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MCQ in Pediatric Cardiology

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Multiple choice questions in Pediatric Cardiology

The post contains multiple-choice based questions in cardiology covering cardiovascular physiology and congenital heart disease useful for DNB and MRCPCH part 1 examinations.

1. What is the most common congenital heart defect with a left to right shunt causing congestive heart failure in the pediatric age group?

  1. Atrial septal defect
  2. Atrioventricular canal
  3. Ventricular septal defect VSD
  4. Patent ductus arteriosus
  5. Aortopulmonary window
Check Your Answer

It is C

2. All true regarding ASD Except

  1. Atrial septal defect is the second most common congenital heart defect in children and adults.
  2. Patients with atrial septal defects may have an embolic stroke as the initial presentation.
  3. Most children with atrial septal defects are asymptomatic.
  4. The most common yet least serious type of atrial septal defect is an ostium secundum defect.
  5. The most common yet least serious type of atrial septal defect is ostium primum defect.
Check Your Answer

It is D

3. What is the most likely age an infant with a large ventricular septal defect will begin manifesting symptoms of congestive heart failure?

  1. 1 day
  2. 1 week
  3. 1 month
  4. 6 months
  5. 1 year
Check Your Answer

It is C

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4. What is the dominant mechanism with which infants and young children increase their cardiac output?

  1. By increasing ventricular contractility
  2. By increasing heart rate
  3. By increasing ventricular end-diastolic volume
  4. By decreasing heart rate
  5. By increasing respiratory rate
Check Your Answer

It is B

5. The earliest sign of congestive heart failure on a chest X-ray is:

  1. Increased heart size.
  2. Kerley B lines.
  3. Central pulmonary vascular congestion.
  4. Pulmonary edema.
  5. Pleural effusion.
Check Your Answer

It is A

6. A two-day-old cyanotic infant with a grade 3/6 ejection systolic murmur is noted to have decreased pulmonary vascular markings on chest x-ray and left axis deviation on EKG. The most likely diagnosis is:

  1. Tetralogy of Fallot
  2. Transposition of Great Vessels
  3. Truncus Arteriosus
  4. Tricuspid Atresia.
Check Your Answer

It is D

7. A 2-year-old infant is noted to have mild cyanosis who assumes a squatting position during long walking. He is noted to have increasing fussiness followed by increasing cyanosis, limpness, and unresponsiveness. The most likely underlying lesion is:

  1. Hypoplastic left heart
  2. Transposition of the Great Vessels
  3. Anomalous Pulmonary Venous Return
  4. Tetralogy of Fallot
  5. Aspiration with obstruction to air passages
Check Your Answer

It is D

8. An infant with a marked cyanotic congenital heart defect with decreased pulmonary vascularity should be treated with:

  1. Digoxin
  2. Indomethacin
  3. Prostaglandin E1
  4. Epinephrine
Check Your Answer

It is C

9. Cyanosis is produced by the presence of deoxygenated hemoglobin of at least:

  1. 1-2 gm/dL
  2. 3-5 gm/dL
  3. 6-8 gm/dL
  4. 9-10 gm/Dl
Check Your Answer

It is B

10. A "tet spell" or "blue" spell of tetralogy of Fallot is treated with all of the following except:

  1. oxygen
  2. knee-chest position
  3. morphine
  4. digoxin
  5. propranolol
  6. phenylephrine
  7. sodium bicarbonate
Check Your Answer

It is D

11. Pulmonary vascularity is increased in all of the following except:

  1. TAPVR
  2. Tricuspid atresia
  3. TGV
  4. Hypoplastic left heart
Check Your Answer

It is B

12. Pulmonary vascularity is decreased in all of the following except:

  1. Tetralogy of Fallot
  2. Pulmonary atresia
  3. TAPVR
  4. Tricuspid atresia
Check Your Answer

It is C

13. A routine physical examination of a newborn shows a grade 2/6, short and harsh systolic murmur at the apex however the newborn is asymptomatic. What is the most likely diagnosis?

  1. Atrial septal defect
  2. Ventricular septal defect
  3. Mitral stenosis
  4. Mitral regurgitation
  5. Patent ductus arteriosus
Check Your Answer

The answer is B. VSD

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14. A child Presents with fainting spells. A normal neurological examination is revealed on examination. Cardiac examination shows positional (supine vs erect) character of murmur on the left sternal border near the mitral area. What should be the preferred treatment?

  1. Prophylactic antibiotic
  2. Dilatation of the mitral valve
  3. Repair of VSD
  4. Repair of ASD
  5. Removal of myxomas
Check Your Answer

The answer is E. A patient with myxoma appears with fainting spells and has a positional character of murmur. Myxomas should be removed completely.

15. Which of the following murmur denotes a patient with active carditis?

  1. Carey comb murmer
  2. b. Early systolic murmer
  3. c. Pan systolic murmer
  4. d. Machinary murmer
Check Your Answer

The answer is A. Carey Coombs's murmur is a short mid-diastolic murmur caused by active rheumatic carditis. It is caused by mitral-valve inflammation and is similar in characteristics to the mid-diastolic rumble of mitral stenosis.

16. The Carey Coomb murmur is due to

  1. Inflammation of the mitral valve
  2. b) Increased diastolic flow across the mitral valve
  3. c) Cardiac decompression
  4. d) Defibrillation
Check Your Answer

The answer is A. Explanation above.

17. Which of the following is true about Eisenmenger syndrome?

  1. Usually, a primary congenital cyanotic heart disease
  2. Considered a high indication for surgery in a baby with congenital heart disease
  3. Represents a serious complication of non-cyanotic heart disease
  4. Pulmonary hypertension is not always present
Check Your Answer

The answer is C. Eisenmenger syndrome is a reversal of L to R shunt (Acyanotic heart disease). It is always associated with increased pulmonary pressure. Surgery is in fact contraindicated.

18. A 9-month-old with a history of recurrent pneumonia presents with respiratory distress. Physical examination shows wheezing, intercostal retractions, mild cyanosis, hyperdynamic precordium, and a loud to-and-fro murmur over the left upper sternal border. The most likely diagnosis is?

  1. Pulmonic stenosis
  2. Aortic stenosis
  3. Aortic regurgitation
  4. Truncus arteriosus
  5. Congenital absence of the pulmonary valve
Check Your Answer

The answer is E. Congenital absence of the pulmonary valve produces a syndrome that manifests with signs of upper airway obstruction. Marked aneurysmal dilatation of the main and right or left pulmonary artery resulting in compression of the bronchi that
causes wheezing and recurrent pneumonia. Cyanosis may be absent, mild, or moderate. This syndrome may be associated with TOF.

19. Therapy of blue spell in Fallot tetralogy includes all the following, Except

  1. a. Knee chest position
  2. b. Oxygen
  3. c. Morphine
  4. d. Dopamine
Check Your Answer

The answer is D. Dopamine will increase the SVR but at the same time, it will increase PVR since it is nonselective.

20. A child was diagnosed with a coarctation of the aorta. After Several months of operative repair, he developed a systolic ejection murmur along the left sternal border. The most likely condition that becomes apparent after a surgical procedure for coarctation of the aorta is?

  1. Aortic insufficiency
  2. Recurrence of aortic coarctation
  3. Mitral stenosis
  4. Mitral insufficiency
  5. Sub-valvular aortic stenosis
Check Your Answer

The answer is E. Subvalvular aortic stenosis may become apparent after a successful repair of other cardiac defects (e.g., VSD, PDA, or coarctation of the aorta).

21. The following condition is an important risk factor for developing infective endocarditis in children with cyanotic heart disease.

  1. Diarrhea
  2. RSV infection
  3. MMR vaccination
  4. Poor dental hygiene
  5. Arrhythmias
Check Your Answer

The correct answer is D. Poor dental hygiene

22. An ECG finding in a patient reveals a heart-rate corrected Q-T interval is 0.49 seconds. The most likely diagnosis is?

  1. First-degree heart block
  2. Second-degree heart block
  3. Third-degree heart block
  4. Long Q-T syndrome
  5. Normal finding
Check Your Answer

The answer is D. Long Q-T syndrome. Heart-rate corrected Q-T interval ofmore than 0.47 seconds is highly indicative of long Q-T syndromeand more than0.44seconds issuggestiveof long Q-T syndrome.

23. What is the most common complication of Infective endocarditis?

  1. Hematuria.
  2. Pericardial effusion.
  3. Splenomegaly.
  4. Cerebral stroke
  5. CHF
Check Your Answer

The answer is E. Microscopic hematuria is seen in about 50% of cases. Pericardial effusion is widely believed to signify more advanced infective endocarditis and a generally worse outcome. Splenomegaly occurs in 37% of patients with active infective endocarditis and in 64% of those with prosthetic valve endocarditis. Acute stroke is the second most common complication of left-sided infective endocarditis. Congestive heart failure (CHF) is the most common complication of all.

24. A newborn presents to emergency with a pink right arm and blue lower extremities. What is the most likely diagnosis?

  1. Tetralogy of Fallot
  2. Transposition of great arteries
  3. Truncus arteriosus
  4. Coarctation of aorta
  5. Total anomalous pulmonary venous return
Check Your Answer

The answer is D. Differential cyanosis is noted in coarctation of the aorta, interrupted aortic arch, and persistent pulmonary hypertension (PPHN).

25. Which of the following infection is commonly associated with Rheumatic fever?

  1. Group A Streptococcus lower respiratory tract infection.
  2. Streptococcus pneumoniae upper respiratory infection.
  3. Adenovirus lower respiratory tract infection
  4. Staphylococcus aureus upper respiratory tract infection
  5. Group A Streptococcus upper respiratory tract infection
Check Your Answer

Group A Streptococcus upper respiratory tract infections are associated with an acute rheumatic fever and rheumatic heart disease.

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Author

about authors

Ajay Agade | DNB(Pediatrics), FNB(Pediatric Intensive Care), Fellowship in Pediatric pulmonology and LTV

Ajay is a Paediatric Intensivist, currently working in Pediatric Pulmonology & LTV at Great Ormond Street Hospital NHS, London

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