Cardiology — MCQs
On this page
Coarctation of the aorta is common in which syndrome?
Which of the following is NOT a major criterion for the clinical diagnosis of congenital heart disease?
An infant presents with cardiac failure. Examination reveals a weaker femoral pulse when compared to the radial pulse. What is the probable diagnosis?
What is the most common heart lesion associated with Down syndrome?
A young female presents with a history of dyspnea on exertion. On examination, she has a wide, fixed split S2 with an ejection systolic murmur in the left second intercostal space. Her ECG shows left axis deviation. What is the most probable diagnosis?
Globular heart with plethoric lung fields is seen in which condition?
A 16-year-old boy was found to have a grade 2 ejection systolic murmur along the left sternal border, which decreased with squatting and increased with sudden standing. An ECG shows left ventricular hypertrophy. His cousin brother died at the age of 20 years while playing hockey due to heart disease. What is the recommendation regarding his participation in sports?
What is the most common cardiac anomaly in Turner's syndrome?
What is the treatment of a child with supraventricular tachycardia?
Systolic murmur in Tetralogy of Fallot is primarily due to which of the following?
Cardiology Indian Medical PG Practice Questions and MCQs
Question 241: Coarctation of the aorta is common in which syndrome?
- A. Down syndrome
- B. Turner syndrome (Correct Answer)
- C. Klinefelter syndrome
- D. Noonan syndrome
Explanation: ### Explanation **Correct Answer: B. Turner Syndrome** **Medical Concept:** Turner syndrome (45, XO) is the most common sex chromosome abnormality in females. Approximately 30–50% of patients with Turner syndrome have congenital heart defects. **Coarctation of the aorta (CoA)** is the classic cardiovascular association, occurring in about 10–15% of cases. It is often associated with a **Bicuspid Aortic Valve (BAV)**, which is actually the *most common* overall cardiac anomaly in these patients (30%). The coarctation typically occurs in the pre-ductal or juxtaductal position. **Analysis of Incorrect Options:** * **A. Down Syndrome (Trisomy 21):** The most common cardiac defect is an **Endocardial Cushion Defect** (Atrioventricular Septal Defect/AVSD), followed by VSD and ASD. * **C. Klinefelter Syndrome (47, XXY):** This syndrome is not classically associated with structural congenital heart disease, though there is a slightly increased risk of Mitral Valve Prolapse (MVP). * **D. Noonan Syndrome:** Often called the "male Turner syndrome" (though it affects both sexes), its hallmark cardiac lesion is **Pulmonary Stenosis** (due to dysplastic valves) and Hypertrophic Cardiomyopathy (HCM). **High-Yield Clinical Pearls for NEET-PG:** * **Classic Sign:** Radio-femoral delay and BP upper limb > BP lower limb. * **X-ray finding:** "Figure of 3" sign and rib notching (due to collateral circulation). * **Turner Syndrome Triad:** Short stature, Webbed neck, and Primary amenorrhea (streak ovaries). * **Infantile vs. Adult CoA:** Turner syndrome is traditionally associated with the pre-ductal (infantile) type, though it can present later in life.
Question 242: Which of the following is NOT a major criterion for the clinical diagnosis of congenital heart disease?
- A. Diastolic murmur
- B. Cyanosis
- C. Congestive cardiac failure
- D. Abnormal chest X-ray (Correct Answer)
Explanation: In pediatric cardiology, the clinical diagnosis of significant congenital heart disease (CHD) is primarily based on **Major Clinical Criteria**. These criteria are highly specific indicators of structural or functional heart disease that necessitate urgent evaluation. ### **Why "Abnormal chest X-ray" is the correct answer:** While a chest X-ray (CXR) is a vital diagnostic tool to assess cardiomegaly or pulmonary vascularity, it is considered a **minor or supportive finding**, not a major clinical criterion. Many neonates have an "abnormal" looking cardiac silhouette due to a large thymus, and conversely, some significant CHDs (like TGA) may initially present with a relatively normal-sized heart. Therefore, an abnormal CXR alone is not definitive for a clinical diagnosis of CHD. ### **Analysis of Incorrect Options (Major Criteria):** * **Diastolic Murmur:** Any diastolic murmur in a child is **always pathological** and is a major criterion. Unlike systolic murmurs, which can be "innocent," diastolic murmurs indicate structural issues like valvular regurgitation or shunts. * **Cyanosis:** Central cyanosis (not peripheral acrocyanosis) in a newborn is a hallmark of right-to-left shunts (Cyanotic CHD) and is a major clinical sign. * **Congestive Cardiac Failure (CCF):** Clinical signs of heart failure (tachycardia, tachypnea, hepatomegaly) in an infant are major indicators of underlying structural defects, such as large VSDs or PDA. ### **NEET-PG High-Yield Pearls:** * **Major Criteria for CHD:** 1. Cyanosis, 2. Diastolic murmur, 3. Congestive heart failure, 4. Loud/Single S2, 5. Systolic murmur Grade ≥3/6. * **Most common CHD:** VSD (overall); Bicuspid Aortic Valve (most common congenital heart anomaly). * **Most common Cyanotic CHD:** Tetralogy of Fallot (after 1 year of age); TGA (most common in the neonatal period). * **Innocent Murmurs:** Usually mid-systolic, Grade <3/6, and change with position (e.g., Still’s murmur).
Question 243: An infant presents with cardiac failure. Examination reveals a weaker femoral pulse when compared to the radial pulse. What is the probable diagnosis?
- A. Patent Ductus Arteriosus (PDA)
- B. Coarctation of the Aorta (COA) (Correct Answer)
- C. Aorto-illiac vasculitis
- D. Ventricular Septal Defect (VSD)
Explanation: **Explanation** The clinical hallmark of **Coarctation of the Aorta (COA)** is the discrepancy between upper and lower limb pulses. In COA, there is a narrowing of the aortic lumen, typically near the insertion of the ductus arteriosus (juxtaductal). This obstruction creates high pressure proximal to the narrowing (supplying the arms via the subclavian arteries) and low pressure distal to it (supplying the lower limbs). Consequently, the radial pulse is strong, while the **femoral pulse is weak and delayed** (radio-femoral delay). In infants, this increased afterload can lead to acute left-sided heart failure. **Analysis of Incorrect Options:** * **Patent Ductus Arteriosus (PDA):** Characterized by a continuous machinery murmur and **bounding pulses** (water-hammer pulse) due to a wide pulse pressure, rather than a localized pulse deficit. * **Aorto-iliac Vasculitis (Takayasu Arteritis):** While it can cause pulse deficits ("pulseless disease"), it typically presents in older children or young women and is extremely rare in infants. * **Ventricular Septal Defect (VSD):** Presents with a pansystolic murmur and features of congestive heart failure, but pulses are generally equal in all four limbs. **NEET-PG High-Yield Pearls:** * **Classic Sign:** Radio-femoral delay or a blood pressure systolic difference >20 mmHg between upper and lower limbs. * **X-ray Findings:** "Figure of 3" sign (aorta) and "Rib notching" (due to collateral circulation; usually seen in children >5 years). * **Association:** Highly associated with **Turner Syndrome** (45,XO). * **Management:** Prostaglandin E1 (PGE1) is used in neonates to keep the ductus open and maintain distal perfusion until surgery.
Question 244: What is the most common heart lesion associated with Down syndrome?
- A. Endocardial cushion defect (Correct Answer)
- B. Atrial septal defect with ostium secundum
- C. Ventricular septal defect
- D. Coarctation of the aorta
Explanation: **Explanation:** Down syndrome (Trisomy 21) is the most common chromosomal disorder associated with congenital heart disease (CHD), occurring in approximately 40–50% of affected children. **Why Option A is Correct:** The most common cardiac lesion in Down syndrome is the **Endocardial Cushion Defect**, also known as an **Atrioventricular Septal Defect (AVSD)**. It accounts for nearly 40% of all CHD cases in these patients. This defect occurs due to the failure of the endocardial cushions to fuse, resulting in a combined defect of the atrial septum (ostium primum type), the ventricular septum, and the AV valves (mitral and tricuspid). **Analysis of Incorrect Options:** * **B. Atrial Septal Defect (ASD) secundum:** While ASDs are common in Down syndrome, the *ostium primum* type (part of the AVSD spectrum) is more characteristic than the *ostium secundum* type. * **C. Ventricular Septal Defect (VSD):** VSD is the most common CHD in the **general population**. While it is the second most common lesion in Down syndrome, it is surpassed by AVSD in this specific population. * **D. Coarctation of the Aorta:** This is classically associated with **Turner Syndrome** (45, XO), not Down syndrome. **NEET-PG High-Yield Pearls:** * **Order of frequency in Down Syndrome:** AVSD (40%) > VSD (35%) > ASD (15%). * **ECG Finding in AVSD:** "Left axis deviation" with a "Superior QRS axis" (due to the posteroinferior displacement of the AV node) is a classic diagnostic clue. * **Management:** Early surgical repair is often required (usually by 6 months of age) because these patients are highly prone to developing early **pulmonary hypertension** (Eisenmenger syndrome).
Question 245: A young female presents with a history of dyspnea on exertion. On examination, she has a wide, fixed split S2 with an ejection systolic murmur in the left second intercostal space. Her ECG shows left axis deviation. What is the most probable diagnosis?
- A. Total anomalous pulmonary venous drainage
- B. Tricuspid atresia
- C. Ostium primum atrial septal defect (Correct Answer)
- D. Ventricular septal defect with pulmonary arterial hypertension
Explanation: ### Explanation The clinical presentation of a **wide, fixed split S2** and an **ejection systolic murmur (ESM)** in the left second intercostal space is classic for an **Atrial Septal Defect (ASD)**. The ESM is caused by increased stroke volume across the pulmonary valve, not the defect itself. The differentiating factor in this question is the **ECG finding of Left Axis Deviation (LAD)**. * **Ostium Secundum ASD** (the most common type) typically presents with **Right Axis Deviation (RAD)** and RSR' pattern (RBBB). * **Ostium Primum ASD** (part of the endocardial cushion defects) is uniquely associated with **Left Axis Deviation** due to the postero-inferior displacement of the AV node and the early activation of the left ventricle. #### Why the other options are incorrect: * **Total Anomalous Pulmonary Venous Drainage (TAPVD):** While it presents with a wide, fixed split S2, the ECG typically shows severe Right Ventricular Hypertrophy (RVH) and **Right Axis Deviation**, not LAD. * **Tricuspid Atresia:** This condition does present with LAD and a cyanotic picture, but it would not feature a wide, fixed split S2 or the characteristic ESM of an ASD. * **VSD with PAH (Eisenmenger Syndrome):** A VSD typically presents with a pansystolic murmur. Once PAH develops, the murmur may disappear and S2 becomes loud and single (or narrowly split), not wide and fixed. #### NEET-PG High-Yield Pearls: * **ASD + LAD = Ostium Primum ASD** (associated with Down Syndrome). * **ASD + RAD = Ostium Secundum ASD** (most common type). * **Fixed splitting of S2** occurs because the respiratory variations in venous return are buffered by the large atrial shunt, keeping the stroke volume of the right ventricle constant throughout the respiratory cycle. * **Lutembacher Syndrome:** Mitral stenosis + Ostium secundum ASD.
Question 246: Globular heart with plethoric lung fields is seen in which condition?
- A. Transposition of the great arteries (TGA) (Correct Answer)
- B. Total anomalous pulmonary venous connection (TAPVC)
- C. Tricuspid atresia
- D. Ebstein's anomaly
Explanation: ### Explanation The correct answer is **Transposition of the Great Arteries (TGA)**. #### 1. Why TGA is Correct In TGA, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. This creates two parallel circuits. The classic X-ray finding is an **"Egg-on-a-string"** appearance. * **Globular Heart:** The "egg" shape is due to right ventricular hypertrophy and a dilated right atrium. * **Plethoric Lung Fields:** Because the pulmonary artery is connected to the high-pressure left ventricle, there is increased pulmonary blood flow (PBF), leading to pulmonary plethora (increased vascular markings). * **Narrow Mediastinum:** The "string" represents the narrow superior mediastinum caused by the anteroposterior relationship of the great vessels and thymic atrophy. #### 2. Why Other Options are Incorrect * **TAPVC (Total Anomalous Pulmonary Venous Connection):** Classically shows a **"Snowman" or "Figure-of-8"** appearance (in the supracardiac type) due to a dilated persistent left vertical vein and SVC. While it has plethora, the heart shape is distinct. * **Tricuspid Atresia:** Characteristically shows **oligemic lung fields** (decreased PBF) because blood cannot enter the right ventricle directly. The heart may be enlarged, but the lungs are clear. * **Ebstein’s Anomaly:** Shows a massive, **"Box-shaped" heart** due to severe right atrial enlargement. However, the lung fields are typically **oligemic** because of reduced flow to the pulmonary artery. #### 3. High-Yield Clinical Pearls for NEET-PG * **Boot-shaped heart (Coeur en sabot):** Tetralogy of Fallot (TOF) – Oligemic lungs. * **Sitting Swan appearance:** Tricuspid Atresia. * **Box-shaped heart:** Ebstein’s Anomaly – Oligemic lungs. * **Snowman/Figure-of-8:** TAPVC (Supracardiac) – Plethoric lungs. * **Egg-on-a-string:** TGA – Plethoric lungs. * **Scimitar Sign:** Hypoplastic lung with anomalous pulmonary venous return (PAPVC).
Question 247: A 16-year-old boy was found to have a grade 2 ejection systolic murmur along the left sternal border, which decreased with squatting and increased with sudden standing. An ECG shows left ventricular hypertrophy. His cousin brother died at the age of 20 years while playing hockey due to heart disease. What is the recommendation regarding his participation in sports?
- A. Only non-contact competitive sports are allowed
- B. Participation in competitive sports is not allowed (Correct Answer)
- C. Non-contact competitive sports with beta-blocker therapy are allowed
- D. High-intensity competitive sports are acceptable with beta-blocker therapy
Explanation: ### Explanation **Diagnosis: Hypertrophic Obstructive Cardiomyopathy (HOCM)** The clinical presentation—an ejection systolic murmur that **increases with standing** (decreased preload) and **decreases with squatting** (increased preload/afterload)—is classic for HOCM. The presence of Left Ventricular Hypertrophy (LVH) on ECG and a family history of sudden cardiac death (SCD) in a young relative further confirm this diagnosis. **1. Why Option B is Correct:** HOCM is the most common cause of sudden cardiac death in young athletes. Physical exertion can trigger fatal arrhythmias (like Ventricular Tachycardia/Fibrillation) due to myocardial ischemia or outflow tract obstruction. According to the AHA/ACC guidelines, patients with a definitive diagnosis of HOCM are generally **disqualified from most competitive sports**, regardless of whether they are on medication or have an ICD, to minimize the risk of SCD. **2. Why the Other Options are Incorrect:** * **Options A & C:** Even "non-contact" sports can be high-intensity (e.g., sprinting, swimming). The risk in HOCM is related to **hemodynamic stress and catecholamine surge**, not physical impact. Beta-blockers reduce symptoms but do not provenly eliminate the risk of exercise-induced SCD. * **Option D:** High-intensity sports are strictly contraindicated. Beta-blockers are the first-line treatment for symptoms but do not provide "clearance" for high-intensity athletics. **3. Clinical Pearls for NEET-PG:** * **Dynamic Murmurs:** Most murmurs decrease with standing (less blood in heart). HOCM and Mitral Valve Prolapse (MVP) are the **exceptions**—their murmurs increase with standing/Valsalva. * **Genetics:** HOCM is most commonly caused by mutations in the **Beta-myosin heavy chain** or **Myosin-binding protein C** genes (Autosomal Dominant). * **Histology:** Look for **"Myocardial fiber disarray"** in pathology descriptions. * **Management:** Beta-blockers (first-line), Verapamil, or Disopyramide. Avoid Nitrates, Diuretics, and Digitalis as they worsen the obstruction.
Question 248: What is the most common cardiac anomaly in Turner's syndrome?
- A. Coarctation of aorta
- B. Bicuspid aortic valve (Correct Answer)
- C. Ventricular septal defect
- D. Atrial septal defect
Explanation: **Explanation:** **Bicuspid Aortic Valve (BAV)** is the most common cardiac anomaly in Turner Syndrome (45,X), occurring in approximately **30–50%** of patients. While often asymptomatic in childhood, it carries a long-term risk of aortic stenosis, regurgitation, and infective endocarditis. **Why the other options are incorrect:** * **Coarctation of Aorta (CoA):** This is the second most common anomaly (approx. 10–15%). While CoA is a classic "textbook" association with Turner Syndrome and often the most tested *hemodynamic* lesion, BAV is statistically more frequent. * **Ventricular Septal Defect (VSD) & Atrial Septal Defect (ASD):** These are common in the general population and other chromosomal trisomies (like Down Syndrome), but they are not the hallmark cardiac features of Turner Syndrome. **Clinical Pearls for NEET-PG:** 1. **Left-Sided Lesions:** Turner Syndrome is predominantly associated with left-sided obstructive lesions (BAV, CoA, and Hypoplastic Left Heart Syndrome). 2. **Aortic Dissection:** Patients with Turner Syndrome have a significantly increased risk of aortic root dilation and dissection, even in the absence of hypertension or CoA. 3. **Screening:** Every patient diagnosed with Turner Syndrome must undergo a baseline **Echocardiogram** and/or Cardiac MRI to screen for these anomalies. 4. **Karyotype:** Remember that 45,X is the most common karyotype, but mosaicism (e.g., 45,X/46,XX) can also occur and may present with milder cardiac phenotypes.
Question 249: What is the treatment of a child with supraventricular tachycardia?
- A. Adenosine (Correct Answer)
- B. Digoxin
- C. Sotalol
- D. Flecainide
Explanation: **Explanation:** Supraventricular Tachycardia (SVT) is the most common symptomatic tachyarrhythmia in children. The management depends on the hemodynamic stability of the patient. **1. Why Adenosine is the Correct Answer:** Adenosine is the **drug of choice** for the acute termination of SVT in both pediatric and adult populations. It works by transiently blocking conduction through the Atrioventricular (AV) node, effectively "resetting" the heart's rhythm. It has an extremely short half-life (<10 seconds), necessitating rapid IV push followed by a saline flush. **2. Why the Other Options are Incorrect:** * **Digoxin:** While used for long-term rate control or maintenance therapy, it has a slow onset of action and is never used for the acute termination of SVT. * **Sotalol:** A Class III antiarrhythmic used primarily for chronic prophylaxis of refractory SVT or ventricular arrhythmias. It is not a first-line agent for acute conversion. * **Flecainide:** A Class Ic antiarrhythmic used for long-term management of SVT (especially in Wolff-Parkinson-White syndrome). It carries a risk of proarrhythmia and is not used in the emergency setting. **Clinical Pearls for NEET-PG:** * **First Step:** If the child is hemodynamically stable, try **Vagal maneuvers** first (e.g., applying an ice bag to the face for 15–20 seconds in infants; Valsalva in older children). * **Unstable Patient:** If the child shows signs of shock or heart failure, the immediate treatment of choice is **Synchronized Cardioversion** (0.5 to 1 J/kg). * **Adenosine Dosage:** Initial dose is **0.1 mg/kg** (max 6 mg), which can be doubled to **0.2 mg/kg** (max 12 mg) if the first dose fails. * **ECG Finding:** SVT is characterized by a narrow QRS complex (<0.09s) and the absence of P-waves (or abnormal P-waves). In infants, the heart rate is typically >220 bpm; in children, it is >180 bpm.
Question 250: Systolic murmur in Tetralogy of Fallot is primarily due to which of the following?
- A. Ventricular Septal Defect (VSD)
- B. Pulmonary stenosis (Correct Answer)
- C. Atrial Septal Defect (ASD)
- D. None of the above
Explanation: **Explanation:** In Tetralogy of Fallot (TOF), the characteristic systolic murmur is a **Crescendo-Decrescendo Ejection Systolic Murmur (ESM)** heard best at the left upper sternal border. **1. Why Pulmonary Stenosis is correct:** The murmur in TOF originates from the **Right Ventricular Outflow Tract Obstruction (RVOTO)**, specifically infundibular or valvular pulmonary stenosis. The turbulence created as blood is forced through the narrowed pulmonary orifice during systole produces the ejection systolic murmur. A key clinical pearl: the intensity of this murmur is inversely proportional to the severity of the obstruction. In a "Tet Spell," the murmur actually softens or disappears because blood shunts right-to-left away from the lungs. **2. Why other options are incorrect:** * **Ventricular Septal Defect (VSD):** While TOF involves a large VSD, it is typically **non-restrictive** (equal pressures in both ventricles). Because there is no significant pressure gradient across the defect, the VSD in TOF is "silent" and does not produce a pansystolic murmur. * **Atrial Septal Defect (ASD):** An ASD is not a component of the classic Tetralogy (it is present in "Pentalogy of Fallot"). Even when present, simple ASDs do not produce a murmur; the associated murmur is usually due to increased flow across the pulmonary valve. **High-Yield NEET-PG Facts:** * **Boot-shaped heart (Coeur en sabot):** Seen on X-ray due to right ventricular hypertrophy and an upturned apex. * **Oligemic lung fields:** Due to decreased pulmonary blood flow. * **Squatting position:** Increases systemic vascular resistance (SVR), decreasing the right-to-left shunt and improving oxygenation. * **Most common cyanotic heart disease** after the first year of life.
Practice by Chapter
Congenital Heart Diseases: Cyanotic
Practice Questions
Congenital Heart Diseases: Acyanotic
Practice Questions
Rheumatic Heart Disease
Practice Questions
Kawasaki Disease
Practice Questions
Infective Endocarditis
Practice Questions
Myocarditis and Cardiomyopathies
Practice Questions
Arrhythmias in Children
Practice Questions
Heart Failure in Children
Practice Questions
Pulmonary Hypertension
Practice Questions
Systemic Hypertension
Practice Questions
Dyslipidemia in Children
Practice Questions
Cardiac Evaluation and Diagnostics
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free