Cardiology Practice Questions

Q: Which of the following statements about the ductus arteriosus is true?

Its patency may cause a machinery murmur.. **Explanation:** The **Ductus Arteriosus (DA)** is a vital fetal vascular structure connecting the pulmonary artery to the descending aorta, bypassing the non-functional fetal lungs. **Why Option D is Correct:** In Patent Ductus Arteriosus (PDA), blood flows from the high-pressure aorta to the lower-pressure pulmonary artery throughout the cardiac cycle. This continuous pressure gradient results in a **continuous "machinery" murmur**, heard loudest at the left infraclavicular area (Gibson’s murmur). **Analysis of Incorrect Options:** * **Option A:** Functional closure occurs within 10–15 hours of birth due to smooth muscle contraction. However, **anatomic closure** (fibrosis into the ligamentum arteriosum) takes much longer, typically **2 to 3 weeks**. * **Option B:** The DA connects the **pulmonary artery** (specifically the bifurcation or left branch) to the **descending aorta**, not the pulmonary vein. * **Option C:** Prostaglandins (PGE1 and PGE2) maintain patency. Closure is actually induced by **decreased prostaglandin levels** and the **rise in arterial oxygen tension (PaO2)** after the first breath. **High-Yield NEET-PG Pearls:** * **Drug of Choice for Closure:** Intravenous **Indomethacin** or **Ibuprofen** (NSAIDs that inhibit prostaglandin synthesis). Paracetamol is also used. * **Maintaining Patency:** In cyanotic heart diseases (e.g., Transposition of Great Arteries), **Alprostadil (PGE1)** is administered to keep the ductus open. * **Associated Infection:** Maternal **Rubella** infection during pregnancy is strongly associated with PDA in the newborn.

Q: A newborn with a marked congenital heart defect (CHD) and decreased pulmonary vascularity should be treated with which of the following medications?

Prostaglandin E1. ### Explanation **Correct Answer: C. Prostaglandin E1 (Alprostadil)** **Medical Concept:** The clinical presentation of a newborn with a cyanotic congenital heart defect (CHD) and **decreased pulmonary vascularity** on X-ray indicates a **ductal-dependent pulmonary circulation**. In conditions like Pulmonary Atresia, Tricuspid Atresia, or severe Tetralogy of Fallot, pulmonary blood flow is restricted. The infant relies entirely on the **Ductus Arteriosus** to shunt blood from the aorta to the lungs for oxygenation. As the ductus naturally begins to close within the first hours or days of life, these infants develop profound cyanosis and shock. **Prostaglandin E1 (PGE1)** is life-saving because it maintains the patency of the ductus arteriosus, ensuring adequate pulmonary perfusion until surgical intervention (like a Blalock-Taussig shunt) can be performed. **Why Incorrect Options are Wrong:** * **A. Digoxin:** This is an inotrope used for heart failure or certain arrhythmias (SVT). It does not address the anatomical obstruction to pulmonary blood flow. * **B. Indomethacin:** This is a prostaglandin synthesis inhibitor used to **close** a Patent Ductus Arteriosus (PDA) in preterm infants. In this scenario, closing the ductus would be fatal. * **D. Epinephrine:** While used in resuscitation for cardiac arrest or severe shock, it does not solve the underlying problem of restricted pulmonary blood flow in a ductal-dependent lesion. **High-Yield Clinical Pearls for NEET-PG:** 1. **Ductal-dependent Systemic Circulation:** Conditions like Hypoplastic Left Heart Syndrome or Coarctation of the Aorta also require PGE1 to maintain systemic output. 2. **Side Effect of PGE1:** The most common high-yield side effect to watch for is **Apnea**; always be prepared for endotracheal intubation. 3. **X-ray Finding:** "Decreased pulmonary vascularity" (Oligemic lung fields) is a classic sign of right-to-left shunts with pulmonary obstruction.

Q: Which of the following is FALSE regarding Kawasaki disease?

Unilateral, suppurative cervical lymphadenopathy. **Explanation:** Kawasaki Disease (KD) is an acute, self-limiting systemic medium-vessel vasculitis. The diagnosis is clinical, based on the presence of high-grade fever for ≥5 days along with specific diagnostic criteria. **Why Option D is False:** While **unilateral cervical lymphadenopathy** (usually >1.5 cm) is a classic diagnostic criterion for KD, it is characteristically **non-suppurative**. If a lymph node is fluctuant or draining pus (suppurative), it points toward a bacterial etiology (like *Staphylococcus aureus* lymphadenitis) rather than Kawasaki disease. **Analysis of Other Options:** * **Option A (Strawberry tongue):** This is a classic finding of oral mucosal involvement in KD, caused by the sloughing of filiform papillae and hypertrophy of fungiform papillae. * **Option B (Periungual desquamation):** This is a hallmark of the **subacute phase** (occurring 2–3 weeks after fever onset). Skin peeling begins under the fingernails and toenails. * **Option C (Self-limiting febrile illness):** KD is indeed self-limiting; the fever and acute inflammation usually resolve even without treatment. However, treatment (IVIG) is mandatory to prevent the serious complication of coronary artery aneurysms. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Complication:** Coronary artery aneurysms (occurs in 20–25% of untreated cases). * **Treatment of Choice:** High-dose **IVIG** (2g/kg) plus **Aspirin**. (Note: This is one of the few pediatric conditions where Aspirin is indicated despite the risk of Reye syndrome). * **Cardiac Screening:** Echocardiography should be performed at diagnosis, at 2 weeks, and at 6–8 weeks. * **Incomplete Kawasaki:** Suspect in infants with prolonged fever and fewer than 4 criteria; check ESR/CRP and Echo.

Q: All are features of Kawasaki disease, except?

Peak incidence at age > 5 years. **Explanation:** Kawasaki Disease (KD) is an acute, self-limiting systemic medium-vessel vasculitis. It is the leading cause of acquired heart disease in children in developed nations. **Why Option A is the correct answer (The "Except"):** The peak incidence of Kawasaki Disease is in children **younger than 5 years** (specifically between 6 months and 2 years of age). It is rare in infants under 3 months or children older than 8 years. Therefore, "Peak incidence at age > 5 years" is factually incorrect. **Why other options are incorrect (Features of KD):** * **Option B (Coronary Artery Aneurysm):** This is the most serious complication, occurring in 20–25% of untreated cases. It typically develops in the subacute phase. * **Option C (Enlarged Lymph Nodes):** Cervical lymphadenopathy (usually >1.5 cm and unilateral) is one of the five classic diagnostic criteria. * **Option D (Fever):** High-grade, spiking fever lasting for at least 5 days is the mandatory hallmark for diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria (CRASH and Burn):** **C**onjunctivitis (bilateral, non-purulent), **R**ash (polymorphous), **A**denopathy (cervical), **S**trawberry tongue (and oral mucosal changes), **H**ands/feet (edema/erythema/desquamation), and **Burn** (Fever ≥ 5 days). * **Treatment:** High-dose **IVIG** (2g/kg) and **Aspirin**. IVIG is most effective if given within the first 10 days to prevent coronary aneurysms. * **Incomplete Kawasaki:** Common in infants; requires high clinical suspicion as they are at high risk for aneurysms despite not meeting all criteria. * **Echo:** Should be performed at diagnosis, at 2 weeks, and 6–8 weeks.

Q: The child shown below is suffering from a congenital heart disease. Which congenital heart defect is most commonly seen in these children?

Atrioventricular septal defect. ***Atrioventricular septal defect*** - **Endocardial cushion defects** (AVSD) are the most common congenital heart disease in **Down syndrome**. Congenital heart disease occurs in roughly **40–50%** of people with Down syndrome, and AVSD is one of the most characteristic and common defects. - Results from incomplete fusion of the **endocardial cushions**, leading to defects in both the atrial and ventricular septum with **common atrioventricular valve**. *Patent ductus arteriosus* - More commonly associated with **prematurity** and **maternal rubella infection** rather than Down syndrome. - Characterized by persistent connection between the **aorta and pulmonary artery**, causing a **continuous "machinery" murmur**. *Atrial septal defect* - While seen in Down syndrome, it's less frequent than **AVSD** in this population. - More commonly associated with **Holt-Oram syndrome** and presents with a **fixed split S2** heart sound. *Ventricular septal defect* - Though **VSD is the most common CHD overall** in the general population, it's not the predominant defect in Down syndrome. - Typically presents with a **holosystolic murmur** at the left sternal border and may cause **failure to thrive**.

Q: A neonate has recurrent attacks of abdominal pain, restless irritability, and diaphoresis on feeding. Cardiac auscultation reveals a nonspecific murmur. The neonate is believed to be at risk for myocardial infarction. What is the likely diagnosis?

Anomalous coronary artery. **Explanation:** The clinical presentation describes **ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery)**, also known as **Bland-White-Garland Syndrome**. **1. Why the Correct Answer is Right:** In ALCAPA, the left coronary artery arises from the pulmonary artery instead of the aorta. As pulmonary vascular resistance drops after birth, the left ventricle receives deoxygenated blood at low pressure. Eventually, blood flows retrograde from the right coronary artery to the pulmonary artery (coronary steal). This leads to **myocardial ischemia**, especially during exertion like **feeding**. The "abdominal pain," irritability, and diaphoresis are classic signs of **infantile angina**. Without intervention, these infants are at high risk for myocardial infarction and heart failure. **2. Why Incorrect Options are Wrong:** * **ASD & VSD:** These are left-to-right shunts. While they can cause tachypnea and failure to thrive, they do not typically cause episodic, angina-like pain or early myocardial infarction. * **Tetralogy of Fallot (TOF):** Presents with cyanosis and "Tet spells" (hyperpnea and cyanosis), not typically isolated diaphoresis and irritability mimicking angina during feeding. **3. High-Yield Clinical Pearls for NEET-PG:** * **ECG Findings:** Pathological **Q-waves** in leads I, aVL, and V4–V6 (anterolateral infarct pattern). * **Chest X-ray:** Significant cardiomegaly due to left ventricular dysfunction. * **Management:** Surgical reimplantation of the anomalous artery into the aorta is the definitive treatment. * **Key Differentiator:** If a neonate presents with symptoms of **congestive heart failure + ECG evidence of infarction**, always suspect ALCAPA.

Q: Which of the following congenital heart diseases is associated with cyanosis, except?

Atrial septal defect with mitral stenosis. ### Explanation The core concept in pediatric cardiology is distinguishing between **Cyanotic Congenital Heart Disease (CCHD)** and **Acyanotic Congenital Heart Disease**. **Why Option D is Correct:** **Atrial Septal Defect (ASD) with Mitral Stenosis** is clinically known as **Lutembacher Syndrome**. In this condition, the mitral stenosis increases left atrial pressure, which further augments the **left-to-right shunt** through the ASD. Since oxygenated blood is moving from the left side to the right side of the heart, there is no mixing of deoxygenated blood into the systemic circulation; hence, the patient remains **acyanotic**. **Why the Other Options are Incorrect:** * **A. Complete Transposition of the Great Arteries (TGA):** This is a classic CCHD where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, creating two parallel circuits. Cyanosis is inevitable and severe. * **B. Single Ventricle:** This represents a "common mixing" lesion. Whether or not pulmonic stenosis is present, deoxygenated systemic venous return and oxygenated pulmonary venous return mix in a single chamber before being pumped to the body, causing cyanosis. * **C. Hypoplastic Left Heart Syndrome (HLHS):** This is a critical CCHD where the left-sided structures are underdeveloped. Systemic perfusion depends on the ductus arteriosus, and mixing of blood occurs at the atrial level, leading to cyanosis. **NEET-PG High-Yield Pearls:** * **Lutembacher Syndrome:** Defined as the combination of acquired Mitral Stenosis (usually rheumatic) and a congenital ASD (usually Secundum type). * **The 5 T’s of Cyanotic Heart Disease:** TGA, Tetralogy of Fallot, Truncus Arteriosus, Tricuspid Atresia, and Total Anomalous Pulmonary Venous Return (TAPVC). * **Admixture Lesions:** Single ventricle and HLHS are categorized as "mixing lesions" which always present with some degree of arterial desaturation.

Question 1

Which of the following statements about the ductus arteriosus is true?

Accepted Answer

Its patency may cause a machinery murmur.

Answer

It undergoes anatomic closure within 24 hours of birth.

Answer

It connects the aorta to the pulmonary vein.

Answer

It is induced to close by high levels of prostaglandins.

Question 2

A 34-day-old baby presented with increased respiratory effort along with grunting. The infant is always irritable, feeds very poorly, and has not been able to gain weight. There is a history of frequent recurrent pneumonia requiring hospitalization. On examination, the findings include wide pulse pressure, bounding peripheral pulses, a hyperkinetic apex, a continuous thrill in the 2nd left intercostal space, and a continuous murmur localized to the 2nd left intercostal space and radiating down the left sternal border. Which of the following concomitant findings is most likely to be present in this child?

Accepted Answer

Nuclear cataract

Answer

Limb hypoplasias

Answer

Optic atrophy

Answer

Periventricular calcifications

Question 3

A newborn with a marked congenital heart defect (CHD) and decreased pulmonary vascularity should be treated with which of the following medications?

Accepted Answer

Prostaglandin E1

Answer

Digoxin

Answer

Indomethacin

Answer

Epinephrine

Question 4

Which of the following is FALSE regarding Kawasaki disease?

Accepted Answer

Unilateral, suppurative cervical lymphadenopathy

Answer

Strawberry tongue

Answer

Periungual desquamation

Answer

Self-limiting febrile illness

Question 5

All are features of Kawasaki disease, except?

Accepted Answer

Peak incidence at age > 5 years

Answer

Aneurysm of coronary artery

Answer

Enlarged lymph nodes

Answer

Fever

Question 6

The child shown below is suffering from a congenital heart disease. Which congenital heart defect is most commonly seen in these children?

Accepted Answer

Atrioventricular septal defect

Answer

Patent ductus arteriosus

Answer

Atrial septal defect

Answer

Ventricular septal defect

Question 7

All of the following are congenital heart diseases with oligemic lung fields except?

Accepted Answer

Transposition of the great arteries (TGA)

Answer

Tricuspid atresia

Answer

Ebstein's anomaly

Answer

Mitral regurgitation

Question 8

A 7-day-old baby presents to the emergency department with unconsciousness, cyanosis, and an oxygen saturation of 85%. What is the most likely diagnosis?

Accepted Answer

Transposition of the Great Arteries (TGA)

Answer

Tetralogy of Fallot

Answer

Total Anomalous Pulmonary Venous Connection (TAPVC)

Answer

Patent Ductus Arteriosus (PDA)

Question 9

A neonate has recurrent attacks of abdominal pain, restless irritability, and diaphoresis on feeding. Cardiac auscultation reveals a nonspecific murmur. The neonate is believed to be at risk for myocardial infarction. What is the likely diagnosis?

Accepted Answer

Anomalous coronary artery

Answer

Atrial Septal Defect (ASD)

Answer

Ventricular Septal Defect (VSD)

Answer

Tetralogy of Fallot (TOF)

Question 10

Which of the following congenital heart diseases is associated with cyanosis, except?

Accepted Answer

Atrial septal defect with mitral stenosis

Answer

Complete transposition of the great arteries

Answer

Single ventricle with or without pulmonic stenosis

Answer

Hypoplastic left heart

Cardiology — MCQs

Cardiology — MCQs

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