Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 291: A 1-year-old child with severe acute malnutrition develops pneumonia which is not responding to treatment. Chest X-ray picture is given. What is the likely etiology?

A. Mycoplasma
B. Pneumococcus
C. Staphylococcus aureus (Correct Answer)
D. Adenovirus

Explanation: ***Staphylococcus aureus*** - The chest X-ray shows extensive **bilateral infiltrates** with areas of potential **abscess formation** or **necrotizing pneumonia**, suggested by the poorly defined lucencies within consolidation, which are characteristic of Staphylococcal infection, especially in immunocompromised individuals like a malnourished child. - Staphylococcal pneumonia is often severe, can lead to **necrosis**, **cavitation**, and is known for its **resistance to common antibiotics**, explaining the poor response to initial treatment in a severely malnourished child. *Mycoplasma* - Mycoplasma pneumoniae typically causes **"walking pneumonia"** with milder symptoms and **diffuse interstitial infiltrates** visible on Chest X-ray, which are not as severe or focal as seen in the image. - It's less common to cause rapidly progressing, severe, and necrotizing pneumonia in this age group, even in malnourished children. *Pneumococcus* - **Streptococcus pneumoniae (Pneumococcus)** usually causes **lobar pneumonia** with dense, homogeneous consolidation in one lobe, often with a visible air bronchogram, rather than the more patchy, bilateral, and potentially necrotizing pattern seen here. - While it can be severe, especially in malnourished children, the radiographic pattern is less typical for pneumococcal infection. *Adenovirus* - Adenovirus can cause a range of respiratory infections, from common colds to severe pneumonia, especially in young children. However, the Chest X-ray findings typically include **perihilar infiltrates**, **bronchial wall thickening**, and hyperinflation, which do not fully match the extensive, severe, and potentially cavitating pattern observed. - While it can cause severe pneumonia, the given X-ray features, particularly the suggestion of necrosis, are less characteristic of adenoviral infection.

Question 292: A 3-year-old child presents with the clinical features shown in the image. What is the most likely diagnosis?

A. Kawasaki disease (Correct Answer)
B. Scarlet fever
C. Kikuchi disease
D. Rosai-Dorfman disease

Explanation: ***Kawasaki disease*** * The image displays classic signs of **Kawasaki disease**, including **bilateral conjunctivitis without exudates** (top left), **erythema of the palms and soles with desquamation** (top right), **cervical lymphadenopathy** (bottom left, indicated by swelling in the neck region), and a **strawberry tongue** (bottom right). * These clinical features, especially in a young child, are diagnostic for **Kawasaki disease**, which is a vasculitis affecting medium-sized arteries, most notably the coronary arteries. *Scarlet fever* * While **scarlet fever** can cause a **strawberry tongue** and a rash, the rash is typically a **fine, sandpaper-like rash** that blanches with pressure, not usually characterized by the distinct palm/sole erythema and desquamation seen in the image. * **Conjunctivitis** is not a prominent feature of scarlet fever, and the lymphadenopathy is typically less pronounced and may be tender. *Kikuchi disease* * **Kikuchi disease** (histiocytic necrotizing lymphadenitis) primarily presents with **cervical lymphadenopathy, fever**, and often rash, but it does **not typically involve conjunctivitis or changes in the hands, feet, or tongue** as dramatically depicted. * It is a self-limiting condition of unknown etiology, distinct from the systemic vasculitis of Kawasaki disease. *Rosai-Dorfman disease* * **Rosai-Dorfman disease** (sinus histiocytosis with massive lymphadenopathy) is characterized by **massive, painless lymphadenopathy**, particularly cervical, with fever and other systemic symptoms. * However, it does **not present with the specific mucocutaneous findings** of conjunctivitis, strawberry tongue, or characteristic hand/foot changes seen in the images indicative of Kawasaki disease.

Question 293: A 10-year-old child with Valvular heart disease on heart failure treatment, has the following ECG tracing. What is the diagnosis?

A. Tall tented T-wave
B. Ventricular bigeminy
C. Non paroxysmal atrial tachycardia with irregular AV block
D. Non paroxysmal atrial tachycardia with regular AV block (Correct Answer)

Explanation: ***Non paroxysmal atrial tachycardia with regular AV block*** - The ECG shows a sustained atrial tachycardia with a **consistent P-P interval**, indicating a non-paroxysmal origin. - There is a **fixed ratio between P waves and QRS complexes** (e.g., 2:1 or 3:1), demonstrating a regular AV block, likely due to increased vagal tone or AV nodal dysfunction, often seen in cases of **digoxin toxicity** (given the patient is on heart failure treatment for valvular heart disease). *Tall tented T-wave* - **Tall, tented T-waves** are characteristic of **hyperkalemia**, but the ECG tracing does not exhibit this morphology. - While hyperkalemia can cause rhythm disturbances, the predominant feature here is a regular atrial tachycardia with AV block, not T-wave changes typical of electrolyte imbalance. *Ventricular bigeminy* - **Ventricular bigeminy** would manifest as alternating normal QRS complexes with premature ventricular contractions (PVCs). - The ECG shows a narrow complex tachycardia with visible P waves, which are not characteristic of PVCs or ventricular bigeminy. *Non paroxysmal atrial tachycardia with irregular AV block* - Although there is non-paroxysmal atrial tachycardia, the **AV block is regular** (e.g., a consistent 2:1 or 3:1 conduction ratio), not irregular. - An irregular AV block would suggest variability in AV nodal conduction, such as in AV Wenckebach or Mobitz type II with variable conduction, which is not what is seen in this tracing.

Question 294: A 1-year-old child with CHD is on heart failure treatment. The ECG shows all except:

A. Ventricular bigeminy
B. Heart rate of 60 bpm approximately (Correct Answer)
C. ST depression
D. U wave

Explanation: ***Heart rate of 60 bpm approximately*** - The ECG rhythm is irregular; however, the predominant rhythm shows a normal heart rate for a 1-year-old child. A heart rate of 60 bpm would be considered **bradycardia** in an infant, where the normal heart rate ranges from 100-160 bpm. - The calculated heart rate from the provided ECG strip is approximately 100-120 bpm (counting 10 small squares between R waves, which corresponds to 1500/100 = 150 bpm, or 15 small squares, hence 1500/15 = 100 bpm if the duration between two consecutive R waves is 15 small squares on the ECG graph). *Ventricular bigeminy* - The ECG shows a regular QRS complex followed by a premature ventricular contraction (PVC), which is then followed by another regular QRS complex, fitting the pattern of **ventricular bigeminy**. - This pattern can be observed as the wide, bizarre QRS complexes interspersed between normal beats. *ST depression* - The ST-segment, which is the interval between the end of the QRS complex and the beginning of the T wave, appears to be **depressed**, particularly in the leads shown (V3 and V6). - This finding can indicate **myocardial ischemia** or strain, commonly seen in heart failure. *U wave* - A **U wave** is a small deflection immediately following the T wave, typically positive and best seen in V2-V3. - These waves are visible on this ECG, often prominent when there's hypokalemia or digitalis toxicity, which is plausible in a child on heart failure treatment.

Question 295: Which one of the following is a cyanotic congenital heart disease?

A. Patent ductus arteriosus
B. Ventricular septal defect
C. Tetralogy of Fallot (Correct Answer)
D. Atrial septal defect

Explanation: ***Tetralogy of Fallot*** - This condition is characterized by **four distinct heart defects** that result in **right-to-left shunting** of unoxygenated blood into the systemic circulation, leading to cyanosis. - The four defects are **ventricular septal defect**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy**. *Patent ductus arteriosus* - This is an **acyanotic heart defect** where there is a persistent opening between the aorta and pulmonary artery, leading to a **left-to-right shunt**, increasing pulmonary blood flow. - It does not typically cause cyanosis unless there is severe pulmonary hypertension leading to shunt reversal (Eisenmenger syndrome). *Ventricular septal defect* - This is also primarily an **acyanotic heart defect** where a hole exists between the ventricles, causing a **left-to-right shunt** of oxygenated blood. - Cyanosis would only occur in severe cases with significant pulmonary hypertension and shunt reversal (Eisenmenger syndrome). *Atrial septal defect* - This is an **acyanotic heart defect** involving an opening between the atria, usually resulting in a **left-to-right shunt** of oxygenated blood into the right atrium. - It rarely causes cyanosis unless there are significant complications like pulmonary hypertension with shunt reversal.

Question 296: Which of the following cyanotic heart diseases cause increased pulmonary blood flow? 1. Ebstein anomaly 2. Tetralogy of Fallot 3. Transposition of the great arteries (TGA) 4. Total anomalous pulmonary venous communication (TAPVC) Select the correct combination:

A. 3,4 (Correct Answer)
B. 1,2
C. 2,4
D. 1,4

Explanation: ***3,4 (TGA and TAPVC)*** - **Transposition of the great arteries (TGA)** involves two parallel circulations with the aorta arising from the right ventricle and pulmonary artery from the left ventricle. Mixing occurs through defects (ASD, VSD, or PDA), leading to **pulmonary overcirculation** as oxygenated blood recirculates through the lungs. - **Total anomalous pulmonary venous connection (TAPVC)** results in all pulmonary veins draining into the systemic venous circulation (typically right atrium). This causes **increased volume load on the right heart** and subsequently increased pulmonary blood flow, with obligatory mixing at the atrial level. *1,2 (Ebstein and ToF)* - Both conditions cause **decreased pulmonary blood flow**. - **Ebstein anomaly** involves apical displacement of the tricuspid valve with "atrialization" of the right ventricle, causing tricuspid regurgitation and right-to-left shunting through an ASD/PFO. - **Tetralogy of Fallot** features right ventricular outflow tract obstruction (pulmonary stenosis) as its defining feature, causing reduced pulmonary blood flow. *2,4* - Incorrect combination: **Tetralogy of Fallot causes decreased pulmonary blood flow** due to RVOT obstruction, not increased. *1,4* - Incorrect combination: **Ebstein anomaly causes decreased pulmonary blood flow**, not increased.

Question 297: Which of the following is considered a minor clinical finding suggestive of congenital heart disease?

A. Low BP
B. Systolic murmur grade-3
C. Abnormal 2nd heart sound (Correct Answer)
D. Diastolic murmur

Explanation: ***Abnormal 2nd heart sound*** - An abnormal (loud, soft, split, or single) **second heart sound (S2)** is a minor clinical finding that can suggest congenital heart disease (CHD). - This reflects abnormalities in the **pulmonary** or **aortic valve closure**, common in various CHDs. *Low BP* - **Low blood pressure** is a general sign of circulatory compromise and is not a specific or minor clinical finding for congenital heart disease itself. - It might indicate severe heart failure or shock, which are major, late-stage complications of CHD, rather than an early suggestive sign. *Systolic murmur grade-3* - A **systolic murmur of grade 3 or higher** is generally considered a **major clinical finding** and often indicates significant structural heart disease. - Minor findings are typically less intense or specific signs that still warrant further investigation. *Diastolic murmur* - The presence of **any diastolic murmur** is considered a **major clinical finding** that is highly suggestive of significant heart disease, as it often implies structural valve abnormalities or abnormal blood flow during diastole. - This is not a "minor" finding as it virtually always indicates pathology.

Question 298: A child with fever for 6 days, strawberry tongue, conjunctival congestion with peeling of skin. What will be the treatment option for this child?

A. Antibiotics
B. Steroids
C. Antipyretics
D. IVIG (Correct Answer)

Explanation: ***IVIG*** - The constellation of **fever for 6 days (prolonged fever)**, **strawberry tongue**, **conjunctival congestion**, and **peeling skin** is highly indicative of **Kawasaki disease**. - **Intravenous immunoglobulin (IVIG) 2 g/kg as a single infusion** is the cornerstone of treatment for Kawasaki disease to reduce the risk of **coronary artery aneurysms** (from ~25% to <5%). - IVIG should be administered within **10 days of fever onset** for maximum efficacy. - **High-dose aspirin** (80-100 mg/kg/day) is given concurrently until the fever subsides, then switched to low-dose aspirin (3-5 mg/kg/day) for antiplatelet effect. *Antibiotics* - Kawasaki disease is a **vasculitis**, not a bacterial infection, so antibiotics are ineffective. - While other conditions like scarlet fever can present with strawberry tongue, the prolonged fever and other classic Kawasaki features differentiate it. *Steroids* - While steroids can reduce inflammation, they are **not the primary treatment** for Kawasaki disease and are typically used in conjunction with IVIG in **refractory cases** or for IVIG-resistant disease. - **Monotherapy with steroids** is not recommended for acute Kawasaki disease due to potential for increased aneurysm risk. *Antipyretics* - **Antipyretics** like acetaminophen can help manage the fever symptomatically. - However, they **do not treat the underlying vasculitis** or prevent the serious cardiac complications of Kawasaki disease. - Note: **NSAIDs like ibuprofen should be avoided** when high-dose aspirin is being used due to risk of drug interactions.

Question 299: Which of the following congenital heart disease has equal saturation in all heart chambers?

A. Total anomalous pulmonary venous circulation (Correct Answer)
B. Tetralogy of Fallot
C. Transposition of great arteries
D. Tricuspid atresia

Explanation: ***Total anomalous pulmonary venous circulation*** - In this condition, all **pulmonary veins drain abnormally** into the systemic venous circulation, mixing oxygenated and deoxygenated blood before it reaches the left atrium. - This complete mixing results in **equal oxygen saturation** throughout all four heart chambers and the great arteries, as there is a single common mixing chamber. *Tetralogy of Fallot* - This condition involves **four defects**: pulmonary stenosis, ventricular septal defect (VSD), overriding aorta, and right ventricular hypertrophy, leading to right-to-left shunting. - Oxygen saturations would be **lower in the systemic circulation** and aorta compared to the pulmonary circulation (if measurable), but not equal across all chambers due to deoxygenated blood mixing in the systemic flow. *Transposition of great arteries* - Characterized by the **aorta arising from the right ventricle** and the pulmonary artery from the left ventricle, creating two parallel circulations. - Without mixing lesions (like a VSD or patent foramen ovale), the systemic circulation would be severely desaturated and the pulmonary circulation fully saturated, resulting in **highly disparate saturations** between chambers. *Tricuspid atresia* - Involves the **absence of a tricuspid valve**, preventing blood flow from the right atrium to the right ventricle, necessitating an atrial septal defect (ASD) or patent foramen ovale (PFO) for survival. - Blood from the right atrium goes directly to the left atrium, and then via a VSD to the pulmonary artery, leading to **different saturations** in the systemic and pulmonary circulations and not equal saturation in all chambers.

Question 300: Most common cardiac abnormality in Noonan syndrome is:-

A. Pulmonary stenosis (Correct Answer)
B. Atrial septal defect
C. Tetralogy of Fallot
D. Ventricular septal defect

Explanation: ***Pulmonary stenosis*** - **Valvular pulmonary stenosis**, particularly a dysplastic pulmonary valve, is the **most common cardiac defect** found in individuals with Noonan syndrome. - This condition can lead to an obstruction of blood flow from the right ventricle into the **pulmonary artery**. *Atrial septal defect* - While **atrial septal defects (ASDs)** can occur in Noonan syndrome, they are less common than pulmonary stenosis. - ASDs are characterized by a hole in the septum separating the two upper chambers of the heart. *Tetralogy of Fallot* - **Tetralogy of Fallot** is a complex congenital heart defect involving four specific abnormalities, which is not the most common cardiac finding in Noonan syndrome. - It is typically associated with a different set of genetic syndromes or occurs sporadically. *Ventricular septal defect* - **Ventricular septal defects (VSDs)** are also observed in some cases of Noonan syndrome but are less prevalent than pulmonary stenosis. - VSDs involve a hole in the wall separating the heart's lower two chambers.

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Congenital Heart Diseases: Cyanotic

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Congenital Heart Diseases: Acyanotic

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Rheumatic Heart Disease

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Kawasaki Disease

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Infective Endocarditis

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Myocarditis and Cardiomyopathies

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Arrhythmias in Children

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Heart Failure in Children

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Pulmonary Hypertension

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Systemic Hypertension

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Dyslipidemia in Children

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Cardiac Evaluation and Diagnostics

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Cardiology — MCQs

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