LE 3 2024 Flashcards
A 2-hour-old newborn has generalized cyanosis, O₂ saturation of 69%, tachycardia, and tachypnea. Oxygen was given but did not improve saturation. On exam, there is a loud second heart sound (S2) and no murmur. Chest X-ray shows normal to slightly increased pulmonary vascular markings, a narrow mediastinum, and an oval-shaped cardiac silhouette. What is the next step in management?
Choices:
A. Administer dopamine infusion
B. Refer to cardiovascular surgery for placement of Blalock–Taussig shunt
C. Start Prostaglandin E1 infusion
D. Refer to cardiovascular surgery for total correction
A 5-month-old boy with Tetralogy of Fallot is admitted due to increasing frequency of cyanotic spells, especially when crying. On examination, a systolic ejection murmur is softer during the episodes. What is the most appropriate next step in management?
Choices:
A. Start dopamine infusion
B. Intubate and hook to a mechanical ventilator
C. Place the patient in a knee-chest position
D. Refer to pediatric cardiologist
A 10-year-old girl had surgical repair of coarctation of the aorta 3 years ago. On follow-up, her BP in the right upper arm is 170/85 mmHg and O₂ saturation is 97%. A systolic ejection murmur is heard across the precordium. She is otherwise asymptomatic. What is the most appropriate next step in management?
Choices:
A. Ask the patient to follow up after 6 months for reevaluation
B. Check the BP and peripheral pulses in all extremities
C. Refer immediately to cardiovascular surgery
D. Do 2D-Echocardiography to rule out bicuspid aortic valve
A 5-year-old boy presents with chronic cough, chest pain, low-grade fever, and tachypnea. On physical exam, he has distended neck veins and muffled heart sounds. Chest X-ray shows a “water bottle” shaped cardiac silhouette. What is the most likely diagnosis?
Choices:
A. Congenital heart disease
B. Pericarditis with effusion
C. Dilated cardiomyopathy
D. Rheumatic myocarditis
A 1-month-old infant presents to the outpatient clinic for evaluation of a heart murmur. The infant is otherwise well, growing normally, and has an O₂ saturation of 98% in room air. On auscultation, there is a Grade 4/6 pansystolic murmur with a thrill at the left mid-sternal border. Femoral pulses are normal. Suspecting a small ventricular septal defect (VSD), which of the following is true?
Choices:
A. Refer to cardiovascular surgery for open-heart surgery
B. The murmur may disappear and spontaneously close without intervention
C. Eisenmenger syndrome will eventually develop
D. Congestive heart failure will develop without intervention
Which congenital heart disease is the only one that presents with cyanosis during the newborn period and shows left axis deviation (LAD) and left ventricular hypertrophy (LVH) on ECG?
Choices:
A. Tetralogy of Fallot with pulmonary stenosis
B. Tetralogy of Fallot with pulmonary valve atresia
C. Tricuspid valve atresia
D. Truncus arteriosus
A 5-year-old healthy boy is evaluated in the outpatient clinic for immunization. On exam, you hear a continuous murmur below the right midclavicular area. The murmur is loudest when the child is sitting and disappears when he lies supine. What is the most likely diagnosis?
Choices:
A. Still’s murmur
B. Venous hum
C. Patent ductus arteriosus (PDA)
D. Aortic stenosis with aortic insufficiency
A 15-year-old male athlete complains of chest pain during basketball practice. He has no prior heart disease. On examination, there is a harsh systolic ejection murmur at the apex, which increases with standing and Valsalva maneuver. ECG shows left axis deviation and left ventricular hypertrophy. Peripheral pulses are normal. What is the most likely diagnosis?
Choices:
A. Coarctation of the aorta
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. Mitral valve prolapse
Which of the following cardiac conditions does NOT require antibiotic prophylaxis against infective endocarditis?
Choices:
A. Isolated atrial septal defect (ASD), secundum
B. Patent ductus arteriosus (PDA)
C. Ventricular septal defect (VSD), uncorrected
D. Wolff-Parkinson-White (WPW) syndrome
A 2-month-old male infant with Down syndrome presents with cough and poor feeding. Vital signs: RR 72, HR 170, weight 3.2 kg. On exam: diffuse rales on both lung fields, a Grade 3/6 pansystolic murmur, and hepatomegaly (liver palpable 4 cm below right subcostal margin). What is the most likely cause of these findings?
Choices:
A. Atrial septal defect (ASD)
B. Complete atrioventricular septal defect (AVSD)
C. Small patent ductus arteriosus (PDA)
D. Pulmonary stenosis
A newborn is diagnosed with a congenital heart defect. What is the risk of congenital heart disease in a future sibling?
Choices:
A. 1.5%
B. 2–4%
C. 6–10%
D. 15%
What is the classic clinical sign of coarctation of the aorta?
Choices:
A. Bounding radial and carotid pulses
B. Diminished or absent femoral pulses
C. Wide pulse pressure
D. Narrow pulse pressure
Which of the following presents with a holosystolic murmur and is the most common congenital heart defect?
Choices:
A. Ventricular septal defect
B. Atrial septal defect
C. Patent ductus arteriosus
D. Coarctation of the aorta
An egg-shaped or oval cardiac silhouette seen on chest X-ray is characteristic of which congenital heart disease?
Choices:
A. Tricuspid valve atresia
B. Truncus arteriosus
C. Transposition of the great arteries
D. Tetralogy of Fallot
A 15-year-old boy presents to the ER with easy fatigability and chest pain. He has a history of frequent sore throat. On exam: BP 120/0 mmHg, RR 26/min, suprasternal pulsations, and bounding pulses. A Grade 3/6 diastolic blowing murmur is heard over the left upper sternal border radiating to the apex. What is the most likely diagnosis?
Choices:
A. Rheumatic heart disease (RHD), aortic regurgitation (AR), not in failure
B. RHD, mitral stenosis (MS), not in failure
C. RHD, mitral regurgitation (MR), in failure
D. RHD, AR and aortic stenosis (AS), in failure
What is the recommended duration of secondary prophylaxis against rheumatic fever in children without residual valvular disease?
Choices:
A. 2 years
B. 5 years
C. 10 years
D. 15 years
Auscultation of the second heart sound (S2) is a reliable indicator in evaluating congenital heart disease. S2 is single in all of the following conditions EXCEPT:
Choices:
A. Atrial septal defect (ASD)
B. Tetralogy of Fallot with pulmonary valve atresia
C. D-transposition of the great arteries (D-TGA)
D. Aortic stenosis
A 6-month-old infant is referred for evaluation of cyanosis. Which of the following clinical scenarios is most consistent with a hypercyanotic (hypoxic) spell?
Choices:
A. The infant has bronchospasm
B. The infant’s older brother has congenital heart disease
C. The infant has Tetralogy of Fallot
D. The infant has frequent respiratory tract infections
Ostium primum atrial septal defect (ASD) is most commonly associated with which of the following?
Choices:
A. Cleft of the mitral valve
B. Cleft of the tricuspid valve
C. Cleft of the aortic valve
D. Cleft of the pulmonic valve
Which of the following findings would lead you to consider a murmur to be innocent in a 4-year-old child?
Choices:
A. Pansystolic timing
B. Association with a thrill
C. Radiation towards the axilla
D. Marked variation in loudness with change in posture
Which of the following findings strongly suggests that cyanosis is cardiac in origin?
Choices:
A. Cyanosis with chest retractions and alar flaring
B. Less cyanosis when agitated or crying
C. Arterial PO₂ > 150 Torr
D. No response to hyperoxic test
Which of the following is true regarding Tetralogy of Fallot (TOF)?
Choices:
A. Causes congestive heart failure during infancy
B. Shows pulmonary venous congestion on chest X-ray
C. Produces right-to-left shunt and decreased pulmonary blood flow
D. Produces a loud and widely split P2
What is a common physical examination finding in infants with a large patent ductus arteriosus (PDA)?
Choices:
A. Normal peripheral pulses with narrow pulse pressure
B. Cyanosis of the lower extremities
C. Continuous machinery-like murmur in newborns
D. Evidence of congestive heart failure
The diagnosis of acute rheumatic fever is primarily based on:
Choices:
A. Blood culture
B. Throat culture
C. Clinical signs
D. Chest radiography
Following a dental extraction in a child with congenital heart disease, transient bacteremia is most commonly due to:
Choices:
A. Staphylococcus aureus
B. Escherichia coli
C. Streptococcus viridans
D. Group A Streptococcus
What is the most serious major manifestation of acute rheumatic fever that leads to severe morbidity and mortality?
Choices:
A. Cardiac manifestations
B. Joint manifestations
C. Skin manifestations
D. Central nervous system manifestations
Which of the following statements is NOT correct regarding rheumatic polyarthritis?
Choices:
A. It must be migratory
B. It involves 2 or more large joints
C. It can cause severe disability
D. It resolves spontaneously even without treatment
Which of the following is NOT a characteristic of atrial fibrillation?
Choices:
A. Heart rate of 250–400 bpm
B. Fibrillatory “P” waves
C. Irregularly irregular heart rhythm
D. Prolonged QRS complexes
In developing countries, the highest risk of infective endocarditis is seen in patients with:
Choices:
A. Congenital heart disease
B. Structurally normal hearts
C. Rheumatic heart disease
D. Prosthetic valve
What is the accepted mechanism of tissue injury responsible for the major clinical manifestations of acute rheumatic fever?
Choices:
A. Bacteremia
B. Immunologic reaction
C. Invasion of the heart valves by streptococcus
D. Exotoxin production by streptococcus
Clinical suspicion for myocarditis in children is increased in all of the following conditions EXCEPT:
Choices:
A. Presence of heart murmur
B. Tachycardia out of proportion to the extent of fever
C. Cardiomegaly in the absence of structural heart defect
D. Presence of cardiomegaly and congestive heart failure
In early childhood, what is the most likely cause of purulent pericarditis?
Choices:
A. Haemophilus influenzae type B
B. Streptococcus pneumoniae
C. Streptococcus viridans
D. Staphylococcus aureus
What is the most definitive laboratory test to confirm the diagnosis of infective endocarditis in a febrile patient?
Choices:
A. CBC with differential count
B. Blood culture
C. Urinalysis for RBCs
D. ESR and CRP
A 12-year-old boy with confirmed rheumatic heart disease (RHD) is undergoing tooth extraction. What is the most appropriate drug to give for infective endocarditis prophylaxis?
Choices:
A. Ampicillin
B. Amoxicillin
C. Penicillin VK
D. Cephalosporins
A 6-year-old girl with PDA presents with fever of unknown origin and is suspected to have infective endocarditis. What is the most appropriate initial treatment regimen?
Choices:
A. Ampicillin and Gentamicin for 2–3 weeks
B. Ceftriaxone and Gentamicin for 2–3 weeks
C. Clindamycin and Gentamicin for 2–3 weeks
D. Penicillin and Gentamicin for 4–6 weeks
Newborns with intracardiac shunt anomalies such as ventricular septal defect (VSD) commonly present with signs and symptoms of congestive heart failure (CHF) at what age?
Choices:
A. 5 days
B. 10 days
C. 2 weeks
D. 3 weeks
What is the most common mechanism of paroxysmal supraventricular tachycardia (PSVT) in infants and children?
Choices:
A. Ectopic focus
B. Reentry
C. Nodal or junctional non-reciprocating
D. Automaticity
Premature ventricular contractions (PVCs) in children are considered significant and should be treated if:
Choices:
A. They are less frequent with activity or exercise
B. There are runs of PVCs
C. They are uniform or unifocal
D. They occur in the setting of a structurally normal heart
What is the most appropriate initial treatment for ventricular tachycardia (VT) in a child who becomes unconscious?
Choices:
A. Lidocaine IV bolus
B. Magnesium sulfate IV
C. Cardiac pacing
D. Synchronized DC cardioversion
A 1-day-old newborn delivered to a mother with systemic lupus erythematosus (SLE) and gestational diabetes develops petechiae, bruising, bradycardia (HR ~60), and a rash on the cheeks and bridge of the nose. What is the most common fetal arrhythmia associated with maternal SLE?
Choices:
A. First-degree AV block
B. Second-degree AV block
C. Paroxysmal supraventricular tachycardia
D. Complete heart block
Permanent pacemaker insertion is best indicated in which of the following conditions?
Choices:
A. Patient with surgically induced complete heart block
B. Asymptomatic infants with heart rate <90 bpm
C. TOF patients with complete right bundle branch block
D. Patients with premature ventricular beats of 10 PVCs/min
Which of the following statements is false regarding tuberculous pericarditis?
Choices:
A. It develops via retrograde spread from peribronchial or paratracheal lymph nodes
B. It may arise from hematogenous spread of tuberculosis
C. The end result may be constrictive pericarditis
D. It is best treated with continuous drainage of pericardial fluid
What is the most common immediate valvular lesion resulting from acute rheumatic fever, especially in children?
Choices:
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Aortic stenosis
A 15-year-old girl presents with recurrent syncopal episodes triggered by emotional stress. She has congenital deafness and consanguineous parents. What is the most likely cardiac diagnosis?
Choices:
A. Congenital heart block
B. Hypertrophic cardiomyopathy
C. Prolonged QT syndrome
D. Congestive heart failure
Hypoplastic left heart syndrome (HLHS) involves all of the following EXCEPT:
Choices:
A. Mitral stenosis
B. Aortic atresia
C. Hypoplasia of the aortic arch
D. Strong peripheral pulse
An infant previously diagnosed with a large ventricular septal defect (VSD) presents with poor feeding, no weight gain, apathy, tachypnea, and wheezing with rales. What is the most likely cardiac diagnosis?
Choices:
A. Congenital heart block
B. Hypertrophic cardiomyopathy
C. Prolonged QT syndrome
D. Congestive heart failure
A 10-year-old boy had a sore throat 2 weeks ago, and several cases of acute rheumatic fever have been reported locally. His mother is worried. You explain that while multiple criteria are needed for diagnosis, the most common major manifestation of acute rheumatic fever is:
Choices:
A. Carditis
B. Polyarthritis
C. Erythema marginatum
D. Sydenham’s chorea
E. Subcutaneous nodules
A child with atrial septal defect (ASD) has a loud pulmonic component of S2 (P2) and an ECG showing right ventricular hypertrophy. These findings suggest the child has:
Choices:
A. Valvar pulmonic stenosis
B. Pulmonary insufficiency
C. Congestive heart failure
D. Pulmonary hypertension
Which cyanotic congenital heart disease is associated with the greatest longevity if left uncorrected?
Choices:
A. Transposition of the great arteries (TGA)
B. Tetralogy of Fallot (TOF)
C. Total anomalous pulmonary venous return (TAPVR)
D. Tricuspid atresia
Which of the following conditions is associated with decreased pulmonary vascularity on chest radiograph?
Choices:
A. Ventricular septal defect
B. VSD with pulmonic stenosis
C. Atrial septal defect
D. Patent ductus arteriosus
Which of the following major manifestations of acute rheumatic fever can occur as an isolated lesion?
Choices:
A. Polyarthritis
B. Carditis
C. Erythema marginatum
D. Sydenham’s chorea
All of the following are clinical features of a ventricular septal defect (VSD) EXCEPT:
Choices:
A. A pansystolic murmur over the left midsternal border
B. A fixed, widely split second heart sound
C. Spontaneous closure may occur in 25–30% of cases
D. If uncorrected, may lead to pulmonary hypertension
A 2-year-old child presents with minimal cyanosis, S3 and S4 (quadruple rhythm), systolic murmur in the pulmonic area, and mid-diastolic murmur. ECG shows right atrial hypertrophy and bundle branch block pattern. What is the most likely diagnosis?
Choices:
A. Wolff-Parkinson-White syndrome
B. Tetralogy of Fallot
C. Atrioventricular canal defect
D. Ebstein’s anomaly of the tricuspid valve
Which of the following cardiac conditions is least likely to be strongly suspected based on physical examination?
Choices:
A. Coarctation of the aorta
B. Mitral valve prolapse
C. Patent ductus arteriosus
D. Dextrocardia
In cyanotic congenital heart disease with increased pulmonary blood flow, cyanosis is most often caused by:
Choices:
A. Abnormal ventriculo-arterial connections
B. Ventilation-perfusion mismatch
C. Total mixing of systemic and pulmonary venous blood within the heart
D. Both A and C are correct
A 16-year-old female frequently experiences palpitations and episodes of syncope with immediate recovery. Which test is most likely to yield the correct diagnosis?
Choices:
A. EEG
B. Endocrine studies
C. Blood glucose and electrolytes
D. ECG and 2D-echocardiography
Which of the following statements about infective endocarditis in children is inaccurate?
Choices:
A. Positive pulsus paradoxus is a frequent finding
B. Blood culture remains a definitive diagnostic criterion
C. Streptococcus viridans is the most common etiologic agent
D. Amoxicillin is a drug of choice for its prevention
A 4-year-old girl suddenly became pale and stopped playing, then recovered after 30 minutes. Physical exam, CXR, and echo are normal. ECG shows a slurred upslope of the QRS complex (delta wave). What is the diagnosis?
Choices:
A. Ventricular tachycardia
B. Paroxysmal supraventricular tachycardia
C. Wolff-Parkinson-White syndrome
D. Stokes-Adams pattern
Which of the following is a major criterion for infective endocarditis based on Duke’s criteria?
Choices:
A. Presence of vegetation on 2D-echocardiogram
B. Persistent fever
C. Thromboembolic phenomena
D. Positive rheumatoid factor
Subacute infective endocarditis is rarely associated with which of the following conditions?
Choices:
A. Combined mitral valvular disease
B. Patent ductus arteriosus
C. Atrial septal defect
D. Advanced mitral stenosis
The risk of recurrence of rheumatic heart disease (RHD) is increased in patients who:
Choices:
A. Have poor compliance to monthly benzathine penicillin injection
B. Are exposed to chronic carrier of Streptococcus
C. Fail to take anti-congestive medication
D. Use oral penicillin twice daily
A 10-year-old boy with a history of frequent tonsillitis now presents with migratory joint pain, fever, palpitations, and fatigue. Exam shows split S2 with accentuated P2, and a holosystolic murmur at the apex radiating to the axilla and back. What is the most likely cardiac lesion?
Choices:
A. Mitral regurgitation
B. Mitral stenosis
C. Aortic regurgitation
D. Aortic stenosis
A newborn baby boy presents with cyanosis at 4 hours of life. PE: no respiratory distress, active, good suck, single S2, no murmur, full pulses. ABG shows hypoxemia. What is the most likely diagnosis?
Choices:
A. Tetralogy of Fallot (TOF)
B. Respiratory distress syndrome (RDS)
C. Patent ductus arteriosus (PDA)
D. Transposition of the great arteries (TGA)
A 2-year-old has a continuous machinery-type murmur best heard at the left upper sternal border. What is the most likely cardiac diagnosis?
Choices:
A. Coarctation of the aorta
B. Atrial septal defect
C. Patent ductus arteriosus
All of the following statements about acute rheumatic fever are incorrect, EXCEPT:
Choices:
A. Erythromycin is the drug of choice for secondary prophylaxis
B. Mitral regurgitation is the most common valvular pathology involved
C. Rheumatic activity lasts for 3–4 months
D. Prednisone is the drug of choice for all cases of severe carditis
Which of the following is NOT a major cause of morbidity and mortality in rheumatic heart disease (RHD)?
Choices:
A. Recurrence of rheumatic activity
B. Development of infective endocarditis
C. Occurrence of atrial fibrillation
D. Post-valvular surgery
A 4-month-old infant presents with failure to thrive, mild cyanosis, tachypnea, gallop rhythm, and a Grade 2/6 systolic murmur. S2 is widely and fixed split. Chest X-ray shows “snowman” sign and increased pulmonary vascularity. What is the most likely diagnosis?
Choices:
A. Hypoplastic left heart syndrome
B. Transposition of the great arteries (TGA)
C. Truncus arteriosus
D. Total anomalous pulmonary venous return (TAPVR)
Which of the following statements about tricuspid valve atresia (TVA) is correct?
Choices:
A. ECG will show LAD and LVH
B. No definitive surgical procedure available for total correction
C. The S1 can exhibit wide fixed splitting similar to S2
D. Children with TVA tend to be asymptomatic during infancy
An 8-year-old presents with tender swelling of the right knee followed by swelling of the left ankle, and has fever. According to the Modified Jones Criteria, what combination does this patient fulfill?
Choices:
A. 1 Major 1 Minor
B. 1 Major 2 Minors
C. 2 Majors
D. 2 Minors
All of the following are complications of rheumatic mitral stenosis, EXCEPT:
Choices:
A. Atrial flutter/fibrillation
B. Hemoptysis
C. Left-sided heart failure
D. Subacute bacterial endocarditis
Which of the following statements about constrictive pericarditis is false?
Choices:
A. Tuberculosis is a leading cause
B. There is restriction of diastolic expansion of ventricles
C. It is considered an end point of pericardial inflammation
D. Dilated cardiomyopathy is an important differential diagnosis
Which of the following is a recognized ECG change seen in hyperkalemia?
Choices:
A. Prominent U waves
B. Narrow QRS complexes
C. Depression of the ST segment
D. Tall, tented T waves
Congestive heart failure during the first week of life is least likely to be caused by:
Choices:
A. Critical aortic stenosis
B. Ventricular septal defect
C. Hypoplastic left heart syndrome
D. Interrupted aortic arch
An 8-year-old boy with frequent sore throats, fever, and joint pain has leukocytosis, elevated acute phase reactants, and an ECG showing PR interval prolongation. What is the most likely ECG diagnosis?
Choices:
A. First-degree AV block
B. Second-degree AV block, Mobitz type I
C. Second-degree AV block, Mobitz type II
D. Sinus bradycardia
What palliative surgical procedure is indicated for cyanotic congenital heart disease with pulmonary stenosis, hypoxic spells, polycythemia, and small pulmonary arteries?
Choices:
A. Balloon atrial septostomy (BAS)
B. Blalock-Taussig shunt (BTS)
C. Glenn shunt
D. Pulmonary artery banding (PAB)
In congenital heart disease (CHD) with no obstruction to pulmonary blood flow, cyanosis may be caused by:
Choices:
A. Normal ventriculo-arterial connections
B. Ventilation-perfusion mismatch
C. Total mixing of systemic and pulmonary venous blood within the heart
D. Increased pulmonary vascular resistance and arterial pressure
Clubbing of the fingers and toes typically develops in cyanotic congenital heart disease after how long?
Choices:
A. < 1 month
B. 2 months
C. 4 months
D. > 6 months
Which of the following laboratory tests is a more accurate marker of tissue inflammation and degree of rheumatic activity?
Choices:
A. ESR
B. CBC
C. C-reactive protein (CRP)
D. Serum LDH
Question:
Which of the following clinical features is NOT typically seen in dilated cardiomyopathy?
Choices:
A. Diastolic dysfunction
B. AV valve regurgitation
C. Dilated, hypocontractile left ventricle
D. PR prolongation and atrial arrhythmias
Which of the following auscultatory features is highly suggestive of an innocent (functional) murmur?
Choices:
A. Grade 2/6 diastolic murmur at the apex
B. Grade 3/6 holosystolic murmur at the LMSB radiating to axilla
C. Grade 4/6 continuous murmur with thrill at the infraclavicular area
D. Grade 2/6 soft systolic murmur at the left parasternal area that varies in position
A 4-year-old boy presents with fatigability and exertional dyspnea. PE reveals a harsh grade 3/6 crescendo-decrescendo systolic murmur best heard at the base of the heart, radiating to the neck. No ejection click is heard. Pulses are weak and slowly rising. ECG shows LVH. CXR shows left atrial enlargement and pulmonary congestion. What is the most likely diagnosis?
Choices:
A. Severe pulmonary stenosis
B. Severe valvular aortic stenosis
C. Severe mitral stenosis
D. Mild subvalvular aortic stenosis
Which of the following statements is most accurate regarding the relative occurrence of ventricular septal defects (VSDs)?
Choices:
A. Nearly 75% of all VSDs are of the inlet type
B. Nearly 75% of all VSDs are of the muscular type
C. Nearly 75% of all VSDs are of the outlet type
D. Nearly 75% of all VSDs are of the perimembranous type
Small VSDs, which usually do not affect growth or health, are typically associated with what type of murmur?
Choices:
A. Soft and high-pitched
B. Loud and high-pitched
C. Loud and low-pitched
D. Soft and low-pitched
Large VSDs that result in pulmonary overcirculation are most likely to present with which symptoms?
Choices:
A. A harsh gurgling heart murmur
B. Rapid breathing, poor feeding, and poor weight gain
C. Generalized cyanosis
D. Shallow breathing and facial edema
Which of the following statements is accurate regarding treatment of atrial septal defect (ASD)?
Choices:
A. Medical management is advocated first, then surgery for unresponsive cases
B. Medical management is effective in all cases
C. Spontaneous closure is common, so observation into adolescence is recommended
D. Surgical or catheter closure is indicated for moderate and large ASDs
A 16-year-old boy complains of chest pain during basketball practice. Physical exam reveals a harsh systolic ejection murmur at the apex, and ECG shows left axis deviation (LAD) and left ventricular hypertrophy (LVH). You suspect hypertrophic cardiomyopathy. What is the most appropriate initial management?
Choices:
A. Admit for surgical myomectomy for septal hypertrophy
B. Start β-adrenergic blocker or calcium channel blocker to reduce LVOT
C. Reassure the patient and allow continued sports participation
D. Request for Troponin-I to rule out acute myocardial infarction
A 4-month-old girl with failure to thrive, poor feeding, tachypnea, and appearing dusky has findings of S3, faint expiratory rales, and hepatomegaly. What is the most likely explanation for her congestive heart failure?
Choices:
A. TOF with severe pulmonary stenosis
B. D-TGA with intact ventricular septum
C. Truncus arteriosus with severe truncal valve incompetence
D. Total anomalous pulmonary venous return without obstruction
A 10-year-old boy with anorexia, abdominal discomfort, and vomiting has marked cardiomegaly, JVD, and hepatomegaly. Which finding is most suggestive of CHF due to dilated cardiomyopathy?
Choices:
A. Distant heart sounds
B. Pulsus paradoxus
C. Prominent S3 gallop
D. Prominent S4 sound
An 8-year-old boy with right ankle pain, a history of left knee swelling, fever, and a holosystolic murmur at the apex most likely has a rheumatic fever relapse. What lab result supports this diagnosis?
Choices:
A. Blood culture showing Streptococcus viridans
B. Positive rheumatoid factor
C. Urinalysis showing microscopic hematuria
D. Elevated antistreptolysin O (ASO) titer
During a sports physical, a 16-year-old girl is found to have a late systolic murmur with a mid-systolic click at the apex. Family history is positive for a similar murmur. What is the most likely diagnosis?
Choices:
A. Atrial septal defect
B. Aortic stenosis
C. Tricuspid regurgitation
D. Mitral valve prolapse
An adolescent in the ICU with critical congenital heart disease develops a life-threatening arrhythmia on the ECG monitor (assumed to be ventricular fibrillation based on context). What is the immediate intervention?
Choices:
A. Lidocaine IV bolus 1 mg/kg
B. Rapid digitalization
C. Adenosine IV bolus
D. Defibrillation
A 6-month-old infant develops sudden tachycardia. The ECG rhythm (based on previous context) is likely showing narrow-complex tachycardia, possibly SVT. What is the best initial treatment?
Choices:
A. DC countershock
B. Adenosine IV bolus
C. Lidocaine IV bolus
D. Vagal maneuver
Which of the following lab tests is more accurate for determining tissue inflammation and rheumatic activity?
Choices:
A. ESR determination
B. CRP determination
C. CBC with differential count
D. Serum LDH
You interpret an ECG rhythm strip that shows isolated wide QRS complexes not preceded by P waves, based on previous image questions likely indicating PVCs. What is the most likely arrhythmia?
Choices:
A. Premature ventricular beats
B. First-degree AV block
C. Second-degree AV block
D. Third-degree AV block
What is the most common cause of secondary hypertension in children?
Choices:
A. Renal parenchymal disease
B. Congenital cardiac defects
C. Endocrine disorders
D. Thyroid disorders
What is the drug of choice in the acute management of hypertension in children?
Choices:
A. Captopril
B. Nifedipine
C. Diltiazem
D. Propranolol
A 14-year-old boy is evaluated during a sports participation physical. He is in the 90th percentile for height and weight, with BP 135/85 mmHg and HR 84/min. Physical exam is normal. His maternal grandfather has hypertension. What is the most appropriate initial step?
Choices:
A. Advise on low salt diet
B. Advise on weight reduction program
C. Request renal function tests
D. Remeasure the BP ensuring the bladder cuff covers 2/3 of upper arm circumference
Which of the following hypertensive pediatric patients should NOT be treated immediately?
Choices:
A. Patients with target organ damage
B. Patients with secondary hypertension
C. Obese adolescents with labile hypertension
D. Patients with persistent primary hypertension
A 10-year-old girl with thick lips, long philtrum, short stature, mild cognitive delays, and a history of neonatal electrolyte issues is likely to have what cardiac lesion associated with Williams syndrome?
Choices:
A. Coarctation of the aorta
B. Supravalvular aortic stenosis
C. Aortic aneurysm
D. Patent ductus arteriosus
A 1-month-old girl with poor feeding, mild cyanosis, systolic thrill, precordial heave, and systolic murmur radiating to the back has an ECG showing RAD and RVH. What will her chest X-ray most likely show?
Choices:
A. Prominence of the pulmonary artery segment
B. Cardiac enlargement
C. Anterior displacement of cardiac apex
D. Increased pulmonary vasculature
