Cardiology Practice Questions

Q: Most common type of TAPVC is -

Supracardiac. ***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.

Q: Most common syndrome associated with A-V canal defect -

Down syndrome. ***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

Q: 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?

Propranolol. ***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**.

Q: Double aortic arch is associated with which syndrome?

DiGeorge syndrome. ***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.

Q: In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?

Hepatomegaly. ***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).

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: 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: The most common congenital anomaly in a baby born to an IDDM mother is:

Cardiovascular anomalies. ***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.

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: 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.

Question 1

Most common type of TAPVC is -

Accepted Answer

Supracardiac

Answer

Cardiac

Answer

Infracardiac

Answer

Multiple

Question 2

Most common syndrome associated with A-V canal defect -

Accepted Answer

Down syndrome

Answer

Klinefelter syndrome

Answer

Turner syndrome

Answer

Marfan syndrome

Question 3

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?

Accepted Answer

Propranolol

Answer

Digoxin

Answer

Frusemide

Answer

Isoptin

Question 4

Double aortic arch is associated with which syndrome?

Accepted Answer

DiGeorge syndrome

Answer

CATCH 22 syndrome

Answer

Shprintzen syndrome

Answer

None of the options

Question 5

In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?

Accepted Answer

Hepatomegaly

Answer

Pedal edema

Answer

Raised JVP

Answer

Basal crepitations

Question 6

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 7

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 8

The most common congenital anomaly in a baby born to an IDDM mother is:

Accepted Answer

Cardiovascular anomalies

Answer

Neural tube defect

Answer

G.I.T anomalies

Answer

Pulmonary anomalies

Question 9

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 10

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

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?