[PEDIA2] LE3 2026

Question 1

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

Answer 1

Question 2

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

Answer 2

Question 3

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

Answer 3

Question 4

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

Answer 4

Question 5

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

Answer 5

Question 6

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

Answer 6

Question 7

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

Answer 7

Question 8

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

Answer 8

Question 9

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

Answer 9

Question 10

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

Answer 10

Question 11

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%

Answer 11

Question 12

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

Answer 12

Question 13

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

Answer 13

Question 14

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

Answer 14

Question 15

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

Answer 15

Question 16

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

Answer 16

Question 17

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

Answer 17

Question 18

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

Answer 18

Question 19

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

Answer 19

Question 20

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

Answer 20

Question 21

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

Answer 21

Question 22

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

Answer 22

Question 23

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

Answer 23

Question 24

The diagnosis of acute rheumatic fever is primarily based on:

Choices:
A. Blood culture
B. Throat culture
C. Clinical signs
D. Chest radiography

Answer 24

Question 25

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

Answer 25

Question 26

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

Answer 26

Question 27

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

Answer 27

Question 28

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

Answer 28

Question 29

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

Answer 29

Question 30

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

Answer 30

Question 31

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

Answer 31

Question 32

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

Answer 32

Question 33

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

Answer 33

Question 34

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

Answer 34

Question 35

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

Answer 35

Question 36

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

Answer 36

Question 37

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

Answer 37

Question 38

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

Answer 38

Question 39

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

Answer 39

Question 40

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

Answer 40

Question 41

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

Answer 41

Question 42

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

Answer 42

Question 43

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

Answer 43

Question 44

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

Answer 44

Question 45

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

Answer 45

Question 46

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

Answer 46

Question 47

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

Answer 47

Question 48

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

Answer 48

Question 49

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

Answer 49

Question 50

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

Answer 50

Question 51

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

Answer 51

Question 52

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

Answer 52

Question 53

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

Answer 53

Question 54

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

Answer 54

Question 55

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

Answer 55

Question 56

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

Answer 56

Question 57

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

Answer 57

Question 58

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

Answer 58

Question 59

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

Answer 59

Question 60

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

Answer 60

Question 61

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

Answer 61

Question 62

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

Answer 62

Question 63

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)

Answer 63

Question 64

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

Answer 64

Question 65

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

Answer 65

Question 66

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

Answer 66

Question 67

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)

Answer 67

Question 68

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

Answer 68

Question 69

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

Answer 69

Question 70

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

Answer 70

Question 71

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

Answer 71

Question 72

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

Answer 72

Question 73

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

Answer 73

Question 74

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

Answer 74

Question 75

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)

Answer 75

Question 76

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

Answer 76

Question 77

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

Answer 77

Question 78

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

Answer 78

Question 79

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

Answer 79

Question 80

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

Answer 80

Question 81

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

Answer 81

Question 82

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

Answer 82

Question 83

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

Answer 83

Question 84

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

Answer 84

Question 85

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

Answer 85

Question 86

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

Answer 86

Question 87

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

Answer 87

Question 88

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

Answer 88

Question 89

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

Answer 89

Question 90

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

Answer 90

Question 91

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

Answer 91

Question 92

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

Answer 92

Question 93

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

Answer 93

Question 94

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

Answer 94

Question 95

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

Answer 95

Question 96

What is the drug of choice in the acute management of hypertension in children? Choices: A. Captopril B. Nifedipine C. Diltiazem D. Propranolol

Answer 96

Question 97

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

Answer 97

Question 98

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

Answer 98

Question 99

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

Answer 99

Question 100

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

Answer 100