Cardiology Practice Questions

Q: Clinical manifestations of large VSD in children typically appear at:

2 months. ***2 months*** - **Large ventricular septal defects (VSDs)** manifest clinically around **6 to 8 weeks (2 months) of age** because the **pulmonary vascular resistance (PVR)** decreases significantly around this time. - As PVR falls, increased **left-to-right shunting** occurs, leading to pulmonary overcirculation and symptoms like **tachypnea, poor feeding, and growth failure**. *2 days* - At **2 days of age**, PVR is still **elevated**, minimizing **left-to-right shunting** through a VSD, so symptoms are usually absent. - Significant symptoms from large left-to-right shunts due to congenital heart disease are uncommon in the **immediate postnatal period**. *2 weeks* - At **2 weeks of age**, PVR is still **relatively high**, and the decrease is not yet sufficient to cause significant symptomatic **pulmonary overcirculation** from a large VSD. - Clinical manifestations typically become evident when PVR has dropped considerably lower, around the 6-8 week mark. *6 months* - While symptoms would certainly be present at **6 months**, the typical onset of symptoms for a large VSD with significant left-to-right shunting occurs **earlier**, around 2 months of age. - By 6 months, if untreated, infants with large VSDs would likely have well-established signs of **heart failure** and **pulmonary hypertension**.

Q: A one month old infant with a congenital cardiac lesion shows increased sweating during feeding. Which of the following is the sure sign of congestive cardiac failure in this infant?

Liver enlargement. ***Liver enlargement*** - **Hepatomegaly** is a **cardinal sign** of **congestive cardiac failure** in infants due to venous congestion and fluid retention. - The infant's immature lymphatic system and pliable chest wall make other signs less reliable, while the liver quickly reflects increased systemic venous pressure. *JVP* - **Jugular venous pressure (JVP)** is notoriously difficult to assess accurately in infants due to their short necks and poorly developed neck muscles. - Therefore, it is **not a reliable indicator** of congestive cardiac failure in this age group. *Basal crepitations* - **Basal crepitations**, indicating pulmonary edema, can be a sign but are often subtle and can also be present in other respiratory conditions prevalent in infants. - The infant's small lung fields and rapid respiratory rate make the detection of crepitations challenging and less specific than liver enlargement. *Pedal oedema* - **Pedal edema** is less common in infants with congestive heart failure because they tend to retain fluid in the **extracellular space**, leading to generalized edema rather than localized peripheral swelling. - The distribution of fluid retention in infants often manifests as puffiness around the eyes or generalized anasarca rather than prominent pedal edema.

Q: A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :

SVT. **SVT** - A heart rate of 250/min in a 3-4 month old infant, along with a **narrow QRS complex ( 0.09-0.10 sec in adults, proportionally less in infants) because the impulse originates in the ventricles. - The patient's QRS complex is **narrow (<0.07 sec)**, ruling out typical VT. *PSVT with block* - **Paroxysmal supraventricular tachycardia (PSVT) with block** would still present with a rapid atrial rate, and while there might be block to the ventricles, the dominant rhythm would stem from supraventricular activity causing narrow QRS, but the term "with block" usually implies some degree of AV nodal block which would lead to a ventricular rate slower than the atrial rate, unlike the observed 250/min. - The absence of P waves makes identification of a specific "block" pattern difficult, and the high ventricular rate favors a direct conduction rather than a blocked rhythm limiting ventricular response. *Sinus tachycardia* - **Sinus tachycardia** is usually characterized by discernible **P waves** preceding each QRS complex and a heart rate that typically doesn't exceed 220 bpm in infants unless under extreme physiological stress. - A heart rate of 250/min is generally above the physiological limit for sinus tachycardia in infants, and the **absence of P waves** further distinguishes it from sinus tachycardia.

Q: Ductus dependent blood flow is required for all of these congenital heart diseases except:

Persistent truncus arteriosus. ***Persistent truncus arteriosus*** - In **persistent truncus arteriosus**, there is a single great artery overriding a ventricular septal defect, supplying both systemic and pulmonary circulation. **Ductus arteriosus** closure does not critically compromise blood flow to either system. - Pulmonary blood flow is often increased in truncus arteriosus, so a patent ductus is not necessary for pulmonary circulation, nor is it essential for systemic circulation as the single trunk directly supplies the aorta. *Pulmonary stenosis* - Severe **pulmonary stenosis** in neonates can restrict blood flow to the lungs, making a **patent ductus arteriosus** essential for pulmonary blood flow via a right-to-left shunt if the stenosis is critical. - Without the **ductus arteriosus**, severe hypoxemia and acidosis can develop due to insufficient oxygenation. *Hypoplastic left heart syndrome* - In **hypoplastic left heart syndrome**, the left ventricle and aorta are underdeveloped, making the **ductus arteriosus** crucial for systemic blood flow from the right ventricle. - Its closure would severely impair blood supply to the body, leading to circulatory collapse and death. *TGA with intact ventricular septum* - With **transposition of the great arteries (TGA)** and an **intact ventricular septum**, systemic and pulmonary circulations are parallel rather than in series. - A **patent ductus arteriosus** is necessary to allow mixing of oxygenated and deoxygenated blood to sustain life.

Q: Not true about Kawasaki disease is

Thrombocytopenia. ***Thrombocytopenia*** - **Kawasaki disease** typically presents with **thrombocytosis** (elevated platelet count), especially during the subacute phase, as an inflammatory response. - **Thrombocytopenia** (low platelet count) is generally not seen in Kawasaki disease and would suggest an alternative diagnosis. *Posterior cervical lymphadenopathy* - **Cervical lymphadenopathy** is a common diagnostic criterion for Kawasaki disease, often unilateral and **anterior**. - While **posterior cervical lymphadenopathy** is less typical, lymph node involvement is a key feature, making this a plausible (though not the most common) manifestation. *Erythema* - **Erythema** (redness) is a common dermatological finding in Kawasaki disease, often presenting as a polymorphous rash on the trunk and extremities. - It can also manifest as **erythema of the lips and oral mucosa**, including a "strawberry tongue," or **redness and swelling of the hands and feet**. *Conjunctivitis* - **Bilateral non-exudative conjunctivitis** is one of the classic diagnostic criteria for Kawasaki disease. - The eyes appear red without pus or discharge, differentiating it from bacterial conjunctivitis.

Q: The most common cause of Blue baby syndrome

Tetralogy of Fallot. **Tetralogy of Fallot** - **Tetralogy of Fallot (TOF)** is the most common cyanotic congenital heart defect, often presenting as "blue baby syndrome" due to **right-to-left shunting** of unoxygenated blood. - This condition involves **four key defects**: a large ventricular septal defect (VSD), pulmonary stenosis, overriding aorta, and right ventricular hypertrophy, which collectively lead to cyanosis. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect but typically causes a left-to-right shunt, leading to **acyanotic** heart disease, not cyanosis. - While a large VSD can sometimes be part of a more complex cyanotic defect, in isolation, it usually does not cause a "blue baby." *Cardiac Ischemia* - **Cardiac ischemia** refers to reduced blood flow to the heart muscle, most commonly seen in adults due to **coronary artery disease**. - It is not a congenital condition and does not typically present as "blue baby syndrome" in infants. *None of the options* - This option is incorrect because **Tetralogy of Fallot** is indeed the most common cause of "blue baby syndrome."

Q: A 10 year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity is measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis is:

Coarctation of aorta. ***Coarctation of aorta*** - The combination of **severe hypertension in the upper extremities** (200/140 mm Hg), **impalpable femoral pulses**, and seizures in a 10-year-old boy is highly suggestive of **aortic coarctation**. - Aortic coarctation causes a **pressure gradient** across the narrowed aorta, leading to high pressure proximal to the coarctation (upper body) and low pressure distal to it (lower body). *Renal parenchymal disease* - While renal parenchymal disease can cause **hypertension**, it typically does not present with **differential blood pressures** between upper and lower extremities or absent femoral pulses. - The hypertension in renal disease is usually due to **fluid overload** and **renin-angiotensin-aldosterone system activation**. *Takayasu arteritis* - Takayasu arteritis is a form of **large vessel vasculitis** that can affect the aorta and its branches, leading to differential pulses and hypertension. - However, it more commonly affects **young adult women** (typically 10-40 years old) and often presents with systemic symptoms like **fever, malaise**, and **arterial bruits**, which are not mentioned here. *Grand mal seizures* - Grand mal seizures are a neurological symptom, not a diagnosis of the underlying cause. - While **severe hypertension** from any cause can lead to seizures (hypertensive encephalopathy), this option does not explain the specific cardiovascular findings of **differential blood pressure** and **impalpable femoral pulses**.

Q: A 7 year old child with a known history of rheumatic heart disease presents with a 3 weeks history of fever with palpitations. Most likely cause is:

Staphylococcal endocarditis. **Staphylococcal endocarditis** - Children with **rheumatic heart disease** are at increased risk for **infective endocarditis** due to pre-existing valvular damage. - The symptoms of **fever** and **palpitations** over 3 weeks in a child with a predisposing cardiac condition are highly suggestive of subacute bacterial endocarditis, with *Staphylococcus* being a common pathogen. *Kawasaki's disease* - **Kawasaki's disease** is characterized by fever for at least 5 days, along with specific criteria such as **conjunctivitis**, **oral changes**, **rash**, and **lymphadenopathy**, which are not mentioned here. - Although it can cause cardiac complications like **coronary artery aneurysms**, it does not typically present with palpitations in the context of pre-existing rheumatic heart disease. *None of the options* - This option is incorrect because **Staphylococcal endocarditis** is a highly plausible diagnosis given the clinical presentation. - The combination of **rheumatic heart disease**, prolonged fever, and palpitations strongly points towards a specific cardiac infection. *Collagen vascular disease* - **Collagen vascular diseases** like SLE or juvenile idiopathic arthritis can present with fever, but **palpitations** in a child with pre-existing **rheumatic heart disease** is less specific for these conditions. - These diseases typically have other systemic manifestations, such as **arthralgia**, **rash**, or **organ involvement**, which are not described.

Q: What is the most common type of congenital cyanotic heart disease?

TOF. ***TOF*** - **Tetralogy of Fallot** is the most common **cyanotic congenital heart disease**, characterized by four key defects leading to right-to-left shunting and reduced pulmonary blood flow. - The combination of **pulmonary stenosis**, **ventricular septal defect (VSD)**, **overriding aorta**, and **right ventricular hypertrophy** causes cyanosis. *ASD* - **Atrial septal defect (ASD)** is typically an **acyanotic congenital heart disease**, as blood usually shunts from the left atrium to the right atrium due to pressure differences. - While it can lead to pulmonary hypertension over time, it's not the most common cyanotic lesion. *PDA* - **Patent ductus arteriosus (PDA)** is generally an **acyanotic congenital heart disease** where blood shunts from the aorta to the pulmonary artery, increasing pulmonary blood flow. - Cyanosis may occur in specific complex scenarios, but it is not commonly classified as a primary cyanotic defect. *VSD* - **Ventricular septal defect (VSD)** is the **most common congenital heart defect overall** but is primarily an **acyanotic lesion**, causing left-to-right shunting. - Cyanosis in VSD usually only occurs in advanced stages with **Eisenmenger syndrome**, which is not the typical presentation.

Q: Which of the following clinical findings is most suggestive of congenital heart disease?

Diastolic murmur. ***Diastolic murmur*** - A **diastolic murmur** is almost always pathological and is a strong indicator of underlying structural heart disease, including **congenital heart defects**. - These murmurs reflect abnormal blood flow during the **diastolic phase** of the cardiac cycle, often due to stenotic atrioventricular valves or regurgitant semilunar valves. *Abnormal blood pressure* - While certain congenital heart diseases (e.g., **coarctation of the aorta**) can cause abnormal blood pressure, it is not a universally specific or most suggestive finding for the broad category of **congenital heart disease**. - Many other conditions, both cardiac and non-cardiac, can lead to abnormal blood pressure readings. *Systolic murmur grade I or II* - A **soft, low-grade systolic murmur** (Grade I or II) is often **physiologic** or innocent, especially in children, and does not necessarily indicate structural heart disease. - Many healthy individuals can have an innocent systolic murmur due to normal blood flow dynamics. *Abnormal electrocardiogram* - An **abnormal ECG** can suggest various cardiac issues, including congenital heart disease, but it is not as direct or specific as a diastolic murmur for initial clinical suspicion. - ECG abnormalities can be non-specific or related to acquired conditions, and a normal ECG does not rule out all forms of congenital heart disease.

Question 1

Clinical manifestations of large VSD in children typically appear at:

Accepted Answer

2 months

Answer

2 days

Answer

2 weeks

Answer

6 months

Question 2

A one month old infant with a congenital cardiac lesion shows increased sweating during feeding. Which of the following is the sure sign of congestive cardiac failure in this infant?

Accepted Answer

Liver enlargement

Answer

JVP

Answer

Basal crepitations

Answer

Pedal oedema

Question 3

A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :

Accepted Answer

SVT

Answer

VT

Answer

PSVT with block

Answer

Sinus tachycardia

Question 4

Ductus dependent blood flow is required for all of these congenital heart diseases except:

Accepted Answer

Persistent truncus arteriosus

Answer

Pulmonary stenosis

Answer

Hypoplastic left heart syndrome

Answer

TGA with intact ventricular septum

Question 5

Not true about Kawasaki disease is

Accepted Answer

Thrombocytopenia

Answer

Posterior cervical lymphadenopathy

Answer

Erythema

Answer

Conjunctivitis

Question 6

The most common cause of Blue baby syndrome

Accepted Answer

Tetralogy of Fallot

Answer

VSD

Answer

Cardiac Ischemia

Answer

None of the options

Question 7

A 10 year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity is measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis is:

Accepted Answer

Coarctation of aorta

Answer

Renal parenchymal disease

Answer

Takayasu arteritis

Answer

Grand mal seizures

Question 8

A 7 year old child with a known history of rheumatic heart disease presents with a 3 weeks history of fever with palpitations. Most likely cause is:

Accepted Answer

Staphylococcal endocarditis

Answer

Kawasaki's disease

Answer

None of the options

Answer

Collagen vascular disease

Question 9

What is the most common type of congenital cyanotic heart disease?

Accepted Answer

TOF

Answer

ASD

Answer

PDA

Answer

VSD

Question 10

Which of the following clinical findings is most suggestive of congenital heart disease?

Accepted Answer

Diastolic murmur

Answer

Abnormal blood pressure

Answer

Systolic murmur grade I or II

Answer

Abnormal electrocardiogram

Cardiology — MCQs

Cardiology — MCQs

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