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 maintain mixing of oxygenated and deoxygenated blood to ensure systemic circulation. - **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: Which congenital heart disease is associated with the defect shown?

Endocardial cushion defect. ***Endocardial cushion defect*** - The image displays a **single palmar crease** (also known as a **simian crease**), which is a common dermatological feature observed in patients with **Down syndrome (Trisomy 21)**. - 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 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, especially in a young child, are diagnostic for **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:

Heart rate of 60 bpm approximately. ***Heart rate of 60 bpm approximately*** - The ECG rhythm is irregular; however, the predominant rhythm shows a normal heart rate for a 1-year-old child. A heart rate of 60 bpm would be considered **bradycardia** in an infant, where the normal heart rate ranges from 100-160 bpm. - The calculated heart rate from the provided ECG strip is approximately 100-120 bpm (counting 10 small squares between R waves, which corresponds to 1500/100 = 150 bpm, or 15 small squares, hence 1500/15 = 100 bpm if the duration between two consecutive R waves is 15 small squares on the ECG graph). *Ventricular bigeminy* - The ECG shows a regular QRS complex followed by a premature ventricular contraction (PVC), which is then followed by another regular QRS complex, fitting the pattern of **ventricular bigeminy**. - This pattern can be observed as the wide, bizarre QRS complexes interspersed between normal beats. *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. *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.

Question 1

A 6-week-old term baby presents with poor feeding. All are true about the condition shown except:

Accepted Answer

Ductal-dependent systemic circulation

Answer

Ibuprofen inhibits Prostaglandin production leading to closure

Answer

Left ventricular failure

Answer

Anatomical closure occurs by 2-3 weeks

Question 2

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 3

Which congenital heart disease is associated with the defect shown?

Accepted Answer

Endocardial cushion defect

Answer

Tricuspid atresia

Answer

Double outlet right ventricle

Answer

Aortic regurgitation

Question 4

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 5

Choose the TRUE statement regarding the disease depicted in the images below:

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 6

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 7

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 8

A 3-year-old child presents with 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 9

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

Accepted Answer

Heart rate of 60 bpm approximately

Answer

Ventricular bigeminy

Answer

ST depression

Answer

U wave

Question 10

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

Cardiology — MCQs

Cardiology — MCQs

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