ABP Pediatric Cardiology Certification Exam
Practice Questions and Correct Answers
(Verified Answers) Plus Rationales
Question 1
Describe VSD
Correct Answer
The most common congenital heart defect. Seen in down syndrome, edward, patau
syndrome, fetal alcohol syndrome, TORCH. L -> R shunt with RV volume overload -
> RV hypertrophy, excessive pulmonary blood flow and high pulmonary artery
pressures -> pulmonary HTN and right sided heart hypertrophy
Question 2
How do you treat CHF?
Correct Answer
- Treat the underlying cause
- Oxygen if the patient is hypoxic or in respiratory distress.
- Medication like digitalis (for ventricular function), diuretics (decrease volume
overload and pulmonary edema), afterload reducing agents (ACE inhibitors, calcium
channel blockers) dilate vasculature and decrease the work on the heart.
Question 3
What would an EKG show in pericarditis and why?
Correct Answer
Diffusely low voltages due to insulation caused by the fluid (normally 30 mL in
adult). PR depression and ST elevation also happen.
Page 1 of 86
,Question 4
What does lying down in the left lateral position do to the heart?
Correct Answer
No effect.
Question 1: Which of the following is the most common cyanotic congenital
heart defect presenting in the neonatal period?
A. Tetralogy of Fallot
B. Transposition of the great arteries
C. Truncus arteriosus
D. Total anomalous pulmonary venous return
CORRECT ANSWER: B. Transposition of the great arteries
Rationale: Transposition of the great arteries is the most frequent cyanotic
congenital heart lesion presenting with severe cyanosis in the first days of life due
to parallel systemic and pulmonary circulations. Prompt diagnosis and balloon atrial
septostomy are often required for survival.
Question 2: In a newborn with suspected coarctation of the aorta, which
physical finding is most characteristic?
A. Bounding femoral pulses
B. Delayed or diminished femoral pulses relative to brachial pulses
C. Continuous machinery murmur at the left upper sternal border
D. Fixed splitting of the second heart sound
CORRECT ANSWER: B. Delayed or diminished femoral pulses relative to
brachial pulses
Rationale: Coarctation produces obstruction to lower-body blood flow, resulting in
radio-femoral delay or weak femoral pulses. This finding, especially when
accompanied by upper-extremity hypertension, is highly suggestive of the
diagnosis.
Question 3: Which electrocardiographic finding is most typical of an infant
with anomalous left coronary artery from the pulmonary artery (ALCAPA)?
A. Right ventricular hypertrophy
B. Deep Q waves in leads I and aVL with anterolateral ischemia
C. Complete right bundle-branch block
D. Prolonged QT interval
CORRECT ANSWER: B. Deep Q waves in leads I and aVL with anterolateral
ischemia
Page 2 of 86
,Rationale: ALCAPA leads to myocardial ischemia in the left coronary distribution
once pulmonary vascular resistance falls. Characteristic ECG changes include Q
waves and ST-T abnormalities in the lateral precordial leads.
Question 4: The ductus arteriosus is derived embryologically from which
structure?
A. Left sixth aortic arch
B. Right fourth aortic arch
C. Left fourth aortic arch
D. Third aortic arch
CORRECT ANSWER: A. Left sixth aortic arch
Rationale: The ductus arteriosus arises from the left sixth aortic arch and connects
the pulmonary artery to the descending aorta, allowing fetal right-to-left shunting
of blood away from the lungs.
Question 5: Which of the following lesions is most likely to present with a
continuous murmur?
A. Ventricular septal defect
B. Atrial septal defect
C. Patent ductus arteriosus
D. Pulmonary stenosis
CORRECT ANSWER: C. Patent ductus arteriosus
Rationale: Continuous flow through a patent ductus arteriosus throughout systole
and diastole produces the classic machinery murmur, typically heard best at the left
infraclavicular area.
Question 6: In tetralogy of Fallot, the degree of cyanosis is primarily
determined by which factor?
A. Size of the ventricular septal defect
B. Severity of right ventricular outflow tract obstruction
C. Presence of an atrial septal defect
D. Degree of aortic override
CORRECT ANSWER: B. Severity of right ventricular outflow tract obstruction
Rationale: The severity of pulmonary stenosis or right ventricular outflow tract
obstruction dictates the amount of right-to-left shunting across the VSD and
therefore the degree of systemic desaturation.
Question 7: Which medication is first-line therapy to maintain ductal patency
in a neonate with ductal-dependent systemic blood flow?
Page 3 of 86
, A. Indomethacin
B. Prostaglandin E1
C. Digoxin
D. Furosemide
CORRECT ANSWER: B. Prostaglandin E1
Rationale: Continuous infusion of prostaglandin E1 (alprostadil) maintains ductal
patency, which is critical for systemic perfusion in lesions such as hypoplastic left
heart syndrome or critical coarctation until surgical intervention can be performed.
Question 8: The most common arrhythmia requiring treatment in the pediatric
population is:
A. Atrial fibrillation
B. Supraventricular tachycardia
C. Ventricular tachycardia
D. Complete heart block
CORRECT ANSWER: B. Supraventricular tachycardia
Rationale: Supraventricular tachycardia, most often atrioventricular reentrant
tachycardia utilizing an accessory pathway, is the most frequent symptomatic
tachyarrhythmia in infants and children.
Question 9: In a child with Kawasaki disease, which coronary artery finding on
echocardiography is most concerning for long-term risk?
A. Transient coronary dilation
B. Giant coronary artery aneurysm (>8 mm)
C. Mild ectasia of the left main coronary artery
D. Normal coronary dimensions
CORRECT ANSWER: B. Giant coronary artery aneurysm (>8 mm)
Rationale: Giant coronary aneurysms carry the highest risk of thrombosis, stenosis,
and myocardial infarction and require lifelong surveillance and often
anticoagulation or antiplatelet therapy.
Question 10: Which of the following is the preferred initial imaging modality
for evaluating suspected congenital heart disease in a neonate?
A. Cardiac magnetic resonance imaging
B. Chest radiography
C. Transthoracic echocardiography
D. Computed tomography angiography
CORRECT ANSWER: C. Transthoracic echocardiography
Page 4 of 86
Practice Questions and Correct Answers
(Verified Answers) Plus Rationales
Question 1
Describe VSD
Correct Answer
The most common congenital heart defect. Seen in down syndrome, edward, patau
syndrome, fetal alcohol syndrome, TORCH. L -> R shunt with RV volume overload -
> RV hypertrophy, excessive pulmonary blood flow and high pulmonary artery
pressures -> pulmonary HTN and right sided heart hypertrophy
Question 2
How do you treat CHF?
Correct Answer
- Treat the underlying cause
- Oxygen if the patient is hypoxic or in respiratory distress.
- Medication like digitalis (for ventricular function), diuretics (decrease volume
overload and pulmonary edema), afterload reducing agents (ACE inhibitors, calcium
channel blockers) dilate vasculature and decrease the work on the heart.
Question 3
What would an EKG show in pericarditis and why?
Correct Answer
Diffusely low voltages due to insulation caused by the fluid (normally 30 mL in
adult). PR depression and ST elevation also happen.
Page 1 of 86
,Question 4
What does lying down in the left lateral position do to the heart?
Correct Answer
No effect.
Question 1: Which of the following is the most common cyanotic congenital
heart defect presenting in the neonatal period?
A. Tetralogy of Fallot
B. Transposition of the great arteries
C. Truncus arteriosus
D. Total anomalous pulmonary venous return
CORRECT ANSWER: B. Transposition of the great arteries
Rationale: Transposition of the great arteries is the most frequent cyanotic
congenital heart lesion presenting with severe cyanosis in the first days of life due
to parallel systemic and pulmonary circulations. Prompt diagnosis and balloon atrial
septostomy are often required for survival.
Question 2: In a newborn with suspected coarctation of the aorta, which
physical finding is most characteristic?
A. Bounding femoral pulses
B. Delayed or diminished femoral pulses relative to brachial pulses
C. Continuous machinery murmur at the left upper sternal border
D. Fixed splitting of the second heart sound
CORRECT ANSWER: B. Delayed or diminished femoral pulses relative to
brachial pulses
Rationale: Coarctation produces obstruction to lower-body blood flow, resulting in
radio-femoral delay or weak femoral pulses. This finding, especially when
accompanied by upper-extremity hypertension, is highly suggestive of the
diagnosis.
Question 3: Which electrocardiographic finding is most typical of an infant
with anomalous left coronary artery from the pulmonary artery (ALCAPA)?
A. Right ventricular hypertrophy
B. Deep Q waves in leads I and aVL with anterolateral ischemia
C. Complete right bundle-branch block
D. Prolonged QT interval
CORRECT ANSWER: B. Deep Q waves in leads I and aVL with anterolateral
ischemia
Page 2 of 86
,Rationale: ALCAPA leads to myocardial ischemia in the left coronary distribution
once pulmonary vascular resistance falls. Characteristic ECG changes include Q
waves and ST-T abnormalities in the lateral precordial leads.
Question 4: The ductus arteriosus is derived embryologically from which
structure?
A. Left sixth aortic arch
B. Right fourth aortic arch
C. Left fourth aortic arch
D. Third aortic arch
CORRECT ANSWER: A. Left sixth aortic arch
Rationale: The ductus arteriosus arises from the left sixth aortic arch and connects
the pulmonary artery to the descending aorta, allowing fetal right-to-left shunting
of blood away from the lungs.
Question 5: Which of the following lesions is most likely to present with a
continuous murmur?
A. Ventricular septal defect
B. Atrial septal defect
C. Patent ductus arteriosus
D. Pulmonary stenosis
CORRECT ANSWER: C. Patent ductus arteriosus
Rationale: Continuous flow through a patent ductus arteriosus throughout systole
and diastole produces the classic machinery murmur, typically heard best at the left
infraclavicular area.
Question 6: In tetralogy of Fallot, the degree of cyanosis is primarily
determined by which factor?
A. Size of the ventricular septal defect
B. Severity of right ventricular outflow tract obstruction
C. Presence of an atrial septal defect
D. Degree of aortic override
CORRECT ANSWER: B. Severity of right ventricular outflow tract obstruction
Rationale: The severity of pulmonary stenosis or right ventricular outflow tract
obstruction dictates the amount of right-to-left shunting across the VSD and
therefore the degree of systemic desaturation.
Question 7: Which medication is first-line therapy to maintain ductal patency
in a neonate with ductal-dependent systemic blood flow?
Page 3 of 86
, A. Indomethacin
B. Prostaglandin E1
C. Digoxin
D. Furosemide
CORRECT ANSWER: B. Prostaglandin E1
Rationale: Continuous infusion of prostaglandin E1 (alprostadil) maintains ductal
patency, which is critical for systemic perfusion in lesions such as hypoplastic left
heart syndrome or critical coarctation until surgical intervention can be performed.
Question 8: The most common arrhythmia requiring treatment in the pediatric
population is:
A. Atrial fibrillation
B. Supraventricular tachycardia
C. Ventricular tachycardia
D. Complete heart block
CORRECT ANSWER: B. Supraventricular tachycardia
Rationale: Supraventricular tachycardia, most often atrioventricular reentrant
tachycardia utilizing an accessory pathway, is the most frequent symptomatic
tachyarrhythmia in infants and children.
Question 9: In a child with Kawasaki disease, which coronary artery finding on
echocardiography is most concerning for long-term risk?
A. Transient coronary dilation
B. Giant coronary artery aneurysm (>8 mm)
C. Mild ectasia of the left main coronary artery
D. Normal coronary dimensions
CORRECT ANSWER: B. Giant coronary artery aneurysm (>8 mm)
Rationale: Giant coronary aneurysms carry the highest risk of thrombosis, stenosis,
and myocardial infarction and require lifelong surveillance and often
anticoagulation or antiplatelet therapy.
Question 10: Which of the following is the preferred initial imaging modality
for evaluating suspected congenital heart disease in a neonate?
A. Cardiac magnetic resonance imaging
B. Chest radiography
C. Transthoracic echocardiography
D. Computed tomography angiography
CORRECT ANSWER: C. Transthoracic echocardiography
Page 4 of 86
