peds- cardiology

Question 1

Which congenital heart defect causes severe cyanosis in the first days of life?
A) aortico-pulmonary fenestration
B) postductal coarctation of the aorta
C) atrioventricular septal defect
D) transposition of the great arteries
E) persistent ductus arteriosus

Answer 1

D) transposition of the great arteries

Question 2

A cyanotic newborn has a chest x-ray, which shows decreased vascularisation of the lungs. Which of these congenital heart defects is the most likely diagnosis?
A) Transposition of the great arteries
B) Total anomalous pulmonary venous return
C) Pulmonary atresia

Answer 2

C) Pulmonary atresia

Question 3

One of these statements does not apply to an isolated ventricular septal defect in the newborn.
A) the left-to-right shunt increases with time
B) can lead to decompensation
C) there could be signs of pulmonary congestion
D) it always causes cyanosis, which disappears later

Answer 3

D) it always causes cyanosis, which disappears later

Question 4

A newborn showing signs of congestive heart failure has easily palpable upper extremity pulses, but the pulse can not be felt on the lower extremities. What is the most likely diagnosis?
A) hypoplastic left heart syndrome
B) severe, „critical” valvular aortic stenosis
C) coarctation of the aorta

Answer 4

C) coarctation of the aorta

Question 5

Which of the following maternal diseases increase the risk of congenital heart defect in the fetus?
1) alcoholism
2) phenylketonuria
3) Type 1-diabetes mellitus
4) hyperthyreoidism

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 5

A) Answers 1, 2 and 3 are correct

Question 6

Which of the following can be a sign of a congenital heart defect?
1) heart murmur
2) pulse difference
3) central cyanosis
4) heart failure

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 6

E) All of the answers are correct

Question 7

Cardiac cause(s) of chest pain:
1) coronary artery malformation
2) tachy-arrhythmia
3) pericarditis/myocarditis
4) cardiac decompensation

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 7

A) Answers 1, 2 and 3 are correct

Question 8

Which of the following can be a sign/symptom of tetralogy of Fallot?
1) cardiac decompensation
2) cyanosis
3) tachypnea
4) polycythemia

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 8

C) Answers 2 and 4 are correct

Question 9

In which of the following heart defects is it necessary to keep the ductus arteriosus open?
1) transposition of the great arteries
2) pulmonary atresia
3) critical coarctation of the aorta
4) common arterial trunk

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 9

A) Answers 1, 2 and 3 are correct

Question 10

Cardiac examinations which would cause radiation exposure:
1) CT-angiography
2) Cardiac MRI
3) cardiac catheterization
4) echocardiography

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 10

B) Answers 1 and 3 are correct

Question 11

Synchronized cardiversion can effectively stop the following rhythm disturbancy (-ies):
1) atrial ectopic tachycardia
2) atrial flutter
3) pulseless Torsades de pointes tachycardia
4) atrioventricular reentry tachycardia (AVRT)

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 11

C) Answers 2 and 4 are correct

Question 12

A bolus of adenosin can stop the following rhythm disturbancy(-ies):
1) Atrial flutter
2) Atrial fibrillation
3) Ventricular tachycardia
4) Atrioventricular reentry tachycardia

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 12

D) Only answer 4 is correct

Question 13

Cardiac decompensation can cause the following in children:
1) loss of apetite
2) tachypnea
3) hepatomegaly
4) edema of the ankles

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 13

A) Answers 1, 2 and 3 are correct

Question 14

Characteristic of the AV reentry tachycardia:
1) The pulse gradually increases at the beginning of the episode and gradually decreases at the end
2) during the tachycardia the R-R distance is variable
3) never occurs under 1 year of age
4) adenosine can stop it

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 14

D) Only answer 4 is correct

Question 15

Tetralogy of Fallot constitutes of:
1) Big subaortic ventricular septal defect
2) Aorta overriding the ventricular septal defect
3) Right ventricular outflow tract obstruction
4) Right ventricular hypertrophy

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 15

E) All of the answers are correct

Question 16

Characteristic of the hypoxic (also called: cyanotic) spell of the Fallot-patient:
1) It is caused by an increased right-to –left shunt through the ventricular septal defect, which results in more desoxygeneted blood entering the systemic circulation.
2) It is contraindicated to give oxygen during the spell.
3) Calming the baby and putting him/her in a chest-knee position help to cease the spell.
4) Fortunately the spell nevel leads to a serious condition.

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 16

B) Answers 1 and 3 are correct

Question 17

The risk of infectious endocarditis increases in the following conditions:
1) Uncorrected cyanotic heart defect
2) Previous infectious endocarditis
3) Artificial heart valve
4) Uncorrected ventricular septal defect

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 17

A) Answers 1, 2 and 3 are correct

Question 18

In endocarditis profilaxis…
1) the patient with a congenital heart defect needs antibiotics if he has fever.
2) the type of the heart defect is irrelevant.
3) is obligatory in endoscopic procedures.
4) a single dose of antibiotics is needed one hour prior to the procedure.

A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer 18

D) Only answer 4 is correct

Question 19

Which of the following heart auscultatory points are the punctum maximum of the listed murmurs or heart defects?
A) left parasternal 3rd-4th intercostal space
B) left parasternal 2nd intercostal space
C) between the left scapula and the spine on the back
D) right parasternal 2nd intercostal space
E) infraclavicular area

PED - 6.19 - Still’s murmur (vibratory murmur)
PED - 6.20 - Venous hum
PED - 6.21 - Valvular pulmonary stenosis
PED - 6.22 - Atrial septal defect
PED - 6.23 - Valvular aortic stenosis
PED - 6.24 - Ventricular septal defect
PED - 6.25 - Pulmonary flow murmur
PED - 6.26 - Coarctation of the aorta at the isthmus

Answer 19

19- A
20- E
21- B
22- B
23- D
24- A
25- B
26- C

Question 20

Pair the different types of cardiomyopathies with their characteristics:
A) Hypertophic cardiomyopathy
B) Dilated cardiomyopathy
C) Restrictive cardiomyopathy

PED - 6.27 - Dominant inheritance with varied penetrance and expressivity
PED - 6.28 - The most common cause of death in young sportsmen
PED - 6.29 - It can be caused by a cardiothoxic chemotherapy
PED - 6.30 - The ventricles have normal sizes, the atria are markedly enlarged
PED - 6.31 - The most common form requiring heart transplant
PED - 6.32 - The thickened ventricular septum can impede the outflow from the left ventricle
PED - 6.33 - The systolic function of the left ventricle is reduced

Answer 20

27- A
28- A
29- B
30- C
31- B
32- A
33- B

Question 21

What is the most likely diagnosis?
A 2-month-old infant is taken to the emergency room with the following complaint: he seemed to be less active the day before and has taken less mothermilk. Today he is remarkebly sleepy, a little tachypneic and has only accepted little mothermilk. On physical examination his skin is a little colder and looks paler. Breath rate: 60/min, pulse: 290/min, liver is 2 cm below the costal margin.
A) Bacterial sepsis
B) Paroxismal supraventricular tachycardia
C) Ventricular tachycardia
D) Sinus tachycardia caused by thyrotoxicosis

Answer 21

B) Paroxismal supraventricular tachycardia

Question 22

An ECG is done. What is the most likely finding on the ECG?
A 2-month-old infant is taken to the emergency room with the following complaint: he seemed to be less active the day before and has taken less mothermilk. Today he is remarkebly sleepy, a little tachypneic and has only accepted little mothermilk. On physical examination his skin is a little colder and looks paler. Breath rate: 60/min, pulse: 290/min, liver is 2 cm below the costal margin.
A) F-waves with 2:1 conduction block to the ventricles
B) Wide QRS tachycardia
C) Reguler, narrow QRS tachycardia, p-waves can not be identified
D) Irregular narrow QRS tachycardia

Answer 22

C) Reguler, narrow QRS tachycardia, p-waves can not be identified

Question 23

What do the other signs on the physical examination refer to?
A 2-month-old infant is taken to the emergency room with the following complaint: he seemed to be less active the day before and has taken less mothermilk. Today he is remarkebly sleepy, a little tachypneic and has only accepted little mothermilk. On physical examination his skin is a little colder and looks paler. Breath rate: 60/min, pulse: 290/min, liver is 2 cm below the costal margin.
A) Cardiac decompensation
B) Dehydration (hypovolemia)
C) Infection
D) Patent arterial duct

Answer 23

A) Cardiac decompensation

Question 24

Which of the following drugs can stop the attack?
A 2-month-old infant is taken to the emergency room with the following complaint: he seemed to be less active the day before and has taken less mothermilk. Today he is remarkebly sleepy, a little tachypneic and has only accepted little mothermilk. On physical examination his skin is a little colder and looks paler. Breath rate: 60/min, pulse: 290/min, liver is 2 cm below the costal margin.
A) Antibiotics
B) Adenosine
C) Prostaglandin E1 (alprostadil)
D) Beta-blocker

Answer 24

B) Adenosine

Question 25

After the paroxysm stops, a new ECG is done. What is the most probable abnormality on the ECG?
A 2-month-old infant is taken to the emergency room with the following complaint: he seemed to be less active the day before and has taken less mothermilk. Today he is remarkebly sleepy, a little tachypneic and has only accepted little mothermilk. On physical examination his skin is a little colder and looks paler. Breath rate: 60/min, pulse: 290/min, liver is 2 cm below the costal margin.
A) Everything is normal
B) Prolonged QTc interval
C) 1st degree AV-block
D) Short PR interval and delta wave of the QRS

Answer 25

D) Short PR interval and delta wave of the QRS

Question 26

Which congenital heart defect should be considered?
A 2-week-old baby girl is taken to the emergency department. She had no problems until today. Today she seems lethargic, could hardly be fed, she is tachypneic and had low urine output. On physical examination the baby’s skin is a little cold and pale. She has tachypnea (70-80/min breath rate), tachycardia (160/min), the liver is 2.5 cm-s below the costal margin. The brachial pulses are well palpable, but the femoral pulses are very weak.
A) Aortic stenosis
B) Patent ductus arteriosus
C) Coarctation of the aorta
D) Aortic atresia

Answer 26

C) Coarctation of the aorta

Question 27

Which of the following simple diagnostic method can reinforce our suspicion?
A 2-week-old baby girl is taken to the emergency department. She had no problems until today. Today she seems lethargic, could hardly be fed, she is tachypneic and had low urine output. On physical examination the baby’s skin is a little cold and pale. She has tachypnea (70-80/min breath rate), tachycardia (160/min), the liver is 2.5 cm-s below the costal margin. The brachial pulses are well palpable, but the femoral pulses are very weak.
A) Blood gas analysis
B) Upper- lower body saturation measurement
C) Four extremity blood pressure measurement
D) Blood count, CRP test

Answer 27

C) Four extremity blood pressure measurement

Question 28

An echocardiography confirms our suspected diagnosis. Which drug can be life-saving in this situation?
A 2-week-old baby girl is taken to the emergency department. She had no problems until today. Today she seems lethargic, could hardly be fed, she is tachypneic and had low urine output. On physical examination the baby’s skin is a little cold and pale. She has tachypnea (70-80/min breath rate), tachycardia (160/min), the liver is 2.5 cm-s below the costal margin. The brachial pulses are well palpable, but the femoral pulses are very weak.
A) Steroid bolus
B) Peripheral vasoconstrictor
C) A drug for ductus arteriosus closure (indomethacin, ibuprophen or paracetamol)
D) Prostaglandin E1 (alprostadil)

Answer 28

D) Prostaglandin E1 (alprostadil)

Question 29

We start the drug therapy. What shall we do now?
A 2-week-old baby girl is taken to the emergency department. She had no problems until today. Today she seems lethargic, could hardly be fed, she is tachypneic and had low urine output. On physical examination the baby’s skin is a little cold and pale. She has tachypnea (70-80/min breath rate), tachycardia (160/min), the liver is 2.5 cm-s below the costal margin. The brachial pulses are well palpable, but the femoral pulses are very weak.
A) The patient has to be transported to a cardiac surgery center as soon as possible.
B) Pediatric intensive care monitoring until the symptoms get better.
C) We reevaluate the patient in 24 hours and decide the next step then.
D) It is enough to monitor the patient in a normal infant ward.

Answer 29

A) The patient has to be transported to a cardiac surgery center as soon as possible.

Question 30

Sometimes this type of congenital heart defect is only diagnosed later in childhood. What symptoms are the most common for the referral of these patients?
A 2-week-old baby girl is taken to the emergency department. She had no problems until today. Today she seems lethargic, could hardly be fed, she is tachypneic and had low urine output. On physical examination the baby’s skin is a little cold and pale. She has tachypnea (70-80/min breath rate), tachycardia (160/min), the liver is 2.5 cm-s below the costal margin. The brachial pulses are well palpable, but the femoral pulses are very weak.
A) Hypertension
B) Fatigue
C) Heart murmur
D) Cyanosis

Answer 30

B) Fatigue