[MCQ] Congenital Heart Disease in the Adult- Part 1

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Congenital Heart Disease in the Adult- Part 1

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Question 1

The most common birth defects have origin in ?

A	Cardiovascular system
B	Central nervous system
C	Gastrointestinal system
D	Urogenital system

Question 2

Congenital heart disease complicates what percentage of all live births ?

A	~ 1 %
B	~ 2 %
C	~ 3 %
D	~ 4 %

Question 2 Explanation:

CHD complicates ~1% of all live births in general population, but occurs in 4% of offspring of women with CHD

Question 3

Which of the following arches develop as the internal carotid arteries ?

A	1
B	2
C	3
D	4

Question 3 Explanation:

Truncus arteriosus & aortic sac initially develop six paired symmetric arches. Development of arch 3 results in internal carotid arteries, left arch 4 as the aortic arch and right subclavian artery, and part of arch 6 as the patent ductus arteriosus

Question 4

Sinus venosus receives which of the following veins ?

A	Umbilical vein
B	Vitelline vein
C	Common cardinal vein
D	All of the above

Question 4 Explanation:

Sinus venosus receives the umbilical, vitelline, and common cardinal veins.

Question 5

Which of the following congenital heart disease is more common in females ?

A	ASD
B	Congenital valvular AS
C	Coarctation of aorta
D	Complete transposition of great vessels

Question 5 Explanation:

ASD occurs more frequently in females. Congenital valvular AS, Coarctation of aorta and Complete transposition of great vessels is more frequent in males.

Question 6

Which of the following ASD type is associated with anomalous pulmonary venous connection ?

A	Sinus venosus ASD
B	Ostium primum ASD
C	Ostium secundum ASD
D	Patent foramen ovale

Question 6 Explanation:

ASD in sinus venosus type is high up in the atrial septum near the entry of superior vena cava into right atrium. It is associated frequently with anomalous pulmonary venous connection from the right lung to the superior vena cava or right atrium.

Question 7

ASD occurs in the basal portion of the interventricular septum in which of the following ?

A	Sinus venosus ASD
B	Ostium primum ASD
C	Ostium secundum ASD
D	Patent foramen ovale

Question 8

Which of the following ASD is more common in Down syndrome ?

A	Sinus venosus ASD
B	Ostium primum ASD
C	Ostium secundum ASD
D	Patent foramen ovale

Question 9

Which out of the following ASD is most common ?

A	Sinus venosus ASD
B	Ostium primum ASD
C	Ostium secundum ASD
D	Patent foramen ovale

Question 10

Which out of the following ASD involves the fossa ovalis ?

A	Sinus venosus ASD
B	Ostium primum ASD
C	Ostium secundum ASD
D	Patent foramen ovale

Question 11

Mid-diastolic rumbling murmur in ASD is loudest at ?

A	3rd intercostal space, along left sternal border
B	3rd intercostal space, along right sternal borde
C	4th intercostal space, along left sternal border
D	4th intercostal space, along right sternal border

Question 12

Which of the following cardiac murmurs can be heard in various types of compensated ASD ?

A	Midsystolic pulmonary outflow murmur
B	Mid-diastolic left parasternal murmur
C	Mid-diastolic left parasternal murmur
D	All of the above

Question 12 Explanation:

Increased flow across the pulmonic valve is responsible for a midsystolic pulmonary outflow murmur. Mid-diastolic murmur at fourth intercostal space and along left sternal border indicates increased flow across tricuspid valve. In ostium primum ASD, apical holosystolic murmur indicates associated mitral or tricuspid regurgitation or a ventricular septal defect (VSD).

Question 13

In ASD, second heart sound is widely split and is relatively fixed in relation to ?

A	Respiration
B	Posture
C	Heart rate
D	All of the above

Question 13 Explanation:

In ASD, second heart sound is widely split and is relatively fixed in relation to respiration

Question 14

In adults with an ASD and atrial fibrillation, the physical findings may be confused with ?

A	Mitral stenosis
B	Tricuspid stenosis
C	Pulmonary stenosis
D	Mitral regurgitation

Question 14 Explanation:

In adults with an ASD and atrial fibrillation, physical findings may be confused with mitral stenosis with pulmonary hypertension because the tricuspid diastolic flow murmur and widely split second heart sound may be mistakenly thought to represent the diastolic murmur of mitral stenosis and the mitral “opening snap,” respectively

Question 15

Which of the following statements about ostium secundum type of ASD is false ?

A	ECG shows left axis deviation
B	S2 widely split and relatively fixed
C	Middiastolic rumbling murmur
D	Midsystolic pulmonary ejection murmur

Question 15 Explanation:

In ostium secundum ASD, ECG shows right-axis deviation and an rSr’ pattern in right precordial leads representing enlargement of the RV outflow tract

Question 16

In ECG of cases of ostium primum ASD, which of the following is true ?

A	Right-axis deviation
B	Left superior axis deviation
C	Left inferior axis deviation
D	Left-axis deviation

Question 17

In ECG of cases of ostium primum ASD, which of the following is true ?

A	Clockwise rotation of frontal plane QRS loop
B	Counterclockwise rotation of frontal plane QRS loop
C	Clockwise rotation of sagittal plane QRS loop
D	Counterclockwise rotation of sagittal plane QRS loop

Question 17 Explanation:

In ostium primum ASD, the RV conduction defect is accompanied by left superior axis deviation and counterclockwise rotation of the frontal plane QRS loop.

Question 18

Which of them is a finding in echocardiogram of a patient of ASD ?

A	Pulmonary arterial dilatation
B	RV and RA dilatation
C	Abnormal (paradoxical) ventricular septal motion
D	All of the above

Question 18 Explanation:

In ASD, echocardiography reveals pulmonary arterial and RV and RA dilatation with abnormal (paradoxical) ventricular septal motion in the presence of a significant right heart volume overload. ASD may be visualized directly by two-dimensional imaging, color-flow imaging, or echocontrast.

Question 19

Which of the following about atrial septal defect is false ?

A	Sinus venosus ASD cases rarely die before 5th decade
B	Ostium secundum ASD cases rarely die before 5th decade
C	Risk of infective endocarditis in ASD is low
D	Risk of infective endocarditis in ASD is low

Question 19 Explanation:

Closure by an appropriate method should be advised in uncomplicated secundum ASD with significant left-to-right shunting, i.e., pulmonary-to-systemic flow ratios 2:1. Patients with sinus venosus or ostium secundum ASDs rarely die before the fifth decade. Risk of infective endocarditis is quite low unless ASD is complicated by valvular regurgitation or has recently been repaired with a patch or device.

Question 20

In Eisenmenger’s syndrome, a large communication between systemic and pulmonary circulation exists at ?

A	Aortopulmonary level
B	Ventricular level
C	Atrial level
D	Any of the above

Question 20 Explanation:

Any of the above

Question 21

In Eisenmenger syndrome, symptoms in adult life consist of ?

A	Chest pain
B	Syncope
C	Hemoptysis
D	All of the above

Question 21 Explanation:

In patients with Eisenmenger syndrome, symptoms in adult life consist of exertional dyspnea, chest pain, syncope, and hemoptysis.

Question 22

In patients with Eisenmenger syndrome, right-to-left shunt leads to ?

A	Cyanosis
B	Clubbing
C	Erythrocytosis
D	All of the above

Question 22 Explanation:

In patients with Eisenmenger syndrome, right-to-left shunt leads to cyanosis, clubbing, and erythrocytosis.

Question 23

Pulmonary vascular disease does not progress after operative correction of shunt, if pulmonary vascular resistance is less than systemic vascular resistance by ?

A	One-third
B	One-half
C	Two-third
D	Three-fourth

Question 23 Explanation:

The degree to which pulmonary vascular resistance is elevated before operation is a critical factor determining prognosis. If the pulmonary vascular resistance is one-third or less of the systemic value, progression of pulmonary vascular disease after operation is unusua

Question 24

Which of the following is a consequence of chronic hypoxemia in cyanotic CHD ?

A	Secondary erythrocytosis
B	Abnormal hemostasis
C	Hyperviscosity
D	All of the above

Question 25

Which of the following about Ductus Arteriosus is false ?

A	Originates from bifurcation of pulmonary artery
B	Ends at aorta just distal to left subclavian artery
C	Continuous murmur best heard at upper left sternal edge
D	None of the above

Question 26

Differential cyanosis is best related to ?

A	ASD
B	VSD
C	Patent ductus arteriosus
D	Tetralogy of Fallot

Question 26 Explanation:

In PDA, severe pulmonary vascular disease results in reversal of flow through ductus therby unoxygenated blood is shunted to descending aorta leading to cyanosis and clubbing of the toes, but not fingers. This is called differential cyanosis

Question 27

Leading cause of death in adults with PDA is ?

A	Infective endocarditis
B	Cardiac arrhythmia
C	Brain abscess
D	Restrictive lung disease

Question 27 Explanation:

Leading causes of death in adults with patent ductus are cardiac failure & infective endocarditis

Question 28

Which of the following is aortic root - to - right-heart shunt ?

A	Congenital aneurysm of aortic sinus of Valsalva with fistula
B	Coronary arteriovenous fistula
C	Anomalous origin of LCA from pulmonary trunk
D	All of the above

Question 28 Explanation:

The three most common causes of aortic root–to-right-heart shunts are congenital aneurysm of an aortic sinus of Valsalva with fistula, coronary arteriovenous fistula, and anomalous origin of the left coronary artery (LCA) from the pulmonary trunk

Question 29

In aneurysm of an aortic sinus of Valsalva, when the noncoronary cusp is ruptured, the fistula drains into ?

A	Right atrium
B	Right ventricle
C	Left atrium
D	Left ventricle

Question 29 Explanation:

Rupture of aneurysm of an aortic sinus of Valsalva leads to aorticocardiac fistula mostly between right coronary cusp and the right ventricle. When the noncoronary cusp is involved, the fistula drains into the right atrium .

Question 30

Cause of continuous murmur that accentuates in diastole is ?

A	Rupture of aneurysm of an aortic sinus of Valsalva
B	VSD
C	Patent ductus arteriosus
D	Tetralogy of Fallot

Question 30 Explanation:

Abrupt rupture causes chest pain, bounding pulses, a continuous murmur accentuated in diastole, and volume overload of the heart.

Question 31

In coronary arteriovenous fistula, there occurs communication between a coronary artery and ?

A	Coronary sinus
B	Right atrium
C	Right ventricle
D	Any of the above

Question 31 Explanation:

Coronary arteriovenous fistula consists of a communication between a coronary artery and another cardiac chamber, usually coronary sinus, right atrium, or right ventricle

Question 32

Which of the following is true for the murmur due to coronary arteriovenous fistula ?

A	Loud and superficial
B	Continuous
C	Best heard at lower or midsternal border
D	All of the above

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Congenital Heart Disease in the Adult- Part 1| Congenital Heart Disease in the Adult- Part 2

1.The most common birth defects have origin in ?
A. Cardiovascular system
B. Central nervous system
C. Gastrointestinal system
D. Urogenital system

2. Congenital heart disease complicates what percentage of all live births ?
A. ~ 1 %
B. ~ 2 %
C. ~ 3 %
D. ~ 4 %

3. Which of the following arches develop as the internal carotid arteries ?
A. 1
B. 2
C. 3
D. 4

4. Sinus venosus receives which of the following veins ?
A. Umbilical vein
B. Vitelline vein
C. Common cardinal vein
D. All of the above

5. Which of the following congenital heart disease is more common in females ?
A. ASD
B. Congenital valvular AS
C. Coarctation of aorta
D. Complete transposition of great vessels

6. Which of the following ASD type is associated with anomalous pulmonary venous connection ?
A. Sinus venosus ASD
B. Ostium primum ASD
C. Ostium secundum ASD
D. Patent foramen ovale

7. ASD occurs in the basal portion of the interventricular septum in which of the following ?
A. Sinus venosus ASD
B. Ostium primum ASD
C. Ostium secundum ASD
D. Patent foramen ovale

8. Which of the following ASD is more common in Down syndrome ?
A. Sinus venosus ASD
B. Ostium primum ASD
C. Ostium secundum ASD
D. Patent foramen ovale

9. Which out of the following ASD is most common ?
A. Sinus venosus ASD
B. Ostium primum ASD
C. Ostium secundum ASD
D. Patent foramen ovale
10. Which out of the following ASD involves the fossa ovalis ?
A. Sinus venosus ASD
B. Ostium primum ASD
C. Ostium secundum ASD
D. Patent foramen ovale
11. Mid-diastolic rumbling murmur in ASD is loudest at ?
A. 3rd intercostal space, along left sternal border
B. 3rd intercostal space, along right sternal border
C. 4th intercostal space, along left sternal border
D. 4th intercostal space, along right sternal border

12. Which of the following cardiac murmurs can be heard in various types of compensated ASD ?
A. Midsystolic pulmonary outflow murmur
B. Mid-diastolic left parasternal murmur
C. Apical holosystolic murmur
D. All of the above

13. In ASD, second heart sound is widely split and is relatively fixed in relation to ?
A. Respiration
B. Posture
C. Heart rate
D. All of the above

14. In adults with an ASD and atrial fibrillation, the physical findings may be confused with ?
A. Mitral stenosis
B. Tricuspid stenosis
C. Pulmonary stenosis
D. Mitral regurgitation

15. Which of the following statements about ostium secundum type of ASD is false ?
A. ECG shows left axis deviation
B. S
2 widely split and relatively fixed
C. Middiastolic rumbling murmur
D. Midsystolic pulmonary ejection murmur

16. In ECG of cases of ostium primum ASD, which of the following is true ?
A. Right-axis deviation
B. Left superior axis deviation
C. Left inferior axis deviation
D. Left-axis deviation
17. In ECG of cases of ostium primum ASD, which of the following is true ?
A. Clockwise rotation of frontal plane QRS loop
B. Counterclockwise rotation of frontal plane QRS loop
C. Clockwise rotation of sagittal plane QRS loop
D. Counterclockwise rotation of sagittal plane QRS loop

18. Which of them is a finding in echocardiogram of a patient of ASD ?
A. Pulmonary arterial dilatation
B. RV and RA dilatation
C. Abnormal (paradoxical) ventricular septal motion
D. All of the above

19. Which of the following about atrial septal defect is false ?
A. Sinus venosus ASD cases rarely die before 5th decade
B. Ostium secundum ASD cases rarely die before 5th decade
C. Risk of infective endocarditis in ASD is low
D. None of the above

20. In Eisenmenger’s syndrome, a large communication between systemic and pulmonary circulation exists at ?
A. Aortopulmonary level
B. Ventricular level
C. Atrial level
D. Any of the above

21. In Eisenmenger syndrome, symptoms in adult life consist of ?
A. Chest pain
B. Syncope
C. Hemoptysis
D. All of the above

22. In patients with Eisenmenger syndrome, right-to-left shunt leads to ?
A. Cyanosis
B. Clubbing
C. Erythrocytosis
D. All of the above

23. Pulmonary vascular disease does not progress after operative correction of shunt, if pulmonary vascular resistance is less than systemic vascular resistance by ?

A. One-third
B. One-half
C. Two-third
D. Three-fourth

24. Which of the following is a consequence of chronic hypoxemia in cyanotic CHD ?
A. Secondary erythrocytosis
B. Abnormal hemostasis
C. Hyperviscosity
D. All of the above
25. Which of the following about Ductus Arteriosus is false ?
A. Originates from bifurcation of pulmonary artery
B. Ends at aorta just distal to left subclavian artery
C. Continuous murmur best heard at upper left sternal edge
D. None of the above
26. Differential cyanosis is best related to ?
A. ASD
B. VSD
C. Patent ductus arteriosus
D. Tetralogy of Fallot

27. Leading cause of death in adults with PDA is ?
A. Infective endocarditis
B. Cardiac arrhythmia
C. Brain abscess
D. Restrictive lung disease

28. Which of the following is aortic root – to – right-heart shunt ?
A. Congenital aneurysm of aortic sinus of Valsalva with fistula
B. Coronary arteriovenous fistula
C. Anomalous origin of LCA from pulmonary trunk
D. All of the above

29. In aneurysm of an aortic sinus of Valsalva, when the noncoronary cusp is ruptured, the fistula drains into ?
A. Right atrium
B. Right ventricle

C. Left atrium
D. Left ventricle

30. Cause of continuous murmur that accentuates in diastole is ?
A. Rupture of aneurysm of an aortic sinus of Valsalva
B. VSD
C. Patent ductus arteriosus
D. Tetralogy of Fallot

31. In coronary arteriovenous fistula, there occurs communication between a coronary artery and ?
A. Coronary sinus
B. Right atrium
C. Right ventricle
D. Any of the above

32. Which of the following is true for the murmur due to coronary arteriovenous fistula ?
A. Loud and superficial
B. Continuous
C. Best heard at lower or midsternal border
D. All of the above

Congenital Heart Disease in the Adult

[MCQ] Congenital Heart Disease in the Adult- Part 1

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Congenital Heart Disease in the Adult- Part 1

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