fallot** (together with ventricular septal defect, pulmonary stenosis, and an overriding aorta). - While not always directly visible as an enlarged chamber on a CXR, its presence is inferred by the **boot-shaped heart** configuration and the physiological adaptations to pulmonary outflow obstruction.

Q: A 3-year-old child presents with persistent fever for 5 days and the clinical features shown in the image. What is the most likely diagnosis?

Kawasaki disease. ***Kawasaki disease*** * The image displays classic signs of **Kawasaki disease**, including **bilateral conjunctivitis without exudates** (top left), **erythema of the palms and soles with desquamation** (top right), **cervical lymphadenopathy** (bottom left, indicated by swelling in the neck region), and a **strawberry tongue** (bottom right). * These clinical features, interpreted in the setting of persistent fever, strongly support the diagnosis of **Kawasaki disease**, which is a vasculitis affecting medium-sized arteries, most notably the coronary arteries. *Scarlet fever* * While **scarlet fever** can cause a **strawberry tongue** and a rash, the rash is typically a **fine, sandpaper-like rash** that blanches with pressure, not usually characterized by the distinct palm/sole erythema and desquamation seen in the image. * **Conjunctivitis** is not a prominent feature of scarlet fever, and the lymphadenopathy is typically less pronounced and may be tender. *Kikuchi disease* * **Kikuchi disease** (histiocytic necrotizing lymphadenitis) primarily presents with **cervical lymphadenopathy, fever**, and often rash, but it does **not typically involve conjunctivitis or changes in the hands, feet, or tongue** as dramatically depicted. * It is a self-limiting condition of unknown etiology, distinct from the systemic vasculitis of Kawasaki disease. *Rosai-Dorfman disease* * **Rosai-Dorfman disease** (sinus histiocytosis with massive lymphadenopathy) is characterized by **massive, painless lymphadenopathy**, particularly cervical, with fever and other systemic symptoms. * However, it does **not present with the specific mucocutaneous findings** of conjunctivitis, strawberry tongue, or characteristic hand/foot changes seen in the images indicative of Kawasaki disease.

Q: A 1-year-old child with CHD is on heart failure treatment. The ECG shows all except:

Ventricular bigeminy. ***Ventricular bigeminy*** - The ECG does not demonstrate ventricular bigeminy. Ventricular bigeminy is characterized by alternating normal (sinus) QRS complexes and premature ventricular contractions (PVCs), where the PVCs appear wide and bizarre in morphology. The visible QRS complexes on this tracing are narrow and occur at regular intervals of approximately 5 large squares, without any interspersed wide, premature ventricular complexes. Therefore, ventricular bigeminy is NOT seen on this ECG and is the correct exception. *Total ventricular rate of 60 bpm approximately* - The visible QRS complexes occur at approximately 5 large squares (25 small squares) apart. Using the formula 300/5 = 60 bpm, the total ventricular rate is approximately 60 bpm, which IS consistent with the tracing. Therefore, option D is seen on this ECG and is not the exception. *ST depression* - The ST-segment, which is the interval between the end of the QRS complex and the beginning of the T wave, appears to be **depressed**, particularly in the leads shown (V3 and V6). - This finding can indicate **myocardial ischemia** or strain, commonly seen in heart failure. Importantly, in a child on heart failure treatment, a scooped or sagging ST-segment depression should also raise suspicion for **digitalis effect**, as digoxin is commonly used in pediatric heart failure and produces a characteristic "reverse tick" or scooped ST-segment depression that is distinct from ischemic ST changes. *U wave* - A **U wave** is a small deflection immediately following the T wave, typically positive and best seen in V2-V3. - These waves are visible on this ECG, often prominent when there's hypokalemia or digitalis toxicity, which is plausible in a child on heart failure treatment.

Q: The given ECG of a neonate born to a mother with SLE shows?

Complete heart block. ***Complete heart block*** - The ECG demonstrates **complete dissociation** between the P waves (atrial activity) and the QRS complexes (ventricular activity). The atrial rate is faster than the ventricular rate, and there is no consistent relationship between P waves and QRS complexes. - In a neonate of a mother with SLE, **congenital complete heart block** is a well-known complication due to transplacental transfer of maternal antibodies (anti-Ro/SSA and anti-La/SSB) that damage the atrioventricular (AV) node. *Mobitz I heart block* - This type of heart block (also known as **Wenckebach phenomenon**) is characterized by a **progressive prolongation of the PR interval** until a P wave is eventually not conducted, leading to a dropped QRS complex. - The ECG provided does not show a gradual lengthening of the PR interval; rather, it shows a complete lack of conduction between atria and ventricles. *Mobitz II heart block* - In Mobitz II block, there is a **fixed PR interval** for conducted beats, but some P waves are **intermittently blocked** without prior PR prolongation. - The ECG in the question shows no consistent PR interval whatsoever, as P waves and QRS complexes are completely dissociated. *Sick sinus syndrome* - This condition involves a malfunction of the **sinoatrial node**, leading to a variety of rhythm disturbances such as sinus bradycardia, sinus arrest, or *tachycardia-bradycardia syndrome*. - While it can cause bradycardia, it does not typically present with the **P-QRS dissociation** characteristic of advanced AV block seen in the ECG.

Q: Which one of the following is a cyanotic congenital heart disease?

Tetralogy of Fallot. ***Tetralogy of Fallot*** - This condition is characterized by **four distinct heart defects** that result in **right-to-left shunting** of unoxygenated blood into the systemic circulation, leading to cyanosis. - The four defects are **ventricular septal defect**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy**. *Patent ductus arteriosus* - This is an **acyanotic heart defect** where there is a persistent opening between the aorta and pulmonary artery, leading to a **left-to-right shunt**, increasing pulmonary blood flow. - It does not typically cause cyanosis unless there is severe pulmonary hypertension leading to shunt reversal (Eisenmenger syndrome). *Ventricular septal defect* - This is also primarily an **acyanotic heart defect** where a hole exists between the ventricles, causing a **left-to-right shunt** of oxygenated blood. - Cyanosis would only occur in severe cases with significant pulmonary hypertension and shunt reversal (Eisenmenger syndrome). *Atrial septal defect* - This is an **acyanotic heart defect** involving an opening between the atria, usually resulting in a **left-to-right shunt** of oxygenated blood into the right atrium. - It rarely causes cyanosis unless there are significant complications like pulmonary hypertension with shunt reversal.

Question 1

A neonate presents with a congenital heart disease as shown below. Which drug should be started immediately? (Recent NEET Pattern 2016-17)

Accepted Answer

Alprostadil

Answer

Digoxin

Answer

Ivabradine

Answer

Propranolol

Question 2

A child with Down syndrome presents with the finding shown. Which congenital heart disease is most commonly associated with this condition?

Accepted Answer

Endocardial cushion defect

Answer

Tricuspid atresia

Answer

Double outlet right ventricle

Answer

Aortic regurgitation

Question 3

A 1 day old neonate presents with central cyanosis. CXR and ECG are performed (shown in the image). Which diagnosis is most consistent with these findings?

Accepted Answer

Cardiomegaly with normal ECG suggestive of hypoplastic left heart syndrome

Answer

Cardiomegaly and Tall T waves in ECG suggestive of tetralogy of Fallot

Answer

Cardiomegaly with delta waves in ECG suggestive of Wolff-Parkinson-White syndrome

Answer

Cardiomegaly, Himalayan P waves in ECG suggestive of tricuspid atresia

Question 4

A 4-year-old boy presents with 6 days of fever, bilateral non-exudative conjunctival injection, strawberry tongue with cracked lips, erythema and edema of the hands and feet, and a polymorphous truncal rash. The images below show key clinical and imaging findings of his diagnosis. Choose the TRUE statement regarding this disease:

Accepted Answer

Intravenous immunoglobulin (IVIG) and aspirin are the mainstays of treatment

Answer

Antibiotics should be started immediately to prevent cardiac complications

Answer

Corticosteroids are the first-line treatment for this condition

Answer

NSAIDs other than aspirin are preferred to reduce inflammatory response

Question 5

Child presents with strawberry tongue, fever for 5 days, cracked lips, Periungual peeling of the skin and bulbar congestion. Which of the following cardiac lesions will be seen in this child?

Accepted Answer

Mitral regurgitation

Answer

Mitral stenosis

Answer

Tricuspid stenosis

Answer

Pulmonary regurgitation

Question 6

A 1-week-old neonate presents with anoxic spells and single S2. CXR shows all except:

Accepted Answer

Pulmonary plethora

Answer

Boot-shaped heart

Answer

Right-sided aortic arch

Answer

Right ventricular hypertrophy

Question 7

A 3-year-old child presents with persistent fever for 5 days and the clinical features shown in the image. What is the most likely diagnosis?

Accepted Answer

Kawasaki disease

Answer

Scarlet fever

Answer

Kikuchi disease

Answer

Rosai-Dorfman disease

Question 8

A 1-year-old child with CHD is on heart failure treatment. The ECG shows all except:

Accepted Answer

Ventricular bigeminy

Answer

Total ventricular rate of 60 bpm approximately

Answer

ST depression

Answer

U wave

Question 9

The given ECG of a neonate born to a mother with SLE shows?

Accepted Answer

Complete heart block

Answer

Mobitz I heart block

Answer

Mobitz II heart block

Answer

Sick sinus syndrome

Question 10

Which one of the following is a cyanotic congenital heart disease?

Accepted Answer

Tetralogy of Fallot

Answer

Patent ductus arteriosus

Answer

Ventricular septal defect

Answer

Atrial septal defect

Cardiology — MCQs

Cardiology — MCQs

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