Imaging & Diagnostics Questions - Set 2¶
Question 1¶
What normal ECG finding in children would be abnormal in adults?
A) Sinus arrhythmia B) Right axis deviation in infancy C) T-wave inversions in V1-V3 in children D) All of the above E) None - pediatric and adult ECGs are identical
Answer
**Correct Answer: D** Normal pediatric ECG findings: - **Sinus arrhythmia**: respiratory variation - **Right axis deviation** in infants (RVH from fetal circulation) - **T-wave inversions V1-V3** in children (juvenile T-wave pattern) These would be concerning in adults. **Board Pearl:** Pediatric ECG has normal RAD, T inversions V1-V3, sinus arrhythmiaQuestion 2¶
What QTc value is considered prolonged in children?
A) >420 ms B) >440 ms C) >460 ms D) >480 ms E) >500 ms
Answer
**Correct Answer: C** QTc prolongation: - **>460 ms** considered prolonged - >480 ms more concerning - >500 ms high-risk for arrhythmia - Use Bazett correction (QT/√RR) **Board Pearl:** QTc >460ms = prolonged; >500ms = high arrhythmia riskQuestion 3¶
In a patient with suspected AAOCA, what imaging modality best defines coronary course?
A) Echocardiography B) CT angiography C) Stress echocardiography D) Nuclear perfusion imaging E) Invasive coronary angiography
Answer
**Correct Answer: B** **CT angiography** gold standard for AAOCA: - Defines origin, course, relationship to great vessels - Identifies interarterial (malignant) course - 3D reconstruction for surgical planning - MRI also acceptable **Board Pearl:** AAOCA workup = CT angiography (defines course precisely)Question 4¶
What is the first echocardiographic sign of RV volume overload in an ASD?
A) RV dilation B) Paradoxical septal motion C) TR velocity elevation D) RA dilation E) Pulmonary valve gradient
Answer
**Correct Answer: A** **RV dilation** is the earliest sign: - Followed by paradoxical septal motion - RA dilation occurs later - Qp:Qs >1.5 indicates significant shunt **Board Pearl:** ASD RV volume overload = RV dilation → paradoxical septumQuestion 5¶
The PHN coronary Z-score equations should be calculated using which measurement?
A) Height B) Weight C) Body surface area D) Age E) Length
Answer
**Correct Answer: C** **PHN Z-scores** use BSA: - Boston equations (BSA-based) - Most validated in children - Calculate for RCA, LMCA, LAD, Cx - Available on dallastools.org/z-score/ **Board Pearl:** PHN coronary Z-scores = BSA-based; use Boston equationsQuestion 6¶
What chest X-ray finding is classic for total anomalous pulmonary venous return?
A) Boot-shaped heart B) Egg-on-a-string appearance C) Snowman or figure-8 sign D) Wall-to-wall heart E) Box-shaped heart
Answer
**Correct Answer: C** **Snowman/figure-8 sign** in supracardiac TAPVR: - Dilated vertical vein + SVC creates "head" - Heart creates "body" - Only visible in supracardiac type after several months - Infracardiac type doesn't show this **Board Pearl:** Supracardiac TAPVR = snowman sign on CXRQuestion 7¶
What is the normal mitral valve E/A ratio in children?
A) <1 B) 1-2 C) 2-3 D) >3 E) Variable, no normal range
Answer
**Correct Answer: B** Normal E/A ratio: - Children: **1-2** (E dominant) - Infants: May have E/A closer to 1 - Decreased E/A suggests diastolic dysfunction - Very high E/A with restrictive physiology **Board Pearl:** Normal pediatric E/A = 1-2; A>E suggests diastolic dysfunctionQuestion 8¶
In evaluating pulmonary hypertension, what PA pressure estimate suggests moderate PH?
A) mPAP 20-25 mmHg B) mPAP 25-35 mmHg C) mPAP 35-45 mmHg D) mPAP 45-60 mmHg E) mPAP >60 mmHg
Answer
**Correct Answer: C** PH severity by mPAP: - Normal: <20 mmHg - Mild: 20-35 mmHg - **Moderate: 35-45 mmHg** - Severe: >45 mmHg (or systemic level) Also use PVR for assessment. **Board Pearl:** PH severity: mild <35, moderate 35-45, severe >45 mmHg mPAPQuestion 9¶
What ECG finding is characteristic of Ebstein anomaly?
A) Left axis deviation B) Tall, peaked P waves in II and V1 C) Short PR interval D) Left bundle branch block E) ST elevation in precordial leads
Answer
**Correct Answer: B** Ebstein ECG: - **Tall, broad P waves** ("Himalayan P waves") - RA enlargement - Right bundle branch block - WPW pattern in 20-30% - Low voltage QRS possible **Board Pearl:** Ebstein = giant P waves + RBBB ± WPWQuestion 10¶
What is the recommended imaging interval for surveillance of a bicuspid aortic valve with mildly dilated aortic root (Z-score 2.5)?
A) Every 6 months B) Every 1 year C) Every 2 years D) Every 5 years E) Only if symptoms develop