Cardiology — MCQs
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In the context of hypercyanotic spells (tet spells) in children with congenital heart disease, when does crying typically stop?
Most common type of TAPVC is -
Most common syndrome associated with A-V canal defect -
Double aortic arch is associated with which syndrome?
In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?
A 9-month-old child of a diabetic mother presents with tachypnea and hepatomegaly. Echocardiography shows normal cardiac morphology with asymmetric septal hypertrophy. Which of the following medications is indicated for the management of this child's condition?
A 7-year-old child with rheumatic fever would require the following investigations, except:
In which of the following conditions is an atrial septal defect (ASD) commonly observed?
The most common congenital anomaly in a baby born to an IDDM mother is:
What is the most characteristic auscultatory location for a patent ductus arteriosus (PDA) murmur?
Cardiology Indian Medical PG Practice Questions and MCQs
Question 421: In the context of hypercyanotic spells (tet spells) in children with congenital heart disease, when does crying typically stop?
- A. Forced Expiration
- B. Forced inspiration (Correct Answer)
- C. Mid inspiration
- D. Crying is continuous
Explanation: ***Forced inspiration*** - During a hypercyanotic spell (Tet spell), the infant exhibits **inconsolable, forceful crying that characteristically stops at forced inspiration**. - The child takes a **deep, forceful inspiratory breath** which temporarily increases intrathoracic negative pressure and systemic vascular resistance. - This distinctive breathing pattern is a **hallmark clinical feature** of Tet spells and helps differentiate them from other causes of cyanosis. - The forced inspiration is often followed by a brief pause before the cycle may repeat. *Forced Expiration* - Crying does not typically stop at forced expiration during hypercyanotic spells. - The expiratory phase is part of the crying effort but not where the characteristic cessation occurs. - The key clinical observation is the deep inspiratory effort that interrupts the crying pattern. *Mid inspiration* - While inspiration is involved, the cessation is specifically at **forced/deep inspiration**, not mid-inspiration. - Mid-inspiration would not capture the characteristic forceful, deep inspiratory effort that defines the pattern. - The clinical significance lies in the maximal inspiratory effort, not a partial one. *Crying is continuous* - Crying during Tet spells is **not continuous**; it has a characteristic pattern of interruption. - The crying is forceful and prolonged but punctuated by periods of forced inspiration. - Recognition of this non-continuous pattern with forced inspiratory pauses is clinically important for diagnosis.
Question 422: Most common type of TAPVC is -
- A. Supracardiac (Correct Answer)
- B. Cardiac
- C. Infracardiac
- D. Multiple
Explanation: ***Supracardiac*** - This is the **most common type** of Total Anomalous Pulmonary Venous Connection (TAPVC), accounting for about 50% of cases. - Pulmonary veins drain into a **common vertical vein** that ascends to connect with the **innominate vein** or superior vena cava. *Cardiac* - In this type, the pulmonary veins drain directly into the **right atrium** or a coronary sinus. - It is relatively less common than the supracardiac type. *Infracardiac* - This is the **least common** and most severe type, where the pulmonary veins drain below the diaphragm, typically into the portal vein, ductus venosus, or inferior vena cava. - It is often associated with **pulmonary venous obstruction**, leading to cyanosis and pulmonary hypertension. *Multiple* - While it is possible to have anomalous drainage sites, **multiple sites** draining into different systemic veins are less common than a single primary site for TAPVC. - TAPVC is typically classified into specific anatomic types rather than 'multiple' as a primary category.
Question 423: Most common syndrome associated with A-V canal defect -
- A. Klinefelter syndrome
- B. Down syndrome (Correct Answer)
- C. Turner syndrome
- D. Marfan syndrome
Explanation: ***Down syndrome*** - **Down syndrome (Trisomy 21)** is the most common syndrome associated with **atrioventricular (AV) canal defects** (endocardial cushion defects) - Occurs in approximately **40-50% of individuals with Down syndrome**, making it the hallmark cardiac anomaly in this condition - AV canal defects range from partial to complete defects involving atrial and ventricular septa and AV valves *Klinefelter syndrome* - **Klinefelter syndrome (47,XXY)** is not characteristically associated with AV canal defects - May have **mitral valve prolapse** or **aortic root dilation**, but AV canal defects are not a typical feature *Turner syndrome* - **Turner syndrome (45,X)** has distinct cardiovascular associations including **coarctation of the aorta** and **bicuspid aortic valve** - AV canal defects are **not** characteristic of Turner syndrome *Marfan syndrome* - **Marfan syndrome** is a connective tissue disorder with **aortic root dilation**, **aortic aneurysms**, and **mitral valve prolapse** - **AV canal defects are not a feature** of Marfan syndrome
Question 424: Double aortic arch is associated with which syndrome?
- A. DiGeorge syndrome (Correct Answer)
- B. CATCH 22 syndrome
- C. Shprintzen syndrome
- D. None of the options
Explanation: ***DiGeorge syndrome*** - **DiGeorge syndrome** is caused by a **22q11.2 deletion** affecting the development of the third and fourth pharyngeal pouches, leading to **thymic hypoplasia**, **parathyroid hypoplasia**, and **cardiac anomalies**. - Common cardiac defects include **interrupted aortic arch type B**, **truncus arteriosus**, **tetralogy of Fallot**, and **VSD**. - **Double aortic arch** can occur in 22q11.2 deletion syndrome, though it is less common than other cardiac anomalies; however, among the syndromes listed, this represents the most appropriate association. - The question tests recognition that various cardiac arch anomalies, including double aortic arch, may be seen in this genetic syndrome. *CATCH 22 syndrome* - This is an **acronym** for DiGeorge syndrome: **C**ardiac defects, **A**bnormal facies, **T**hymic hypoplasia, **C**left palate, **H**ypocalcemia, and **22q11 deletion**. - It is **essentially the same condition** as DiGeorge syndrome, just using different nomenclature. - While technically correct, "DiGeorge syndrome" is the more standard medical terminology currently used. *Shprintzen syndrome* - **Shprintzen syndrome** (also called **velocardiofacial syndrome or VCFS**) is caused by the **same 22q11.2 deletion** as DiGeorge syndrome. - It represents a **phenotypic variant within the 22q11.2 deletion syndrome spectrum**, with more emphasis on palatal and facial features. - Since it shares the same genetic basis, it can also present with similar cardiac anomalies, but "DiGeorge syndrome" is the more commonly recognized term for this genetic disorder. *None of the options* - This is incorrect because the three syndromes listed above (DiGeorge, CATCH 22, and Shprintzen) all refer to **22q11.2 deletion syndrome** or its variants, which can be associated with various cardiac anomalies including double aortic arch. - Among the listed options, **DiGeorge syndrome** is the most appropriate and widely recognized answer.
Question 425: In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?
- A. Pedal edema
- B. Raised JVP
- C. Basal crepitations
- D. Hepatomegaly (Correct Answer)
Explanation: ***Hepatomegaly*** - In children, **hepatomegaly** is a crucial indicator of **right-sided heart failure** due to congestion of the hepatic venous system. - The liver is a compressible organ and can accommodate a significant increase in blood volume, causing it to enlarge considerably before other signs of **venous congestion** become apparent. *Raised JVP* - **Raised jugular venous pressure (JVP)** is often difficult to assess reliably in infants and young children due to their short necks and uncooperative nature. - While present in older children with CHF, it is not considered as sensitive or specific as other signs in younger pediatric patients. *Pedal edema* - **Pedal edema** is less common in pediatric CHF compared to adults, particularly in infants and toddlers. - Their shorter hydrostatic columns and tendency to spend more time supine make dependent edema less prominent. *Basal crepitations* - **Basal crepitations** (rales) indicate **pulmonary edema**, which is a sign of **left-sided heart failure**. - While a part of CHF, **hepatomegaly** is a more consistent and often earlier sign that can be detected across different forms of pediatric CHF (right or left-sided).
Question 426: A 9-month-old child of a diabetic mother presents with tachypnea and hepatomegaly. Echocardiography shows normal cardiac morphology with asymmetric septal hypertrophy. Which of the following medications is indicated for the management of this child's condition?
- A. Digoxin
- B. Frusemide
- C. Propranolol (Correct Answer)
- D. Isoptin
Explanation: ***Propranolol*** - **Propranolol** is a **beta-blocker** that is indicated for **hypertrophic cardiomyopathy** (HCM) in infants, especially those of diabetic mothers. - It works by reducing the **heart rate** and **myocardial contractility**, which decreases the **left ventricular outflow tract (LVOT) obstruction** caused by the hypertrophied septum. *Digoxin* - **Digoxin** is a **positive inotrope**, meaning it increases the force of myocardial contraction. - This effect would worsen the **outflow tract obstruction** in hypertrophic cardiomyopathy and is therefore contraindicated. *Frusemide* - **Frusemide** is a **diuretic** used to manage **fluid overload** and **congestive heart failure**. - While fluid management can be part of heart failure treatment, frusemide does not directly address the underlying **asymmetric septal hypertrophy** or **LVOT obstruction** in this context. *Isoptin* - **Isoptin** (verapamil) is a **non-dihydropyridine calcium channel blocker**. - While some calcium channel blockers can be used in adult hypertrophic cardiomyopathy, verapamil is generally avoided in infants with HCM due to its potential for **negative inotropic effects** and worsening hypotension, especially in the presence of outflow obstruction, and the risk of significant **bradycardia** and **atrioventricular block**.
Question 427: A 7-year-old child with rheumatic fever would require the following investigations, except:
- A. Electrocardiogram
- B. Echocardiogram
- C. Blood culture
- D. Urine examination (Correct Answer)
Explanation: ***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.
Question 428: In which of the following conditions is an atrial septal defect (ASD) commonly observed?
- A. Down syndrome
- B. Turner's syndrome
- C. Holt-Oram syndrome (Correct Answer)
- D. Ellis-van Creveld syndrome
Explanation: ***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
Question 429: The most common congenital anomaly in a baby born to an IDDM mother is:
- A. Neural tube defect
- B. Cardiovascular anomalies (Correct Answer)
- C. G.I.T anomalies
- D. Pulmonary anomalies
Explanation: ***Cardiovascular anomalies*** - **Ventricular septal defects (VSDs)**, atrial septal defects (ASDs), and **transposition of the great arteries** are among the most common congenital heart defects seen in infants of diabetic mothers. - Maternal diabetes, especially poor glycemic control during early pregnancy, significantly increases the risk of these cardiac malformations due to its impact on **cardiogenesis**. *Neural tube defect* - While **neural tube defects** (NTDs) like anencephaly and spina bifida are increased in infants of diabetic mothers, they are not the most common type of anomaly. - The risk of NTDs is higher with **poor glycemic control** during the first trimester. *G.I.T anomalies* - **Gastrointestinal anomalies**, such as **anorectal atresia** or **duodenal atresia**, are also associated with maternal diabetes. - However, their incidence is lower compared to cardiovascular anomalies in this population. *Pulmonary anomalies* - **Pulmonary anomalies** are less common as major congenital malformations directly linked to maternal diabetes. - The primary pulmonary issue in infants of diabetic mothers is often related to **delayed lung maturity** (respiratory distress syndrome), rather than structural defects.
Question 430: What is the most characteristic auscultatory location for a patent ductus arteriosus (PDA) murmur?
- A. Prominent in left infraclavicular space
- B. Prominent at apex (5th intercostal space, midclavicular line)
- C. Prominent in left 2nd intercostal space (Correct Answer)
- D. Prominent in right 2nd intercostal space
Explanation: ***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.
Practice by Chapter
Congenital Heart Diseases: Cyanotic
Practice Questions
Congenital Heart Diseases: Acyanotic
Practice Questions
Rheumatic Heart Disease
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Kawasaki Disease
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Infective Endocarditis
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Myocarditis and Cardiomyopathies
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Arrhythmias in Children
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Heart Failure in Children
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Pulmonary Hypertension
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Systemic Hypertension
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Dyslipidemia in Children
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Cardiac Evaluation and Diagnostics
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