ABP PEDIATRIC CARDIOLOGY CERTIFICATION
EXAM Practice Questions & Answers |
Comprehensive Board Review Study Guide
Maximize your board review efficiency and pass the
American Board of Pediatrics subspecialty test with this
targeted Pediatric Cardiology certification practice exam.
This high-yield resource features comprehensive clinical
questions covering congenital heart disease, arrhythmias,
pharmacology, and advanced cardiac imaging. It is an
indispensable tool for pediatric cardiology fellows and
practicing physicians seeking board certification or
maintenance of certification (MOC).
SECTION 1: FETAL & NEONATAL CARDIOLOGY
(Questions 1-30)
1. A 3-day-old term newborn is noted to have central cyanosis and a
systolic ejection murmur at the left upper sternal border. The oxygen
saturation is 78% on room air, with minimal improvement on 100%
oxygen. Which congenital heart defect is most likely?
A) Tetralogy of Fallot
B) Transposition of the Great Arteries
C) Truncus Arteriosus
D) Hypoplastic Left Heart Syndrome
,Answer: B
Rationale: Transposition of the Great Arteries (TGA) presents with severe
cyanosis in the first hours to days of life due to parallel circulation. The
minimal response to oxygen (hyperoxia test) is characteristic of cyanotic
congenital heart disease with decreased pulmonary blood flow or mixing
lesions. The murmur is often soft or absent initially .
2. A 2-day-old infant with prenatally diagnosed Transposition of the
Great Arteries has an oxygen saturation of 72% with a maximum of
76% on 100% oxygen. Which intervention is most appropriate?
A) Surgical arterial switch operation
B) Balloon atrial septostomy
C) Prostaglandin E1 infusion
D) Oxygen therapy
Answer: C
Rationale: Prostaglandin E1 (PGE1) is the initial medical therapy for ductal-
dependent cyanotic heart defects such as TGA. It maintains ductus arteriosus
patency, improving pulmonary blood flow and mixing. Balloon atrial
septostomy may be needed after stabilization .
3. A 4-hour-old infant presents with respiratory distress, cyanosis, and
a single S2. The chest X-ray shows a "boot-shaped" heart and
decreased pulmonary vascular markings. Which diagnosis is most
likely?
A) Tetralogy of Fallot
B) Hypoplastic Left Heart Syndrome
,C) Truncus Arteriosus
D) Total Anomalous Pulmonary Venous Return
Answer: A
Rationale: The classic "boot-shaped" heart on chest X-ray (coeur en sabot)
and decreased pulmonary vascular markings are characteristic of Tetralogy
of Fallot. A single S2 is due to the absence of pulmonary valve closure .
4. A newborn with Down syndrome is found to have a murmur. Which
congenital heart defect is most commonly associated with Down
syndrome?
A) Ventricular Septal Defect (VSD)
B) Tetralogy of Fallot
C) Atrioventricular Septal Defect (AVSD)
D) Patent Ductus Arteriosus
Answer: C
Rationale: Atrioventricular Septal Defect (AVSD) is the most common
congenital heart defect associated with Down syndrome, occurring in 40-50%
of affected infants. Complete AVSD is the classic lesion .
5. Which of the following fetal structures allows oxygenated blood
from the placenta to bypass the pulmonary circulation?
A) Foramen Ovale
B) Ductus Arteriosus
C) Ductus Venosus
D) Umbilical Vein
, Answer: C
Rationale: The ductus venosus allows oxygenated blood from the placenta
(via the umbilical vein) to bypass the hepatic circulation and enter the
inferior vena cava. The foramen ovale and ductus arteriosus are additional
shunts but serve different functions .
6. A 1-day-old infant with prenatal suspicion of coarctation of the
aorta has blood pressures of 75/45 in the right arm and 55/30 in the
lower extremities. Which finding is expected on physical examination?
A) Bounding femoral pulses
B) Diminished femoral pulses
C) Holosystolic murmur at the apex
D) Split S2
*Answer: B
Rationale: Coarctation of the aorta presents with diminished or absent
femoral pulses compared to upper extremity pulses. The differential in blood
pressure (>20 mmHg between upper and lower extremities) is characteristic .
7. A full-term newborn has a murmur and a continuous "machine-like"
murmur. Which is the most likely diagnosis?
A) Ventricular Septal Defect
B) Patent Ductus Arteriosus
C) Pulmonary Stenosis
D) Atrial Septal Defect
*Answer: B
EXAM Practice Questions & Answers |
Comprehensive Board Review Study Guide
Maximize your board review efficiency and pass the
American Board of Pediatrics subspecialty test with this
targeted Pediatric Cardiology certification practice exam.
This high-yield resource features comprehensive clinical
questions covering congenital heart disease, arrhythmias,
pharmacology, and advanced cardiac imaging. It is an
indispensable tool for pediatric cardiology fellows and
practicing physicians seeking board certification or
maintenance of certification (MOC).
SECTION 1: FETAL & NEONATAL CARDIOLOGY
(Questions 1-30)
1. A 3-day-old term newborn is noted to have central cyanosis and a
systolic ejection murmur at the left upper sternal border. The oxygen
saturation is 78% on room air, with minimal improvement on 100%
oxygen. Which congenital heart defect is most likely?
A) Tetralogy of Fallot
B) Transposition of the Great Arteries
C) Truncus Arteriosus
D) Hypoplastic Left Heart Syndrome
,Answer: B
Rationale: Transposition of the Great Arteries (TGA) presents with severe
cyanosis in the first hours to days of life due to parallel circulation. The
minimal response to oxygen (hyperoxia test) is characteristic of cyanotic
congenital heart disease with decreased pulmonary blood flow or mixing
lesions. The murmur is often soft or absent initially .
2. A 2-day-old infant with prenatally diagnosed Transposition of the
Great Arteries has an oxygen saturation of 72% with a maximum of
76% on 100% oxygen. Which intervention is most appropriate?
A) Surgical arterial switch operation
B) Balloon atrial septostomy
C) Prostaglandin E1 infusion
D) Oxygen therapy
Answer: C
Rationale: Prostaglandin E1 (PGE1) is the initial medical therapy for ductal-
dependent cyanotic heart defects such as TGA. It maintains ductus arteriosus
patency, improving pulmonary blood flow and mixing. Balloon atrial
septostomy may be needed after stabilization .
3. A 4-hour-old infant presents with respiratory distress, cyanosis, and
a single S2. The chest X-ray shows a "boot-shaped" heart and
decreased pulmonary vascular markings. Which diagnosis is most
likely?
A) Tetralogy of Fallot
B) Hypoplastic Left Heart Syndrome
,C) Truncus Arteriosus
D) Total Anomalous Pulmonary Venous Return
Answer: A
Rationale: The classic "boot-shaped" heart on chest X-ray (coeur en sabot)
and decreased pulmonary vascular markings are characteristic of Tetralogy
of Fallot. A single S2 is due to the absence of pulmonary valve closure .
4. A newborn with Down syndrome is found to have a murmur. Which
congenital heart defect is most commonly associated with Down
syndrome?
A) Ventricular Septal Defect (VSD)
B) Tetralogy of Fallot
C) Atrioventricular Septal Defect (AVSD)
D) Patent Ductus Arteriosus
Answer: C
Rationale: Atrioventricular Septal Defect (AVSD) is the most common
congenital heart defect associated with Down syndrome, occurring in 40-50%
of affected infants. Complete AVSD is the classic lesion .
5. Which of the following fetal structures allows oxygenated blood
from the placenta to bypass the pulmonary circulation?
A) Foramen Ovale
B) Ductus Arteriosus
C) Ductus Venosus
D) Umbilical Vein
, Answer: C
Rationale: The ductus venosus allows oxygenated blood from the placenta
(via the umbilical vein) to bypass the hepatic circulation and enter the
inferior vena cava. The foramen ovale and ductus arteriosus are additional
shunts but serve different functions .
6. A 1-day-old infant with prenatal suspicion of coarctation of the
aorta has blood pressures of 75/45 in the right arm and 55/30 in the
lower extremities. Which finding is expected on physical examination?
A) Bounding femoral pulses
B) Diminished femoral pulses
C) Holosystolic murmur at the apex
D) Split S2
*Answer: B
Rationale: Coarctation of the aorta presents with diminished or absent
femoral pulses compared to upper extremity pulses. The differential in blood
pressure (>20 mmHg between upper and lower extremities) is characteristic .
7. A full-term newborn has a murmur and a continuous "machine-like"
murmur. Which is the most likely diagnosis?
A) Ventricular Septal Defect
B) Patent Ductus Arteriosus
C) Pulmonary Stenosis
D) Atrial Septal Defect
*Answer: B
