Cardiology Practice Questions

Q: A 7-year-old child with rheumatic fever would require the following investigations, except:

Urine examination. ***Urine examination*** - A urine examination is **not typically required** for the diagnosis or monitoring of acute rheumatic fever. - While some systemic inflammatory conditions can affect the kidneys, it is **not a primary diagnostic or prognostic tool** for rheumatic fever. *Electrocardiogram* - An **ECG** is crucial to assess for cardiac involvement, such as **conduction abnormalities** (e.g., prolonged PR interval due to carditis). - It helps detect inflammation of the heart muscle, a major manifestation of rheumatic fever. *Echocardiogram* - An **echocardiogram** is essential for diagnosing **rheumatic carditis**, especially valvular damage. - It visualizes the heart's structure and function, identifying effects like **mitral or aortic regurgitation**. *Blood culture* - A **blood culture** is often done to rule out other infectious causes of similar symptoms like **septic arthritis** or **infective endocarditis**. - While rheumatic fever is triggered by *Streptococcus pyogenes*, the bacteria are typically no longer present in the bloodstream at the time of acute rheumatic fever.

Q: Which among the following diagnostic criteria is most characteristic of Kawasaki disease?

Non-exudative bilateral conjunctival injection. ***Non-exudative bilateral conjunctival injection*** - **Non-exudative bilateral conjunctival injection** is a key diagnostic criterion for Kawasaki disease, indicating inflammation without pus or discharge. - This finding is one of the five principal clinical features used to diagnose the condition, alongside fever of at least five days. *Unilateral cervical lymphadenopathy* - **Unilateral cervical lymphadenopathy** is a common diagnostic criterion for Kawasaki disease, but it must be larger than **1.5 cm** to be considered significant. - While present in many cases, its unilateral nature and specific size requirement make it less universally characteristic than bilateral conjunctival injection. *Gastrointestinal symptoms* - **Gastrointestinal symptoms**, such as diarrhea, vomiting, and abdominal pain, can occur in Kawasaki disease but are **non-specific** and not primary diagnostic criteria. - These symptoms are often present due to systemic inflammation but do not directly help in distinguishing Kawasaki from other febrile illnesses. *Periungual desquamation (peeling of skin around the nails)* - **Periungual desquamation** is a characteristic feature of **subacute or convalescent phase** of Kawasaki disease, occurring typically *after* the acute febrile stage. - While highly suggestive of Kawasaki disease, it is not an acute diagnostic criterion used to initially identify the illness during its active phase.

Q: What is the most characteristic auscultatory location for a patent ductus arteriosus (PDA) murmur?

Prominent in left 2nd intercostal space. ***Prominent in left 2nd intercostal space*** - The classic **"machinery" murmur** of a **patent ductus arteriosus (PDA)** is best heard at the **left upper sternal border** (left 2nd intercostal space). - This location corresponds to the anatomical position where the **ductus arteriosus** connects the **pulmonary artery** to the **descending aorta**. - The murmur is **continuous**, heard throughout systole and diastole, with peak intensity around the second heart sound. *Prominent in left infraclavicular space* - While the PDA murmur may radiate to the **left infraclavicular area**, this is not the primary auscultatory location. - The **left 2nd intercostal space** remains the **loudest and most diagnostic point** for detecting this murmur. *Prominent in right 2nd intercostal space* - The right 2nd intercostal space is the classic location for **aortic valve** murmurs, not PDA. - PDA is a **left-sided finding** due to the anatomical position of the ductus between the pulmonary artery and aorta. *Prominent at apex (5th intercostal space, midclavicular line)* - The apex is the primary location for **mitral valve** pathology, not PDA. - While some cardiac murmurs may radiate to multiple areas, the PDA murmur is characteristically **loudest at the left upper sternal border**, not the apex.

Q: In which of the following conditions is an atrial septal defect (ASD) commonly observed?

Holt-Oram syndrome. ***Correct: Holt-Oram syndrome*** - Holt-Oram syndrome has the **strongest and most specific association with secundum atrial septal defects (ASDs)** among the options listed - Approximately **75% of patients have congenital heart defects**, with **ASD being the most common** (followed by VSD) - Classic presentation: **upper limb abnormalities** (radial ray defects, triphalangeal thumb) + **ASD** - Autosomal dominant inheritance with mutations in TBX5 gene - When a question asks about "commonly observed" ASD, Holt-Oram is the classic teaching association *Incorrect: Ellis-van Creveld syndrome* - While Ellis-van Creveld syndrome does have a high incidence of cardiac defects (50-60%), the **most characteristic cardiac finding is a common atrium (single atrium)** rather than a typical secundum ASD - A common atrium is an extreme form of ASD where there is complete absence of the atrial septum - The syndrome is primarily characterized by **chondroectodermal dysplasia**: short limbs, short ribs, polydactyly, and dental/nail abnormalities - Much rarer than Holt-Oram syndrome *Incorrect: Down syndrome* - Down syndrome (Trisomy 21) has a high prevalence of congenital heart defects (40-50%), but the **most characteristic defect is an atrioventricular septal defect (AVSD)**, also known as endocardial cushion defect - While AVSDs involve the atrial septum, they are **distinct from isolated ASDs** and involve both the atrial and ventricular septa with abnormal AV valves - Other common defects: VSD, PDA, and tetralogy of Fallot *Incorrect: Turner's syndrome* - Turner's syndrome (45,XO) is characterized by congenital heart defects in about 25-50% of cases - The **most common cardiac abnormalities are coarctation of the aorta (30%) and bicuspid aortic valve (30%)** - Left-sided obstructive lesions predominate; **ASDs are less commonly associated** with Turner's syndrome - Other features: short stature, webbed neck, lymphedema, and gonadal dysgenesis

Q: A child presenting to the clinic with features of Down syndrome. What is the most common cardiac lesion in children with Down syndrome?

Atrioventricular Septal Defect. ***Atrioventricular Septal Defect*** - **Atrioventricular septal defect (AVSD)**, also known as **endocardial cushion defect**, is the most common cardiac anomaly in children with **Down syndrome**, occurring in about 40-50% of those with congenital heart disease. - It involves defects in both the atrial and ventricular septa, often with a common AV valve, leading to significant **shunting** and potential **pulmonary hypertension**. *VSD* - While **ventricular septal defects (VSDs)** are common congenital heart lesions, they are less prevalent than AVSDs in patients with Down syndrome. - VSDs involve a hole in the septum separating the ventricles, leading to a left-to-right shunt. *Coarctation of aorta* - **Coarctation of the aorta** is a narrowing of the aorta, typically occurring distal to the left subclavian artery. - This lesion is not specifically associated with Down syndrome and is much less common than septal defects in this population. *Transposition of great vessels* - **Transposition of the great arteries (TGA)** involves the aorta arising from the right ventricle and the pulmonary artery from the left ventricle, leading to parallel circulations. - This complex cyanotic heart defect is not typically associated with Down syndrome and has a different embryological origin.

Q: Which of the following vasculitides is predominantly seen in children?

Kawasaki disease. ***Kawasaki disease*** - This is the **most common vasculitis in children**, with approximately 90% of cases occurring in children **under 5 years of age**. - It is **predominantly a pediatric condition** and rarely occurs in adults. - Characterized by fever lasting more than 5 days, along with conjunctivitis, oral changes (strawberry tongue, cracked lips), rash, cervical lymphadenopathy, and extremity changes. - The major complication is **coronary artery aneurysms**, which can lead to myocardial infarction if untreated. - Treatment with **IVIG and aspirin** reduces the risk of coronary complications. *Henoch-Schönlein purpura (HSP)* - While this is a **common vasculitis in children** (peak age 4-6 years), it also occurs in adults. - Presents with palpable purpura, arthritis, abdominal pain, and glomerulonephritis. - Caused by **IgA-mediated immune complex deposition** in small vessels. - However, it is not as **exclusively pediatric** as Kawasaki disease. *Takayasu arteritis* - A **large vessel vasculitis** affecting the aorta and its major branches. - Predominantly affects **young women** between 10-40 years of age, not specifically children. - Presents with absent pulses, hypertension, and vascular bruits. *Susac syndrome* - A rare microangiopathy affecting the brain, retina, and inner ear. - Typically occurs in **young adults** (mean age 30-40 years), not in children. - Characterized by encephalopathy, branch retinal artery occlusions, and sensorineural hearing loss.

Q: Which of the following is the most common cause of syncope in children?

Neurocardiogenic syncope. ***Neurocardiogenic syncope*** - This is the **most common cause of syncope** in children and adolescents, often triggered by prolonged standing, pain, or emotional stress. - It results from a **reflex-mediated drop in heart rate and blood pressure**, leading to temporary cerebral hypoperfusion. *Breath holding spells* - While common in infants and toddlers (6 months to 6 years), these are typically **self-limiting, benign events** related to anger or pain, and not the most common cause of syncope across all pediatric ages. - They are characterized by **cyanosis** or pallor followed by a brief loss of consciousness, but differ from true syncope in their underlying mechanism. *Hypoglycemia* - Although it can cause **lightheadedness, confusion, and sometimes loss of consciousness**, it is not the most frequent cause of syncope in generally healthy children without underlying metabolic disorders or diabetes. - Diagnosis requires demonstrating **low blood sugar levels** at the time of the event. *Hypovolemia* - This can cause syncope due to **decreased circulating blood volume** and reduced cerebral perfusion, often seen in cases of severe dehydration or hemorrhage. - However, in the general pediatric population, it is a **less common cause of syncope** compared to neurocardiogenic mechanisms.

Q: Which of the following congenital heart defects is least likely to cause recurrent pulmonary infections?

Tetralogy of Fallot (TOF). ***Tetralogy of Fallot (TOF)*** - This is a **cyanotic heart defect** characterized by **right-to-left shunting** of blood, leading to reduced pulmonary blood flow. - Reduced pulmonary blood flow means less blood congests the lungs, thus decreasing the risk of **pulmonary edema** and subsequent infections. *Ventricular Septal Defect (VSD)* - VSD results in a **left-to-right shunt**, increasing blood flow to the pulmonary artery and causing **pulmonary overcirculation**. - This **pulmonary congestion** makes the lungs more susceptible to recurrent infections due to increased fluid and pressure in the pulmonary vasculature. *Patent Ductus Arteriosus (PDA)* - PDA also causes a **left-to-right shunt** from the aorta to the pulmonary artery, leading to **pulmonary overcirculation**. - The increased blood flow and pressure in the pulmonary system contribute to **pulmonary edema** and heightened risk of respiratory infections. *Atrial Septal Defect (ASD)* - An ASD typically causes a **left-to-right shunt** at the atrial level, increasing blood flow to the lungs and resulting in **pulmonary overcirculation**. - While generally less severe than VSD or PDA, significant pulmonary blood flow can still predispose individuals to recurrent **pulmonary infections**.

Q: A five-day-old, full-term male infant who was severely cyanotic at birth, showed improvement in oxygenation after initial administration of prostaglandin E1 and subsequent balloon atrial septostomy, is most likely diagnosed with which of the following conditions?

Transposition of great vessels. ***Transposition of great vessels*** - Severe **cyanosis at birth** that improves with **prostaglandin E1 (PGE1)** and **balloon atrial septostomy** is highly characteristic of transposition of the great arteries (TGA), as these interventions improve mixing of oxygenated and deoxygenated blood. - PGE1 maintains **ductus arteriosus** patency, while balloon atrial septostomy creates or enlarges an **atrial septal defect**, both crucial for survival in TGA by allowing blood mixing. *Tetralogy Fallot* - While it causes cyanosis, Tetralogy of Fallot typically presents with **hypercyanotic spells** that worsen with activity and is not typically managed acutely with a balloon atrial septostomy for severe immediate cyanosis at birth. - The primary defect in Tetralogy of Fallot is **right ventricular outflow tract obstruction**, which is not directly addressed by PGE1 or atrial septostomy as definitive treatment. *Truncus Arteriosus* - Truncus arteriosus involves a single great artery overriding the ventricular septum and typically results in severe **congestive heart failure** and **pulmonary overcirculation** rather than severe, isolated cyanosis at birth requiring PGE1 and atrial septostomy for acute improvement. - Cyanosis may be present but is usually not the predominant life-threatening feature in the immediate newborn period in the same way as TGA. *Tricuspid Atresia* - Although tricuspid atresia causes cyanosis due to an absent tricuspid valve, it often presents with **right ventricular hypoplasia** and requires either an atrial septal defect or patent foramen ovale for survival, which may be enlarged by septostomy. - However, the severity of cyanosis and the dramatic response to both PGE1 and septostomy, particularly in a *severe* cyanotic newborn, is more indicative of the circulatory defect in TGA.

Q: A 4-year-old girl is brought to the pediatrician's office, where her father reports that she suddenly became pale and stopped running while playfully chasing her and her pet Chihuahua. After 30 minutes, she was no longer pale and wanted to resume the game. She has never had a previous episode and has never been cyanotic. Her physical examination was normal, as were her chest x-ray and echocardiogram. An ECG shows a specific pattern indicating which of the following?

Wolff-Parkinson-White syndrome. ***Wolff-Parkinson-White syndrome*** - The ECG shows a **short PR interval** and a **delta wave** (slurring of the initial upstroke of the QRS complex), which are classic signs of **pre-excitation** seen in Wolff-Parkinson-White (WPW) syndrome. - The child's symptoms of sudden pallor and stopping activity, followed by spontaneous recovery, suggest a brief episode of **tachycardia** due to WPW, which can cause symptoms stemming from reduced cardiac output. *Paroxysmal ventricular tachycardia* - **Ventricular tachycardia** is characterized by wide, bizarre QRS complexes originating from the ventricles, often without a preceding P wave, which is not clearly depicted in the provided ECG. - While it can cause sudden symptoms like pallor due to reduced cardiac output, the distinctive **delta wave** and **short PR interval** seen in the ECG point away from primary VT and towards pre-excitation. *Stokes-Adams syndrome* - This syndrome involves recurrent episodes of **syncope** due to a transient **heart block** or **bradyarrhythmia**, leading to a sudden decrease in cerebral perfusion. - The ECG in Stokes-Adams syndrome would typically show evidence of severe bradycardia or asystole during an event, which is not consistent with the depicted ECG or the likely tachyarrhythmic nature of the symptoms. *Paroxysmal supraventricular tachycardia* - While **paroxysmal supraventricular tachycardia (PSVT)** is common in children and can cause symptoms like pallor, the ECG would typically show a **narrow QRS complex tachycardia** with absent or abnormal P waves, but **lacks the delta wave and short PR interval** characteristic of WPW. - WPW syndrome is a common cause of PSVT in children, but the ECG findings specifically indicate the underlying Wolff-Parkinson-White pattern, rather than just the generic PSVT.

Question 1

A 7-year-old child with rheumatic fever would require the following investigations, except:

Accepted Answer

Urine examination

Answer

Electrocardiogram

Answer

Echocardiogram

Answer

Blood culture

Question 2

Which among the following diagnostic criteria is most characteristic of Kawasaki disease?

Accepted Answer

Non-exudative bilateral conjunctival injection

Answer

Unilateral cervical lymphadenopathy

Answer

Gastrointestinal symptoms

Answer

Periungual desquamation (peeling of skin around the nails)

Question 3

What is the most characteristic auscultatory location for a patent ductus arteriosus (PDA) murmur?

Accepted Answer

Prominent in left 2nd intercostal space

Answer

Prominent in left infraclavicular space

Answer

Prominent at apex (5th intercostal space, midclavicular line)

Answer

Prominent in right 2nd intercostal space

Question 4

In which of the following conditions is an atrial septal defect (ASD) commonly observed?

Accepted Answer

Holt-Oram syndrome

Answer

Down syndrome

Answer

Turner's syndrome

Answer

Ellis-van Creveld syndrome

Question 5

A child presenting to the clinic with features of Down syndrome. What is the most common cardiac lesion in children with Down syndrome?

Accepted Answer

Atrioventricular Septal Defect

Answer

VSD

Answer

Transposition of great vessels

Answer

Coarctation of aorta

Question 6

Which of the following vasculitides is predominantly seen in children?

Accepted Answer

Kawasaki disease

Answer

Takayasu arteritis

Answer

Susac syndrome

Answer

Henoch-Schonlein purpura

Question 7

Which of the following is the most common cause of syncope in children?

Accepted Answer

Neurocardiogenic syncope

Answer

Breath holding spells

Answer

Hypoglycemia

Answer

Hypovolemia

Question 8

Which of the following congenital heart defects is least likely to cause recurrent pulmonary infections?

Accepted Answer

Tetralogy of Fallot (TOF)

Answer

Ventricular Septal Defect (VSD)

Answer

Atrial Septal Defect (ASD)

Answer

Patent Ductus Arteriosus (PDA)

Question 9

A five-day-old, full-term male infant who was severely cyanotic at birth, showed improvement in oxygenation after initial administration of prostaglandin E1 and subsequent balloon atrial septostomy, is most likely diagnosed with which of the following conditions?

Accepted Answer

Transposition of great vessels

Answer

Tetralogy Fallot

Answer

Truncus Arteriosus

Answer

Tricuspid Atresia

Question 10

A 4-year-old girl is brought to the pediatrician's office, where her father reports that she suddenly became pale and stopped running while playfully chasing her and her pet Chihuahua. After 30 minutes, she was no longer pale and wanted to resume the game. She has never had a previous episode and has never been cyanotic. Her physical examination was normal, as were her chest x-ray and echocardiogram. An ECG shows a specific pattern indicating which of the following?

Accepted Answer

Wolff-Parkinson-White syndrome

Answer

Paroxysmal ventricular tachycardia

Answer

Stokes-Adams syndrome

Answer

Paroxysmal supraventricular tachycardia

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?