Congenital Heart Disease MCQ Quiz With Answer

1. An ECG in tricuspid atresia shows:

Left axis deviation

Right axis deviation

Most forms of congenital heart disease show right axis deviation and right heart strain. In TA, the right ventricle is bypassed, and the left ventricle ends up doing all the work.

Explanation

Most forms of congenital heart disease show right axis deviation and right heart strain. In TA, the right ventricle is bypassed, and the left ventricle ends up doing all the work.

2. Atherosclerosis is a type of:

Stroke

Heart attack

Arteriosclerosis

Coronary heart disease

Arteriosclerosis is the correct answer because atherosclerosis is a specific type of arteriosclerosis. Arteriosclerosis refers to the thickening and hardening of the arterial walls, while atherosclerosis specifically involves the buildup of plaque within the arteries. Atherosclerosis can lead to various cardiovascular conditions such as heart attacks and strokes, but it is a subtype of arteriosclerosis.

Explanation

Arteriosclerosis is the correct answer because atherosclerosis is a specific type of arteriosclerosis. Arteriosclerosis refers to the thickening and hardening of the arterial walls, while atherosclerosis specifically involves the buildup of plaque within the arteries. Atherosclerosis can lead to various cardiovascular conditions such as heart attacks and strokes, but it is a subtype of arteriosclerosis.

3. The differential of a collapsed, cyanotic baby include:

Sepsis

Inborn error of metabolism

Severe respiratory distress

Non-accidental injury

All may be accompanied by hypoperfusion, hypothermia, hypoglycemia, or acidosis. A big liver may suggest heart failure, or else an inborn error of glucose metabolism, or else a hyperinflated chest. A high pCO2 suggests respiratory failure. A low pCO2 suggests respiratory compensation for metabolic acidosis. Subconjunctival or retinal hemorrhages suggest NAI.

Explanation

All may be accompanied by hypoperfusion, hypothermia, hypoglycemia, or acidosis. A big liver may suggest heart failure, or else an inborn error of glucose metabolism, or else a hyperinflated chest. A high pCO2 suggests respiratory failure. A low pCO2 suggests respiratory compensation for metabolic acidosis. Subconjunctival or retinal hemorrhages suggest NAI.

Submit

4. Congenital heart disease can be:

Asymptomatic at birth

Associated with immunodeficiency

Easily detected on routine neonatal examination

Cyanotic or acyanotic

Seen more commonly in low birth weight babies

Often asymptomatic, at least until pulmonary resistance falls and the duct closes. Di George syndrome (22q) consists of cellular immunodeficiency (related to the thymus) and is associated with coarctation. Routine neonatal examination misses about 50% of cases. Cyanotic vs. cyanotic is the easiest way to think about the many different conditions. Mean birth weight is reduced for all cardiac conditions except transposition.

Explanation

Often asymptomatic, at least until pulmonary resistance falls and the duct closes. Di George syndrome (22q) consists of cellular immunodeficiency (related to the thymus) and is associated with coarctation. Routine neonatal examination misses about 50% of cases. Cyanotic vs. cyanotic is the easiest way to think about the many different conditions. Mean birth weight is reduced for all cardiac conditions except transposition.

Submit

5. Fallot's tetralogy:

Is so called because there are 4 diagnostic features

May have pulmonary atresia

Shows overriding of the aorta

Features first described by Étienne-Louis Fallot in 1888

Is characterized by spells

Pulmonary stenosis is the cardinal feature, but in its most extreme manifestation, there may be full atresia. Overriding of the aorta, along with VSD and right ventricular hypertrophy, are the other features that make up the 4 part description. Numerous descriptions of these features were made before Fallot's more comprehensive description, including one by Scotland's own William Hunter. "Spells" are episodes of pulmonary artery spasm causing acute hypoxia.

Explanation

Pulmonary stenosis is the cardinal feature, but in its most extreme manifestation, there may be full atresia. Overriding of the aorta, along with VSD and right ventricular hypertrophy, are the other features that make up the 4 part description. Numerous descriptions of these features were made before Fallot's more comprehensive description, including one by Scotland's own William Hunter. "Spells" are episodes of pulmonary artery spasm causing acute hypoxia.

Submit

6. Immediate management of a collapsed baby with a duct-dependent cardiac lesion includes:

Intubation and ventilation

Correction of hypoglycemia

Intravenous fluid bolus

ECG

IV prostaglandin

Positive pressure ventilation enhances cardiac output, so it is beneficial even in the absence of respiratory disease. A fluid bolus is often beneficial even in the presence of an obstructive cardiac defect to increase preload - but should be considered an emergency measure pending treatment with inotropes and prostaglandin. Prostaglandin is the definitive treatment, but other supportive treatments, e.g., correction of hypoglycemia, are also important.

Explanation

Positive pressure ventilation enhances cardiac output, so it is beneficial even in the absence of respiratory disease. A fluid bolus is often beneficial even in the presence of an obstructive cardiac defect to increase preload - but should be considered an emergency measure pending treatment with inotropes and prostaglandin. Prostaglandin is the definitive treatment, but other supportive treatments, e.g., correction of hypoglycemia, are also important.

Submit

7. Chest x-ray:

May show pulmonary oedema in congenital heart disease

Always shows an enlarged heart in heart failure

May show a characteristic heart shadow in transposition of the great arteries called "egg on a string."

May show a characteristic heart shadow in Tetralogy called "moon in june."

May show pulmonary oligaemia in congenital heart disease

Pulmonary edema is a feature of left ventricular failure. If this is progressive over a few days, then the heart tends to dilate; however, in acute cases, this may not occur. Pulmonary oligaemia (dark lung fields) may be seen in pulmonary atresia/stenosis. The heart in Tetralogy is described as "boot-shaped."

Explanation

Pulmonary edema is a feature of left ventricular failure. If this is progressive over a few days, then the heart tends to dilate; however, in acute cases, this may not occur. Pulmonary oligaemia (dark lung fields) may be seen in pulmonary atresia/stenosis. The heart in Tetralogy is described as "boot-shaped."

Submit

8. The following statements are true:

The Blalock - Taussig shunt is a procedure performed to alleviate poor pulmonary blood flow.

Taussig was a woman

Taussig was a deaf cardiologist

Taussig was dyslexic

The Blalock - Taussig shunt is a procedure performed to alleviate poor pulmonary blood flow. Taussig being a woman, a deaf cardiologist, and dyslexic are additional facts about her, but they are not directly related to the procedure itself.

Explanation

The Blalock - Taussig shunt is a procedure performed to alleviate poor pulmonary blood flow. Taussig being a woman, a deaf cardiologist, and dyslexic are additional facts about her, but they are not directly related to the procedure itself.

Submit

9. A patent ductus arteriosus:

Can be a cause of heart failure but may also be life-saving

Causes a left-to-right shunt

Is associated with intraventricular hemorrhage, pulmonary hemorrhage, and necrotizing enterocolitis

Is normal on day 14 of life

In preterms is due to lack of endothelial cushions, hypoxia and high pulmonary resistance

PDA may produce heart failure if there is a significant left to right shunt. On the other hand, if there is an obstructive cardiac defect, e.g., hypoplastic left heart, perfusion of the organs may be dependent on it. The direction of the shunt depends on the pressure difference between the left and right: Normally, this will be greater on the left but may be reversed if there is pulmonary hypertension, e.g., due to birth asphyxia. The duct normally closes in the first week of life.

Explanation

PDA may produce heart failure if there is a significant left to right shunt. On the other hand, if there is an obstructive cardiac defect, e.g., hypoplastic left heart, perfusion of the organs may be dependent on it. The direction of the shunt depends on the pressure difference between the left and right: Normally, this will be greater on the left but may be reversed if there is pulmonary hypertension, e.g., due to birth asphyxia. The duct normally closes in the first week of life.

Submit

10. For a well-baby with a murmur at the routine neonatal examination:

Saturations should be checked.

An ECG should be checked.

Trained nurses/midwives are as good as doctors at assessing.

A sternal or subxiphoid heave should be looked for

Parents should be warned that symptoms of heart disease may present before the 6 weeks follow up.

A new study from Sweden in BMJ suggests routine pulse oximetry is helpful in increasing sensitivity without too many extra false positives. ECG, and CXR may be abnormal but do not change management (echo for definitive diagnosis). Trained nurses/midwives are just as good as doctors in studies from centers where they perform routine neonatal checks. A heave implies a cardiac defect rather than an innocent murmur. Congenital cardiac disease can become symptomatic before the 6-week appointment, but given the very high false-positive rate, parents should be reminded that any concerns in general about their baby should be directed without hesitation to their community midwife, health visitor, or GP; to mention a murmur then talk about symptoms of heart failure specifically is likely to cause anxiety.

Explanation

A new study from Sweden in BMJ suggests routine pulse oximetry is helpful in increasing sensitivity without too many extra false positives. ECG, and CXR may be abnormal but do not change management (echo for definitive diagnosis). Trained nurses/midwives are just as good as doctors in studies from centers where they perform routine neonatal checks. A heave implies a cardiac defect rather than an innocent murmur. Congenital cardiac disease can become symptomatic before the 6-week appointment, but given the very high false-positive rate, parents should be reminded that any concerns in general about their baby should be directed without hesitation to their community midwife, health visitor, or GP; to mention a murmur then talk about symptoms of heart failure specifically is likely to cause anxiety.

Submit