Prevention & Screening Questions¶
Question 1¶
Per AAP guidelines, when should universal lipid screening be performed?
A) Age 2-5 years B) Age 9-11 years C) Age 12-16 years D) Age 18-21 years E) Only with family history of early CVD
Answer
**Correct Answer: B** Universal lipid screening: - **Age 9-11 years** (pre-puberty) - Again at **age 17-21 years** - Earlier if high-risk (obesity, family history, diabetes) **Board Pearl:** Universal lipid screening = ages 9-11 and 17-21 per AAPQuestion 2¶
At what blood pressure percentile is a child diagnosed with Stage 1 hypertension?
A) ≥90th percentile B) ≥95th percentile C) ≥95th percentile + 12 mmHg D) ≥99th percentile E) ≥120/80 only
Answer
**Correct Answer: B** 2017 AAP hypertension stages: - Elevated BP: 90th-<95th percentile (or 120/<80 in teens) - **Stage 1: ≥95th percentile to <95th + 12 mmHg** (or 130/80-139/89) - Stage 2: ≥95th + 12 mmHg (or ≥140/90) **Board Pearl:** Stage 1 HTN = ≥95th percentile (or 130/80-139/89 in teens)Question 3¶
A 10-year-old has LDL of 190 mg/dL with family history of MI at age 42 in father. What is the diagnosis?
A) Polygenic hypercholesterolemia B) Familial hypercholesterolemia C) Familial combined hyperlipidemia D) Secondary hyperlipidemia E) Normal variant
Answer
**Correct Answer: B** **Familial hypercholesterolemia (FH)**: - LDL ≥160 + family history of early CVD, OR - LDL ≥190 without other cause - Autosomal dominant (LDLR, ApoB, PCSK9) - Treat with statin from age 8-10 **Board Pearl:** LDL ≥190 or ≥160 + FH of early CVD = familial hypercholesterolemiaQuestion 4¶
Which sport classification is MOST restricted for an athlete with Marfan syndrome and aortic root Z-score of 3.0?
A) Low static, low dynamic (golf) B) Low static, moderate dynamic (tennis) C) Moderate static, moderate dynamic (basketball) D) High static, high dynamic (rowing) E) All equally restricted
Answer
**Correct Answer: D** Marfan with aortic dilation: - Avoid **high static, high intensity activities** - Avoid contact sports - Avoid Valsalva-type activities - Low-moderate dynamic generally acceptable Golf, walking, cycling at low intensity = OK **Board Pearl:** Marfan + aortopathy = avoid high static/isometric activitiesQuestion 5¶
What is the recommended timing for CCHD screening in newborns?
A) Immediately after birth B) 2-4 hours after birth C) 24-48 hours after birth or before discharge D) At 1 week of age E) At 1 month of age
Answer
**Correct Answer: C** CCHD screening timing: - **24-48 hours** after birth (or before discharge if <24h) - Earlier screening = more false positives - 2025 update: only 1 retest if borderline - Pre- and post-ductal SpO2 required **Board Pearl:** CCHD screen = 24-48 hours or before dischargeQuestion 6¶
What conditions require infective endocarditis prophylaxis before dental procedures?
A) All congenital heart disease B) Isolated ASD or VSD C) Prosthetic valves, unrepaired cyanotic CHD, recent repair with prosthetic material D) Mitral valve prolapse with regurgitation E) Bicuspid aortic valve without stenosis
Answer
**Correct Answer: C** IE prophylaxis indicated for: - **Prosthetic valves** (mechanical or bioprosthetic) - **Previous IE** - **Unrepaired cyanotic CHD** (including palliative shunts) - **Repaired CHD with prosthetic material** (first 6 months) - **Residual defects adjacent to prosthetic material** - **Heart transplant with valvulopathy** NOT for isolated VSD/ASD, MVP, or BAV. **Board Pearl:** IE prophylaxis: prosthetic valves, prior IE, unrepaired cyanotic CHDQuestion 7¶
At what age should cardiac surveillance begin in a child with a family history of Marfan syndrome?
A) At birth B) Age 5 C) Age 10 D) When clinical features appear E) In adulthood only
Answer
**Correct Answer: A** Marfan family screening: - **Echo at birth/infancy** for at-risk children - Annual thereafter - Genetic testing available - Early detection allows appropriate management **Board Pearl:** Marfan family screening = start at birth; annual echo thereafterQuestion 8¶
What is the target LDL for a child with heterozygous familial hypercholesterolemia on statin therapy?
A) <70 mg/dL B) <100 mg/dL C) <130 mg/dL D) <160 mg/dL E) 50% reduction from baseline
Answer
**Correct Answer: C** Pediatric FH treatment goals: - **LDL <130 mg/dL** primary target - Or 50% reduction from baseline - LDL <100 if diabetes or other risk factors - More aggressive in homozygous FH **Board Pearl:** Pediatric FH goal = LDL <130 mg/dL or 50% reductionQuestion 9¶
What is the appropriate pre-participation cardiovascular screening for a high school athlete?
A) ECG for all athletes B) Echo for all athletes C) History and physical examination D) Exercise stress testing E) Cardiac MRI
Answer
**Correct Answer: C** US guidelines = **History + physical exam**: - Personal and family history (AHA 14-element screening) - Physical exam including cardiac auscultation - ECG not universally recommended in US (debated) - Further testing based on findings **Board Pearl:** PPE screening = history + physical (AHA 14-element); ECG debatedQuestion 10¶
A child with Turner syndrome should have cardiovascular surveillance for which condition?
A) Supravalvar aortic stenosis B) Bicuspid aortic valve and aortic coarctation C) Pulmonary stenosis D) Complete AVSD E) Truncus arteriosus