Cardiology Practice Questions

Q: Tetralogy of Fallot is characterized by following except –

AS. ***AS (Aortic Stenosis)*** - **Aortic stenosis (AS)** is characterized by a **narrowing of the aortic valve**, obstructing blood flow from the left ventricle to the aorta. - This is **NOT a component of Tetralogy of Fallot** and is a separate congenital or acquired cardiac condition. - The four main features of Tetralogy of Fallot are **ventricular septal defect**, **pulmonary stenosis** (typically infundibular), **overriding aorta**, and **right ventricular hypertrophy**. *VSD (Ventricular Septal Defect)* - A **ventricular septal defect (VSD)** is a communication between the right and left ventricles, allowing blood to shunt between chambers. - This is **one of the four essential components** of Tetralogy of Fallot, typically a large, non-restrictive VSD. *Over-riding of aorta* - An **overriding aorta** means the aortic root is positioned directly over the ventricular septal defect, straddling both ventricles instead of arising solely from the left ventricle. - This is a **hallmark feature of Tetralogy of Fallot**, leading to mixing of oxygenated and deoxygenated blood, contributing to cyanosis. *Infundibular constriction* - **Infundibular constriction**, also known as **pulmonary infundibular stenosis**, refers to the narrowing of the muscular outflow tract of the right ventricle (infundibulum) leading to the pulmonary artery. - This **subvalvular pulmonary stenosis** is a **critical component of Tetralogy of Fallot**, contributing to right ventricular hypertrophy, reduced pulmonary blood flow, and right-to-left shunting through the VSD.

Q: A mother brings her 5-year-old boy to see you as a General Physician. On examination, he has red eyes, dry, cracked lips and a rash on his hands and feet. He also has cervical lymphadenopathy. What is the most important investigation to rule out a serious complication of this condition?

Echocardiography. ***Echocardiography*** - The constellation of symptoms (red eyes, cracked lips, rash on hands and feet, cervical lymphadenopathy in a 5-year-old) is highly suggestive of **Kawasaki disease**. - **Coronary artery aneurysms** are the most serious complication of Kawasaki disease, making echocardiography crucial for early detection and management. *Blood pressure* - While important in any pediatric assessment, **blood pressure measurement** is not specific for diagnosing or monitoring the most critical complication of Kawasaki disease. - Hypertensive or hypotensive episodes are not classic features and do not directly assess **coronary artery involvement**. *ECG* - An **ECG** can detect arrhythmias or signs of myocardial ischemia, which might occur with **coronary artery pathology**. - However, it is less sensitive and specific than **echocardiography** for directly visualizing and quantifying **coronary artery aneurysms**. *Blood tests for autoantibodies* - Kawasaki disease is not an autoimmune condition primarily diagnosed by **autoantibodies**; it is a **vasculitis** of unknown etiology. - Blood tests for autoantibodies would not be the most important investigation to rule out its most serious complication.

Q: Commonly associated in tetralogy of Fallot is:

Right sided aortic arch. ***Right sided aortic arch*** - A **right-sided aortic arch** is a known anomaly that frequently coexists with Tetralogy of Fallot, occurring in about 20-25% of cases. - This association is due to disturbances in the normal development of the **aortic arches** during embryonic life. *Coarctation of aorta* - **Coarctation of the aorta** is a narrowing of the aorta, most commonly found in the juxtaductal region. - While it can occur with other congenital heart defects, it is not particularly associated with Tetralogy of Fallot. *Aortopulmonary window* - An **aortopulmonary window** is a rare defect involving a communication between the aorta and the pulmonary artery, distinct from a patent ductus arteriosus. - It results from incomplete fusion of the aorticopulmonary septum and is not a common associated anomaly in Tetralogy of Fallot. *Aberrant right subclavian artery* - An **aberrant right subclavian artery** (also known as *arteria lusoria*) arises from the descending aorta and passes posterior to the esophagus. - While a congenital anomaly of the great vessels, it is not a characteristic or commonly associated finding with Tetralogy of Fallot.

Q: Most common cardiac defect seen in Rubella syndrome

PDA. ***Patent Ductus Arteriosus (PDA)*** - **PDA is the most common cardiac defect** associated with congenital rubella syndrome, occurring in 40-60% of cardiac cases. - Rubella virus infection during the **first trimester** causes failure of ductus arteriosus closure after birth. - The classic triad of congenital rubella syndrome includes **cardiac defects (PDA most common), cataracts, and deafness**. - PDA in rubella syndrome may be **isolated or combined** with other cardiac anomalies. *Pulmonary stenosis* - **Peripheral pulmonary artery stenosis (PPS)** is the second most common cardiac defect in rubella syndrome (20-30% of cases). - The option "pulmonary stenosis" typically refers to valvular PS, which is less specific to rubella. - PPS involves **multiple stenoses at branching points** of pulmonary arteries rather than valvular obstruction. *VSD* - **Ventricular Septal Defect** can occur in rubella syndrome but is **less common** than PDA or PPS. - VSD is more frequently associated with other congenital infections and genetic syndromes. *ASD* - **Atrial Septal Defect** is the least common cardiac defect among the listed options in congenital rubella syndrome. - While possible, ASD is not characteristically associated with maternal rubella infection during pregnancy.

Q: The most common paediatric cardiac tumour among the following is

Rhabdomyomas. ***Rhabdomyomas*** - **Rhabdomyomas** are the most common primary cardiac tumors in **infants and children**, accounting for over 50% of all pediatric cardiac tumors. - They are strongly associated with **tuberous sclerosis**, with up to 90% of children with cardiac rhabdomyomas having tuberous sclerosis. *Myxomas* - **Myxomas** are the most common primary cardiac tumors in **adults**, primarily found in the left atrium. - They are rare in children, making them an unlikely answer for the most common pediatric cardiac tumor. *Hemangiomas* - **Hemangiomas** are benign vascular tumors that can occur in various organs, including the heart, but they are **exceedingly rare as primary cardiac tumors**, especially compared to rhabdomyomas in children. - While they can be present at birth, cardiac hemangiomas are not the most common pediatric cardiac tumor. *Fibromas* - **Cardiac fibromas** are the **second most common primary cardiac tumor in children**, but they are significantly less common than rhabdomyomas. - They are typically single, large, and can cause symptoms due to their mass effect and potential for arrhythmias, but they do not outrank rhabdomyomas in frequency.

Q: A 29-day-old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. The most likely diagnosis is:

Ventricular septal defect. ***Ventricular septal defect*** - A **ventricular septal defect (VSD)** causes a left-to-right shunt, leading to increased pulmonary blood flow and can result in **congestive cardiac failure** and **left ventricular hypertrophy** as pulmonary vascular resistance drops in the first few weeks of life. - Large VSDs typically present with a **holosystolic murmur** best heard at the left lower sternal border; however, in the early neonatal period or with muscular VSDs, the murmur may be **shorter and less prominent** as pulmonary resistance is still relatively elevated. - Among the given options, VSD is the **most likely acyanotic heart defect** to present with CHF and LVH in this age group. *Rheumatic fever* - **Rheumatic fever** is an inflammatory disease following **Group A Streptococcal pharyngitis**, typically occurring in children **over 3 years of age**. - It is **extremely rare in infants** and would not explain CHF and LVH in a 29-day-old neonate. *Transposition of great arteries* - **Transposition of the great arteries (TGA)** is a cyanotic congenital heart defect where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. - Infants with TGA present with **severe cyanosis within hours to days of birth**, not primarily CHF. - The murmur is often **absent or soft** unless there is an associated VSD or PDA. *Tetralogy of Fallot* - **Tetralogy of Fallot (ToF)** is a cyanotic heart disease with four components: VSD, pulmonary stenosis, overriding aorta, and **right ventricular hypertrophy** (not left). - Infants present with **cyanosis** (not CHF) and a **loud systolic ejection murmur** at the left upper sternal border due to pulmonary stenosis. - The pathophysiology leads to **RVH, not LVH**, making this inconsistent with the clinical findings.

Q: A child presents with LVH and pulmonary complications. ECG shows left axis deviation. Most likely diagnosis is:

Tricuspid atresia. ***Tricuspid atresia*** - **Left ventricular hypertrophy (LVH)** is common because the entire systemic venous return must pass from the right atrium through an atrial septal defect (ASD) into the left atrium and then to the left ventricle. The left ventricle then pumps blood through both the systemic circulation and, via a VSD, to the pulmonary circulation. - **Left axis deviation** is a classic ECG finding due to the hypoplastic right ventricle and the dominance of the left ventricle in pumping both systemic and pulmonary blood. *TOF* - **Tetralogy of Fallot** typically presents with **right ventricular hypertrophy (RVH)** due to the right ventricular outflow tract obstruction. - ECG usually shows **right axis deviation** and RVH, not LVH or left axis deviation. *TAPVC* - **Total anomalous pulmonary venous connection (TAPVC)** usually leads to **right ventricular volume overload** and **pulmonary hypertension**, resulting in right ventricular hypertrophy. - While it can cause pulmonary complications, **LVH and left axis deviation are not characteristic features**. *VSD* - A large **ventricular septal defect (VSD)** can cause **biventricular hypertrophy** or predominantly **left ventricular hypertrophy** due to increased pulmonary blood flow and left ventricular volume overload. - However, isolated, uncomplicated VSD does not typically present with **left axis deviation**; ECG findings are variable but often show an rsR' pattern in V1 or increased QRS voltages.

Q: An 8-month-old female child presented to the emergency department with a heart rate of 220/minute and features of congestive heart failure. Her heart rate returned to normal after administering intravenous adenosine. What is the most likely diagnosis?

Paroxysmal supraventricular tachycardia. ***Paroxysmal supraventricular tachycardia*** - **Paroxysmal supraventricular tachycardia (PSVT)** is a common cause of **tachyarrhythmia** in infants and typically responds well to **adenosine**, which transiently blocks the AV node. - The presentation of a heart rate of **220/minute** in an 8-month-old, along with signs of congestive heart failure, is characteristic of PSVT. *Atrial flutter* - While atrial flutter can cause a rapid heart rate, it often presents with a characteristic **sawtooth pattern** on ECG and may less consistently respond to adenosine with complete rhythm conversion. - Typically, the ventricular rate in atrial flutter is a fraction of the atrial rate (e.g., 2:1 or 3:1 block), which might be high but not always resolve completely with adenosine. *Atrial fibrillation* - **Atrial fibrillation** is rare in infants without significant structural heart disease and usually presents with an **irregularly irregular rhythm**, which is not explicitly mentioned. - Although adenosine can slow the ventricular response, it generally does not convert atrial fibrillation back to sinus rhythm. *Ventricular tachycardia* - **Ventricular tachycardia** is generally less common than PSVT in infants and is often associated with more severe underlying cardiac pathology or poorer hemodynamic stability. - While adenosine can sometimes terminate certain types of VT, it is typically used cautiously and is less effective than in PSVT.

Q: The heart lesion not found in Congenital Rubella infection is –

ASD. ***Atrial Septal Defect (ASD)*** - **ASD is NOT a typical cardiac manifestation** of congenital rubella syndrome and is generally not reported as part of the classic cardiovascular anomalies. - The characteristic cardiac defects in congenital rubella involve **persistent fetal structures** (PDA) and **pulmonary outflow abnormalities** (peripheral and valvular pulmonary stenosis). - Among the options listed, **ASD** is the lesion least associated with congenital rubella infection. *Ventricular Septal Defect (VSD)* - **VSD is also not a classic feature** of congenital rubella syndrome, though isolated case reports exist. - However, compared to ASD, **VSD has slightly more literature support** as an occasional finding. - The defect involves the **interventricular septum**. *Pulmonary Stenosis (PS)* - **Peripheral pulmonary artery stenosis** is one of the most characteristic cardiovascular anomalies in congenital rubella syndrome (found in ~50-60% of cardiac cases). - Involves narrowing of the **branch pulmonary arteries**, often multiple sites. - **Pulmonary valve stenosis** is also commonly seen. *Patent Ductus Arteriosus (PDA)* - **PDA is the most common cardiac defect** in congenital rubella syndrome, occurring in up to 80% of affected infants with heart disease. - Represents failure of the **ductus arteriosus** to close after birth. - Part of the classic triad: **PDA + peripheral PS + pulmonary valve stenosis**.

Q: Which of the following does not complicate into CHF –

Tetralogy of Fallot. ***Tetralogy of Fallot*** - This condition is characterized by **right-to-left shunting** due to a large ventricular septal defect (VSD) and right ventricular outflow tract obstruction, leading to **cyanosis** rather than heart failure. - The right ventricular hypertrophy and pulmonary stenosis in Tetralogy of Fallot actually **protect the pulmonary circulation** from volume overload, thus reducing the risk of CHF. *Patent ductus arteriosus* - A PDA causes a **left-to-right shunt** from the aorta to the pulmonary artery, increasing pulmonary blood flow and leading to **pulmonary hypertension** and eventually **left ventricular volume overload**, which can lead to CHF. - The continuous flow through the PDA can cause **volume overload** on the left ventricle and a subsequent increase in cardiac work leading to heart failure. *Transposition of great vessels* - In TGV, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, creating **two parallel circulations**. Complete TGV without a septal defect is incompatible with life. - If a VSD is present, it can lead to **volume overload** of the left ventricle and pulmonary hypertension, increasing the risk of CHF. *Coarctation of aorta* - This is a narrowing of the aorta, typically distal to the left subclavian artery, causing **increased afterload** on the left ventricle. - The increased workload and pressure overload on the left ventricle can lead to **left ventricular hypertrophy** and ultimately **heart failure**.

Question 1

Tetralogy of Fallot is characterized by following except –

Accepted Answer

AS

Answer

VSD

Answer

Over–riding of aorta

Answer

Infundibular constriction

Question 2

A mother brings her 5-year-old boy to see you as a General Physician. On examination, he has red eyes, dry, cracked lips and a rash on his hands and feet. He also has cervical lymphadenopathy. What is the most important investigation to rule out a serious complication of this condition?

Accepted Answer

Echocardiography

Answer

Blood pressure

Answer

ECG

Answer

Blood tests for autoantibodies

Question 3

Commonly associated in tetralogy of Fallot is:

Accepted Answer

Right sided aortic arch

Answer

Coarctation of aorta

Answer

Aortopulmonary window

Answer

Aberrant right subclavian artery

Question 4

Most common cardiac defect seen in Rubella syndrome

Accepted Answer

PDA

Answer

VSD

Answer

ASD

Answer

Pulmonary stenosis

Question 5

The most common paediatric cardiac tumour among the following is

Accepted Answer

Rhabdomyomas

Answer

Myxomas

Answer

Hemangiomas

Answer

Fibromas

Question 6

A 29-day-old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. The most likely diagnosis is:

Accepted Answer

Ventricular septal defect

Answer

Rheumatic fever

Answer

Transposition of great arteries

Answer

Tetralogy of Fallot

Question 7

A child presents with LVH and pulmonary complications. ECG shows left axis deviation. Most likely diagnosis is:

Accepted Answer

Tricuspid atresia

Answer

TOF

Answer

TAPVC

Answer

VSD

Question 8

An 8-month-old female child presented to the emergency department with a heart rate of 220/minute and features of congestive heart failure. Her heart rate returned to normal after administering intravenous adenosine. What is the most likely diagnosis?

Accepted Answer

Paroxysmal supraventricular tachycardia

Answer

Atrial flutter

Answer

Atrial fibrillation

Answer

Ventricular tachycardia

Question 9

The heart lesion not found in Congenital Rubella infection is –

Accepted Answer

ASD

Answer

VSD

Answer

PS

Answer

PDA

Question 10

Which of the following does not complicate into CHF –

Accepted Answer

Tetralogy of Fallot

Answer

Patent ductus arteriosus

Answer

Transposition of great vessels

Answer

Coarctation of aorta

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?