Cardiology Practice Questions

Q: PDA true is all except -

More common in term baby. ***More common in term baby*** ✗ (EXCEPTION - This is FALSE) - This statement is **INCORRECT** and is the exception among the options. - PDA is actually significantly **more prevalent in premature infants**, not term babies, due to the immaturity of the ductus arteriosus and its closure mechanisms. - The persistence of the ductus arteriosus is a major complication of **prematurity**, with incidence inversely proportional to gestational age. *More common in preterm baby* ✓ - **TRUE statement**: Patency of ductus arteriosus (PDA) is indeed much more common in preterm babies, especially those with very low birth weight. - The physiological closure mechanisms, including increased oxygen tension and decreased prostaglandin E2 levels, are less effective in **premature infants**. - Incidence can be as high as **60-70% in infants <28 weeks gestation**. *Left to right shunt* ✓ - **TRUE statement**: In most cases, the pressure in the aorta is higher than in the pulmonary artery, leading to a **left-to-right shunt** of blood through the PDA. - This shunting causes increased pulmonary blood flow, which can lead to **pulmonary congestion** and heart failure if significant. - Creates the characteristic **continuous "machinery" murmur**. *Acyanotic congenital heart disease* ✓ - **TRUE statement**: PDA is classified as an **acyanotic congenital heart disease** because the shunt is typically left-to-right, meaning oxygenated blood recirculates to the lungs. - Cyanosis (bluish discoloration of the skin) only occurs in rare instances of **Eisenmenger syndrome**, where severe pulmonary hypertension reverses the shunt to right-to-left.

Q: Most common cause of death in Rett syndrome is

Respiratory failure. ***Respiratory failure*** - In **Rett syndrome**, severe **scoliosis** and **kyphosis** can restrict lung capacity and lead to chronic breathing difficulties, predisposing to respiratory failure. - Abnormal breathing patterns, such as **apnea** and hyperventilation, are common in Rett syndrome and can contribute to respiratory complications and increased risk of respiratory compromise. - Additional risk factors include aspiration and impaired airway clearance. *Cardiac arrhythmias* - While **cardiac issues**, particularly **QT prolongation**, are recognized in Rett syndrome, they are not the most common direct cause of death. - Cardiac arrhythmias are a significant concern but rank below respiratory failure in mortality statistics for this condition. *Hypoglycemia* - **Hypoglycemia** is not a characteristic feature or a common cause of death in individuals with Rett syndrome. - Although metabolic issues can occur in some genetic conditions, hypoglycemia is typically not associated with Rett syndrome. *Seizures* - While **seizures** are very common in Rett syndrome, affecting up to 80% of individuals, they are rarely the direct cause of death. - Long-term seizure control is usually managed with medication, and while status epilepticus can be life-threatening, it is less common than other causes of death.

Q: Ebstein's anomaly is seen with intake of –

Lithium. ***Lithium*** - **Lithium** exposure during the first trimester of pregnancy is associated with an increased risk of **Ebstein's anomaly**, a congenital heart defect. - This defect involves the **tricuspid valve** being displaced into the right ventricle, leading to tricuspid regurgitation and right heart failure. - The risk is approximately **1-2%** with first-trimester lithium exposure compared to baseline risk of 1 in 20,000. *Mercury* - **Mercury poisoning**, especially in utero, can lead to neurological developmental issues, such as **Minamata disease**, characterized by sensory disturbances, ataxia, and cognitive impairment. - It is not directly linked to cardiac malformations like Ebstein's anomaly. *Lead* - **Lead exposure** during pregnancy is associated with adverse outcomes such as preterm birth, low birth weight, and neurodevelopmental delays in the child. - It is not a known cause of specific cardiac anomalies like Ebstein's anomaly. *Copper* - While **copper excess** (e.g., in Wilson's disease) or deficiency can lead to various health problems, there is no established direct link between maternal copper intake and Ebstein's anomaly. - **Genetic factors** or other teratogens are more commonly implicated in congenital heart defects.

Q: Which of the following is the most common type of congenital cardiac cyanotic anomaly?

Tetralogy of Fallot. ***Tetralogy of Fallot*** - It is the **most common cyanotic heart disease** contributing to approximately 5-7% of all congenital heart defects and about 50% of all cyanotic CHD. - It consists of four main defects: **ventricular septal defect (VSD)**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy**. *Transposition of great vessels* - This is the **second most common cyanotic congenital heart disease** where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. - It requires a coexisting defect (like a VSD or PDA) for survival as it creates two separate circulatory systems. *TAPVC* - **Total anomalous pulmonary venous connection (TAPVC)** is a rare cyanotic heart defect where all four pulmonary veins connect to the systemic venous circulation instead of the left atrium. - While serious, it is considerably less common than Tetralogy of Fallot. *Ebstein's anomaly* - This is a rare congenital heart defect involving the **tricuspid valve**, which is displaced downwards into the right ventricle. - It is characterized by variable degrees of cyanosis and right heart failure, but is much less frequent than Tetralogy of Fallot.

Q: A 2-week-old baby is irritable and feeding poorly. On physical examination, the infant is irritable, diaphoretic, tachypneic and tachycardic. There is circumoral cyanosis, which is not alleviated by nasal oxygen. A systolic thrill and holosystolic murmur are heard along the left sternal border. An echocardiogram reveals a heart defect in which a single arterial trunk overrides a ventricular septal defect. What is the appropriate diagnosis?

Truncus arteriosus. ***Truncus arteriosus*** - The description of the **aorta and pulmonary artery forming a single vessel that overrides a ventricular septal defect** is the hallmark of truncus arteriosus. - The infant's symptoms of **irritability, poor feeding, diaphoresis, tachypnea, tachycardia, and circumoral cyanosis not alleviated by oxygen** are consistent with significant **cyanotic congenital heart disease** like truncus arteriosus, which often presents in early infancy with congestive heart failure and cyanosis. *Coarctation of aorta, preductal* - This condition involves a **narrowing of the aorta**, typically presenting with **differential pulses** (stronger in upper extremities, weaker in lower) and a **systolic murmur** heard best over the back or left axilla, which are not described. - While it can manifest with heart failure symptoms, the echocardiogram finding of a single overriding vessel contradicts this diagnosis. *Patent ductus arteriosus* - A PDA typically presents with a **continuous "machinery" murmur** loudest in the left infraclavicular area and may lead to heart failure symptoms but often with subtle or no cyanosis (unless severe pulmonary hypertension develops). - The echocardiogram finding of a single great artery overriding a VSD is not characteristic of PDA. *Atrial septal defect* - An ASD is typically associated with a **fixed, wide splitting of the second heart sound** and a **systolic ejection murmur** at the upper left sternal border due to increased pulmonary blood flow, and often remains asymptomatic in infancy. - Cyanosis is rare, and the specific echocardiographic finding of a single great artery is not seen with an isolated ASD.

Q: Which of the following congenital heart diseases is MOST OFTEN associated with decreased pulmonary blood flow?

Single ventricle with pulmonary stenosis. ***Single ventricle with pulmonary stenosis*** - The combination of a **single ventricle (functional or anatomic)** and **pulmonary stenosis** **MOST CONSISTENTLY** causes severely decreased pulmonary blood flow. - This anatomical arrangement creates an **obligatory shunt** (usually a VSD or PDA) to allow for some mixing of systemic and pulmonary venous return, but the stenotic pulmonary outflow tract significantly limits the total volume reaching the lungs. - This is a **classic cyanotic lesion with consistently decreased pulmonary blood flow**. *TAPVC* - **Total anomalous pulmonary venous connection (TAPVC)** is associated with **increased pulmonary blood flow** because all pulmonary venous return eventually shunts from the systemic circulation back to the pulmonary circulation, causing recirculation. - This condition leads to right heart dilation and pulmonary hypertension due to the excessive volume load on the pulmonary circuit. *Truncus arteriosus* - **Truncus arteriosus** is characterized by a single great artery overriding a large ventricular septal defect, leading to a **left-to-right shunt** and **increased pulmonary blood flow** and pressure. - Both systemic and pulmonary circulations receive blood from the single truncal artery, but pulmonary vascular resistance is usually lower, causing significant shunt to the lungs. *Ebstein's anomaly* - **Ebstein's anomaly** involves **tricuspid valve displacement** into the right ventricle causing functional RV hypoplasia and tricuspid regurgitation. - While it **CAN cause decreased pulmonary blood flow** when severe (with right-to-left shunt across an ASD), the severity is **highly variable** - mild cases may have normal or only slightly reduced pulmonary blood flow. - Unlike single ventricle with pulmonary stenosis, Ebstein's anomaly does **NOT consistently** present with severely decreased pulmonary blood flow.

Q: Congenital cyanotic heart disease with pulmonary oligemia is seen with –

Tricuspid atresia. ***Tricuspid atresia*** - **Tricuspid atresia** is a **cyanotic congenital heart disease** where the tricuspid valve is absent, preventing blood flow from the right atrium to the right ventricle, leading to **pulmonary hypoperfusion** or **oligemia**. - Systemic venous return must shunt across an **atrial septal defect (ASD)** or **patent foramen ovale (PFO)** to the left atrium, mixing with oxygenated blood, resulting in cyanosis. - Chest X-ray characteristically shows **decreased pulmonary vascular markings** (oligemia). *VSD* - A **Ventricular Septal Defect (VSD)** typically causes a **left-to-right shunt**, leading to **pulmonary plethora (increased pulmonary blood flow)**, not oligemia. - While large VSDs can eventually lead to Eisenmenger syndrome with cyanosis, the initial presentation is usually characterized by increased pulmonary flow. *Hypoplastic left ventricle* - **Hypoplastic left heart syndrome (HLHS)** is a **cyanotic** condition, but it results in **pulmonary plethora (increased pulmonary blood flow)**, not oligemia. - All systemic venous return flows to the right ventricle, which pumps to both the pulmonary arteries (normal pathway) and to the systemic circulation via a **patent ductus arteriosus (PDA)**, resulting in normal or increased pulmonary blood flow. - The primary issue is a severely underdeveloped left side of the heart, which does not lead to pulmonary oligemia. *ASD* - An **Atrial Septal Defect (ASD)** usually causes a **left-to-right shunt**, leading to **pulmonary plethora (increased pulmonary blood flow)** and is typically an **acyanotic** heart condition. - Cyanosis only develops late if pulmonary hypertension leads to shunt reversal (Eisenmenger syndrome), which is not the primary presentation.

Q: Which of the following is least likely in PDA?

CO, wash out. ***CO₂ washout*** - **CO₂ washout** is not a recognized clinical complication or standard finding associated with PDA - While PDA causes **pulmonary overcirculation**, this does not translate into a clinically significant "CO₂ washout" phenomenon - The other options represent well-established associations with hemodynamically significant PDA - This is the **least likely** finding in PDA *Bounding pulse* - **Classic finding** in PDA due to left-to-right shunt from aorta to pulmonary artery - Results in **wide pulse pressure** as diastolic pressure drops (blood "runs off" into pulmonary circulation) - Creates characteristic **water-hammer** or **bounding peripheral pulses** *Pulmonary hemorrhage* - Well-recognized complication of hemodynamically significant PDA, especially in **premature infants** - **Increased pulmonary blood flow and pressure** from left-to-right shunt leads to pulmonary edema and capillary damage - Fragile pulmonary vasculature in preterm infants predisposes to **hemorrhage** *Necrotizing enterocolitis* - **Significant association** between PDA and NEC in premature infants - Mechanism: **Diastolic steal** phenomenon causes mesenteric hypoperfusion - The left-to-right shunt diverts blood flow during diastole, leading to **gut ischemia** - PDA is a recognized **risk factor** for NEC development

Q: A child after 4 weeks of age presents with an acyanotic ejection systolic murmur. Which of the following is the most likely cause?

VSD. ***VSD*** - A **ventricular septal defect (VSD)** typically presents with a **pansystolic (holosystolic) murmur** that becomes **audible after 4 weeks of age** when **pulmonary vascular resistance drops**. - It is the **most common acyanotic congenital heart disease** presenting at this age, with blood shunting from left to right ventricle. - The murmur is best heard at the **left lower sternal border** and increases pulmonary blood flow. - Small VSDs become clinically apparent around 4-6 weeks as PVR falls and the shunt increases. *PDA* - A **patent ductus arteriosus (PDA)** presents with a **continuous "machinery" murmur**, not an ejection systolic murmur. - While it's an **acyanotic lesion**, its characteristic continuous quality heard best at the left upper sternal border differentiates it from VSD. *Coarctation of aorta* - **Coarctation of the aorta** presents with a **systolic murmur** heard best over the **back/interscapular area**. - Characterized by **diminished or delayed femoral pulses** and **differential blood pressures** (higher in upper extremities). - May present earlier with heart failure in severe cases, but not typically with prominent murmur at 4 weeks. *TOF* - **Tetralogy of Fallot (TOF)** is a **cyanotic heart disease** due to right-to-left shunting, which contradicts the "acyanotic" presentation in the question. - The murmur is an **ejection systolic murmur** from pulmonary stenosis (RVOT obstruction), but the presence of cyanosis rules it out. - Presents with **cyanotic spells** and progressive cyanosis, not isolated murmur finding.

Question 1

PDA true is all except -

Accepted Answer

More common in term baby

Answer

More common in preterm baby

Answer

Left to right shunt

Answer

Acyanotic congenital heart disease

Question 2

Most common cause of death in Rett syndrome is

Accepted Answer

Respiratory failure

Answer

Cardiac arrhythmias

Answer

Hypoglycemia

Answer

Seizures

Question 3

A 2-month-old infant is brought to the clinic because of poor feeding, sweating, and difficulty breathing. The parents state that she was doing very well, and has actually been a "very easy going baby", until about a week ago. They assumed that she was developing a "cold", but it has not passed, and the symptoms have been worsening. Cardiac examination reveals a loud, harsh systolic murmur with a thrill that is heard best at the left sternal border. The most likely underlying abnormality is

Accepted Answer

ventricular septal defect

Answer

aortic stenosis

Answer

atrial septal defect

Answer

patent ductus arteriosus

Question 4

Ebstein's anomaly is seen with intake of –

Accepted Answer

Lithium

Answer

Mercury

Answer

Lead

Answer

Copper

Question 5

Which of the following is the most common type of congenital cardiac cyanotic anomaly?

Accepted Answer

Tetralogy of Fallot

Answer

Transposition of great vessels

Answer

TAPVC

Answer

Ebstein's anomaly

Question 6

A 2-week-old baby is irritable and feeding poorly. On physical examination, the infant is irritable, diaphoretic, tachypneic and tachycardic. There is circumoral cyanosis, which is not alleviated by nasal oxygen. A systolic thrill and holosystolic murmur are heard along the left sternal border. An echocardiogram reveals a heart defect in which a single arterial trunk overrides a ventricular septal defect. What is the appropriate diagnosis?

Accepted Answer

Truncus arteriosus

Answer

Coarctation of aorta, preductal

Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Question 7

Which of the following congenital heart diseases is MOST OFTEN associated with decreased pulmonary blood flow?

Accepted Answer

Single ventricle with pulmonary stenosis

Answer

TAPVC

Answer

Truncus arteriosus

Answer

Ebstein's anomaly

Question 8

Congenital cyanotic heart disease with pulmonary oligemia is seen with –

Accepted Answer

Tricuspid atresia

Answer

VSD

Answer

Hypoplastic left ventricle

Answer

ASD

Question 9

Which of the following is least likely in PDA?

Accepted Answer

CO, wash out

Answer

Bounding pulse

Answer

Pulmonary hemorrhage

Answer

Necrotizing enterocolitis

Question 10

A child after 4 weeks of age presents with an acyanotic ejection systolic murmur. Which of the following is the most likely cause?

Accepted Answer

VSD

Answer

PDA

Answer

Coarctation of aorta

Answer

TOF

Cardiology — MCQs

Cardiology — MCQs

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