Cardiology Practice Questions

Q: The most common paediatric cardiac tumour among the following is

Rhabdomyomas. ***Rhabdomyomas*** - **Rhabdomyomas** are the most common primary cardiac tumors in **infants and children**, accounting for over 50% of all pediatric cardiac tumors. - They are strongly associated with **tuberous sclerosis**, with up to 90% of children with cardiac rhabdomyomas having tuberous sclerosis. *Myxomas* - **Myxomas** are the most common primary cardiac tumors in **adults**, primarily found in the left atrium. - They are rare in children, making them an unlikely answer for the most common pediatric cardiac tumor. *Hemangiomas* - **Hemangiomas** are benign vascular tumors that can occur in various organs, including the heart, but they are **exceedingly rare as primary cardiac tumors**, especially compared to rhabdomyomas in children. - While they can be present at birth, cardiac hemangiomas are not the most common pediatric cardiac tumor. *Fibromas* - **Cardiac fibromas** are the **second most common primary cardiac tumor in children**, but they are significantly less common than rhabdomyomas. - They are typically single, large, and can cause symptoms due to their mass effect and potential for arrhythmias, but they do not outrank rhabdomyomas in frequency.

Q: In septum primum type of ASD overburden occurs in which chamber?

RA + RV. ***RA + RV*** - In a **septum primum ASD**, blood shunts from the left atrium to the right atrium due to higher left-sided pressures [3]. - This increased volume then flows into the **right ventricle**, causing **volume overload** in both the right atrium and right ventricle [1], [3]. *LA* - The left atrium experiences **decreased pressure** and **volume** as blood shunts out, not overload. - The primary burden is on the right side of the heart, not the left atrium. *LA + LV* - The left atrium and left ventricle do not experience **volume overload** in a typical ASD; instead, they may have reduced filling [2]. - The shunt primarily offloads the left side and creates overload on the right side [3]. *RA + LA* - While the **right atrium** is volume overloaded, the **left atrium** is not; it is actually under-filled. - The combination of right atrial overload and left atrial normal or slightly reduced volume does not accurately describe the overall burden.

Q: A 29-day-old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. The most likely diagnosis is:

Ventricular septal defect. ***Ventricular septal defect*** - A **ventricular septal defect (VSD)** causes a left-to-right shunt, leading to increased pulmonary blood flow and can result in **congestive cardiac failure** and **left ventricular hypertrophy** as pulmonary vascular resistance drops in the first few weeks of life. - Large VSDs typically present with a **holosystolic murmur** best heard at the left lower sternal border; however, in the early neonatal period or with muscular VSDs, the murmur may be **shorter and less prominent** as pulmonary resistance is still relatively elevated. - Among the given options, VSD is the **most likely acyanotic heart defect** to present with CHF and LVH in this age group. *Rheumatic fever* - **Rheumatic fever** is an inflammatory disease following **Group A Streptococcal pharyngitis**, typically occurring in children **over 3 years of age**. - It is **extremely rare in infants** and would not explain CHF and LVH in a 29-day-old neonate. *Transposition of great arteries* - **Transposition of the great arteries (TGA)** is a cyanotic congenital heart defect where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. - Infants with TGA present with **severe cyanosis within hours to days of birth**, not primarily CHF. - The murmur is often **absent or soft** unless there is an associated VSD or PDA. *Tetralogy of Fallot* - **Tetralogy of Fallot (ToF)** is a cyanotic heart disease with four components: VSD, pulmonary stenosis, overriding aorta, and **right ventricular hypertrophy** (not left). - Infants present with **cyanosis** (not CHF) and a **loud systolic ejection murmur** at the left upper sternal border due to pulmonary stenosis. - The pathophysiology leads to **RVH, not LVH**, making this inconsistent with the clinical findings.

Q: A child presents with LVH and pulmonary complications. ECG shows left axis deviation. Most likely diagnosis is:

Tricuspid atresia. ***Tricuspid atresia*** - **Left ventricular hypertrophy (LVH)** is common because the entire systemic venous return must pass from the right atrium through an atrial septal defect (ASD) into the left atrium and then to the left ventricle. The left ventricle then pumps blood through both the systemic circulation and, via a VSD, to the pulmonary circulation. - **Left axis deviation** is a classic ECG finding due to the hypoplastic right ventricle and the dominance of the left ventricle in pumping both systemic and pulmonary blood. *TOF* - **Tetralogy of Fallot** typically presents with **right ventricular hypertrophy (RVH)** due to the right ventricular outflow tract obstruction. - ECG usually shows **right axis deviation** and RVH, not LVH or left axis deviation. *TAPVC* - **Total anomalous pulmonary venous connection (TAPVC)** usually leads to **right ventricular volume overload** and **pulmonary hypertension**, resulting in right ventricular hypertrophy. - While it can cause pulmonary complications, **LVH and left axis deviation are not characteristic features**. *VSD* - A large **ventricular septal defect (VSD)** can cause **biventricular hypertrophy** or predominantly **left ventricular hypertrophy** due to increased pulmonary blood flow and left ventricular volume overload. - However, isolated, uncomplicated VSD does not typically present with **left axis deviation**; ECG findings are variable but often show an rsR' pattern in V1 or increased QRS voltages.

Q: An 8-month-old female child presented to the emergency department with a heart rate of 220/minute and features of congestive heart failure. Her heart rate returned to normal after administering intravenous adenosine. What is the most likely diagnosis?

Paroxysmal supraventricular tachycardia. ***Paroxysmal supraventricular tachycardia*** - **Paroxysmal supraventricular tachycardia (PSVT)** is a common cause of **tachyarrhythmia** in infants and typically responds well to **adenosine**, which transiently blocks the AV node. - The presentation of a heart rate of **220/minute** in an 8-month-old, along with signs of congestive heart failure, is characteristic of PSVT. *Atrial flutter* - While atrial flutter can cause a rapid heart rate, it often presents with a characteristic **sawtooth pattern** on ECG and may less consistently respond to adenosine with complete rhythm conversion. - Typically, the ventricular rate in atrial flutter is a fraction of the atrial rate (e.g., 2:1 or 3:1 block), which might be high but not always resolve completely with adenosine. *Atrial fibrillation* - **Atrial fibrillation** is rare in infants without significant structural heart disease and usually presents with an **irregularly irregular rhythm**, which is not explicitly mentioned. - Although adenosine can slow the ventricular response, it generally does not convert atrial fibrillation back to sinus rhythm. *Ventricular tachycardia* - **Ventricular tachycardia** is generally less common than PSVT in infants and is often associated with more severe underlying cardiac pathology or poorer hemodynamic stability. - While adenosine can sometimes terminate certain types of VT, it is typically used cautiously and is less effective than in PSVT.

Q: The heart lesion not found in Congenital Rubella infection is –

ASD. ***Atrial Septal Defect (ASD)*** - **ASD is NOT a typical cardiac manifestation** of congenital rubella syndrome and is generally not reported as part of the classic cardiovascular anomalies. - The characteristic cardiac defects in congenital rubella involve **persistent fetal structures** (PDA) and **pulmonary outflow abnormalities** (peripheral and valvular pulmonary stenosis). - Among the options listed, **ASD** is the lesion least associated with congenital rubella infection. *Ventricular Septal Defect (VSD)* - **VSD is also not a classic feature** of congenital rubella syndrome, though isolated case reports exist. - However, compared to ASD, **VSD has slightly more literature support** as an occasional finding. - The defect involves the **interventricular septum**. *Pulmonary Stenosis (PS)* - **Peripheral pulmonary artery stenosis** is one of the most characteristic cardiovascular anomalies in congenital rubella syndrome (found in ~50-60% of cardiac cases). - Involves narrowing of the **branch pulmonary arteries**, often multiple sites. - **Pulmonary valve stenosis** is also commonly seen. *Patent Ductus Arteriosus (PDA)* - **PDA is the most common cardiac defect** in congenital rubella syndrome, occurring in up to 80% of affected infants with heart disease. - Represents failure of the **ductus arteriosus** to close after birth. - Part of the classic triad: **PDA + peripheral PS + pulmonary valve stenosis**.

Q: Which of the following does not complicate into CHF –

Tetralogy of Fallot. ***Tetralogy of Fallot*** - This condition is characterized by **right-to-left shunting** due to a large ventricular septal defect (VSD) and right ventricular outflow tract obstruction, leading to **cyanosis** rather than heart failure. - The right ventricular hypertrophy and pulmonary stenosis in Tetralogy of Fallot actually **protect the pulmonary circulation** from volume overload, thus reducing the risk of CHF. *Patent ductus arteriosus* - A PDA causes a **left-to-right shunt** from the aorta to the pulmonary artery, increasing pulmonary blood flow and leading to **pulmonary hypertension** and eventually **left ventricular volume overload**, which can lead to CHF. - The continuous flow through the PDA can cause **volume overload** on the left ventricle and a subsequent increase in cardiac work leading to heart failure. *Transposition of great vessels* - In TGV, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, creating **two parallel circulations**. Complete TGV without a septal defect is incompatible with life. - If a VSD is present, it can lead to **volume overload** of the left ventricle and pulmonary hypertension, increasing the risk of CHF. *Coarctation of aorta* - This is a narrowing of the aorta, typically distal to the left subclavian artery, causing **increased afterload** on the left ventricle. - The increased workload and pressure overload on the left ventricle can lead to **left ventricular hypertrophy** and ultimately **heart failure**.

Q: A child presented with headache, dizziness, intermittent claudication with occasional dyspnea. The most probable diagnosis is:

Coarctation of aorta. ***Coarctation of aorta*** - **Coarctation of the aorta** presents with upper extremity hypertension and lower extremity hypotension. - This pressure difference typically causes symptoms such as **headache**, **dizziness**, and **intermittent claudication** in the legs. *PDA* - A **patent ductus arteriosus (PDA)** typically presents with a continuous murmur and, if large, signs of heart failure or pulmonary hypertension. - While it can cause dyspnea, **headache, dizziness, and claudication** are not defining symptoms. *TOF* - **Tetralogy of Fallot (TOF)** is characterized by cyanosis, exertional dyspnea, and "tet spells." - It does not typically cause **headaches, dizziness, or claudication** in the absence of severe complications. *ASD* - An **atrial septal defect (ASD)** is often asymptomatic until adulthood or presents with mild symptoms like fatigue or dyspnea with exertion. - It is not associated with **headache, dizziness, or intermittent claudication**.

Q: True statement about Rheumatic fever in children -

Polyarthritis is the most common major manifestation. ***Polyarthritis is the most common major manifestation*** - **Polyarthritis** is a migratory inflammation of large joints, typically affecting more than one joint simultaneously or in quick succession, and is indeed the most frequent major manifestation of acute rheumatic fever in children. - It affects about **60-80%** of children with episodes of rheumatic fever, usually resolving without permanent joint damage. *MC valve involvement is Aortic* - The **mitral valve** is the most commonly affected heart valve in rheumatic fever, experiencing damage in 50-70% of cases [1]. - While the aortic valve can be involved, it is less common than mitral valve involvement, with tricuspid and pulmonary valves being affected least frequently. *Caused by Group A beta-hemolytic streptococci* - Acute rheumatic fever is an **autoimmune inflammatory process** that occurs as a sequela of an untreated or inadequately treated infection with Group A Streptococcus (GAS), not directly caused by the bacteria [1]. - The immune response to GAS (specifically *Streptococcus pyogenes*) leads to **molecular mimicry**, where antibodies mistakenly attack host tissues, primarily the heart, joints, brain, and skin [2]. *Erythema marginatum is the most common manifestation* - **Erythema marginatum** is a rare rash associated with rheumatic fever, characterized by red rings or crescent-shaped lesions with clear centers, primarily seen on the trunk and proximal extremities. - It is one of the **minor manifestations** and occurs in less than 5% of cases, making it far from the most common overall manifestation (major or minor).

Q: Uncommon finding in congestive cardiac failure in a newborn -

Pedal edema. ***Pedal edema*** - While **edema** can occur in newborns with **congestive heart failure (CHF)**, it is less common to see isolated **pedal edema** compared to older children or adults. - In newborns, fluid retention often manifests as **generalized edema** or **periorbital edema** due to less developed lymphatic drainage and different fluid distribution. *Tachycardia* - **Tachycardia** (increased heart rate) is a **very common** and significant finding in newborns with **CHF** as the heart attempts to maintain cardiac output. - It is an early compensatory mechanism in response to decreased pump function. *Tachypnoea* - **Tachypnoea** (increased respiratory rate) is a **common symptom** of **CHF** in newborns due to pulmonary congestion and increased effort of breathing. - The lungs become stiff and less compliant, leading to faster, shallow breathing. *Hepatomegaly* - **Hepatomegaly** (enlarged liver) is a **frequent and diagnostically important sign** of **right-sided heart failure** in newborns due to venous congestion. - The liver acts as a reservoir, and its enlargement often indicates increased systemic venous pressure.

Question 1

The most common paediatric cardiac tumour among the following is

Accepted Answer

Rhabdomyomas

Answer

Myxomas

Answer

Hemangiomas

Answer

Fibromas

Question 2

In septum primum type of ASD overburden occurs in which chamber?

Accepted Answer

RA + RV

Answer

LA

Answer

LA + LV

Answer

RA + LA

Question 3

A 29-day-old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. The most likely diagnosis is:

Accepted Answer

Ventricular septal defect

Answer

Rheumatic fever

Answer

Transposition of great arteries

Answer

Tetralogy of Fallot

Question 4

A child presents with LVH and pulmonary complications. ECG shows left axis deviation. Most likely diagnosis is:

Accepted Answer

Tricuspid atresia

Answer

TOF

Answer

TAPVC

Answer

VSD

Question 5

An 8-month-old female child presented to the emergency department with a heart rate of 220/minute and features of congestive heart failure. Her heart rate returned to normal after administering intravenous adenosine. What is the most likely diagnosis?

Accepted Answer

Paroxysmal supraventricular tachycardia

Answer

Atrial flutter

Answer

Atrial fibrillation

Answer

Ventricular tachycardia

Question 6

The heart lesion not found in Congenital Rubella infection is –

Accepted Answer

ASD

Answer

VSD

Answer

PS

Answer

PDA

Question 7

Which of the following does not complicate into CHF –

Accepted Answer

Tetralogy of Fallot

Answer

Patent ductus arteriosus

Answer

Transposition of great vessels

Answer

Coarctation of aorta

Question 8

A child presented with headache, dizziness, intermittent claudication with occasional dyspnea. The most probable diagnosis is:

Accepted Answer

Coarctation of aorta

Answer

PDA

Answer

TOF

Answer

ASD

Question 9

True statement about Rheumatic fever in children -

Accepted Answer

Polyarthritis is the most common major manifestation

Answer

MC valve involvement is Aortic

Answer

Caused by Group A beta-hemolytic streptococci

Answer

Erythema marginatum is the most common manifestation

Question 10

Uncommon finding in congestive cardiac failure in a newborn -

Accepted Answer

Pedal edema

Answer

Tachycardia

Answer

Tachypnoea

Answer

Hepatomegaly

Cardiology — MCQs

Cardiology — MCQs

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