Cardiology Practice Questions

Q: A 3-year-old boy is brought by his parents to the emergency department because they are concerned that he has had a high fever for several days. On examination, the boy has conjunctival and oral erythema. He has palpable cervical lymphadenopathy and erythema of his palms and soles. What is a potential life-threatening complication of this disorder?

Aneurysm of the coronary arteries. ***Aneurysm of the coronary arteries*** - The classic presentation of prolonged fever, **conjunctival and oral erythema**, cervical lymphadenopathy, and erythema of the palms and soles is highly suggestive of **Kawasaki disease**. - **Coronary artery aneurysms** are the most serious and potentially life-threatening complication of Kawasaki disease, especially if left untreated. *Dissection of the thoracic aorta* - This is a rare event in children and is not typically associated with Kawasaki disease. - Thoracic aortic dissection often presents with **sudden, severe chest pain** radiating to the back and is seen more commonly in adults with conditions like uncontrolled hypertension or connective tissue disorders. *Rupture of a berry aneurysm* - **Berry aneurysms** are typically found in the cerebral circulation and their rupture leads to subarachnoid hemorrhage. - While they can occur in children, they are not a characteristic complication of Kawasaki disease. *Aneurysm of the abdominal aorta* - Aneurysms of the abdominal aorta are rare in children and are not directly associated with Kawasaki disease. - These are typically seen in older adults due to **atherosclerosis** or in some genetic syndromes.

Q: Cyanotic heart disease with left axis deviation is:

Tricuspid atresia. ***Tricuspid atresia*** - **Tricuspid atresia** is a **cyanotic congenital heart disease** characterized by the absence of a tricuspid valve, leading to a single ventricle physiology. - The characteristic **ECG finding** in tricuspid atresia is **left axis deviation**, often with left ventricular hypertrophy, which is somewhat counterintuitive given the right-sided lesion. *TAPVC* - **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a **cyanotic heart disease** where all four pulmonary veins drain into the systemic venous circulation. - While cyanotic, it typically presents with a **right axis deviation** and **right ventricular hypertrophy** on ECG, not left axis deviation. *Ebstein anomaly* - **Ebstein anomaly** involves the downward displacement of the septal and posterior leaflets of the tricuspid valve into the right ventricle, often leading to **cyanosis**. - ECG findings are usually characterized by **right atrial enlargement** and **right bundle branch block**, not left axis deviation. *TGA* - **Transposition of the Great Arteries (TGA)** is a **cyanotic heart disease** where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. - ECG typically shows **right axis deviation** and **right ventricular hypertrophy**, reflecting the increased workload of the right ventricle pumping into the high-pressure aortic circuit.

Q: Commonest cause of heart failure in infancy is:

Congenital heart disease. **Congenital heart disease** - **Congenital heart defects** are the leading cause of heart failure in infancy due to structural abnormalities that impair normal cardiac function and blood flow. - Conditions like **ventricular septal defects (VSDs)**, **atrial septal defects (ASDs)**, and **patent ductus arteriosus (PDA)** can lead to volume overload or pressure overload, resulting in heart failure. *Cardiomyopathy* - While a cause of heart failure, **cardiomyopathy** is less common than congenital heart disease in infancy. - It involves primary myocardial dysfunction, which can be genetic, metabolic, or idiopathic. *Rheumatic fever* - **Rheumatic fever** is a post-streptococcal inflammation that can affect the heart, but it is rare in infancy and more typically seen in older children and adolescents. - Its incidence has also significantly decreased in developed countries due to improved hygiene and antibiotic use. *Myocarditis* - **Myocarditis**, often virally induced, can cause heart failure in infants but is less frequent than congenital heart defects. - It involves inflammation of the heart muscle, leading to impaired contractility.

Q: Most common cause of Acquired Complete Heart Block in children is

Cardiac Surgery. ***Cardiac Surgery*** - **Cardiac surgery** for congenital heart disease is the **most common cause** of acquired complete heart block in children, occurring in approximately **1-3% of congenital heart surgeries**. - High-risk procedures include **VSD repair**, **AV canal defect repair**, **tetralogy of Fallot correction**, and surgeries involving the **ventricular septum** near the AV node and bundle of His. - The conduction system may be damaged during surgical manipulation, leading to **immediate or delayed post-operative complete heart block**. - If the block persists beyond **7-10 days post-surgery**, permanent pacemaker implantation is typically required. *Myocarditis* - **Myocarditis** can cause varying degrees of AV block, including complete heart block, particularly following **viral infections** (e.g., Coxsackie virus, adenovirus). - However, complete heart block in myocarditis is **less common** than post-surgical cases in the pediatric population. - Most cases of myocarditis-related conduction disturbances are **transient** and resolve with treatment of the underlying inflammation. *Acute Rheumatic Fever* - **Acute Rheumatic Fever (ARF)** typically causes **first-degree AV block** (prolonged PR interval) as part of rheumatic carditis. - Complete heart block is **rare** in ARF; the carditis more commonly leads to **valvular damage** (mitral and aortic regurgitation) rather than complete AV dissociation. *Drug overdose* - Overdose of **cardiac depressants** (beta-blockers, calcium channel blockers, digoxin) can cause complete heart block. - This is an **acute toxicological cause** and relatively uncommon compared to post-surgical heart block in children. - Treatment involves supportive care, antidotes when available, and temporary pacing if needed.

Q: Which of the following is a defining feature of Tetralogy of Fallot?

Ventricular septal defect. ***Ventricular septal defect*** - A **ventricular septal defect (VSD)** is one of the four cardinal features of **Tetralogy of Fallot**, along with pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. - The VSD in Tetralogy of Fallot is typically **large** and **non-restrictive**, allowing a **right-to-left shunt** due to increased right ventricular pressure from pulmonary stenosis, resulting in cyanosis. - Cyanotic spells (tet spells) occur when there is increased right-to-left shunting due to dynamic worsening of RVOT obstruction. *Atrial septal defect* - An **atrial septal defect (ASD)** is a communication between the atria and is not a defining feature of Tetralogy of Fallot. - While ASDs can occur in conjunction with other congenital heart defects, they are not part of the classic tetralogy. *Mitral valve prolapse* - **Mitral valve prolapse** is a condition where the mitral valve leaflets bulge into the left atrium during systole, and it is not a congenital heart defect associated with Tetralogy of Fallot. - It is a common valvular abnormality that usually develops later in life or can be present congenitally but is unrelated to the pathophysiology of Tetralogy of Fallot. *Patent ductus arteriosus* - A **patent ductus arteriosus (PDA)** is a persistent opening between the aorta and pulmonary artery, which normally closes shortly after birth. - While a PDA can be present in some cases of congenital heart disease, it is not one of the four defects that comprise Tetralogy of Fallot.

Q: Pulmonary plethora is not seen in:

TOF. ***TOF*** - In **Tetralogy of Fallot (TOF)**, the **right ventricular outflow tract obstruction** (pulmonary stenosis) limits blood flow to the lungs, resulting in **pulmonary oligemia** (reduced pulmonary vascular markings) rather than plethora. - The combination of **pulmonary stenosis** and the **ventricular septal defect (VSD)** causes a right-to-left shunt, diverting deoxygenated blood away from the lungs and into the systemic circulation. *Truncus arteriosus* - **Truncus arteriosus** involves a single great artery overriding a **VSD**, leading to **unrestricted blood flow** into both the systemic and pulmonary circulations. - This typically results in **excessive pulmonary blood flow** and thus **pulmonary plethora**. *TAPVC* - In **total anomalous pulmonary venous connection (TAPVC)**, all pulmonary veins drain into the systemic venous circulation, causing **volume overload** of the right heart. - This excessive pulmonary venous return to the right side of the heart leads to **increased pulmonary blood flow** and **pulmonary plethora**. *VSD* - A **ventricular septal defect (VSD)** allows blood to shunt from the high-pressure left ventricle to the lower-pressure right ventricle. - This **left-to-right shunt** increases blood flow to the pulmonary circulation, causing **pulmonary plethora**.

Q: Which of the following cardiac lesions is least likely to occur in Congenital Rubella syndrome?

ASD. ***ASD*** - While **atrial septal defects (ASDs)** can occur in congenital heart disease, they are **rarely associated with congenital rubella syndrome**. - The classic cardiac defects linked to congenital rubella are related to persistent fetal circulation structures or underdeveloped outflow tracts. *VSD* - **Ventricular septal defects (VSDs)** are among the **most common congenital heart defects** and can be associated with congenital rubella syndrome. - Rubella infection can interfere with septal development, leading to these **shunt lesions**. *Pulmonary Stenosis* - **Pulmonary artery stenosis**, particularly **peripheral pulmonary artery stenosis**, is a **characteristic cardiovascular anomaly** in congenital rubella syndrome. - The rubella virus can affect the development of the pulmonary arteries and valves. *PDA* - **Patent ductus arteriosus (PDA)** is the **most common cardiac lesion** seen in congenital rubella syndrome due to the virus's interference with ductal closure. - The infection leads to abnormal development and persistence of the communication between the aorta and pulmonary artery.

Q: Drug of choice for the treatment of Kawasaki disease is

Intravenous Immunoglobulin. ***Intravenous Immunoglobulin*** - **Intravenous Immunoglobulin (IVIG)**, in combination with aspirin, is the cornerstone of therapy for acute Kawasaki disease. - It works by modulating the immune system and reducing inflammation, thereby preventing serious complications like **coronary artery aneurysms**. *Steroids* - While steroids can reduce inflammation, they are generally considered **second-line therapy** in Kawasaki disease, often used in cases unresponsive to IVIG. - Routine initial use of steroids alone is not the drug of choice due to the proven efficacy of IVIG in preventing **coronary artery pathology**. *Low molecular weight Heparin* - **Low molecular weight heparin** is an anticoagulant used to prevent or treat **thrombosis**. - It is not indicated for the primary treatment of the acute inflammatory phase of Kawasaki disease, though it may be used in specific situations if **coronary artery thrombosis** develops. *Aspirin* - **Aspirin** is an essential part of Kawasaki disease treatment, used initially at high doses for its anti-inflammatory effects and later at low doses for its **antiplatelet properties**. - However, aspirin is always administered **in conjunction with IVIG** as the primary treatment to reduce the risk of coronary artery complications.

Q: An infant previously diagnosed with a large muscular VSD comes to the office with complaints from the mother of fatigue and poor feeding over the past month. You note the child has not gained weight since the previous visit 2 months ago. The child is apathetic, tachypneic, and has wheezes and crackles on lung auscultation. What is the most likely cardiac diagnosis based on this patient's presentation?

Congestive heart failure. ***Congestive heart failure*** - The infant's symptoms of **fatigue**, **poor feeding**, **no weight gain**, **apathy**, **tachypnea**, and **wheezes/crackles** are classic signs of **congestive heart failure** in an infant. - A **large muscular VSD** can lead to significant left-to-right shunting, causing **pulmonary overcirculation** and symptoms of heart failure. *Congenital heart block* - This condition involves an abnormality in the heart's electrical conduction system, leading to a **slow heart rate (bradycardia)**. - While it can cause fatigue, it typically doesn't present with respiratory symptoms like **tachypnea** and **rales** unless profound bradycardia leads to heart failure. *Prolonged QT syndrome* - This is an **electrical disorder** that can cause **arrhythmias** and sudden cardiac death, often presenting with syncope or seizures. - It does not typically manifest with the signs of **pulmonary congestion** (wheezes, crackles) or feeding difficulties seen in this infant. *Hypertrophic cardiomyopathy* - This condition involves thickening of the heart muscle, leading to **outflow obstruction** and diastolic dysfunction. - While it can cause symptoms of poor feeding and fatigue, the prominent respiratory symptoms like **tachypnea** and **crackles** are more indicative of pulmonary venous congestion secondary to a large shunt.

Q: Which of the following cardiac defects can be seen in Congenital Rubella Syndrome?

Conduction defect. ***Conduction defect*** - **Congenital Rubella Syndrome (CRS)** causes various **cardiac defects**, including **conduction abnormalities** such as **complete heart block** and **bundle branch blocks**. - These arise from the direct effect of the **rubella virus** on the developing fetal cardiac conduction system. - **Conduction defects** are well-recognized cardiac manifestations of CRS. *VSD* - **Ventricular Septal Defect (VSD)** **can indeed occur** in Congenital Rubella Syndrome and is documented in medical literature as one of the possible cardiac defects. - However, the **most characteristic and commonly emphasized cardiac defects** in CRS are **Patent Ductus Arteriosus (PDA)** - occurring in 60-70% of cases - and **Pulmonary Artery Stenosis/Branch Pulmonary Stenosis**. - While VSD is a recognized cardiac manifestation, **conduction defects** are more specifically highlighted in the context of CRS cardiac involvement in standard textbooks. *Microcephaly* - **Microcephaly** is a severe and common manifestation of **Congenital Rubella Syndrome**, but it is a **neurological defect**, **NOT a cardiac defect**. - This option tests whether candidates can differentiate between cardiac and non-cardiac manifestations. - Other common non-cardiac manifestations include **sensorineural hearing loss**, **cataracts**, and **intrauterine growth restriction**. *All of the options* - This option is **incorrect** because **Microcephaly** is a **neurological manifestation**, not a cardiac defect. - The question specifically asks for **cardiac defects** seen in the syndrome. - Both **Conduction defect** and **VSD** are cardiac manifestations, but only **Conduction defect** is marked as the answer, likely emphasizing the more specifically associated cardiac finding in CRS.

Question 1

A 3-year-old boy is brought by his parents to the emergency department because they are concerned that he has had a high fever for several days. On examination, the boy has conjunctival and oral erythema. He has palpable cervical lymphadenopathy and erythema of his palms and soles. What is a potential life-threatening complication of this disorder?

Accepted Answer

Aneurysm of the coronary arteries

Answer

Dissection of the thoracic aorta

Answer

Rupture of a berry aneurysm

Answer

Aneurysm of the abdominal aorta

Question 2

Cyanotic heart disease with left axis deviation is:

Accepted Answer

Tricuspid atresia

Answer

TAPVC

Answer

Ebstein anomaly

Answer

TGA

Question 3

Commonest cause of heart failure in infancy is:

Accepted Answer

Congenital heart disease

Answer

Cardiomyopathy

Answer

Rheumatic fever

Answer

Myocarditis

Question 4

Most common cause of Acquired Complete Heart Block in children is

Accepted Answer

Cardiac Surgery

Answer

Acute Rheumatic Fever

Answer

Drug overdose

Answer

Myocarditis

Question 5

Which of the following is a defining feature of Tetralogy of Fallot?

Accepted Answer

Ventricular septal defect

Answer

Atrial septal defect

Answer

Mitral valve prolapse

Answer

Patent ductus arteriosus

Question 6

Pulmonary plethora is not seen in:

Accepted Answer

TOF

Answer

Truncus arteriosus

Answer

TAPVC

Answer

VSD

Question 7

Which of the following cardiac lesions is least likely to occur in Congenital Rubella syndrome?

Accepted Answer

ASD

Answer

VSD

Answer

Pulmonary Stenosis

Answer

PDA

Question 8

Drug of choice for the treatment of Kawasaki disease is

Accepted Answer

Intravenous Immunoglobulin

Answer

Steroids

Answer

Low molecular weight Heparin

Answer

Aspirin

Question 9

An infant previously diagnosed with a large muscular VSD comes to the office with complaints from the mother of fatigue and poor feeding over the past month. You note the child has not gained weight since the previous visit 2 months ago. The child is apathetic, tachypneic, and has wheezes and crackles on lung auscultation. What is the most likely cardiac diagnosis based on this patient's presentation?

Accepted Answer

Congestive heart failure

Answer

Congenital heart block

Answer

Prolonged QT syndrome

Answer

Hypertrophic cardiomyopathy

Question 10

Which of the following cardiac defects can be seen in Congenital Rubella Syndrome?

Accepted Answer

Conduction defect

Answer

VSD

Answer

Microcephaly

Answer

All of the options

Cardiology — MCQs

Cardiology — MCQs

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