Cardiology Practice Questions

Q: What is the most common presentation of a double aortic arch in infants?

Tracheal compression symptoms. **Explanation:** **Double Aortic Arch (DAA)** is the most common type of symptomatic vascular ring. It occurs when both the right and left embryonic fourth aortic arches persist, forming a complete ring around the trachea and esophagus. **1. Why Tracheal Compression is Correct:** In infants, the trachea is highly compliant and easily compressible. Because the ring tightly encircles the airway, the most frequent and earliest clinical manifestations are respiratory. These include **expiratory stridor** (often called "noisy breathing"), barking cough, and respiratory distress. While the esophagus is also compressed, respiratory symptoms typically predominate and present earlier than feeding difficulties. **2. Analysis of Incorrect Options:** * **A. Dysphagia:** While esophageal compression occurs (dysphagia lusoria), it is usually less prominent than respiratory distress in infancy. It may become more apparent when the child starts solid foods. * **C. Positional hyperemia/Edema:** These are features of venous obstruction (like Superior Vena Cava Syndrome) or thoracic outlet syndrome, not a vascular ring. * **D. Bleeding:** This is not a feature of DAA. Hemoptysis or hematemesis would only occur in rare, late-stage complications like an aorto-esophageal fistula. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** CT or MRI angiography (to visualize the vascular anatomy). * **Initial Screening:** Barium swallow (shows bilateral/posterior indentation of the esophagus). * **Physical Exam:** Stridor often improves with **neck hyperextension** (which pulls the ring away from the trachea). * **Anatomy:** The **right arch** is usually larger and higher than the left arch in a DAA.

Q: Which of the following statements is NOT true about Tetralogy of Fallot (TOF)?

Atrial septal defect is one of the components of TOF.. **Explanation:** Tetralogy of Fallot (TOF) is defined by a specific constellation of four anatomical defects. Understanding these components is crucial for identifying the incorrect statement. **1. Why Option C is the correct answer (The "NOT true" statement):** The four classic components of TOF are: 1. **Ventricular Septal Defect (VSD):** Large and malaligned. 2. **Overriding of the Aorta:** The aorta sits over the VSD. 3. **Right Ventricular Outflow Tract Obstruction (RVOTO):** Most commonly infundibular pulmonary stenosis. 4. **Right Ventricular Hypertrophy (RVH):** Occurs secondary to the high pressure required to pump against the obstruction. An **Atrial Septal Defect (ASD)** is not a component of the "Tetralogy." When an ASD is present along with TOF, the condition is known as **Pentalogy of Fallot.** **2. Analysis of incorrect options:** * **Option A:** TOF is indeed the most common cyanotic heart disease (CHD) beyond infancy. (Note: Transposition of the Great Arteries is the most common cyanotic CHD at birth). * **Option B:** The degree of cyanosis and clinical severity are directly proportional to the severity of pulmonary stenosis. More obstruction leads to more right-to-left shunting across the VSD. * **Option D:** The "boot-shaped heart" (**Coeur en sabot**) is a classic radiological finding caused by an upturned apex (due to RVH) and a concave pulmonary segment. **Clinical Pearls for NEET-PG:** * **Murmur:** The murmur in TOF is due to **pulmonary stenosis** (ejection systolic), NOT the VSD (which is usually large and non-restrictive). * **X-ray:** Characterized by "Oligaemic lung fields" due to reduced pulmonary blood flow. * **Management:** Squatting helps during a "Tet spell" by increasing systemic vascular resistance, which reduces the right-to-left shunt. * **Drug of Choice for Tet Spell:** Morphine or Beta-blockers (Propranolol).

Q: Which of the following can cause recurrent pulmonary infections, except?

Tetralogy of Fallot (TOF). **Explanation:** The core concept behind recurrent pulmonary infections in congenital heart disease (CHD) is **increased pulmonary blood flow (Left-to-Right Shunt)**. When excess blood reaches the lungs, it leads to pulmonary congestion, interstitial edema, and decreased lung compliance. This fluid-rich environment impairs local immune mechanisms and provides a nidus for bacterial growth, leading to frequent pneumonia. * **Why Tetralogy of Fallot (TOF) is the correct answer:** TOF is a **cyanotic** heart disease characterized by **decreased pulmonary blood flow** due to right ventricular outflow tract obstruction (pulmonary stenosis). Because the lungs are "protected" from high pressure and volume, these patients do not typically suffer from recurrent pulmonary infections. Instead, they present with cyanosis and "Tet spells." * **Why the other options are incorrect:** * **VSD & ASD:** These are **Acyanotic** CHDs with **Left-to-Right shunts**. They cause pulmonary plethora (increased blood flow), making the patient highly susceptible to recurrent lower respiratory tract infections (LRTIs). VSD usually presents earlier and more severely than ASD. * **Recurrent LRTIs:** This option is a clinical manifestation of the underlying shunt physiology mentioned above. **Clinical Pearls for NEET-PG:** 1. **Acyanotic CHD (VSD, ASD, PDA):** Increased pulmonary blood flow → Recurrent LRTIs + Congestive Heart Failure. 2. **Cyanotic CHD (TOF, Tricuspid Atresia):** Decreased pulmonary blood flow → Cyanosis + Hypoxic spells (No recurrent LRTIs). 3. **Exception:** Transposition of the Great Arteries (TGA) is a cyanotic CHD that *can* have increased pulmonary flow and thus may present with infections. 4. **VSD** is the most common congenital heart disease overall.

Q: The term infantile polyarteritis nodosa was formerly used for which condition?

Kawasaki disease. **Explanation:** **Kawasaki Disease (KD)**, also known as mucocutaneous lymph node syndrome, was historically referred to as **infantile polyarteritis nodosa (IPN)**. This is because both conditions are characterized by medium-vessel vasculitis and the formation of coronary artery aneurysms. Pathologically, the vascular lesions in severe infantile cases of KD were found to be indistinguishable from the necrotizing vasculitis seen in Polyarteritis Nodosa (PAN). Today, KD is recognized as a distinct clinical entity and is the most common cause of acquired heart disease in children in developed nations. **Analysis of Incorrect Options:** * **Goodpasture’s Syndrome:** This is an anti-glomerular basement membrane (anti-GBM) disease characterized by pulmonary hemorrhage and glomerulonephritis. It is a small-vessel vasculitis, not related to the medium-vessel pathology of IPN. * **Henoch-Schönlein Purpura (IgA Vasculitis):** This is the most common small-vessel vasculitis in children, presenting with palpable purpura, arthritis, and abdominal pain. It involves IgA deposition rather than the necrotizing arteritis seen in PAN. * **Takayasu’s Arteritis:** Known as "pulseless disease," this is a large-vessel vasculitis primarily affecting the aorta and its main branches. It typically affects adolescent girls and young women, unlike the infantile presentation of KD. **Clinical Pearls for NEET-PG:** * **Diagnostic Criteria for KD:** Fever for ≥5 days plus 4 out of 5 signs (Conjunctivitis, Rash, Edema/Erythema of hands/feet, Adenopathy, Mucosal changes - "CREAM"). * **Cardiac Complication:** Coronary artery aneurysms occur in 20-25% of untreated cases. * **Treatment:** High-dose IVIG (2g/kg) and Aspirin. (Note: KD is one of the few pediatric indications for Aspirin). * **Echo Timing:** Baseline echocardiogram should be done at diagnosis and repeated at 2 and 6–8 weeks.

Q: Which of the following is NOT associated with Kawasaki disease?

Thrombocytopenia. **Explanation:** Kawasaki Disease (KD) is an acute, systemic, medium-vessel vasculitis primarily affecting children under 5 years of age. The diagnosis is clinical, based on the presence of high-grade fever for ≥5 days plus at least four out of five major criteria. **Why Thrombocytopenia is the correct answer:** In Kawasaki disease, the characteristic hematological finding is actually **thrombocytosis** (elevated platelet count), which typically occurs during the subacute phase (2nd–3rd week). A platelet count often exceeding 4.5 lakh/mm³ is a classic marker. While rare cases of "macrophage activation syndrome" associated with KD can cause thrombocytopenia, it is not a standard feature or diagnostic criterion of the disease itself. **Analysis of Incorrect Options:** * **A. Erythema:** This refers to the polymorphous exanthema (skin rash) and erythema of the palms/soles, which are core diagnostic criteria. * **B. Posterior cervical lymphadenopathy:** Lymphadenopathy is a diagnostic criterion. It is typically **unilateral**, non-suppurative, and at least one node must be >1.5 cm. While often anterior, cervical involvement is the hallmark. * **D. Conjunctivitis:** Bilateral, non-exudative (bulbar) conjunctival congestion is a classic diagnostic feature. **High-Yield Clinical Pearls for NEET-PG:** * **CRASH and Burn Mnemonic:** **C**onjunctivitis, **R**ash, **A**denopathy, **S**trawberry tongue (and oral changes), **H**ands/feet (erythema/edema), and **Burn** (5 days of fever). * **Most Serious Complication:** Coronary artery aneurysms (occurs in 20-25% of untreated cases). * **Treatment:** IVIG (2g/kg) and High-dose Aspirin. (Note: This is one of the few pediatric conditions where Aspirin is indicated despite the risk of Reye’s syndrome). * **Echocardiography:** Should be performed at diagnosis, at 2 weeks, and 6–8 weeks.

Q: What is the most common type of Roger's anomaly?

Perimembranous type. **Explanation:** **Roger’s disease** (or Roger’s anomaly) refers to a small, asymptomatic **Ventricular Septal Defect (VSD)**, typically less than 3 mm in diameter. It is characterized by a loud, harsh pansystolic murmur heard best at the left lower sternal border, despite the patient being hemodynamically stable. 1. **Why Perimembranous is correct:** The most common anatomical location for any VSD, including the small restrictive types (Roger’s disease), is the **perimembranous region** (approximately 70–80%). This area is located in the upper part of the septum, near the AV valves and the bundle of His. Because this is the most frequent site for septal defects overall, it is also the most common site for Roger’s anomaly. 2. **Analysis of Incorrect Options:** * **A. Muscular type:** These are the second most common (5–20%). While they have the highest rate of spontaneous closure, they are less frequent than perimembranous defects. * **B. Inlet type:** These occur posterior and inferior to the membranous septum (associated with AV canal defects) and are much rarer. * **C. Outlet type (Supracristal):** These are located beneath the pulmonary valve. They are less common (except in certain populations like East Asians) and are clinically significant because they can lead to aortic valve prolapse. **High-Yield Clinical Pearls for NEET-PG:** * **Murmur Paradox:** In VSD, the **louder** the murmur, the **smaller** the hole (Roger’s disease). A very large VSD may have a soft murmur or no murmur at all due to equalized pressures. * **Spontaneous Closure:** Most small VSDs (Roger’s) close spontaneously, usually within the first 2 years of life. * **Most common congenital heart disease (CHD):** VSD is the most common CHD overall (excluding bicuspid aortic valve).

Q: Which of the following is NOT a major criterion in NADA's criteria?

Abnormal ECG. **Explanation:** NADA’s criteria are a clinical tool used in pediatric cardiology to differentiate between a functional (innocent) murmur and organic heart disease. The criteria are divided into **Major** and **Minor** categories. **Why "Abnormal ECG" is the correct answer:** According to NADA’s criteria, an **Abnormal ECG** (specifically showing ventricular hypertrophy or significant axis deviation) is classified as a **Minor Criterion**, not a major one. To diagnose heart disease using this system, one requires either **one major criterion** or **two minor criteria**. **Analysis of Incorrect Options (Major Criteria):** * **A. Diastolic Murmur:** Any diastolic murmur in a child is considered pathological and is a Major Criterion. * **C. Cyanosis:** Central cyanosis of cardiac origin is a Major Criterion. * **D. Congestive Cardiac Failure (CCF):** Clinical evidence of heart failure (e.g., hepatomegaly, respiratory distress) is a Major Criterion. * *(Note: A Systolic Murmur of Grade III or higher is also a Major Criterion).* **Minor Criteria include:** 1. Systolic murmur (Grade < III). 2. Abnormal ECG. 3. Abnormal X-ray (Cardiomegaly or abnormal pulmonary vascularity). 4. Abnormal Blood Pressure (e.g., Hypertension). **High-Yield NEET-PG Pearls:** * **Memory Aid:** Major criteria are "The Big Four"—Loud Systolic/Any Diastolic Murmurs, Cyanosis, and CCF. Investigations (ECG/X-ray) are generally Minor. * **Innocent Murmurs:** Most common is **Still’s Murmur** (vibratory, systolic, heard at the left lower sternal border). * **NADA’s Criteria** is specifically designed for pediatric populations where invasive testing may not be immediately available.

Q: Which of the following is NOT seen in Tetralogy of Fallot?

Atrial Septal Defect (ASD). **Explanation:** Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD) beyond the neonatal period. As the name "Tetralogy" implies, it is characterized by a classic constellation of **four** anatomical defects resulting from the anterior and cephalad deviation of the infundibular (outflow tract) septum. **1. Why Atrial Septal Defect (ASD) is the Correct Answer:** An ASD is **not** part of the classic tetrad of TOF. While an ASD can coexist with TOF (a condition known as **Pentalogy of Fallot**), it is not a defining feature of the standard diagnosis. **2. Analysis of Incorrect Options (The Classic Tetrad):** * **Ventricular Septal Defect (VSD):** Usually a large, non-restrictive malalignment defect in the membranous septum. * **Pulmonary Stenosis (PS):** Primarily infundibular (subvalvular) stenosis, though valvular and supravalvular stenosis can occur. This is the primary determinant of the degree of cyanosis. * **Right Ventricular Hypertrophy (RVH):** Develops as a secondary response to the high-pressure workload caused by pulmonary stenosis and the large VSD. * **Overriding of the Aorta:** The aorta is displaced to the right, straddling the VSD and receiving blood from both ventricles. **Clinical Pearls for NEET-PG:** * **X-ray Finding:** "Boot-shaped heart" (*Coeur en sabot*) due to an upturned apex (RVH) and a concave pulmonary segment. * **ECG:** Shows Right Axis Deviation (RAD) and RVH. * **Cyanotic Spells (Tet Spells):** Characterized by sudden hyperpnea and cyanosis; managed by the **knee-chest position** (increases systemic vascular resistance) and oxygen. * **Murmur:** The murmur in TOF is due to **Pulmonary Stenosis** (Ejection Systolic Murmur), not the VSD.

Question 1

What is the most common presentation of a double aortic arch in infants?

Accepted Answer

Tracheal compression symptoms

Answer

Dysphagia

Answer

Positional hyperemia with right upper arm edema

Answer

Bleeding

Question 2

Which of the following statements is NOT true about Tetralogy of Fallot (TOF)?

Accepted Answer

Atrial septal defect is one of the components of TOF.

Answer

It is the most common congenital cyanotic heart disease in children.

Answer

The severity of the disease depends on the severity of pulmonary stenosis.

Answer

A boot-shaped heart is seen on chest X-ray.

Question 3

Which of the following can cause recurrent pulmonary infections, except?

Accepted Answer

Tetralogy of Fallot (TOF)

Answer

Ventricular Septal Defect (VSD)

Answer

Recurrent lower respiratory tract infections

Answer

Atrial Septal Defect (ASD)

Question 4

What are the major criteria for rheumatic fever?

Accepted Answer

Arthralgia

Answer

Carditis

Answer

Erythema marginatum

Answer

Subcutaneous nodule

Question 5

The term infantile polyarteritis nodosa was formerly used for which condition?

Accepted Answer

Kawasaki disease

Answer

Goodpasture's syndrome

Answer

Henoch-Schönlein purpura

Answer

Takayasu's arteritis

Question 6

Which of the following is NOT associated with Kawasaki disease?

Accepted Answer

Thrombocytopenia

Answer

Erythema

Answer

Posterior cervical lymphadenopathy

Answer

Conjunctivitis

Question 7

A 2-year-old boy presented to the ER with stridor, hoarseness of breath, and difficulty in swallowing. The patient also has a history of recurrent chest infections for which he was frequently hospitalized. Upper GI endoscopy was normal. Chest x-ray findings are pending. What is the most likely diagnosis?

Accepted Answer

Dysphagia lusoria

Answer

Achalasia cardia

Answer

Nutcracker esophagus

Answer

Diffuse esophageal spasm

Question 8

What is the most common type of Roger's anomaly?

Accepted Answer

Perimembranous type

Answer

Muscular type

Answer

Inlet type

Answer

Outlet type

Question 9

Which of the following is NOT a major criterion in NADA's criteria?

Accepted Answer

Abnormal ECG

Answer

Diastolic murmur

Answer

Cyanosis

Answer

Congestive cardiac failure

Question 10

Which of the following is NOT seen in Tetralogy of Fallot?

Accepted Answer

Atrial Septal Defect (ASD)

Answer

Ventricular Septal Defect (VSD)

Answer

Right Ventricular Hypertrophy (RVH)

Answer

Pulmonary Stenosis (PS)

Cardiology — MCQs

Cardiology — MCQs

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