Cardiology

1.    Heart Murmurs.
***) Concerning innocent murmur all of the following are true, except:
A.    Low-pitched vibratory murmur
B.     Usually diastolic
C.     Not more than grade 2/6 in intensity
D.    No splitting in heart sounds
E.     Best heard in midprecordium

Answer: B* Usually diastolic

***) Auscultatory features characteristic of a benign murmur include all of the following, except:
A.    Confirmation to systoles
B.     Audible in a restricted area of precordium only
C.     A quiet musical quality
D.    No variation with position
E.     Short duration

Answer: D* No variation with position

2.    Congenital Heart Disease.
***) The most common cause of central cyanosis in the neonates is:
A.    Congenital heart disease
B.     Lung disease
C.     CNS disease
D.    Hypoglycemia
E.     Polycythemia

Answer: A* Congenital heart disease

***) One of the following is the most common congenital heart defect in infants and children:
A.    ASD
B.     VSD
C.     Aortic coarctation
D.    Right ventricular hypertrophy
E.     Pulmonary artery stenosis

Answer: B* VSD

***) All of the following statements are correct, except:
A.    Cyanosis at birth may indicate transposition of the great arteries TGA
B.     Aortic regurgitation is the most common heart lesion in rheumatic carditis
C.     Ventricular septal defect VSD is the most common CHD
D.    Patent ductus arteriosus PDA is more common in premature
E.     Chest X-ray will show olgemic lung fields in pulmonary artery stenosis

Answer: B* Aortic regurgitation is the most common heart lesion in rheumatic carditis

3.    Acyanotic Congenital Heart Disease.
***) All of the following are acyanotic congenital heart disease, except:
A.    Ventricular septal defect
B.     Fallot tetralogy
C.     Aortic stenosis
D.    Atrial septal defect
E.     Pulmonary stenosis

Answer: B* Fallot tetralogy

***) All of the following are acyanotic congenital heart diseases, except:
A.    Transposition of great vessels
B.     Patent ductus arteriosus
C.     Coarctation of aorta
D.    Atrial septal defect
E.     Ventricular septal defect

Answer: A* Transposition of great vessels

***) The commonest non cyanotic congenital heart disease is:
A.    ASD atrial septal defect
B.     VSD ventricular septal defect
C.     PDA persistent ductus arteriosus
D.    Aortic stenosis
E.     Mitral insufficiency

Answer: B* VSD ventricular septal defect

***) Regarding left to right cardiac shunts all are true, except:
A.    Cyanosis is a prominent feature
B.     Oxygenated blood is shunted from left to right
C.     Systemic flow is decreased
D.    Pulmonary congestion is a prominent feature
E.     Left heart pressures normally exceed those on the right

Answer: A* Cyanosis is a prominent feature

***) In Atrial Septal Defect (ASD) all are true except:
A.    The murmur heard is secondary to flow through the ASD
B.     Surgery is indicated once diagnosed in symptomatic patients
C.     Secundum type is the most common
D.    Usually asymptomatic in childhood
E.     Surgery is contraindicated if severe pulmonary hypertension developed

Answer: A* The murmur heard is secondary to flow through the ASD

***) Large VSD alone in infancy may present by all of the following, except:
A.    Failure to thrive
B.     Recurrent chest infections
C.     Holosystolic murmur
D.    Cardiomegaly and oligemic lungs on chest X-ray
E.     ECG shows biventricular hypertrophy

Answer: D* Cardiomegaly and oligemic lungs on chest X-ray

***) All of the following could be manifestations of large VSD, except:
A.    Feeding difficulties
B.     Left to right shunt
C.     Cardiomegaly
D.    It is the commonest congenital heart disease
E.     Absent femoral pulse

Answer: E* Absent femoral pulse

***) A 2 year old boy, presented with upper respiratory tract infection, the treating physician accidently heard a pansystolic murmur during cardiac auscultation the most likely diagnosis is:
A.    Atrial septal defect
B.     Coarctation of aorta
C.     Transposition of great vessels
D.    Ventricular septal defect
E.     Patent ductus arteriosus

Answer: D* Ventricular septal defect

***) Regarding coarctation of the aorta all are true except:
Affecting males more than females
The ascending aorta is the most common site
Can be presented with hypertension at childhood
In severe narrowing its indication for surgery
The surgical approach is through right rhoracolomy

Answer: 2* The ascending aorta is the most common site

***) All of the following does not require treatment in a newborn, except:
A.    A scrotal hydrocele
B.     Breast enlargement
C.     Mongolian spot
D.    An erupted tooth
E.     Femoral pulses absent

Answer: E* Femoral pulses absent

4.    Cyanotic Congenital Heart Disease.
***) Cyanotic congenital heart disease includes all of the following, except:
A.    Transposition of great vessels
B.     Fallot tetralogy
C.     Isolated VSD
D.    Tricuspid atresia
E.     Pulmonary artery stenosis

Answer: E* Pulmonary artery stenosis

***) Only one of the following is cyanotic congenital heart disease:
A.    Fallot tetralogy
B.     Patent ductus arteriosus
C.     Atrial septal defect
D.    Ventricular septal defect
E.     Coarctation of aorta

Answer: A* Fallot tetralogy

***) Tetralogy of Fallot exhibits all of the following, except:
A.    Cyanosis
B.     Ventricular septal defect
C.     Patients do not develop congestive heart failure in infancy
D.    Obstruction to right ventricular outflow
E.     Right ventricular hypertrophy

Answer: C* Patients do not develop congestive heart failure in infancy

5.    Congestive Heart Failure.
***) All of the following are common features of heart failure in infancy, except:
A.    Hepatomegaly
B.     Lower limb edema
C.     Feeding difficulties
D.    Tachycardia
E.     Failure to thrive

Answer: B* Lower limb edema

***) Which one of the following is not common in acute heart failure of infancy:
A.    Peripheral edema
B.     Tachypnea
C.     Tachycardia
D.    Gallop rhythm
E.     Hepatomegaly

Answer: A* Peripheral edema

***) Congestive heart failure in infancy is characterized by all of the following, except:
A.    Enlarged palpable liver
B.     Feeding difficulties
C.     Heart rate over 150/min
D.    Respiratory rate over 40/min
E.     Oligemic lung fields in chest X-ray

Answer: E* Oligemic lung fields in chest X-ray

***) Congestive heart failure in infancy commonly presents with all of the following, except:
A.    Peripheral edema
B.     Poor weight gain
C.     Excessive perspiration
D.    Weak cry
E.     Tachypnea

Answer: A* Peripheral edema

***) The first sign of heart failure in infants is usually:
A.    Peripheral edema
B.     Engorged jugular veins
C.     Basal crepitation
D.    Tachypnea and tachycardia
E.     Puffiness of eye lids

Answer: D* Tachypnea and tachycardia

***) Goals of medical therapy for congestive heart failure in children include all the following except:
A.    Reducing the preload
B.     Enhancing cardiac contractility
C.     Increase the after load
D.    Improving oxygen delivery
E.     Enhancing nutrition

Answer: D* Increase the after load

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