Cardiology Practice Questions

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.

Q: Which heart disease is most commonly associated with rubella infection –

PDA. ***PDA*** - **Patent ductus arteriosus (PDA)** is a well-known cardiac malformation associated with congenital rubella syndrome, particularly if the infection occurs during the first trimester. - The rubella virus can interfere with the normal closure of the fetal ductus arteriosus, leading to its persistence after birth. *Eisenmenger's syndrome* - Eisenmenger's syndrome is a severe, late complication of large left-to-right shunts (like uncorrected PDA or VSD) that results in **pulmonary hypertension with shunt reversal** and cyanosis. - While congenital rubella can cause defects that *lead* to Eisenmenger's syndrome if left untreated, it is not the primary immediate cardiac anomaly directly caused by the infection itself. *VSD* - **Ventricular septal defect (VSD)** is a common congenital heart defect where there is an opening between the ventricles. - While VSDs can be associated with various congenital syndromes, they are not the *most commonly* or specifically linked heart defect seen in congenital rubella syndrome compared to PDA. *ASD* - **Atrial septal defect (ASD)** involves an opening between the atria. - Although ASDs are also congenital heart defects, they are not as predominantly associated with congenital rubella syndrome as PDA.

Question 1

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 2

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 3

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 4

The most dreadful complication of Kawasaki disease is

Accepted Answer

Cardiac involvement

Answer

Rash

Answer

Thrombocytosis

Answer

Lymphadenopathy

Question 5

Reversal of shunt is not possible in natural history of?

Accepted Answer

TOF

Answer

PDA

Answer

VSD

Answer

ASD

Question 6

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 7

A major criterion for Jones classification is

Accepted Answer

Chorea

Answer

TPR Interval

Answer

Arthralgia

Answer

Fever

Question 8

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 9

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

Question 10

Which heart disease is most commonly associated with rubella infection –

Accepted Answer

PDA

Answer

Eisenmenger's syndrome

Answer

VSD

Answer

ASD

Cardiology — MCQs

Cardiology — MCQs

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