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WorksheetsCardiac Cycle and Congenital Heart Defects
Total questions: 28
Worksheet time: 14mins
In the normal cardiac cycle, the first heart sound (S1) is produced by closure of which valves?
Aortic and pulmonary
Mitral and tricuspid
Pulmonary and tricuspid
Aortic and mitral
Which statement about diastole is correct?
Semilunar valves are open during most of diastole.
Atrial contraction contributes ~20–30% of ventricular filling.
AV valves remain closed during diastole.
Ventricular pressure is higher than atrial pressure.
A “wide, fixed split S2” is classic for:
VSD
ASD (ostium secundum)
PDA
TOF
A continuous “machinery” murmur best heard at the left infraclavicular area suggests:
VSD
ASD
PDA
Coarctation of aorta
In a large PDA with Eisenmenger physiology, which clinical finding is most characteristic?
Clubbing of the fingers only
Differential cyanosis (lower limbs worse)
Cyanosis of the upper limbs only
Fixed split S2
The most common cause of cyanosis in the first 24 hours of life is:
TOF
TGA (D-TGA)
ASD
PDA
In D-TGA, the definitive surgical correction is:
Blalock–Taussig shunt
Arterial switch (Jatene) procedure
Fontan operation
Coarctation repair
A baby with D-TGA who becomes severely hypoxic after birth usually benefits immediately from:
NSAIDs to close PDA
Prostaglandin E1 infusion
Diuretics
Beta-blockers
The “egg-on-a-string” sign on chest x-ray suggests:
TOF
D-TGA
PDA
Coarctation
In Tetralogy of Fallot, the degree of cyanosis correlates best with:
Size of VSD
Degree of pulmonary stenosis/RVOT obstruction
Presence of ASD
Left ventricular function
A child with TOF has a hypercyanotic “tet spell.” Immediate first-line bedside maneuver is:
Trendelenburg position
Knee–chest position (squatting)
Immediate arterial switch
Give NSAIDs
Which congenital heart lesion is most commonly associated with maternal rubella?
VSD
PDA
TOF
TGA
In L-TGA (ccTGA), which statement is true?
Patients are cyanotic at birth.
Ventricles and great arteries are both discordant (double discordance).
The pulmonary artery arises from the morphologic RV.
Arterial switch is always required in neonates.
Over time, the major long-term problem in L-TGA is:
Progressive LV failure
Progressive RV (systemic) failure and AV (tricuspid) regurgitation
Immediate cyanosis
Recurrent endocarditis only
Which murmur describes a pansystolic (holosystolic) loud murmur at the left lower sternal border?
ASD
VSD
PDA
Aortic stenosis
A small muscular VSD in an infant is most likely to:
Cause early heart failure
Close spontaneously
Require immediate surgical closure
Cause Eisenmenger in infancy
Which lesion most commonly produces a single loud S2 on exam?
TOF
ASD
VSD
PDA
Which congenital lesion often causes paradoxical embolism (stroke) due to right-to-left shunting?
Large VSD in infancy
ASD (patent foramen ovale / secundum ASD)
PDA
TOF only
Best initial diagnostic test to confirm most congenital structural heart lesions is:
Chest X-ray
ECG
Echocardiography
Cardiac catheterization only
A newborn with severe cyanosis not improving with oxygen should make you suspect:
Bronchiolitis
D-TGA or another cyanotic congenital heart disease
Sepsis only
Hypoglycemia
In PDA pharmacologic closure for premature infants, the mechanism of action of indomethacin/ibuprofen is:
Activates prostaglandin synthesis
Inhibits COX and reduces PGE2 levels
Increases PGE2 receptor sensitivity
Stimulates ductal smooth muscle relaxation
The classic CXR finding in Tetralogy of Fallot is:
Egg-on-a-string
Boot-shaped heart
Cardiomegaly with pulmonary plethora
Kerley B lines
Which lesion typically causes increased pulmonary vascular markings on chest x-ray?
TOF without shunt
Large VSD or PDA with significant left-to-right shunt
Severe pulmonary stenosis only
TGA without mixing
A newborn with D-TGA and an intact atrial septum often requires urgent:
Prostaglandin E1 only
Balloon atrial septostomy (Rashkind) to improve mixing
Indomethacin
Conservative management only
In Eisenmenger physiology, closing a long-standing large VSD is:
Always recommended
Contraindicated if pulmonary vascular resistance is irreversible
Best done with indomethacin
Done only after age 50
Which congenital lesion is classically associated with “boot-shaped heart” and squatting behavior in older children?
ASD
TOF
TGA
PDA
Which arrhythmia is common later in life after ASD if untreated?
Ventricular tachycardia
Atrial fibrillation/flutter
Complete heart block always
Sinus brady only
In a VSD with a large left-to-right shunt, the expected physical exam includes:
Loud holosystolic murmur with minimal symptoms always
Signs of heart failure in infancy (tachypnea, poor feeding) if large
Single S2 only
Continuous machinery murmur
