MCQ

Cardiology MCQ
1. Features of polyarthritis of acute rheumatic fever include Except:
A. Polyarticular & migratory.
B. Equally affect large & small joints.
C. It is the commonest major manifestation in children with the initial attack.
D. Almost associated with positive serological evidence of recent streptococcal infection.
E. Shows a dramatic response to acetyl salicylic acid even in subtherapeutic dose.
2. Initial treatment of rheumatic fever with severe carditis & CHF may include all Except:
A. Bentzathine benzyl penicillin 1.2 mega unit.
B. Complete bed rest.
C. Restriction of salt & frusemide therapy.
D. Prednisolone 2 mg/kg/day in 3 divided doses.
E. Acetyl salicylic acid 100 mg/kg/day in 4 divided doses.
3. Underlying origin of precordial murmur may include all Except:
A. Leaky (incompetent) valve.
B. Abnormal communication between both ventricles.
C. Narrow (stenotic) valve or artery.
D. Abnormal communication between both atria.
E. No structural heart disease.
4. Congenital heart disease is suspected in the following clinical situations Except:
A. Infant with Down syndrome with precordial systolic murmur.
B. Asymptomatic child with soft short systolic murmur heard accidentally during febrile
illness in the supine position.
C. Large (macrosomic) newborn with central cyanosis with tachypnea & mild respiratory
distress.
D. Newborn with history of maternal infection with rubella virus in the first trimester.
E. Arterial hypertension in upper extremities with brachio-femoral delay in a child 5 year-old.
5. Clinical presentation of CHF in infancy may include all Except:
A. Feeding difficulty.
B. Excessive sweating.
C. Edema of lower limbs.
D. Nocturnal irritability & cough.
E. Puffy eyelids, rounding of face with sudden weight gain.
6. Features suggestive of large VSD in infant 6 months old may include all Except:
A. Recurrent broncho-pulmonary infection.
B. Normal growth parameters.
C. Cardiomegaly with pulmonary plethora on CXR.
D. Loud pulmonary component of 2nd heart sound.
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E. Biventricular hypertrophy on ECG.

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7. Features suggestive of small VSD in infant may include all Except:

A. Failure to thrive.
B. Normal pulmonary vascularity on CXR.
C. Normal ECG.
D. Normal intensity of 2nd heart sound.
E. Harsh Pansystolic murmur grade IV/VI in left parasternal area.
8. Consequences of arterial hypoxemia secondary to congenital heart disease with right
to left shunt include all Except:
A. Central cyanosis, clubbing.
B. Erythrocytosis & hyperviscosity.
C. Iron deficiency anemia.
D. Pulmonary embolism.
E. Exercise intolerance.
9. Determinants of cyanosis include all Except:
A. Color of skin.
B. Percentage of Hb saturation.
C. Stagnation of blood flow in peripheral circulation.
D. Alveolar ventilation.
E. Percentage of desaturated/total Hb rather than the absolute level of desaturated Hb.
10. Following diagnosis of initial attack of rheumatic fever, RF is considered “active” if
any of the followings is present:
A. Fever of 38 or more for 3 successive days.
B. Positive acute phase reactant.
C. Sleeping pulse > 100 beat/minute.
D. Prolonged P-R interval on ECG.
E. New significant cardiac murmur.
11. Features suggestive of major manifestations of acute rheumatic fever include all Except:
A. Involuntary purposeless, jerky dysrhythmic movement of hands &feet.
B. Joint pain without any objective finding.
C. Non-pruritic erythematous rash over the trunk with fading center & well defined margin.
D. Auscultation of a new apical Pansystolic murmur in a previously normal heart.
E. Small firm painless mobile nodules over bony prominences.
12. Manifestations of the initial attack of rheumatic fever with carditis may include all Except:
A. Tachycardia out of proportion of fever.
B. Pericardial rub.
C. Heart failure.
D. Apical mid-diastolic rumbling murmur with pre-systolic accentuation.
E. Prolonged P-R interval.
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13. Characteristic features of innocent murmurs in childhood may include all Except:
A. Vibratory in character.
B. Grade I or II.
C. Pansystolic in timing.
D. Localized.
E. More likely to be heard if the child is feverish.
14. In TOF, all are true Except:
A. Pulmonary oligemia in chest x-ray.
B. Central cyanosis & clubbing.
C. Basal ejection systolic murmur & single 2nd heart sound.
D. Commonly associated with heart failure.
E. May be complicated by brain abscess in children > 2 years old.
15. The following auscultatory finding may be present in large VSD Except:
A. Pansystolic murmur in left parasternal area.
B. Accentuated 2nd heart sound on left 2nd space.
C. Mid diastolic murmur over the apex.
D. Ejection systolic murmur over 2nd right space.
16. An apical mid-diastolic rumble may be heard in the following structural heart diseases
Except:
A. Large PDA.
B. Severe mitral incompetence.
C. Mitral valve stenosis.
D. Aortic rheumatic carditis with mitral valvitis.
E. Large ASD.
17. The following are common clinical features suggestive of a pathological murmur Except:
A. Harsh quality.
B. Grade III or more in intensity.
C. Pansystolic or diastolic in timing.
D. Affected by posture.
E. Wide radiation.
18. One of the following is not a minor manifestation in the diagnosis of initial attack of RF:
A. Fever.
B. Arthralgia.
C. High ESR.
D. Elevated or rising anti-streptococcal antibody titer.
E. Prolonged P-R interval on ECG.
19. An infant with arterial O2 saturation (50%), the minimal Hb level that is required for
cyanosis to be visible clinically is:
A. 6 gm/dl.
(72)

B. 8 gm/dl. C. 12 gm/dl.
D. 14 gm/dl. E. 9 gm/dl.
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20. An infant with arterial O2 saturation (80%), the minimal Hb level that is required for
cyanosis to be visible clinically is:
A. 18 gm/dl.
B. 20 gm/dl.
C. 15 gm/dl.
D. 12 gm/dl.
E. 10 gm/dl.
21. Carey Coombs murmur is defined as:
A. Apical mid diastolic rumble with presystolic accentuation.
B. Apical mid diastolic rumble in patients with large VSD.
C. Apical mid diastolic rumble in patients with acute rheumatic fever with mitral valvitis.
D. Apical mid diastolic rumble in patients with severe aortic incompetence.
E. A basal mid-systolic murmur in patients with aortic stenosis.
22. One of the following is true in TOF:
A. Cardiac enlargement & hyperactive precordium is a constant feature.
B. Standing position rather than squatting position relieve exercise induced fatigue & Dyspnea.
C. Cyanotic spell is almost associated with increase in intensity of the basal systolic murmur.
D. The lung fields are almost oligemic with right sided arch in 25% of cases.
E. The second heart sound is loud & single due to absent aortic component.
23. The Pathognomonic auscultatory finding in large ASD is:
A. Pansystolic murmur in left parasternal area.
B. Diminished intensity of second heart sound on 2nd left space.
C. Mid-diastolic murmur over the lower left sternal border.
D. Wide fixed splitting of S2.
E. Ejection systolic murmur over 2nd right space.
24. The following is true of Eisenmenger syndrome:
A. The pulmonary component of the S2 is soft on auscultation.
B. ECG shows left ventricular hypertrophy.
C. It is usually secondary to untreated VSD or PDA.
D. The pulmonary artery is characteristically small with peripheral pulmonary oligemia.
25. A 3-year-old asymptomatic child presents with a murmur heard in both systole &
diastole at the upper sternal edge, which disappear upon lying down with otherwise
normal physical examination. The underlying source of this murmur is more likely to
be:
A. PDA.
B. A-V fistula.
C. Venous hum.
D. Aortic stenosis with regurgitation.
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26. The appropriate cuff size width for measurement of ABP in a child with mid-arm
circumference (15cm) & a distance between acromion & olecranon (13cm) is:
A. 3-5 cm.
B. 5-6 cm.
C. 6-7.5 cm.
D. 7-9 cm.
E. 10 cm.
Matching:
For each of the following cardiac lesions, match with the appropriate hemodynamic
abnormality:
27. Large ASD. (a) Left ventricular volume overload.
28. Large PDA. (b) Left ventricular pressure overload.
29. Severe mitral stenosis. (c) Right ventricular volume overload.
30. Cyanotic TOF. (d) Increased left atrial pressure.
31. Severe aortic stenosis. (e) Right ventricular pressure overload.
For each of the following auscultatory finding, match with the appropriate cardiac lesion:
32. Pan-systolic murmur. (a) Innocent murmur.
33. Basal ejection systolic murmur. (b) VSD.
34. Apical mid-diastolic murmur. (c) Mitral stenosis.
35. Single loud aortic component of S2. (d) Aortic incompetence.
36. Basal early diastolic murmur. (e) TOF.
For each of the following clinical signs, match with the appropriate cardiac lesion:
37. Central cyanosis & clubbing. (a) TOF.
38. Hyper-cyanotic spell. (b) Severe aortic stenosis.
39. Collapsing pulse. (c) Eisenmenger syndrome.
40. Weak or absent femoral pulse. (d) Large PDA.
41. Weak 4 extremity arterial pulsations (e) coarctation of aorta.
For each of the following pathophysiologic states, match with the appropriate clinical or
investigatory tools:

42. Small pulmonary artery & lung oligemia. (a) Severe AR.
43. Enlarged LA appendage with obliterated waist. (b) Severe MR.
44. Enlarged pulmonary artery & pulmonary (c) Large ASD.
plethora.
45. Obliteration of retrosternal air space in CXR (d) TOF.
lateral view.
46. Downward & outward displacement of apex (e) Large VSD.
with ↑ cardiothoracic ratio.
(74)

For each of the following clinical situation of rheumatic fever, match with the
appropriate antimicrobial therapy:
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47. Primary prevention of rheumatic fever in (a) Benzathine benzyl penicillin 1.2
patients > 27kg. million units/2 weeks.
48. Secondary prevention of rheumatic fever (b) Single injection of Benzathine benzyl
in patients > 27kg with no history of penicillin 1.2 million units.
penicillin sensitivity.
49. Secondary prevention of rheumatic fever (c) Erythromycin 50mg/kg/day for 10
in penicillin sensitive patients > 27kg. days.
50. Antimicrobial therapy for patient with (d) Sulphadiazine 1 gm oral daily.
initial attack of rheumatic fever with initial
attack of rheumatic fever with
documented history of penicillin
sensitivity.
51. Antimicrobial prophylaxis against infective (e) Amoxacillin 50mg/kg a hour before
endocarditis in patient with rheumatic dental or oral surgery.
valvular heart disease.

For each of the following structural heart disease, match with the appropriate clinical or
radiological finding:
52. ASD. (a) Machinery murmur in the left infraclavicular area
53. PDA. (b) Pansystolic murmur on the apex.
54. MR. (c) Associated with lung oligemia.
55. AS. (d) Wide fixed splitting of S2.
56. TOF. (e) Left ventricular hypertrophy.
Answer the following statements by true or false:
In acute rheumatic fever, answer the following statements either by true or false:
57. Arthritis is always migratory involving large joints.
58. Chorea is usually associated with negative serological evidence of recent streptococcal
infection.
59. Both the initial attack as well as recurrence Is preceded by pharyngeal or skin infection
by group A beta hemolytic streptococci.
60. Carditis is always associated with murmur of mitral and/or aortic incompetence.
61. Carey Coombs murmur is an apical mid-diastolic murmur heard in the acute stage of
carditis due to mitral valvitis.
In examination of the cardiovascular system answer the following statements either by
true or false:
62. An apex beat displaced to the left is Pathognomonic of left atrial hypertrophy.
63. A Pansystolic murmur at the lower left sternal border may be increased with inspiration.
64. Splitting of S2 is wide in pulmonary hypertension.
(75)

65. The murmur of aortic incompetence is similar to murmur of mitral incompetence in

both pitch & quality.
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66. The murmur of aortic stenosis is a Pansystolic murmur in the aortic area.
Concerning chest radiography P-A view, answer the following statements either by true
or false:
67. The right cardiac border is formed by both right atrium & right ventricle.
68. Cardiac waist is bounded superiorly by pulmonary artery segment & below by right ventricle.
69. Obliteration of cardiac waist is a common finding in children with severe rheumatic
mitral incompetence.
70. Cyanotic TOF is almost associated with normal pulmonary vascularity.
71. Pulmonary plethora is a common radiological finding in children with severe aortic stenosis.
Regarding cyanotic form of TOF, answer by true or false:
72. Cardiac contour is characteristically boot shaped with pulmonary oligemia.
73. Intensity of the murmur Is inversely proporthional to the severity of cyanosis.
74. CHF is a common & related to severe pulmonic stenosis.
75. Clubbing is a common finding in infant 2 month-old with severe form of TOF.
76. The murmur is mostly ejection systolic than Pansystolic in duration.
Regarding pediatric cardiac auscultation, answer by true or false:
78. Low pitched sounds as S3 & S4 are best heard by bell of stethoscope.
79. High pitched murmurs as Pansystolic murmur of mitral incompetence is best heard by
the diaphragm of stethoscope.
80. S2 shows movable in the pulmonary area being widened on expiration.
81. Wide fixed splitting of S2 is Pathognomonic of ASD.
82. Decreased & delayed closure of P2 is associated with pulmonary stenosis.
Regarding rheumatic chorea, answer by true or false:
83. The pathological finding is more prominent in midbrain.
84. It is commonly associated with arthritis.
85. The movement is characteristically slow & snake like.
86. It is considered as a major manifestation of acute rheumatic fever.
87. Hypertonia is a constant finding with normal tone in between attacks.
Regarding anti-streptococcal antibody titer in children with probable diagnosis of
rheumatic fever, answer by true or false:
88. It is almost positive in patient with acute migratory polyarthritis.
89. It is usually negative in patient with chorea.
90. It Is considered a minor manifestation on applying Jone’s criteria.
91. A negative test in patients with probable rheumatic fever means the preceding
streptococcal infection is mostly pyoderma.
92. Rheumatic recurrence cannot be diagnosed in the presence of negative serological test.
(76)

Regarding the mechanisms of heart sound production, answer the following statements
by true or false:
93. S1 is produced at the time of closure of A-V valves.
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94. S2 is produced at the time of opening of semilunar valves.

95. S3 is produced by rapid ventricular filling & atrial contraction in late diastole.
96. S4 is produced by ventricular filling in early diastole.
Regarding normal plain chest X-ray in chidren, answer by true or false:
97. The right border in P-A view is formed mainly by right atrium.
98. The main cardiac shadow in the right hemithorax is defined as dextrocardia.
99. The structure that forms the uppermost part of left cardiac border in PA view is
pulmonary artery.
100. In lateral view, the structure that forms the upper posterior part of cardiac silhouette
is the left atrium
101. In lateral view, the right ventricle forms the anterior border of cardiac silhouette.
Regarding cardiac auscultation, answer the following statements by true or false:
102. S1 is loudest & single at the apex and reflects mitral valve closure.
103. S2 marks the end of systole & produced by closure of both pulmonary & aortic valves.
104. On the aortic area, both components of S2 are clearly heard, with aortic closure is
early & more louder.
105. Increased intensity of P2 occurs in pulmonary stenosis while decreased intensity
occurs in pulmonary hypertension.
106. Single S2 indicates that one semilunar valve Is atretic or severely stenotic.
Regarding requirements of good quality & technique of plain x-ray PA view for proper
cardiac assessment, answer the following statements by true or false:
107. Sternal ends of both ventricles are equidistant from the spine.
108. The major part of the first rib should be below the clavicles.
109. The vertebral bodies are slightly visible within the cardiac shadow.
110. The projection of the film is better to be antero-posterior rather than postero-anterior.
111. The right hemi-diaphragmatic leaflet must cut the 8th intercostal space posteriorly or
preferably the 9th rib.
Regarding Jone’s criteria for diagnosis of rheumatic fever, answer the following
statements by true or false:
112. For diagnosis of the initial attack, a minimum of two minor manifestations & one
major manifestation is essential.
113. Isolated chorea, as major manifestation fulfill the criteria in the absence of other
causes.
114. Carditis as a major manifestation with prolonged P-R interval & positive APR as two
minor manifestations satisfy the criteria for diagnosis of rheumatic fever.
115. Presence of two minor manifestations plus positive anti-streptococcal antibody
(77)

makes a presumptive diagnosis of recurrence is more likely.

116. The criteria is not only for diagnosis of rheumatic fever but also for assessment of
disease severity & rheumatic activity.
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117. A thrill in Suprasternal notch may be associated with all EXCEPT:

A. Severe pulmonary stenosis.
B. Severe aortic stenosis.
C. Coarctation of aorta.
D. Severe mitral incompetence.
E. Large PDA.
118. Cardiac involvement in the initial attack of rheumatic fever may be associated with any of
the following EXCEPT:
A. Tachycardia out of proportion of fever.
B. An early diastolic blowing murmur over the base.
C. An apical mid-diastolic rumble with presystolic accentuation.
D. Prolonged P-R interval on ECG.
E. Pericardial rub.
In large ASD; true or false:
119. Hyperactive precordium.
120. Widely split fixed S2.
121. Right atrial and right ventricular dilatation.
122. Infective endocarditis prophylaxis is mandatory.
123. Increased pulmonary vascularity on chest x-ray.
For each of the following structural lesions match with the appropriate abnormalities in 2nd
heart sound:
124. Large ASD. A. Wide fixed splitted S2.
125. Innocent murmur. B. Physiological splitting of S2.
126. TGA. C. Single loud A2.
127. Systemic hypertension. D. Accentuated A2.
128. Eisenmenger syndrome. E. Accentuated P2 with close splitting of S2.
129. In TOF, all are true EXCEPT:
A. Pulmonary oligemia in chest x-ray.
B. Central cyanosis and clubbing.
C. Basal ejection systolic murmur and single 2nd heart sound.
D. Commonly associated with heart failure.
E. May be complicated by brain abscess in children > 2 years old
130. Dullness to the right side of the sternum is due to:
A. Right atrial enlargement. B. Aortic aneurysm.
C. Right ventricular enlargement. D. Left ventricular enlargement.

Match the following:

131. ASD A. Single accentuated S2.
(78)

132. Pulmonary stenosis B. Mid-diastolic murmur.

133. TOF C. Pansystolic murmur over the apex.
134. Mitral regurge D. Fixed splitting S2.
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E. Ejection systolic murmur.

F. Early diastolic murmur.
135. Emergency management of cyanotic spell of tetralogy of Fallot include all EXCEPT:
A. Knee chest position.
B. O2 therapy.
C. Sodium bicarbonate 1 mEq/kg IV.
D. Propranolol 0.1 mg/kg IV.
E. I.V. digoxin.
136. Differential cyanosis may occur in the following structural heart diseases:
A. Large VSD with left to right shunt.
B. Large VSD with right to left shunt.
C. Large PDA with right to left shunt.
D. Pulmonary hypertension with right to left shunt at foramen ovale level.
137. Cyanotic heart disease include all EXCEPT:
A. Small VSD.
B. Severe pulmonary stenosis.
C. Small PDA.
D. Common atrioventricular canal.
138. Complications of TOF include all EXCEPT:
A. Hypoxemic spells.
B. Brain abscess.
C. Infective endocarditis.
D. Eisenmenger syndrome.
139. Clinical features of CHF in infancy may include all EXCEPT:
A. Feeding difficulties.
B. Excessive sweating.
C. Edema of L.L.
D. Nocturnal irritability & cough.
E. Puffy eyelids, rounding of face with sudden weight gain.
140. The most likely age in which an infant with a large VSD will begin manifesting
symptoms of congestive heart failure is:
A. 1 day.
B. 1 week.
C. 1 month.
D. 6 months.
E. 1year.
141. Hypercyanotic spell of TOF is treated with all of the following EXCEPT:
A. Knee chest position.
B. Morphine.
(79)

C. Digoxin.
D. Proplanolol.
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E. Sodium.
142. All of the following are included in the revised Jones Major criteria EXCEPT:
A. New significant murmur indicative of carditis.
B. Migrating polyarthritis.
C. Chorea.
D. Erythema multiform.
E. S.C nodules.
143. Congenital heart disease associated with CHF in the 1st year of life may include all
the following lesions EXCEPT:
A. Severe coarctation of the aorta.
B. Large hemodynamically VSD.
C. Large secondum ASD.
D. Large PDA.
E. Complete atrioventricular septal defect (endocardial cushion defect).
144. In normal plain chest radiography PA view, cardiac chamber or great artery that is
not border forming of the cardiac silhouette is:
A. Left ventricle.
B. Aortic knob.
C. Pulmonary artery segment.
D. Right atrium.
E. Right ventricle.
Answer the following questions by True or False
145. Innocent murmur is a pansystolic murmur.
146. Aortic stenosis is associated ejection diastolic murmur.
147. VSD is associated with an early diastolic murmur.
148. Tricuspid regurge is associated mid-diastolic murmur.
149. Mitral stenosis is associated with mid-diastolic murmur.
150. Features suggestive of major manifestations of acute rheumatic fever include all EXCEPT:
A. Involuntary purposeless, jerky dysrhythmic movements of hands and arms.
B. Joint pain without any objective finding.
C. Nonpruritic erythematous rash over the trunk with fading center and well defined edge.
D. Auscultation of a new apical pansystolic murmur in a previously normal heart.
E. Small firm painless nodules over bony prominences.

151. Cardiac involvement in the initial attack of rheumatic fever may be associated with
any of following(s) EXCEPT:
A. Tachycardia out of proportion to fever.
B. An early diastolic blowing murmur over the base.
(80)

C. An apical mid-diastolic rumple with presystolic accentuation.

D. prolonged P-R interval on ECG.
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E. Pericardial rub.
152. A thrill in suprasternal notch may be associated with all EXCEPT:
A. Severe pulmonary stenosis.
B. Severe aortic stenosis.
C. Coarctation of aorta.
D. Severe mitral incompetence.
E. Large PDA.
153. Features of polyarthritis of acute rheumatic fever include all EXCEPT:
A. Polyarticular & migratory.
B. Equally affect large & small joints.
C. It is the commonest major manifestation in children with the initial attack.
D. Almost associated with positive serological evidence of recent streptococcal infection.
E. Shows a dramatic response to acetyl salicylic acid even in subtherapeutic dose.
154. A 3-year-old asymptomatic child presents with a murmur heard in both systole &
diastole at the upper sternal edge, which disappearance upon lying down with
otherwise normal physical examination. The underlying source of this murmur is more
likely to be:
A. Patent ductus arteriosus. B. Arteriovenous fistula.
C. Venous hum. D. Aortic stenosis with regurgitation.
155. All are essentials of TOF EXCEPT:
A. Pulmonary plethora. B. Infandibular &/or valvular pulmonary stenosis.
C. VSD. D. Right ventricular hypertrophy.
Match the following:
156. Innocent murmur. A. Mid-diastolic murmur.
157. Stenotic smeilunar valve. B. Early systolic or mid systolic.
158. Stenotic A-V valve. C. Ejection systolic murmur.
159. A hole between both ventricles. D. Early diastolic murmur.
160. Regurgitant semilunar valve. E. Pansystolic murmur.
(81)
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