Cardiology — MCQs
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Which of the following clinical findings is most suggestive of congenital heart disease?
The risk of recurrence of congenital heart disease for subsequent pregnancies in families with one affected child is:
Which of the following cyanotic congenital heart disease is associated with increased risk of chest infections?
An x-ray performed on a newborn infant shows enlargement of the left ventricle and left atrium as well as dilatation of the aorta. Echocardiographic studies demonstrate volume-overloading of the left ventricle. Cardiac auscultation reveals the presence of a continuous "machinery" murmur. Which of the following is the most likely diagnosis?
Differential cyanosis is seen in –
Most specific cardiac anomaly seen in baby born to Diabetic Mother
Normal QRS duration at 1 year of age is
The most dreadful complication of Kawasaki disease is
Tetralogy of Fallot presents with one of the following:
The commonest cause of death in a diphtheritic child after few weeks of infection is:
Cardiology Indian Medical PG Practice Questions and MCQs
Question 321: Which of the following clinical findings is most suggestive of congenital heart disease?
- A. Abnormal blood pressure
- B. Diastolic murmur (Correct Answer)
- C. Systolic murmur grade I or II
- D. Abnormal electrocardiogram
Explanation: ***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 322: The risk of recurrence of congenital heart disease for subsequent pregnancies in families with one affected child is:
- A. 10-12%
- B. 1%
- C. 2-6% (Correct Answer)
- D. 0.80%
Explanation: ***2-6%*** - The recurrence risk for **congenital heart disease (CHD)** in subsequent pregnancies after one affected child is generally cited as **2-6%**, reflecting an increased familial predisposition. - This risk is higher than the general population risk but still relatively low, primarily due to the complex, multifactorial etiology of most CHDs. *10-12%* - A **10-12% recurrence risk** is generally too high for most common congenital heart defects, which are typically multifactorial. - Such a high risk might be seen in specific **syndromic forms** of CHD (e.g., genetic aneuploidies or single gene defects), but not for isolated CHD in general. *1%* - A **1% recurrence risk** is comparable to the general population incidence of congenital heart disease (approximately 0.8-1%). - This value does not adequately reflect the established **increased risk for siblings** of an affected child, which is known to be higher than the background population risk. *0.80%* - **0.80%** represents the approximate **general population incidence** of congenital heart disease in live births without a prior affected sibling. - This figure does not account for the **increased familial risk** that exists once one child in a family is already affected.
Question 323: Which of the following cyanotic congenital heart disease is associated with increased risk of chest infections?
- A. Tetralogy of Fallot
- B. Truncus arteriosus (Correct Answer)
- C. Tricuspid atresia
- D. None of the options
Explanation: ***Truncus arteriosus*** - This condition involves a single great artery overriding a **ventricular septal defect**, leading to mixed systemic and pulmonary blood flow. - The **unrestricted pulmonary blood flow** results in **pulmonary hypertension** and edema, making the lungs vulnerable to frequent infections. *Tetralogy of Fallot* - Characterized by **reduced pulmonary blood flow** due to **pulmonary stenosis**, which typically protects the lungs from overload. - While patients can experience complications, an increased risk of frequent chest infections due to pulmonary overcirculation is not a primary feature. *Tricuspid atresia* - Involves the absence of the **tricuspid valve**, leading to mixing of blood in the atria and systemic circulation of deoxygenated blood. - Pulmonary blood flow can be reduced or normal, but severe pulmonary overcirculation leading to recurrent chest infections is not a hallmark. *None of the options* - This option is incorrect because **Truncus arteriosus** is indeed strongly associated with an increased risk of chest infections.
Question 324: An x-ray performed on a newborn infant shows enlargement of the left ventricle and left atrium as well as dilatation of the aorta. Echocardiographic studies demonstrate volume-overloading of the left ventricle. Cardiac auscultation reveals the presence of a continuous "machinery" murmur. Which of the following is the most likely diagnosis?
- A. Atrial septal defect
- B. Tetralogy of Fallot
- C. Pulmonic stenosis
- D. Patent ductus arteriosus (Correct Answer)
Explanation: ***Patent ductus arteriosus*** - The classic **continuous "machinery" murmur** heard on auscultation is pathognomonic for a PDA, resulting from continuous blood flow from the aorta to the pulmonary artery. - The **left ventricle and left atrial enlargement** and **aortic dilatation** with **left ventricular volume overloading** are consistent with the increased blood return to the left heart due to the left-to-right shunt through the PDA. *Atrial septal defect* - While an ASD can cause left atrial enlargement, it primarily causes **right ventricular volume overload** due to shunting into the right atrium, not left ventricular volume overload or aortic dilatation. - The murmur associated with an ASD is typically a **systolic ejection murmur** over the pulmonic area due to increased flow across the pulmonary valve, not a continuous machinery murmur. *Tetralogy of Fallot* - This is a **cyanotic congenital heart disease** characterized by four defects: ventricular septal defect, pulmonic stenosis, overriding aorta, and right ventricular hypertrophy. - Auscultation typically reveals a **systolic ejection murmur** reflecting the pulmonic stenosis, and the condition presents with **cyanosis** and clubbing, which are not mentioned here. *Pulmonic stenosis* - Isolated pulmonic stenosis would primarily cause **right ventricular hypertrophy** and possibly right atrial enlargement due to increased resistance to outflow from the right ventricle. - The murmur is typically a **systolic ejection murmur** at the upper left sternal border with a thrill, and it would not cause left ventricular volume overload or a continuous machinery murmur.
Question 325: Differential cyanosis is seen in –
- A. PDA (Correct Answer)
- B. VSD
- C. TAPVC
- D. TGV
Explanation: ***PDA*** - **Differential cyanosis** occurs in **patent ductus arteriosus (PDA)** with severe **pulmonary hypertension** leading to **right-to-left shunting** (reversed PDA/Eisenmenger syndrome). - Since the PDA connects the pulmonary artery to the descending aorta **below the origin of the left subclavian artery**, deoxygenated blood from the pulmonary artery perfuses the **lower body** (lower limbs cyanosed) while the **upper body** receives oxygenated blood from the left ventricle (upper limbs and head pink). - This creates the classic pattern: **pink upper extremities, cyanosed lower extremities**. *VSD* - A **ventricular septal defect (VSD)** typically causes **left-to-right shunting**, leading to increased pulmonary blood flow, and does not result in differential cyanosis. - While VSD can eventually lead to **Eisenmenger syndrome** with **generalized cyanosis** (affecting entire body uniformly), it does not specifically cause differential cyanosis because the shunt occurs before blood reaches the systemic circulation. *TAPVC* - **Total anomalous pulmonary venous connection (TAPVC)** is a congenital heart defect where all pulmonary veins drain into the systemic venous circulation, leading to **generalized cyanosis** as mixed blood is delivered throughout the body. - It does not present with differential cyanosis, as the venous return is uniformly deoxygenated and mixes before systemic distribution. *TGV* - **Transposition of the great vessels (TGV)** involves the aorta originating from the right ventricle and the pulmonary artery from the left ventricle, creating two parallel circulations. - This condition presents with **severe generalized cyanosis** shortly after birth unless there is mixing between the two circulations (via PDA, ASD, or VSD), and does not cause differential cyanosis.
Question 326: Most specific cardiac anomaly seen in baby born to Diabetic Mother
- A. Ventricular septal defect
- B. Heart blocks
- C. Tetralogy of Fallot
- D. Transposition of Great arteries (Correct Answer)
Explanation: ***Transposition of Great arteries*** - **Transposition of the great arteries (TGA)** is the most specific congenital heart defect associated with infants born to mothers with **pre-gestational diabetes**. - Poor glycemic control in the first trimester of pregnancy is a significant risk factor for the development of TGA. *Ventricular septal defect* - **Ventricular septal defect (VSD)** is the most common congenital heart defect overall, but it is not specific to diabetic mothers, as its occurrence is common in the general population. - While VSDs can occur in infants of diabetic mothers, they are less characteristic of this population compared to TGA. *Heart blocks* - **Congenital heart blocks** are most commonly associated with **maternal autoimmune diseases**, such as Systemic Lupus Erythematosus (SLE), due to the transplacental transfer of anti-Ro/SSA and anti-La/SSB antibodies. - They are not a specific cardiac anomaly linked to maternal diabetes. *Tetralogy of Fallot* - **Tetralogy of Fallot** is a complex congenital heart defect involving four anomalies, but it is not specifically or disproportionately linked to maternal diabetes compared to other congenital heart defects. - Its etiology is multifactorial, with genetic and environmental factors playing roles.
Question 327: Normal QRS duration at 1 year of age is
- A. 0.04-0.08 seconds (Correct Answer)
- B. 0.04-0.09 seconds
- C. 0.06-0.09 seconds
- D. 0.03-0.07 seconds
Explanation: ***0.04-0.08 seconds*** - In children aged 1 year, the **normal QRS duration** typically falls within this range. - A QRS duration wider than this range at 1 year of age would suggest a **ventricular conduction abnormality** if other parameters are normal too. *0.04-0.09 seconds* - While **0.04 seconds** is within the normal lower limit, **0.09 seconds** is slightly prolonged for a 1-year-old. - A QRS duration of 0.09 seconds typically falls into the category of **borderline prolongation** in a 1-year-old child. *0.06-0.09 seconds* - The lower limit of **0.06 seconds** is higher than the generally accepted lowest normal value for a 1-year-old, potentially missing shorter, normal QRS durations. - An upper limit of **0.09 seconds** is considered mildly prolonged for this age group, suggesting a possible **conduction delay**. *0.03-0.07 seconds* - The lower limit of **0.03 seconds** is shorter than the generally accepted lowest normal value, which is usually around 0.04 seconds. - While **0.07 seconds** is within the normal range, this option's lower limit is too restricted and the upper limit may not capture all normal variations.
Question 328: The most dreadful complication of Kawasaki disease is
- A. Cardiac involvement (Correct Answer)
- B. Rash
- C. Thrombocytosis
- D. Lymphadenopathy
Explanation: ***Cardiac involvement*** - **Cardiac complications**, particularly **coronary artery aneurysms**, are the most serious and potentially fatal sequelae of Kawasaki disease. - If untreated, these can lead to **myocardial infarction**, **sudden death**, or chronic ischemic heart disease. *Rash* - A rash is a common and often an early sign of Kawasaki disease, but it is a **benign symptom** and not life-threatening. - It resolves with the other acute symptoms and does not contribute to long-term morbidity or mortality. *Thrombocytosis* - **Thrombocytosis** is a characteristic laboratory finding in the subacute phase of Kawasaki disease but is rarely a direct cause of dreadful complications. - While it may increase the risk of **thrombus formation** in already damaged coronary arteries, it's not the primary "dreadful complication" itself. *Lymphadenopathy* - **Cervical lymphadenopathy** is one of the diagnostic criteria for Kawasaki disease and is a common, but not life-threatening, symptom. - It generally resolves without specific treatment for the lymph nodes and does not lead to serious long-term sequelae.
Question 329: Tetralogy of Fallot presents with one of the following:
- A. Normal ECG and Chest x-ray
- B. Cardiomegaly
- C. Left ventricular hypertrophy
- D. Central cyanosis with clubbing (Correct Answer)
Explanation: ***Central cyanosis with clubbing*** - Tetralogy of Fallot is a **cyanotic congenital heart defect**, meaning it causes inadequate oxygenation of the blood, leading to central cyanosis. - **Chronic hypoxemia** (low oxygen levels) associated with cyanotic heart disease typically results in **clubbing of the fingers and toes** over time. *Normal ECG and Chest x-ray* - An **ECG** in Tetralogy of Fallot typically shows **right ventricular hypertrophy** and an **axis deviation**, which is not normal. - A **chest X-ray** in Tetralogy of Fallot often reveals a characteristic **'boot-shaped' heart** due to right ventricular hypertrophy and decreased pulmonary artery markings. *Cardiomegaly* - While there is **right ventricular hypertrophy**, significant global cardiomegaly (enlargement of the entire heart) is **not a classic or consistent feature** of Tetralogy of Fallot. - The boot-shaped appearance on X-ray reflects the hypertrophied right ventricle, but the overall heart size may not be drastically enlarged. *Left ventricular hypertrophy* - Tetralogy of Fallot is characterized by **right ventricular outflow tract obstruction** and a **large ventricular septal defect**, leading primarily to **right ventricular hypertrophy**. - **Left ventricular hypertrophy** is not a typical finding in Tetralogy of Fallot; in fact, the left ventricle may be smaller due to decreased pulmonary venous return.
Question 330: The commonest cause of death in a diphtheritic child after few weeks of infection is:
- A. Septicemia
- B. Myocarditis (Correct Answer)
- C. IIIrd nerve palsy
- D. Tonsillitis
Explanation: ***Myocarditis*** - Diphtheria toxin's cardiotoxicity can lead to **myocarditis**, characterized by diffuse **interstitial inflammation** and **myocardial fiber necrosis**. - This can result in **cardiac arrhythmias**, **heart failure**, or sudden **cardiac death** weeks after the initial infection, making it the most common cause of fatality in the later stages. *Septicemia* - While septicemia can occur, it is more often seen as a complication of **secondary bacterial infections** rather than a direct, delayed effect of diphtheria toxin. - The direct and most significant delayed organ damage from diphtheria is typically **cardiac** or **neurological**, not widespread systemic infection. *IIIrd nerve palsy* - **Cranial nerve palsies**, including those affecting the 3rd cranial nerve (oculomotor), are a known complication stemming from the **neurotoxic effects** of diphtheria toxin. - However, while significant, **neurological complications** such as palsies are generally less common as a direct cause of death compared to severe myocarditis. *Tonsillitis* - **Tonsillitis** is a symptom of acute diphtheria, presenting at the **initial stage** of the infection with a **grayish pseudomembrane** on the tonsils and pharynx. - It is not a cause of death in itself, but rather a manifestation of the primary infection and can lead to airway obstruction in severe cases, which is an early complication, not a delayed cause of death.
Practice by Chapter
Congenital Heart Diseases: Cyanotic
Practice Questions
Congenital Heart Diseases: Acyanotic
Practice Questions
Rheumatic Heart Disease
Practice Questions
Kawasaki Disease
Practice Questions
Infective Endocarditis
Practice Questions
Myocarditis and Cardiomyopathies
Practice Questions
Arrhythmias in Children
Practice Questions
Heart Failure in Children
Practice Questions
Pulmonary Hypertension
Practice Questions
Systemic Hypertension
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Dyslipidemia in Children
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Cardiac Evaluation and Diagnostics
Practice Questions
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