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ABP Pediatric Cardiology Practice Questions — 100 Original Items
Normal Cardiovascular Structure & Function (1–7)
1. Which of the following best describes the Frank-Starling relationship in the neonatal
myocardium compared to the adult?
A) Neonatal myocardium has greater contractile reserve
B) Neonatal myocardium operates near the peak of its length-tension curve with limited
reserve
C) Neonatal myocardium has more compliant ventricles
D) Neonatal myocardium has higher sarcoplasmic reticulum calcium stores
Answer: B. The neonatal myocardium has fewer contractile elements and operates near the
peak of its length-tension curve, limiting preload reserve .
2. The primary determinant of myocardial oxygen consumption in children is:
A) Heart rate B) Afterload C) Contractility D) Preload
Answer: A. Heart rate is a major determinant of myocardial oxygen demand in pediatric
patients .
3. Which of the following is TRUE regarding fetal circulation?
A) The foramen ovale directs oxygenated blood from the right atrium to the left atrium
B) The ductus arteriosus carries oxygenated blood from the pulmonary artery to the aorta
C) The ductus venosus carries deoxygenated blood from the umbilical vein to the inferior
vena cava
D) Pulmonary vascular resistance is lower than systemic vascular resistance in the fetus
Answer: A. In fetal circulation, oxygenated blood from the placenta travels via the umbilical
vein and ductus venosus to the right atrium, where the foramen ovale directs it to the left
atrium .
4. The primary mechanism of closure of the ductus arteriosus after birth is:
A) Increased oxygen tension and decreased prostaglandin E2
B) Increased pulmonary blood flow
C) Decreased systemic vascular resistance
D) Increased left atrial pressure
Answer: A. Functional closure of the ductus arteriosus occurs within hours to days after
birth due to increased oxygen tension and falling prostaglandin levels .
5. Which of the following correctly describes the relationship between pressure and volume
in a normal left ventricle?
A) The pressure-volume loop shifts rightward with increased contractility
B) The end-systolic pressure-volume relationship is a load-independent measure of
contractility
C) Stroke volume decreases with increased preload
D) Afterload reduction increases end-systolic volume
, 2
Answer: B. The end-systolic pressure-volume relationship (ESPVR) is relatively load-
independent and reflects intrinsic contractility .
6. Which vascular bed has the highest oxygen extraction at rest in children?
A) Coronary circulation B) Renal circulation C) Cerebral circulation D) Skeletal muscle
Answer: A. The coronary circulation has the highest oxygen extraction at rest, making it
vulnerable to ischemia when demand increases .
7. Which of the following is TRUE regarding pulmonary vascular resistance after birth?
A) It remains high for several weeks
B) It falls rapidly in the first 24 hours due to lung inflation and increased oxygen
C) It is primarily regulated by the sympathetic nervous system
D) It reaches adult levels by 1 week of life
Answer: B. Pulmonary vascular resistance falls rapidly after birth due to lung inflation,
increased oxygen tension, and decreased prostaglandin levels .
Basic Pharmacology (8–9)
8. Which medication is considered first-line for afterload reduction in pediatric heart failure?
A) Enalapril B) Propranolol C) Digoxin D) Furosemide
Answer: A. ACE inhibitors such as enalapril are first-line for afterload reduction in pediatric
heart failure .
9. Which antiarrhythmic is contraindicated in patients with long QT syndrome?
A) Amiodarone B) Lidocaine C) Procainamide D) Adenosine
Answer: C. Procainamide prolongs the QT interval and is contraindicated in long QT
syndrome .
Arrhythmias (10–15)
10. A 6-year-old presents with palpitations and a heart rate of 220 bpm. The ECG shows a
narrow-complex tachycardia with no visible P waves. Which is the most likely diagnosis?
A) Ventricular tachycardia B) Supraventricular tachycardia C) Atrial flutter D) Sinus
tachycardia
Answer: B. SVT is the most common symptomatic tachyarrhythmia in children, presenting
with narrow-complex tachycardia and rates typically >220 bpm in infants .
11. Which ECG finding is characteristic of Wolff-Parkinson-White syndrome?
A) Prolonged PR interval B) Delta wave with short PR interval C) Wide QRS with left bundle
branch block D) T-wave inversion in V1-V3
Answer: B. WPW is characterized by a delta wave, short PR interval, and wide QRS due to an
accessory pathway .
12. A newborn is noted to have a heart rate of 50 bpm on the newborn exam. Which is the
most appropriate initial management?
A) Start epinephrine infusion B) Assess for congenital complete heart block C) Administer
ABP Pediatric Cardiology Practice Questions — 100 Original Items
Normal Cardiovascular Structure & Function (1–7)
1. Which of the following best describes the Frank-Starling relationship in the neonatal
myocardium compared to the adult?
A) Neonatal myocardium has greater contractile reserve
B) Neonatal myocardium operates near the peak of its length-tension curve with limited
reserve
C) Neonatal myocardium has more compliant ventricles
D) Neonatal myocardium has higher sarcoplasmic reticulum calcium stores
Answer: B. The neonatal myocardium has fewer contractile elements and operates near the
peak of its length-tension curve, limiting preload reserve .
2. The primary determinant of myocardial oxygen consumption in children is:
A) Heart rate B) Afterload C) Contractility D) Preload
Answer: A. Heart rate is a major determinant of myocardial oxygen demand in pediatric
patients .
3. Which of the following is TRUE regarding fetal circulation?
A) The foramen ovale directs oxygenated blood from the right atrium to the left atrium
B) The ductus arteriosus carries oxygenated blood from the pulmonary artery to the aorta
C) The ductus venosus carries deoxygenated blood from the umbilical vein to the inferior
vena cava
D) Pulmonary vascular resistance is lower than systemic vascular resistance in the fetus
Answer: A. In fetal circulation, oxygenated blood from the placenta travels via the umbilical
vein and ductus venosus to the right atrium, where the foramen ovale directs it to the left
atrium .
4. The primary mechanism of closure of the ductus arteriosus after birth is:
A) Increased oxygen tension and decreased prostaglandin E2
B) Increased pulmonary blood flow
C) Decreased systemic vascular resistance
D) Increased left atrial pressure
Answer: A. Functional closure of the ductus arteriosus occurs within hours to days after
birth due to increased oxygen tension and falling prostaglandin levels .
5. Which of the following correctly describes the relationship between pressure and volume
in a normal left ventricle?
A) The pressure-volume loop shifts rightward with increased contractility
B) The end-systolic pressure-volume relationship is a load-independent measure of
contractility
C) Stroke volume decreases with increased preload
D) Afterload reduction increases end-systolic volume
, 2
Answer: B. The end-systolic pressure-volume relationship (ESPVR) is relatively load-
independent and reflects intrinsic contractility .
6. Which vascular bed has the highest oxygen extraction at rest in children?
A) Coronary circulation B) Renal circulation C) Cerebral circulation D) Skeletal muscle
Answer: A. The coronary circulation has the highest oxygen extraction at rest, making it
vulnerable to ischemia when demand increases .
7. Which of the following is TRUE regarding pulmonary vascular resistance after birth?
A) It remains high for several weeks
B) It falls rapidly in the first 24 hours due to lung inflation and increased oxygen
C) It is primarily regulated by the sympathetic nervous system
D) It reaches adult levels by 1 week of life
Answer: B. Pulmonary vascular resistance falls rapidly after birth due to lung inflation,
increased oxygen tension, and decreased prostaglandin levels .
Basic Pharmacology (8–9)
8. Which medication is considered first-line for afterload reduction in pediatric heart failure?
A) Enalapril B) Propranolol C) Digoxin D) Furosemide
Answer: A. ACE inhibitors such as enalapril are first-line for afterload reduction in pediatric
heart failure .
9. Which antiarrhythmic is contraindicated in patients with long QT syndrome?
A) Amiodarone B) Lidocaine C) Procainamide D) Adenosine
Answer: C. Procainamide prolongs the QT interval and is contraindicated in long QT
syndrome .
Arrhythmias (10–15)
10. A 6-year-old presents with palpitations and a heart rate of 220 bpm. The ECG shows a
narrow-complex tachycardia with no visible P waves. Which is the most likely diagnosis?
A) Ventricular tachycardia B) Supraventricular tachycardia C) Atrial flutter D) Sinus
tachycardia
Answer: B. SVT is the most common symptomatic tachyarrhythmia in children, presenting
with narrow-complex tachycardia and rates typically >220 bpm in infants .
11. Which ECG finding is characteristic of Wolff-Parkinson-White syndrome?
A) Prolonged PR interval B) Delta wave with short PR interval C) Wide QRS with left bundle
branch block D) T-wave inversion in V1-V3
Answer: B. WPW is characterized by a delta wave, short PR interval, and wide QRS due to an
accessory pathway .
12. A newborn is noted to have a heart rate of 50 bpm on the newborn exam. Which is the
most appropriate initial management?
A) Start epinephrine infusion B) Assess for congenital complete heart block C) Administer
