Acquired Heart Disease Questions - Set 1¶
Question 1¶
A 10-year-old presents with fever, migratory polyarthritis, and a new heart murmur 3 weeks after strep pharyngitis. What is the minimum duration of secondary prophylaxis if echo shows no carditis?
A) Until age 18 B) Until age 21 C) 5 years from last episode or until age 21, whichever is longer D) 10 years from last episode or until age 40 E) Lifelong
Answer
**Correct Answer: C** ARF **without carditis**: 5 years OR until age 21 (whichever is longer) With carditis: - Mild/resolved: 10 years or until age 21 - Persistent valvular disease: 10 years or until age 40 - Severe/surgery: Lifelong **Board Pearl:** ARF no carditis = 5 years or age 21; carditis = longer prophylaxisQuestion 2¶
Which of the Jones criteria is NOT a major criterion for acute rheumatic fever?
A) Carditis B) Polyarthritis C) Fever D) Sydenham chorea E) Subcutaneous nodules
Answer
**Correct Answer: C** **Fever is a MINOR criterion** Major criteria (JONES): - **J**oints (polyarthritis) - **O** (carditis) - **N**odules (subcutaneous) - **E**rythema marginatum - **S**ydenham chorea Minor: fever, arthralgia, elevated ESR/CRP, prolonged PR **Board Pearl:** Fever is MINOR criterion; polyarthritis is MAJORQuestion 3¶
A 6-year-old is diagnosed with Kawasaki disease on day 5 of fever. LAD Z-score is 4.0. Per 2024 guidelines, what is the initial treatment?
A) IVIG 2g/kg alone B) IVIG 2g/kg + aspirin C) IVIG 2g/kg + aspirin + corticosteroids D) Infliximab + aspirin E) Aspirin alone initially, IVIG if fever persists
Answer
**Correct Answer: C** Z-score ≥2.5 at diagnosis = **high-risk** = intensified therapy: - IVIG 2g/kg - High-dose aspirin (until afebrile, then low-dose) - **Adjunctive corticosteroids** High-risk features include CAA at diagnosis, age <6 months, shock, MAS. **Board Pearl:** Kawasaki Z ≥2.5 at diagnosis = high-risk = IVIG + ASA + steroidsQuestion 4¶
What is the recommended duration of anticoagulation for a patient with Kawasaki disease and giant coronary artery aneurysm (Z-score 12)?
A) 6 weeks B) 1 year C) Until aneurysm resolves D) Lifelong E) Until surgical intervention
Answer
**Correct Answer: D** Giant aneurysm (Z ≥10 or ≥8mm) = **lifelong anticoagulation**: - Aspirin + warfarin + clopidogrel (triple therapy) - Giant aneurysms rarely fully regress - Highest risk for thrombosis and stenosis **Board Pearl:** Giant CAA (Z≥10) = lifelong triple antithrombotic therapyQuestion 5¶
A 14-year-old presents with chest pain, fever, and elevated troponin. Echo shows normal LV function but small pericardial effusion. ECG shows diffuse ST elevation. What is the diagnosis?
A) Acute myocarditis B) Acute pericarditis C) Myopericarditis D) STEMI E) Stress cardiomyopathy
Answer
**Correct Answer: C** **Myopericarditis**: - Pericarditis features (chest pain, rub, ECG, effusion) - PLUS troponin elevation = myocardial involvement - Management similar to pericarditis - Longer activity restriction (3-6 months vs 2-4 weeks) **Board Pearl:** Pericarditis + troponin elevation = myopericarditis = longer restrictionQuestion 6¶
Which medication significantly reduces recurrence of pericarditis?
A) Ibuprofen B) Prednisone C) Colchicine D) Acetaminophen E) Indomethacin
Answer
**Correct Answer: C** **Colchicine** reduces pericarditis recurrence: - COPE, CORP trials showed ~50% reduction - First episode: 3 months - Recurrence: 6 months - Dose: 0.5mg BID (or once daily if <70kg) **Board Pearl:** Colchicine = prevents pericarditis recurrence; 3-6 month courseQuestion 7¶
What percentage of MIS-C patients have cardiac involvement?
A) 20-30% B) 40-50% C) 60-70% D) 80-90% E) 100%
Answer
**Correct Answer: D** **80-90%** of MIS-C patients have cardiac involvement: - LV dysfunction (50%) - Elevated troponin/BNP (80-90%) - Coronary abnormalities (20%) - Shock (35-50%) **Board Pearl:** MIS-C = 80-90% cardiac involvement; treat with IVIG + steroidsQuestion 8¶
A child diagnosed with myocarditis asks when they can return to sports. What is the minimum restriction period?
A) 2 weeks B) 1 month C) 3 months D) 6 months E) 1 year
Answer
**Correct Answer: C** Myocarditis return to play: - **Minimum 3-6 months** restriction - Must have: normal echo, normal Holter, normal exercise test - CMR without active inflammation if available - Some recommend 6 months for any myocarditis **Board Pearl:** Myocarditis = 3-6 month sports restriction minimumQuestion 9¶
What is the most common cardiac manifestation of Lyme disease?
A) Myocarditis with reduced EF B) AV conduction block C) Pericardial effusion D) Coronary arteritis E) Valvular regurgitation
Answer
**Correct Answer: B** Lyme carditis = **AV block**: - Can progress to complete heart block - Usually resolves with antibiotic treatment - Temporary pacing sometimes needed - Avoid permanent pacemaker (usually unnecessary) **Board Pearl:** Lyme carditis = AV block; resolves with treatmentQuestion 10¶
In infective endocarditis prophylaxis, which procedure does NOT require prophylaxis in a patient with unrepaired VSD?
A) Dental extraction B) Dental cleaning with expected bleeding C) Bronchoscopy with biopsy D) Gastrointestinal endoscopy E) Incision and drainage of infected skin