Pediatric Cardiology Beyond CHD (Rheumatic Fever, Kawasaki, Arrhythmias) MCQs

Pediatrics · 36 free questions with answers & explanations.

1. A 7-year-old child presents with fever, migratory polyarthritis, and a new apical pansystolic murmur. ESR is 85 mm/hr, CRP positive, and ECG shows PR prolongation. Anti-streptolysin O (ASO) titre is 400 IU/mL. What is the Jones criterion classification?
2. A 4-year-old boy has 7 days of fever, bilateral non-purulent conjunctivitis, strawberry tongue, erythema and desquamation of the palms and soles, cervical lymphadenopathy (2.5 cm), and maculopapular rash. Echocardiography shows left anterior descending artery Z-score of +3.2. What is the treatment of choice?
3. A previously healthy 10-year-old presents with sudden onset palpitations, narrow complex tachycardia at 240 bpm on ECG, no structural heart disease on echo. Vagal manoeuvres failed. Which is the first-line pharmacological treatment?
4. Regarding secondary prophylaxis for rheumatic fever with carditis and residual valvular disease, what is the recommended duration of benzathine penicillin G prophylaxis according to Indian guidelines?
5. A 10-year-old presents 3 weeks after a sore throat with fever, painful migratory polyarthritis, and a new high-pitched blowing pansystolic murmur at the apex. Jones criteria 2015 revision: which combination correctly identifies the required number of criteria for high-risk population diagnosis?
6. A 2-year-old has had 6 days of fever unresponsive to antibiotics. On examination: bilateral non-exudative conjunctival injection, fissured lips, strawberry tongue, non-tender cervical lymphadenopathy (1.5 cm), and an erythematous maculopapular rash. ECHO shows a left anterior descending coronary artery z-score of +2.7. This finding on ECHO classifies the coronary involvement as:
7. A 7-year-old presents with palpitations and a resting HR of 220 bpm. ECG shows a regular narrow complex tachycardia with no clearly visible P waves. BP is 90/60 mmHg. He is alert. The initial treatment of choice is:
8. A 14-year-old competitive swimmer experiences sudden cardiac arrest during a swimming race. He is successfully resuscitated. His older brother died suddenly at age 17. ECG shows QTc of 530 ms. Genetic testing reveals KCNQ1 mutation. This condition predisposes primarily to which arrhythmia?
9. A 6-year-old child is diagnosed with Kawasaki disease. After 2 days of high-dose aspirin and IVIG, he remains febrile. Which of the following is the most appropriate next step?
10. A 10-year-old child presents with acute rheumatic fever. Echocardiography shows mitral regurgitation. Jones criteria are met. Which of the following findings on echo would indicate severe carditis with a high risk of permanent valve damage?
11. A 7-year-old child is found incidentally to have a narrow complex tachycardia at 230 bpm with no P waves visible. He is haemodynamically stable. What is the first-line pharmacological treatment?
12. A 14-year-old boy collapses during exercise. His ECG shows a prolonged QTc of 520 ms with a broad-based T-wave morphology and no notching. Family history reveals paternal sudden death at age 30. Which genetic channelopathy is most likely?
13. A 9-year-old presents with fever, migratory polyarthritis, and a new pan-systolic murmur at the apex. Anti-streptolysin O (ASO) titre is 800 IU/mL. Echo shows mitral regurgitation. According to 2015 revised Jones criteria, which combination satisfies the diagnosis of Acute Rheumatic Fever (ARF)?
14. A 4-year-old male has had fever for 7 days, bilateral conjunctival injection, cracked lips, polymorphous rash, and cervical lymphadenopathy. Echocardiography is performed. Which coronary artery finding on echo, if present, classifies the child as having a GIANT coronary artery aneurysm (CAA) in Kawasaki disease?
15. A 6-year-old presents with recurrent syncopal episodes during exercise. ECG shows a short PR interval, delta waves, and a wide QRS complex. Holter monitor demonstrates paroxysmal supraventricular tachycardia. What is the underlying mechanism of tachycardia in this condition?
16. A 14-year-old boy presents with episodic palpitations, near-syncope, and a family history of sudden cardiac death in a young uncle. ECG shows corrected QT interval (QTc) of 520 ms. Which ion channel mutation is MOST commonly associated with congenital long QT syndrome type 1 (LQT1) and what triggers are characteristically associated?
17. An 8-year-old presents with fever, a migratory polyarthritis, a new pansystolic murmur at the apex, and a rash with central clearing on the trunk. Which of the following is the LEAST reliable indicator for confirming rheumatic carditis?
18. A 4-year-old presents with 6 days of fever, cracked lips, strawberry tongue, bilateral conjunctival injection, polymorphous rash on the trunk, and unilateral cervical lymphadenopathy >1.5 cm. Echocardiography shows left anterior descending coronary artery Z-score of +3.1. What is the most important treatment to prevent further coronary involvement?
19. A 13-year-old with palpitations during exercise has ECG showing a short PR interval of 0.08 seconds and a delta wave. He loses consciousness during a school football match. Cardiac monitoring shows a wide-complex tachycardia at 200 bpm. What is the mechanism of this arrhythmia?
20. A 7-year-old child who had rheumatic carditis 2 years ago is currently asymptomatic with mild mitral regurgitation on echocardiography. Which is the correct prophylaxis regimen to prevent recurrence of rheumatic fever?
21. A 7-year-old presents with fever, migratory polyarthritis, and a new soft heart murmur 3 weeks after a throat infection. ASO titer is 800 IU/mL (normal <200). Which Jones criterion is considered the MOST reliable indicator of carditis?
22. A 4-year-old child has had fever for 6 days with bilateral non-purulent conjunctivitis, cracked lips with strawberry tongue, rash, and swollen hands. Echocardiography reveals dilatation of the left anterior descending coronary artery (z-score +3.2). What is the NEXT best step?
23. A 10-year-old child presents with episodic palpitations and an ECG showing a regular narrow-complex tachycardia at 220 bpm with a retrograde P wave visible just after the QRS complex. The MOST likely diagnosis is:
24. A child with established rheumatic heart disease involving the mitral valve is about to undergo dental extraction. Which antibiotic regimen is recommended for endocarditis prophylaxis?
25. A 9-year-old girl presents with 2 weeks of high fever, bilateral non-exudative conjunctival injection, cracked red lips, strawberry tongue, diffuse cervical lymphadenopathy >1.5 cm, and a polymorphous truncal rash. Her CRP is 95 mg/L and ESR 78 mm/hr. She is treated with IVIG 2 g/kg and aspirin. On day 5, she remains febrile. What is the MOST appropriate next step?
26. A 7-year-old boy presents with fleeting polyarthritis involving knees and ankles, low-grade fever, and a new pansystolic murmur at the apex. His throat culture is negative, but ASO titer is 640 IU/mL. What is the MOST accurate Jones criterion classification for this presentation?
27. A 4-year-old child is brought with sudden onset palpitations and HR 220/min on ECG. The ECG shows a narrow complex regular tachycardia with absent visible P waves. BP is 90/60 mmHg. He has no structural heart disease. What is the CORRECT first-line management?
28. A 5-year-old child with confirmed acute rheumatic fever and carditis has been started on benzathine penicillin prophylaxis. According to current guidelines, for how long should secondary prophylaxis be continued if he has rheumatic carditis with persistent valvular disease?
29. A 6-year-old child has had fever for 12 days with conjunctival injection, cracked lips with strawberry tongue, cervical lymphadenopathy (3 cm), and a diffuse polymorphous rash. 2D echocardiography shows a right coronary artery Z-score of +3.2. This patient meets criteria for Kawasaki disease. The first-line treatment and its purpose are:
30. A 10-year-old child is diagnosed with acute rheumatic fever. He has carditis (mitral regurgitation on echo), polyarthritis, and elevated ESR/CRP. He has no penicillin allergy. According to current guidelines, the treatment plan includes secondary prophylaxis. The duration of benzathine penicillin G prophylaxis for this patient with carditis but no residual valve disease after 10 years should be:
31. A 4-year-old child presents with intermittent palpitations. ECG shows a narrow QRS tachycardia at 230 bpm with no visible P waves before the QRS and abrupt onset. After vagal maneuvers fail, the drug of choice for acute termination of this likely SVT is:
32. A 7-year-old boy has acute rheumatic fever with a Jones criteria combination of carditis and polyarthritis. Which Jones criterion is he missing that would still allow diagnosis without another major criterion?
33. A 7-year-old child presents with fever, migratory arthritis, a new grade 3/6 apical pansystolic murmur, subcutaneous nodules and a skin rash over the trunk. ASO titre is 800 IU/mL. Which Jones criterion is MAJOR in this clinical presentation?
34. A 4-year-old male presents with 7 days of fever, conjunctival injection, cracked lips, strawberry tongue, rash and cervical lymphadenopathy >1.5 cm. Echocardiogram shows left anterior descending coronary artery diameter of 4.8 mm (z-score +3.2). Which statement about the management of this child's coronary findings is MOST accurate?
35. A 10-year-old presents with palpitations and an ECG showing a short PR interval (0.08 s) and a slurred upstroke (delta wave) on the QRS complex followed by a wide QRS and normal P-wave axis. This finding is diagnostic of:
36. Prophylaxis against recurrent rheumatic fever to prevent carditis progression is BEST managed by which regimen in an 8-year-old with established rheumatic heart disease?