Cardiology Practice Questions

Q: An x-ray performed on a newborn infant shows enlargement of the left ventricle and left atrium as well as dilatation of the aorta. Echocardiographic studies demonstrate volume-overloading of the left ventricle. Cardiac auscultation reveals the presence of a continuous "machinery" murmur. Which of the following is the most likely diagnosis?

Patent ductus arteriosus. ***Patent ductus arteriosus*** - The classic **continuous "machinery" murmur** heard on auscultation is pathognomonic for a PDA, resulting from continuous blood flow from the aorta to the pulmonary artery. - The **left ventricle and left atrial enlargement** and **aortic dilatation** with **left ventricular volume overloading** are consistent with the increased blood return to the left heart due to the left-to-right shunt through the PDA. *Atrial septal defect* - While an ASD can cause left atrial enlargement, it primarily causes **right ventricular volume overload** due to shunting into the right atrium, not left ventricular volume overload or aortic dilatation. - The murmur associated with an ASD is typically a **systolic ejection murmur** over the pulmonic area due to increased flow across the pulmonary valve, not a continuous machinery murmur. *Tetralogy of Fallot* - This is a **cyanotic congenital heart disease** characterized by four defects: ventricular septal defect, pulmonic stenosis, overriding aorta, and right ventricular hypertrophy. - Auscultation typically reveals a **systolic ejection murmur** reflecting the pulmonic stenosis, and the condition presents with **cyanosis** and clubbing, which are not mentioned here. *Pulmonic stenosis* - Isolated pulmonic stenosis would primarily cause **right ventricular hypertrophy** and possibly right atrial enlargement due to increased resistance to outflow from the right ventricle. - The murmur is typically a **systolic ejection murmur** at the upper left sternal border with a thrill, and it would not cause left ventricular volume overload or a continuous machinery murmur.

Q: Which X-ray finding is more characteristic of ASD compared to VSD?

Normal LA. ***Normal LA*** - In an uncomplicated **atrial septal defect (ASD)**, blood shunts from the left atrium to the right atrium, decompressing the left atrium. - This decompression results in a **normal-sized left atrium** on chest X-ray, distinguishing it from conditions with **left ventricular overload**. *Enlarged LA* - An **enlarged left atrium (LA)** is more characteristic of conditions causing **left-sided volume or pressure overload**, such as **ventricular septal defect (VSD)** with significant left-to-right shunt. - In VSD, blood shunts from the left ventricle to the right ventricle, increasing **pulmonary blood flow** and pressure, ultimately leading to LA enlargement. *Aortic shadow* - The **aortic shadow** on X-ray reflects the size and position of the aorta, and while some cardiac conditions can affect it, changes in its size are not a primary distinguishing feature between ASD and VSD. - A subtle **aortic knuckle** may be seen, but it does not differentiate the two defects. *Pulmonary Congestion* - While both ASD and VSD can cause increased **pulmonary blood flow**, **pulmonary congestion** (interstitial or alveolar edema) is more likely to be prominent in a **large VSD** due to the higher pressure shunt. - ASD typically leads to **pulmonary arterial hypertension** over time, but less frank congestion unless there's associated left-sided heart failure.

Q: Most specific cardiac anomaly seen in baby born to Diabetic Mother

Transposition of Great arteries. ***Transposition of Great arteries*** - **Transposition of the great arteries (TGA)** is the most specific congenital heart defect associated with infants born to mothers with **pre-gestational diabetes**. - Poor glycemic control in the first trimester of pregnancy is a significant risk factor for the development of TGA. *Ventricular septal defect* - **Ventricular septal defect (VSD)** is the most common congenital heart defect overall, but it is not specific to diabetic mothers, as its occurrence is common in the general population. - While VSDs can occur in infants of diabetic mothers, they are less characteristic of this population compared to TGA. *Heart blocks* - **Congenital heart blocks** are most commonly associated with **maternal autoimmune diseases**, such as Systemic Lupus Erythematosus (SLE), due to the transplacental transfer of anti-Ro/SSA and anti-La/SSB antibodies. - They are not a specific cardiac anomaly linked to maternal diabetes. *Tetralogy of Fallot* - **Tetralogy of Fallot** is a complex congenital heart defect involving four anomalies, but it is not specifically or disproportionately linked to maternal diabetes compared to other congenital heart defects. - Its etiology is multifactorial, with genetic and environmental factors playing roles.

Q: Normal QRS duration at 1 year of age is

0.04-0.08 seconds. ***0.04-0.08 seconds*** - In children aged 1 year, the **normal QRS duration** typically falls within this range. - A QRS duration wider than this range at 1 year of age would suggest a **ventricular conduction abnormality** if other parameters are normal too. *0.04-0.09 seconds* - While **0.04 seconds** is within the normal lower limit, **0.09 seconds** is slightly prolonged for a 1-year-old. - A QRS duration of 0.09 seconds typically falls into the category of **borderline prolongation** in a 1-year-old child. *0.06-0.09 seconds* - The lower limit of **0.06 seconds** is higher than the generally accepted lowest normal value for a 1-year-old, potentially missing shorter, normal QRS durations. - An upper limit of **0.09 seconds** is considered mildly prolonged for this age group, suggesting a possible **conduction delay**. *0.03-0.07 seconds* - The lower limit of **0.03 seconds** is shorter than the generally accepted lowest normal value, which is usually around 0.04 seconds. - While **0.07 seconds** is within the normal range, this option's lower limit is too restricted and the upper limit may not capture all normal variations.

Q: The most dreadful complication of Kawasaki disease is

Cardiac involvement. ***Cardiac involvement*** - **Cardiac complications**, particularly **coronary artery aneurysms**, are the most serious and potentially fatal sequelae of Kawasaki disease. - If untreated, these can lead to **myocardial infarction**, **sudden death**, or chronic ischemic heart disease. *Rash* - A rash is a common and often an early sign of Kawasaki disease, but it is a **benign symptom** and not life-threatening. - It resolves with the other acute symptoms and does not contribute to long-term morbidity or mortality. *Thrombocytosis* - **Thrombocytosis** is a characteristic laboratory finding in the subacute phase of Kawasaki disease but is rarely a direct cause of dreadful complications. - While it may increase the risk of **thrombus formation** in already damaged coronary arteries, it's not the primary "dreadful complication" itself. *Lymphadenopathy* - **Cervical lymphadenopathy** is one of the diagnostic criteria for Kawasaki disease and is a common, but not life-threatening, symptom. - It generally resolves without specific treatment for the lymph nodes and does not lead to serious long-term sequelae.

Q: Reversal of shunt is not possible in natural history of?

TOF. ***TOF*** - In **Tetralogy of Fallot (TOF)**, the shunt is typically right-to-left from birth due to **pulmonary stenosis** and a large **VSD** [1]. - This fixed **right-to-left shunt** means that reversal to a left-to-right shunt does not occur naturally [1]. *PDA* - A **patent ductus arteriosus (PDA)** typically features an initial **left-to-right shunt**. - However, if **pulmonary hypertension** develops, the shunt can reverse to become **right-to-left** (Eisenmenger syndrome), meaning reversal *is* possible. *VSD* - A **ventricular septal defect (VSD)** initially presents with a **left-to-right shunt** [2]. - Prolonged systemic-level pressures in the pulmonary arteries can lead to **pulmonary vascular disease** and eventual shunt reversal to **right-to-left** (Eisenmenger syndrome) [2]. *ASD* - An **atrial septal defect (ASD)** typically causes an initial **left-to-right shunt**. - Over time, significant **pulmonary hypertension** can develop, leading to shunt reversal to **right-to-left** (Eisenmenger syndrome), indicating reversal is possible.

Q: Tetralogy of Fallot presents with one of the following:

Central cyanosis with clubbing. ***Central cyanosis with clubbing*** - Tetralogy of Fallot is a **cyanotic congenital heart defect**, meaning it causes inadequate oxygenation of the blood, leading to central cyanosis. - **Chronic hypoxemia** (low oxygen levels) associated with cyanotic heart disease typically results in **clubbing of the fingers and toes** over time. *Normal ECG and Chest x-ray* - An **ECG** in Tetralogy of Fallot typically shows **right ventricular hypertrophy** and an **axis deviation**, which is not normal. - A **chest X-ray** in Tetralogy of Fallot often reveals a characteristic **'boot-shaped' heart** due to right ventricular hypertrophy and decreased pulmonary artery markings. *Cardiomegaly* - While there is **right ventricular hypertrophy**, significant global cardiomegaly (enlargement of the entire heart) is **not a classic or consistent feature** of Tetralogy of Fallot. - The boot-shaped appearance on X-ray reflects the hypertrophied right ventricle, but the overall heart size may not be drastically enlarged. *Left ventricular hypertrophy* - Tetralogy of Fallot is characterized by **right ventricular outflow tract obstruction** and a **large ventricular septal defect**, leading primarily to **right ventricular hypertrophy**. - **Left ventricular hypertrophy** is not a typical finding in Tetralogy of Fallot; in fact, the left ventricle may be smaller due to decreased pulmonary venous return.

Q: A major criterion for Jones classification is

Chorea. ***Chorea*** - **Sydenham's chorea** is a neurological disorder characterized by involuntary, jerky movements, and is a **major criterion** [1] in the Jones classification for **rheumatic fever** [1]. - It is one of the five major manifestations, alongside carditis, polyarthritis, erythema marginatum, and subcutaneous nodules [1]. *TPR Interval* - The **Jones criteria** are used to diagnose **rheumatic fever** and do not directly include the TPR interval as a major or minor criterion. - While cardiac involvement is a major criterion (carditis), specific ECG findings like the TPR interval are not listed as stand-alone criteria. *Arthralgia* - **Arthralgia** (joint pain) is considered a **minor criterion** in the Jones classification. - Unlike **polyarthritis**, which is a major criterion due to objective joint inflammation, arthralgia alone lacks the definitive signs of inflammation. *Fever* - **Fever** is a **minor criterion** in the Jones classification for rheumatic fever. - It is a non-specific symptom that, while common in rheumatic fever, is not sufficiently diagnostic on its own to be considered a major criterion.

Q: The commonest cause of death in a diphtheritic child after few weeks of infection is:

Myocarditis. ***Myocarditis*** - Diphtheria toxin's cardiotoxicity can lead to **myocarditis**, characterized by diffuse **interstitial inflammation** and **myocardial fiber necrosis**. - This can result in **cardiac arrhythmias**, **heart failure**, or sudden **cardiac death** weeks after the initial infection, making it the most common cause of fatality in the later stages. *Septicemia* - While septicemia can occur, it is more often seen as a complication of **secondary bacterial infections** rather than a direct, delayed effect of diphtheria toxin. - The direct and most significant delayed organ damage from diphtheria is typically **cardiac** or **neurological**, not widespread systemic infection. *IIIrd nerve palsy* - **Cranial nerve palsies**, including those affecting the 3rd cranial nerve (oculomotor), are a known complication stemming from the **neurotoxic effects** of diphtheria toxin. - However, while significant, **neurological complications** such as palsies are generally less common as a direct cause of death compared to severe myocarditis. *Tonsillitis* - **Tonsillitis** is a symptom of acute diphtheria, presenting at the **initial stage** of the infection with a **grayish pseudomembrane** on the tonsils and pharynx. - It is not a cause of death in itself, but rather a manifestation of the primary infection and can lead to airway obstruction in severe cases, which is an early complication, not a delayed cause of death.

Q: A 12 year old girl was brought with fever, malaise, and migrating polyarthritis. She had a history of recurrent throat infections in the past. Elevated erythrocyte sedimentation rate is noted. Which among the following is NOT a major Jones criteria for diagnosis of acute rheumatic fever?

Raised ESR. ***Raised ESR*** - **Elevated erythrocyte sedimentation rate (ESR)** is a **minor criterion** in the Jones Criteria for acute rheumatic fever, indicating inflammation but not specific enough to be a major criterion. - While it supports the diagnosis, it is a non-specific inflammatory marker rather than a distinct clinical manifestation of the disease. *Chorea* - **Sydenham's chorea** (St. Vitus' dance) is a **major manifestation** of acute rheumatic fever, characterized by involuntary, purposeless movements. - It results from central nervous system involvement and is a highly diagnostic sign, often appearing late in the disease course. *Arthritis* - **Migratory polyarthritis** is a **major criterion** for acute rheumatic fever, typically affecting large joints in a sequential pattern. - This symptom is often the presenting complaint and is highly responsive to anti-inflammatory treatment. *Carditis* - **Carditis**, involving inflammation of the heart muscle, pericardium, or endocardium, is a **major criterion** and the most serious manifestation of acute rheumatic fever. - It can lead to long-term valvular damage, particularly affecting the mitral and aortic valves.

Question 1

An x-ray performed on a newborn infant shows enlargement of the left ventricle and left atrium as well as dilatation of the aorta. Echocardiographic studies demonstrate volume-overloading of the left ventricle. Cardiac auscultation reveals the presence of a continuous "machinery" murmur. Which of the following is the most likely diagnosis?

Accepted Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Answer

Tetralogy of Fallot

Answer

Pulmonic stenosis

Question 2

Which X-ray finding is more characteristic of ASD compared to VSD?

Accepted Answer

Normal LA

Answer

Enlarged LA

Answer

Aortic shadow

Answer

Pulmonary Congestion

Question 3

Most specific cardiac anomaly seen in baby born to Diabetic Mother

Accepted Answer

Transposition of Great arteries

Answer

Ventricular septal defect

Answer

Heart blocks

Answer

Tetralogy of Fallot

Question 4

Normal QRS duration at 1 year of age is

Accepted Answer

0.04-0.08 seconds

Answer

0.04-0.09 seconds

Answer

0.06-0.09 seconds

Answer

0.03-0.07 seconds

Question 5

The most dreadful complication of Kawasaki disease is

Accepted Answer

Cardiac involvement

Answer

Rash

Answer

Thrombocytosis

Answer

Lymphadenopathy

Question 6

Reversal of shunt is not possible in natural history of?

Accepted Answer

TOF

Answer

PDA

Answer

VSD

Answer

ASD

Question 7

Tetralogy of Fallot presents with one of the following:

Accepted Answer

Central cyanosis with clubbing

Answer

Normal ECG and Chest x-ray

Answer

Cardiomegaly

Answer

Left ventricular hypertrophy

Question 8

A major criterion for Jones classification is

Accepted Answer

Chorea

Answer

TPR Interval

Answer

Arthralgia

Answer

Fever

Question 9

The commonest cause of death in a diphtheritic child after few weeks of infection is:

Accepted Answer

Myocarditis

Answer

Septicemia

Answer

IIIrd nerve palsy

Answer

Tonsillitis

Question 10

A 12 year old girl was brought with fever, malaise, and migrating polyarthritis. She had a history of recurrent throat infections in the past. Elevated erythrocyte sedimentation rate is noted. Which among the following is NOT a major Jones criteria for diagnosis of acute rheumatic fever?

Accepted Answer

Raised ESR

Answer

Chorea

Answer

Arthritis

Answer

Carditis

Cardiology — MCQs

Cardiology — MCQs

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