Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 431: A child presenting to the clinic with features of Down syndrome. What is the most common cardiac lesion in children with Down syndrome?

A. Atrioventricular Septal Defect (Correct Answer)
B. VSD
C. Transposition of great vessels
D. Coarctation of aorta

Explanation: ***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 432: Which of the following vasculitides is predominantly seen in children?

A. Takayasu arteritis
B. Susac syndrome
C. Kawasaki disease (Correct Answer)
D. Henoch-Schonlein purpura

Explanation: ***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.

Question 433: Which of the following congenital heart defects is least likely to cause recurrent pulmonary infections?

A. Ventricular Septal Defect (VSD)
B. Tetralogy of Fallot (TOF) (Correct Answer)
C. Atrial Septal Defect (ASD)
D. Patent Ductus Arteriosus (PDA)

Explanation: ***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**.

Question 434: Which of the following is the most common cause of syncope in children?

A. Breath holding spells
B. Hypoglycemia
C. Neurocardiogenic syncope (Correct Answer)
D. Hypovolemia

Explanation: ***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.

Question 435: 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?

A. Tetralogy Fallot
B. Transposition of great vessels (Correct Answer)
C. Truncus Arteriosus
D. Tricuspid Atresia

Explanation: ***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.

Question 436: What is the most common atrial septal defect in Down syndrome?

A. Ostium primum (Correct Answer)
B. Ostium secondum
C. Absent atrial septum
D. Sinus venosum

Explanation: ***Ostium primum*** - **Ostium primum atrial septal defects** are the most common type of atrial septal defect seen in individuals with **Down syndrome** (Trisomy 21). - This defect is typically associated with **atrioventricular septal defects (AVSDs)**, also known as **endocardial cushion defects**, which are highly prevalent in Down syndrome. *Ostium secondum* - **Ostium secundum ASDs** are the most common type of **isolated** atrial septal defect in the general population, not specifically in Down syndrome. - While they can occur in Down syndrome, they are less characteristic than ostium primum defects which constitute part of the AVSD spectrum. *Absent atrial septum* - An **absent atrial septum**, or **common atrium**, is a very rare and severe cardiac anomaly. - It is not considered the most common type of atrial septal defect in Down syndrome, although individuals with Down syndrome can have complex congenital heart defects. *Sinus venosum* - **Sinus venosum ASDs** are less common and are typically located near the superior or inferior vena cava. - They are often associated with **anomalous pulmonary venous return** but are not the predominant type of ASD in Down syndrome.

Question 437: Which of the following is the most common congenital cardiac malformation?

A. Persistent truncus arteriosus (PTA)
B. Common ventricle (CV)
C. Ventricular septal defect (VSD) (Correct Answer)
D. Atrial septal defect (ASD)

Explanation: ***Ventricular septal defect (VSD)*** - VSDs are the **most common congenital heart defect**, accounting for approximately 25-30% of all congenital cardiac malformations. - They involve a **hole in the septum** separating the left and right ventricles, leading to a left-to-right shunt. *Persistent truncus arteriosus (PTA)* - PTA is a rare congenital heart defect where a **single arterial trunk** arises from the heart, supplying both systemic and pulmonary circulation. - Its incidence is much **lower than VSD**, representing less than 1% of congenital heart defects. *Common ventricle (CV)* - A common ventricle, also known as **single ventricle**, is a complex and rare congenital defect where only one functional ventricle is present. - It is a **severe malformation** and much less common than VSD. *Atrial septal defect (ASD)* - ASDs are congenital heart defects involving a **hole in the wall between the atria** of the heart. - While relatively common, ASDs are **less frequent than VSDs**, accounting for about 5-10% of congenital heart defects.

Question 438: A newborn presents with central cyanosis and decreased oxygen saturation. What is the most likely category of diagnosis?

A. Acyanotic congenital heart defect
B. Congenital cyanotic heart defect (Correct Answer)
C. Acquired heart disease
D. Transposition of the Great Arteries (TGA)

Explanation: **Congenital cyanotic heart defect** - **Central cyanosis** and **decreased oxygen saturation** in a newborn are hallmark signs of **cyanotic congenital heart defects**, which involve right-to-left shunting of deoxygenated blood or inadequate pulmonary blood flow. - These defects lead to arterial hypoxemia, which manifests as a bluish discoloration of the skin and mucous membranes. *Acyanotic congenital heart defect* - **Acyanotic heart defects** typically involve left-to-right shunting (e.g., VSD, ASD) or obstructions (e.g., coarctation), which usually do not cause **central cyanosis** in the newborn period. - While some acyanotic defects can lead to cyanosis later in life due to pulmonary hypertension reversing the shunt (Eisenmenger syndrome), initial presentation in a newborn is not typically cyanotic. *Acquired heart disease* - **Acquired heart disease** in a newborn is rare and usually refers to conditions like myocarditis or endocarditis, which are typically infectious or inflammatory in origin, not congenital structural abnormalities. - While it can manifest with heart failure symptoms, **central cyanosis** in a newborn is far more indicative of a congenital structural anomaly affecting oxygenation. *Transposition of the Great Arteries (TGA)* - **Transposition of the Great Arteries (TGA)** is a specific type of **cyanotic congenital heart defect** where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. - While TGA is a highly likely diagnosis given the symptoms, the question asks for the most likely *category* of diagnosis, which is the broader "congenital cyanotic heart defect" group that includes TGA.

Question 439: Most common cardiac anomaly in Turner's syndrome?

A. Coarctation of aorta (Correct Answer)
B. Ventricular septal defect
C. Atrial septal defect
D. Bicuspid aortic valve

Explanation: ***Coarctation of aorta*** - **Coarctation of the aorta** is considered the **most common clinically significant cardiac anomaly** in Turner syndrome, occurring in **10-15%** of patients - It involves narrowing of the aorta, typically **near the ductus arteriosus** (juxtaductal), leading to upper extremity hypertension and left ventricular hypertrophy - From a **clinical and examination perspective**, coarctation is emphasized as the classic cardiac association with Turner syndrome due to its diagnostic and therapeutic importance - Often found in conjunction with bicuspid aortic valve *Bicuspid aortic valve* - **Bicuspid aortic valve (BAV)** is actually the **most prevalent** cardiac abnormality in Turner syndrome, affecting **30-50%** of individuals - However, it is often **asymptomatic in childhood** and may only manifest with complications (stenosis, regurgitation, endocarditis) later in life - In **examination contexts**, coarctation is typically considered the primary answer due to its greater clinical significance and need for early intervention - BAV is frequently an incidental finding on echocardiography *Ventricular septal defect* - **Ventricular septal defects (VSDs)** are **not characteristic** of Turner syndrome - VSDs are more commonly associated with **Down syndrome** and other chromosomal abnormalities - They involve a hole between the ventricles causing a left-to-right shunt *Atrial septal defect* - **Atrial septal defects (ASDs)**, particularly **partial anomalous pulmonary venous return (PAPVR)**, can occur in Turner syndrome but are less common than coarctation - Standard secundum ASDs are not a primary association with Turner syndrome

Question 440: The MANDATORY diagnostic criterion for Kawasaki disease is which of the following?

A. Cervical lymphadenopathy
B. Bilateral conjunctivitis
C. Polymorphous rash
D. Fever (Correct Answer)

Explanation: **Fever** - **Fever** lasting at least five days is an **absolute prerequisite** for diagnosing Kawasaki disease. - Without this prolonged fever, other symptoms, even if present, are not sufficient for a diagnosis of Kawasaki disease. *Cervical lymphadenopathy* - While **cervical lymphadenopathy** is one of the classic diagnostic criteria for Kawasaki disease, it is not mandatory. - It is present in a significant number of cases but can be absent, especially in infants. *Bilateral conjunctivitis* - **Bilateral conjunctivitis** is a common diagnostic criterion but is not always present in every patient. - It is typically non-exudative and painless. *Polymorphous rash* - A **polymorphous rash** is a characteristic feature of Kawasaki disease but is not mandatory for diagnosis, as it can be transient or mild. - The rash can take various forms, including maculopapular, scarlatiniform, or erythema multiforme-like.

Practice by Chapter

Congenital Heart Diseases: Cyanotic

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Congenital Heart Diseases: Acyanotic

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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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Cardiology — MCQs

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