Cardiology Practice Questions

Q: Commonest congenital heart disease is:

Ventricular septal defect. ***Ventricular septal defect*** - A **ventricular septal defect (VSD)** is the most frequently observed type of congenital heart disease, accounting for approximately 25-30% of all congenital heart lesions. - It involves an opening in the **interventricular septum**, allowing blood to shunt between the left and right ventricles. *Persistent ductus arteriosus* - While common, **patent ductus arteriosus (PDA)** is not as prevalent as VSDs overall. - PDA is more frequently seen in **premature infants**, but VSDs are the most common in the general population of live births with congenital heart disease. *Atrial septal defect* - **Atrial septal defect (ASD)** is a common congenital heart defect, but its incidence is lower than that of VSDs. - ASDs involve a hole in the **interatrial septum**, leading to shunting of blood between the atria. *Mitral valve prolapse* - **Mitral valve prolapse (MVP)** is a relatively common valvular anomaly but is generally considered a minor congenital heart abnormality or sometimes an acquired condition, not typically classified as the most common "congenital heart disease" in the same category as septal defects. - It involves the leaflets of the **mitral valve bulging into the left atrium** during systole.

Q: The following cardiac defects are characterized by ductus dependent blood flow except –

Truncus arteriosus. ***Truncus arteriosus*** - **Truncus arteriosus** is a congenital heart defect where a single arterial trunk arises from the heart, supplying the systemic, pulmonary, and coronary circulations. - Blood mixing occurs **within the heart itself** at the level of the common truncal valve and ventricular septal defect (VSD), which is always present. - The ductus arteriosus is **not required** for survival because the truncal vessel directly supplies both the systemic and pulmonary circulations. - Therefore, truncus arteriosus is **NOT a ductus-dependent lesion**. *Transposition of great arteries with intact septum* - In **TGA with intact ventricular septum**, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, creating **parallel circulations**. - The patent ductus arteriosus (PDA) is **critical for mixing** oxygenated and deoxygenated blood, allowing survival until surgical correction. - This is a classic **ductus-dependent lesion** for mixing. *Hypoplastic left heart syndrome* - **HLHS** involves severe underdevelopment of the left ventricle, mitral valve, aortic valve, and ascending aorta. - The **PDA is essential** for providing systemic blood flow, as the right ventricle must supply both pulmonary and systemic circulations via the ductus. - This is a **ductus-dependent systemic circulation** - closure of the PDA is lethal. *Interrupted aortic arch* - **IAA** involves complete discontinuity of the aortic arch, preventing blood flow to the descending aorta. - The **PDA is critical** for perfusing the lower body and abdominal organs. - This is a **ductus-dependent systemic circulation**.

Q: A child comes with cyanotic spells and chest X-ray was as shown below; What is the most probable diagnosis?

Tetralogy of Fallot. ***Tetralogy of Fallot*** - The **boot-shaped heart** (Coeur en sabot) seen on the chest X-ray is virtually pathognomonic for **Tetralogy of Fallot** due to right ventricular hypertrophy and a concave pulmonary artery segment. - **Cyanotic spells** (hypercyanotic or "tet" spells) are characteristic clinical features resulting from increased right-to-left shunting across the ventricular septal defect. *Tricuspid atresia* - While tricuspid atresia causes **cyanosis**, the classic radiographic finding is usually a **small right ventricle** and a large left ventricle, affecting heart size and shape differently, often with normal or decreased pulmonary vascularity. - A **boot-shaped heart** is not a typical finding; it might show a normal or slightly enlarged heart with distinct chamber enlargement patterns. *TAPVC* - Total anomalous pulmonary venous connection (TAPVC) typically presents with **cyanosis** and can have increased pulmonary vascular markings on CXR, but the classic X-ray finding is a **"snowman" or "figure-of-8" heart** in the supracardiac type due to dilated SVC and anomalous vertical vein. - A **boot-shaped heart** is not associated with TAPVC. *Pulmonary atresia with intact ventricular septum* - This condition presents with **severe cyanosis** at birth. The chest X-ray typically shows a **markedly enlarged right atrium** due to severe tricuspid regurgitation and a small, hypoplastic right ventricle, along with decreased pulmonary vascular markings. - A **boot-shaped heart** is not a characteristic finding; the cardiac silhouette is often described as globular or enlarged differently.

Q: A five-year-old girl presents with fever and conjunctivitis. Physical examination is significant for oral erythema and fissuring along with a generalized maculopapular rash and cervical lymphadenopathy. What is the most likely diagnosis?

Kawasaki disease. ***Kawasaki disease*** - This constellation of symptoms, including prolonged **fever**, **conjunctivitis**, **oral erythema** and **fissuring**, a generalized **rash**, and **cervical lymphadenopathy**, is highly characteristic of incomplete or classic Kawasaki disease. - It is a **vasculitis** primarily affecting **medium-sized arteries**, and early diagnosis and treatment are crucial to prevent **coronary artery aneurysms**. *Henoch-Schönlein purpura* - Characterized by **palpable purpura**, **arthralgia**, **abdominal pain**, and **renal involvement**, often after an upper respiratory infection. - While a rash is present, the specific features of oral changes and generalized erythema are not typical. *Takayasu arteritis* - A rare, large-vessel vasculitis primarily affecting the **aorta** and its major branches, leading to **claudication**, **pulse deficits**, and **hypertension**. - It most commonly affects **young women** and does not present with the acute mucocutaneous and lymph node findings seen in this child. *Polyarteritis nodosa* - A **necrotizing vasculitis** of **medium-sized arteries**, typically presenting with non-specific symptoms such as fever, weight loss, and myalgia, along with organ involvement (e.g., kidney, gastrointestinal, peripheral nerve). - It primarily affects adults and does not usually present with the specific mucocutaneous and lymphatic features seen in this pediatric case.

Q: Most common cardiac anomaly in Turner syndrome: CMC (Vellore) 07; CMC (Ludhiana) 13; UPSC 14

Bicuspid aortic valve. ***Bicuspid aortic valve*** - A **bicuspid aortic valve** is the most frequently observed cardiac anomaly in individuals with Turner syndrome, occurring in approximately 15-30% of cases. - This condition involves the **aortic valve** having two leaflets instead of the usual three, which can lead to complications such as **aortic stenosis** or **aortic regurgitation** over time. *Bifurcation of aorta* - **Aortic bifurcation** is a normal anatomical structure where the aorta divides into the common iliac arteries at the level of L4. - This is not a cardiac anomaly, but rather a standard vascular branching pattern. *Coarctation of aorta* - **Coarctation of the aorta** is a narrowing of the aorta, typically near the ductus arteriosus, and is also common in Turner syndrome (occurring in about 10-15%). - Although common, it is **less frequent** than a bicuspid aortic valve. *Aortic stenosis* - **Aortic stenosis** (narrowing of the aortic valve) can be a consequence of a bicuspid aortic valve, but it is not the primary or most common congenital anomaly itself. - The most common **structural defect** that predisposes to aortic stenosis in Turner syndrome is the bicuspid aortic valve.

Q: PDA true is all except -

More common in term baby. ***More common in term baby*** ✗ (EXCEPTION - This is FALSE) - This statement is **INCORRECT** and is the exception among the options. - PDA is actually significantly **more prevalent in premature infants**, not term babies, due to the immaturity of the ductus arteriosus and its closure mechanisms. - The persistence of the ductus arteriosus is a major complication of **prematurity**, with incidence inversely proportional to gestational age. *More common in preterm baby* ✓ - **TRUE statement**: Patency of ductus arteriosus (PDA) is indeed much more common in preterm babies, especially those with very low birth weight. - The physiological closure mechanisms, including increased oxygen tension and decreased prostaglandin E2 levels, are less effective in **premature infants**. - Incidence can be as high as **60-70% in infants <28 weeks gestation**. *Left to right shunt* ✓ - **TRUE statement**: In most cases, the pressure in the aorta is higher than in the pulmonary artery, leading to a **left-to-right shunt** of blood through the PDA. - This shunting causes increased pulmonary blood flow, which can lead to **pulmonary congestion** and heart failure if significant. - Creates the characteristic **continuous "machinery" murmur**. *Acyanotic congenital heart disease* ✓ - **TRUE statement**: PDA is classified as an **acyanotic congenital heart disease** because the shunt is typically left-to-right, meaning oxygenated blood recirculates to the lungs. - Cyanosis (bluish discoloration of the skin) only occurs in rare instances of **Eisenmenger syndrome**, where severe pulmonary hypertension reverses the shunt to right-to-left.

Q: Which of the following is the most common type of congenital cardiac cyanotic anomaly?

Tetralogy of Fallot. ***Tetralogy of Fallot*** - It is the **most common cyanotic heart disease** contributing to approximately 5-7% of all congenital heart defects and about 50% of all cyanotic CHD. - It consists of four main defects: **ventricular septal defect (VSD)**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy**. *Transposition of great vessels* - This is the **second most common cyanotic congenital heart disease** where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. - It requires a coexisting defect (like a VSD or PDA) for survival as it creates two separate circulatory systems. *TAPVC* - **Total anomalous pulmonary venous connection (TAPVC)** is a rare cyanotic heart defect where all four pulmonary veins connect to the systemic venous circulation instead of the left atrium. - While serious, it is considerably less common than Tetralogy of Fallot. *Ebstein's anomaly* - This is a rare congenital heart defect involving the **tricuspid valve**, which is displaced downwards into the right ventricle. - It is characterized by variable degrees of cyanosis and right heart failure, but is much less frequent than Tetralogy of Fallot.

Q: A 2-week-old baby is irritable and feeding poorly. On physical examination, the infant is irritable, diaphoretic, tachypneic and tachycardic. There is circumoral cyanosis, which is not alleviated by nasal oxygen. A systolic thrill and holosystolic murmur are heard along the left sternal border. An echocardiogram reveals a heart defect in which a single arterial trunk overrides a ventricular septal defect. What is the appropriate diagnosis?

Truncus arteriosus. ***Truncus arteriosus*** - The description of the **aorta and pulmonary artery forming a single vessel that overrides a ventricular septal defect** is the hallmark of truncus arteriosus. - The infant's symptoms of **irritability, poor feeding, diaphoresis, tachypnea, tachycardia, and circumoral cyanosis not alleviated by oxygen** are consistent with significant **cyanotic congenital heart disease** like truncus arteriosus, which often presents in early infancy with congestive heart failure and cyanosis. *Coarctation of aorta, preductal* - This condition involves a **narrowing of the aorta**, typically presenting with **differential pulses** (stronger in upper extremities, weaker in lower) and a **systolic murmur** heard best over the back or left axilla, which are not described. - While it can manifest with heart failure symptoms, the echocardiogram finding of a single overriding vessel contradicts this diagnosis. *Patent ductus arteriosus* - A PDA typically presents with a **continuous "machinery" murmur** loudest in the left infraclavicular area and may lead to heart failure symptoms but often with subtle or no cyanosis (unless severe pulmonary hypertension develops). - The echocardiogram finding of a single great artery overriding a VSD is not characteristic of PDA. *Atrial septal defect* - An ASD is typically associated with a **fixed, wide splitting of the second heart sound** and a **systolic ejection murmur** at the upper left sternal border due to increased pulmonary blood flow, and often remains asymptomatic in infancy. - Cyanosis is rare, and the specific echocardiographic finding of a single great artery is not seen with an isolated ASD.

Q: True about VSD are all except -

Reverse splitting of S2. ***Reverse splitting of S2*** - **Reverse splitting of S2** occurs when the aortic valve closes *after* the pulmonic valve, typically seen in conditions like **aortic stenosis** or **left bundle branch block**. [2] - In VSD, the increased flow through the pulmonary circulation typically causes a **widened and fixed splitting of S2**, rather than reverse splitting, due to delayed pulmonic valve closure and earlier aortic valve closure. *Left to right shunt* - A **ventricular septal defect (VSD)** creates an opening between the left and right ventricles, leading to blood flowing from the higher pressure left ventricle to the lower pressure right ventricle. [1] - This **left-to-right shunt** is the hallmark hemodynamic feature of a VSD in the absence of pulmonary hypertension. [1] *Pansystolic murmur* - The continuous flow of blood across the VSD during systole produces a characteristic **pansystolic (holosystolic) murmur** that starts with S1 and extends to S2. [3] - This murmur is typically heard best at the **left lower sternal border**. [3] *Left atrial hypertrophy* - A significant left-to-right shunt in VSD increases blood flow into the pulmonary circulation, which then returns to the left atrium through the pulmonary veins. - The increased volume load on the left atrium can lead to **left atrial dilatation and hypertrophy** over time. [1]

Question 1

Commonest congenital heart disease is:

Accepted Answer

Ventricular septal defect

Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Answer

Mitral valve prolapse

Question 2

The following cardiac defects are characterized by ductus dependent blood flow except –

Accepted Answer

Truncus arteriosus

Answer

Hypoplastic left heart syndrome

Answer

Interrupted aortic arch

Answer

Transposition of great arteries with intact septum

Question 3

A child comes with cyanotic spells and chest X-ray was as shown below; What is the most probable diagnosis?

Accepted Answer

Tetralogy of Fallot

Answer

Tricuspid atresia

Answer

TAPVC

Answer

Pulmonary atresia with intact ventricular septum

Question 4

A five-year-old girl presents with fever and conjunctivitis. Physical examination is significant for oral erythema and fissuring along with a generalized maculopapular rash and cervical lymphadenopathy. What is the most likely diagnosis?

Accepted Answer

Kawasaki disease

Answer

Henoch-Schönlein purpura

Answer

Takayasu arteritis

Answer

Polyarteritis nodosa

Question 5

Most common cardiac anomaly in Turner syndrome: CMC (Vellore) 07; CMC (Ludhiana) 13; UPSC 14

Accepted Answer

Bicuspid aortic valve

Answer

Bifurcation of aorta

Answer

Coarctation of aorta

Answer

Aortic stenosis

Question 6

PDA true is all except -

Accepted Answer

More common in term baby

Answer

More common in preterm baby

Answer

Left to right shunt

Answer

Acyanotic congenital heart disease

Question 7

A 2-month-old infant is brought to the clinic because of poor feeding, sweating, and difficulty breathing. The parents state that she was doing very well, and has actually been a "very easy going baby", until about a week ago. They assumed that she was developing a "cold", but it has not passed, and the symptoms have been worsening. Cardiac examination reveals a loud, harsh systolic murmur with a thrill that is heard best at the left sternal border. The most likely underlying abnormality is

Accepted Answer

ventricular septal defect

Answer

aortic stenosis

Answer

atrial septal defect

Answer

patent ductus arteriosus

Question 8

Which of the following is the most common type of congenital cardiac cyanotic anomaly?

Accepted Answer

Tetralogy of Fallot

Answer

Transposition of great vessels

Answer

TAPVC

Answer

Ebstein's anomaly

Question 9

A 2-week-old baby is irritable and feeding poorly. On physical examination, the infant is irritable, diaphoretic, tachypneic and tachycardic. There is circumoral cyanosis, which is not alleviated by nasal oxygen. A systolic thrill and holosystolic murmur are heard along the left sternal border. An echocardiogram reveals a heart defect in which a single arterial trunk overrides a ventricular septal defect. What is the appropriate diagnosis?

Accepted Answer

Truncus arteriosus

Answer

Coarctation of aorta, preductal

Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Question 10

True about VSD are all except -

Accepted Answer

Reverse splitting of S2

Answer

Left to right shunt

Answer

Pansystolic murmur

Answer

Left atrial hypertrophy

Cardiology — MCQs

Cardiology — MCQs

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