Cardiology Practice Questions

Q: Ductus dependent blood flow is required for all of these congenital heart diseases except:

Persistent truncus arteriosus. ***Persistent truncus arteriosus*** - In **persistent truncus arteriosus**, there is a single great artery overriding a ventricular septal defect, supplying both systemic and pulmonary circulation. **Ductus arteriosus** closure does not critically compromise blood flow to either system. - Pulmonary blood flow is often increased in truncus arteriosus, so a patent ductus is not necessary for pulmonary circulation, nor is it essential for systemic circulation as the single trunk directly supplies the aorta. *Pulmonary stenosis* - Severe **pulmonary stenosis** in neonates can restrict blood flow to the lungs, making a **patent ductus arteriosus** essential for pulmonary blood flow via a right-to-left shunt if the stenosis is critical. - Without the **ductus arteriosus**, severe hypoxemia and acidosis can develop due to insufficient oxygenation. *Hypoplastic left heart syndrome* - In **hypoplastic left heart syndrome**, the left ventricle and aorta are underdeveloped, making the **ductus arteriosus** crucial for systemic blood flow from the right ventricle. - Its closure would severely impair blood supply to the body, leading to circulatory collapse and death. *TGA with intact ventricular septum* - With **transposition of the great arteries (TGA)** and an **intact ventricular septum**, systemic and pulmonary circulations are parallel rather than in series. - A **patent ductus arteriosus** is necessary to allow mixing of oxygenated and deoxygenated blood to sustain life.

Q: Not true about Kawasaki disease is

Thrombocytopenia. ***Thrombocytopenia*** - **Kawasaki disease** typically presents with **thrombocytosis** (elevated platelet count), especially during the subacute phase, as an inflammatory response. - **Thrombocytopenia** (low platelet count) is generally not seen in Kawasaki disease and would suggest an alternative diagnosis. *Posterior cervical lymphadenopathy* - **Cervical lymphadenopathy** is a common diagnostic criterion for Kawasaki disease, often unilateral and **anterior**. - While **posterior cervical lymphadenopathy** is less typical, lymph node involvement is a key feature, making this a plausible (though not the most common) manifestation. *Erythema* - **Erythema** (redness) is a common dermatological finding in Kawasaki disease, often presenting as a polymorphous rash on the trunk and extremities. - It can also manifest as **erythema of the lips and oral mucosa**, including a "strawberry tongue," or **redness and swelling of the hands and feet**. *Conjunctivitis* - **Bilateral non-exudative conjunctivitis** is one of the classic diagnostic criteria for Kawasaki disease. - The eyes appear red without pus or discharge, differentiating it from bacterial conjunctivitis.

Q: The most common cause of Blue baby syndrome

Tetralogy of Fallot. **Tetralogy of Fallot** - **Tetralogy of Fallot (TOF)** is the most common cyanotic congenital heart defect, often presenting as "blue baby syndrome" due to **right-to-left shunting** of unoxygenated blood. - This condition involves **four key defects**: a large ventricular septal defect (VSD), pulmonary stenosis, overriding aorta, and right ventricular hypertrophy, which collectively lead to cyanosis. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect but typically causes a left-to-right shunt, leading to **acyanotic** heart disease, not cyanosis. - While a large VSD can sometimes be part of a more complex cyanotic defect, in isolation, it usually does not cause a "blue baby." *Cardiac Ischemia* - **Cardiac ischemia** refers to reduced blood flow to the heart muscle, most commonly seen in adults due to **coronary artery disease**. - It is not a congenital condition and does not typically present as "blue baby syndrome" in infants. *None of the options* - This option is incorrect because **Tetralogy of Fallot** is indeed the most common cause of "blue baby syndrome."

Q: The commonest mode of inheritance of congenital heart disease is

Multifactorial. ***Multifactorial*** - **Congenital heart disease (CHD)** is primarily caused by a combination of genetic predispositions and environmental factors [1]. - This **multifactorial inheritance** means that while genes play a role in susceptibility, specific environmental triggers during fetal development are also crucial [1], [4]. *Autosomal recessive* - This mode of inheritance is associated with conditions that only manifest if an individual inherits two copies of a **mutated gene**, one from each parent. - While some rare forms of CHD can be autosomal recessive, it is not the most common inheritance pattern for the majority of cases. *Sex-linked dominant* - **Sex-linked dominant** disorders are caused by mutations on the X chromosome and affect males and females differently, with affected fathers passing the trait to all their daughters but no sons. - This pattern is not typically observed as the primary mode of inheritance for general CHD. *Autosomal dominant* - In **autosomal dominant inheritance**, only one copy of an altered gene is needed for the condition to manifest [2]. - While certain syndromes associated with CHD can be autosomal dominant (e.g., Marfan syndrome), it is not the most frequent mode of inheritance for isolated CHD [3].

Q: A 10 year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity is measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis is:

Coarctation of aorta. ***Coarctation of aorta*** - The combination of **severe hypertension in the upper extremities** (200/140 mm Hg), **impalpable femoral pulses**, and seizures in a 10-year-old boy is highly suggestive of **aortic coarctation**. - Aortic coarctation causes a **pressure gradient** across the narrowed aorta, leading to high pressure proximal to the coarctation (upper body) and low pressure distal to it (lower body). *Renal parenchymal disease* - While renal parenchymal disease can cause **hypertension**, it typically does not present with **differential blood pressures** between upper and lower extremities or absent femoral pulses. - The hypertension in renal disease is usually due to **fluid overload** and **renin-angiotensin-aldosterone system activation**. *Takayasu arteritis* - Takayasu arteritis is a form of **large vessel vasculitis** that can affect the aorta and its branches, leading to differential pulses and hypertension. - However, it more commonly affects **young adult women** (typically 10-40 years old) and often presents with systemic symptoms like **fever, malaise**, and **arterial bruits**, which are not mentioned here. *Grand mal seizures* - Grand mal seizures are a neurological symptom, not a diagnosis of the underlying cause. - While **severe hypertension** from any cause can lead to seizures (hypertensive encephalopathy), this option does not explain the specific cardiovascular findings of **differential blood pressure** and **impalpable femoral pulses**.

Q: A 7 year old child with a known history of rheumatic heart disease presents with a 3 weeks history of fever with palpitations. Most likely cause is:

Staphylococcal endocarditis. **Staphylococcal endocarditis** - Children with **rheumatic heart disease** are at increased risk for **infective endocarditis** due to pre-existing valvular damage. - The symptoms of **fever** and **palpitations** over 3 weeks in a child with a predisposing cardiac condition are highly suggestive of subacute bacterial endocarditis, with *Staphylococcus* being a common pathogen. *Kawasaki's disease* - **Kawasaki's disease** is characterized by fever for at least 5 days, along with specific criteria such as **conjunctivitis**, **oral changes**, **rash**, and **lymphadenopathy**, which are not mentioned here. - Although it can cause cardiac complications like **coronary artery aneurysms**, it does not typically present with palpitations in the context of pre-existing rheumatic heart disease. *None of the options* - This option is incorrect because **Staphylococcal endocarditis** is a highly plausible diagnosis given the clinical presentation. - The combination of **rheumatic heart disease**, prolonged fever, and palpitations strongly points towards a specific cardiac infection. *Collagen vascular disease* - **Collagen vascular diseases** like SLE or juvenile idiopathic arthritis can present with fever, but **palpitations** in a child with pre-existing **rheumatic heart disease** is less specific for these conditions. - These diseases typically have other systemic manifestations, such as **arthralgia**, **rash**, or **organ involvement**, which are not described.

Q: What is the most common type of congenital cyanotic heart disease?

TOF. ***TOF*** - **Tetralogy of Fallot** is the most common **cyanotic congenital heart disease**, characterized by four key defects leading to right-to-left shunting and reduced pulmonary blood flow. - The combination of **pulmonary stenosis**, **ventricular septal defect (VSD)**, **overriding aorta**, and **right ventricular hypertrophy** causes cyanosis. *ASD* - **Atrial septal defect (ASD)** is typically an **acyanotic congenital heart disease**, as blood usually shunts from the left atrium to the right atrium due to pressure differences. - While it can lead to pulmonary hypertension over time, it's not the most common cyanotic lesion. *PDA* - **Patent ductus arteriosus (PDA)** is generally an **acyanotic congenital heart disease** where blood shunts from the aorta to the pulmonary artery, increasing pulmonary blood flow. - Cyanosis may occur in specific complex scenarios, but it is not commonly classified as a primary cyanotic defect. *VSD* - **Ventricular septal defect (VSD)** is the **most common congenital heart defect overall** but is primarily an **acyanotic lesion**, causing left-to-right shunting. - Cyanosis in VSD usually only occurs in advanced stages with **Eisenmenger syndrome**, which is not the typical presentation.

Q: Which of the following clinical findings is most suggestive of congenital heart disease?

Diastolic murmur. ***Diastolic murmur*** - A **diastolic murmur** is almost always pathological and is a strong indicator of underlying structural heart disease, including **congenital heart defects**. - These murmurs reflect abnormal blood flow during the **diastolic phase** of the cardiac cycle, often due to stenotic atrioventricular valves or regurgitant semilunar valves. *Abnormal blood pressure* - While certain congenital heart diseases (e.g., **coarctation of the aorta**) can cause abnormal blood pressure, it is not a universally specific or most suggestive finding for the broad category of **congenital heart disease**. - Many other conditions, both cardiac and non-cardiac, can lead to abnormal blood pressure readings. *Systolic murmur grade I or II* - A **soft, low-grade systolic murmur** (Grade I or II) is often **physiologic** or innocent, especially in children, and does not necessarily indicate structural heart disease. - Many healthy individuals can have an innocent systolic murmur due to normal blood flow dynamics. *Abnormal electrocardiogram* - An **abnormal ECG** can suggest various cardiac issues, including congenital heart disease, but it is not as direct or specific as a diastolic murmur for initial clinical suspicion. - ECG abnormalities can be non-specific or related to acquired conditions, and a normal ECG does not rule out all forms of congenital heart disease.

Q: The risk of recurrence of congenital heart disease for subsequent pregnancies in families with one affected child is:

2-6%. ***2-6%*** - The recurrence risk for **congenital heart disease (CHD)** in subsequent pregnancies after one affected child is generally cited as **2-6%**, reflecting an increased familial predisposition. - This risk is higher than the general population risk but still relatively low, primarily due to the complex, multifactorial etiology of most CHDs. *10-12%* - A **10-12% recurrence risk** is generally too high for most common congenital heart defects, which are typically multifactorial. - Such a high risk might be seen in specific **syndromic forms** of CHD (e.g., genetic aneuploidies or single gene defects), but not for isolated CHD in general. *1%* - A **1% recurrence risk** is comparable to the general population incidence of congenital heart disease (approximately 0.8-1%). - This value does not adequately reflect the established **increased risk for siblings** of an affected child, which is known to be higher than the background population risk. *0.80%* - **0.80%** represents the approximate **general population incidence** of congenital heart disease in live births without a prior affected sibling. - This figure does not account for the **increased familial risk** that exists once one child in a family is already affected.

Q: Which of the following cyanotic congenital heart disease is associated with increased risk of chest infections?

Truncus arteriosus. ***Truncus arteriosus*** - This condition involves a single great artery overriding a **ventricular septal defect**, leading to mixed systemic and pulmonary blood flow. - The **unrestricted pulmonary blood flow** results in **pulmonary hypertension** and edema, making the lungs vulnerable to frequent infections. *Tetralogy of Fallot* - Characterized by **reduced pulmonary blood flow** due to **pulmonary stenosis**, which typically protects the lungs from overload. - While patients can experience complications, an increased risk of frequent chest infections due to pulmonary overcirculation is not a primary feature. *Tricuspid atresia* - Involves the absence of the **tricuspid valve**, leading to mixing of blood in the atria and systemic circulation of deoxygenated blood. - Pulmonary blood flow can be reduced or normal, but severe pulmonary overcirculation leading to recurrent chest infections is not a hallmark. *None of the options* - This option is incorrect because **Truncus arteriosus** is indeed strongly associated with an increased risk of chest infections.

Question 1

Ductus dependent blood flow is required for all of these congenital heart diseases except:

Accepted Answer

Persistent truncus arteriosus

Answer

Pulmonary stenosis

Answer

Hypoplastic left heart syndrome

Answer

TGA with intact ventricular septum

Question 2

Not true about Kawasaki disease is

Accepted Answer

Thrombocytopenia

Answer

Posterior cervical lymphadenopathy

Answer

Erythema

Answer

Conjunctivitis

Question 3

The most common cause of Blue baby syndrome

Accepted Answer

Tetralogy of Fallot

Answer

VSD

Answer

Cardiac Ischemia

Answer

None of the options

Question 4

The commonest mode of inheritance of congenital heart disease is

Accepted Answer

Multifactorial

Answer

Autosomal recessive

Answer

Sex-linked dominant

Answer

Autosomal dominant

Question 5

A 10 year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity is measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis is:

Accepted Answer

Coarctation of aorta

Answer

Renal parenchymal disease

Answer

Takayasu arteritis

Answer

Grand mal seizures

Question 6

A 7 year old child with a known history of rheumatic heart disease presents with a 3 weeks history of fever with palpitations. Most likely cause is:

Accepted Answer

Staphylococcal endocarditis

Answer

Kawasaki's disease

Answer

None of the options

Answer

Collagen vascular disease

Question 7

What is the most common type of congenital cyanotic heart disease?

Accepted Answer

TOF

Answer

ASD

Answer

PDA

Answer

VSD

Question 8

Which of the following clinical findings is most suggestive of congenital heart disease?

Accepted Answer

Diastolic murmur

Answer

Abnormal blood pressure

Answer

Systolic murmur grade I or II

Answer

Abnormal electrocardiogram

Question 9

The risk of recurrence of congenital heart disease for subsequent pregnancies in families with one affected child is:

Accepted Answer

2-6%

Answer

10-12%

Answer

1%

Answer

0.80%

Question 10

Which of the following cyanotic congenital heart disease is associated with increased risk of chest infections?

Accepted Answer

Truncus arteriosus

Answer

Tetralogy of Fallot

Answer

Tricuspid atresia

Answer

None of the options

Cardiology — MCQs

Cardiology — MCQs

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