ABP Pediatric Cardiology Certification
Examination Full-Length Practice Exam
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A | Instant
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,
, Section 1: Congenital Heart Disease – Left-to-Right Shunts
1. A 6-week-old infant presents with tachypnea, poor feeding, and a holosystolic
murmur at the left lower sternal border. A chest X-ray shows cardiomegaly and
increased pulmonary vascular markings. What is the most likely diagnosis?
A) Atrial septal defect (ASD)
B) Ventricular septal defect (VSD)
C) Patent ductus arteriosus (PDA)
D) Tetralogy of Fallot
Correct Answer: B
Rationale: A VSD typically presents at 4-8 weeks of age as pulmonary vascular resistance
falls, leading to increased left-to-right shunting. The holosystolic murmur at the left lower
sternal border is classic. Symptoms include tachypnea, poor feeding, and failure to thrive.
ASD and PDA have different murmur characteristics, and Tetralogy of Fallot is a cyanotic
lesion that would present earlier with cyanosis.
2. A 2-month-old with a large VSD is on diuretic therapy and has a history of poor
weight gain. The most appropriate next step in management is:
A) Continue current medical management and monitor growth
B) Increase the diuretic dose
C) Surgical repair of the VSD
D) Start digoxin
Correct Answer: C
Rationale: When a large VSD causes failure to thrive despite maximal medical therapy,
surgical repair is indicated. Continued medical management alone is insufficient when
growth failure persists.
3. Which of the following is the most common type of ASD in children?
, A) Primum ASD
B) Secundum ASD
C) Sinus venosus ASD
D) Coronary sinus ASD
Correct Answer: B
Rationale: Secundum ASD is the most common type, accounting for approximately 75% of
ASDs. It is located in the region of the fossa ovalis. Primum ASDs are associated with
atrioventricular canal defects and Down syndrome.
4. A patient with a secundum ASD is scheduled for transcatheter closure. What is
the most important anatomic feature to assess before the procedure?
A) Distance of the defect from the coronary sinus
B) Size of the left atrium
C) Adequacy of the rims around the defect for device anchoring
D) Presence of a fenestrated septum
Correct Answer: C
Rationale: Adequate rims (especially the aortic rim) are critical for device closure. The
device must anchor securely without obstructing adjacent structures. Inadequate rims may
preclude device closure.
5. A 32-week premature infant is found to have a hemodynamically significant
PDA. Which treatment is first-line?
A) Ibuprofen or indomethacin
B) Surgical ligation
C) Transcatheter PDA closure
D) Fluid restriction
Correct Answer: A
Rationale: Pharmacologic closure with NSAIDs (ibuprofen or indomethacin) is first-line for
PDA closure in premature infants. Surgical ligation is reserved for those who fail medical
therapy.
Examination Full-Length Practice Exam
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A | Instant
Download Pdf.
,
, Section 1: Congenital Heart Disease – Left-to-Right Shunts
1. A 6-week-old infant presents with tachypnea, poor feeding, and a holosystolic
murmur at the left lower sternal border. A chest X-ray shows cardiomegaly and
increased pulmonary vascular markings. What is the most likely diagnosis?
A) Atrial septal defect (ASD)
B) Ventricular septal defect (VSD)
C) Patent ductus arteriosus (PDA)
D) Tetralogy of Fallot
Correct Answer: B
Rationale: A VSD typically presents at 4-8 weeks of age as pulmonary vascular resistance
falls, leading to increased left-to-right shunting. The holosystolic murmur at the left lower
sternal border is classic. Symptoms include tachypnea, poor feeding, and failure to thrive.
ASD and PDA have different murmur characteristics, and Tetralogy of Fallot is a cyanotic
lesion that would present earlier with cyanosis.
2. A 2-month-old with a large VSD is on diuretic therapy and has a history of poor
weight gain. The most appropriate next step in management is:
A) Continue current medical management and monitor growth
B) Increase the diuretic dose
C) Surgical repair of the VSD
D) Start digoxin
Correct Answer: C
Rationale: When a large VSD causes failure to thrive despite maximal medical therapy,
surgical repair is indicated. Continued medical management alone is insufficient when
growth failure persists.
3. Which of the following is the most common type of ASD in children?
, A) Primum ASD
B) Secundum ASD
C) Sinus venosus ASD
D) Coronary sinus ASD
Correct Answer: B
Rationale: Secundum ASD is the most common type, accounting for approximately 75% of
ASDs. It is located in the region of the fossa ovalis. Primum ASDs are associated with
atrioventricular canal defects and Down syndrome.
4. A patient with a secundum ASD is scheduled for transcatheter closure. What is
the most important anatomic feature to assess before the procedure?
A) Distance of the defect from the coronary sinus
B) Size of the left atrium
C) Adequacy of the rims around the defect for device anchoring
D) Presence of a fenestrated septum
Correct Answer: C
Rationale: Adequate rims (especially the aortic rim) are critical for device closure. The
device must anchor securely without obstructing adjacent structures. Inadequate rims may
preclude device closure.
5. A 32-week premature infant is found to have a hemodynamically significant
PDA. Which treatment is first-line?
A) Ibuprofen or indomethacin
B) Surgical ligation
C) Transcatheter PDA closure
D) Fluid restriction
Correct Answer: A
Rationale: Pharmacologic closure with NSAIDs (ibuprofen or indomethacin) is first-line for
PDA closure in premature infants. Surgical ligation is reserved for those who fail medical
therapy.
