1
ABP PEDIATRIC CARDIOLOGY CERTIFICATION EXAMINATION FULL-
LENGTH PRACTICE EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF ...
1.
A term newborn develops severe cyanosis within the first several hours of life.
Physical examination reveals tachypnea, a single loud second heart sound, and
minimal cardiac murmur despite oxygen saturation remaining approximately 65%.
Echocardiography demonstrates atrial-level mixing, ventriculoarterial discordance,
and parallel rather than serial systemic and pulmonary circulations. The infant
becomes increasingly hypoxemic despite supplemental oxygen. Which immediate
intervention is most appropriate to improve systemic oxygenation while definitive
surgical correction is arranged?
A. Intravenous prostaglandin E1 infusion
B. Indomethacin infusion
C. Intravenous furosemide
D. Oral propranolol
Answer: A. Intravenous prostaglandin E1 infusion
2.
A 6-week-old infant is evaluated for poor weight gain, diaphoresis with feeding,
tachypnea, and recurrent respiratory symptoms. Echocardiography demonstrates a
large ventricular septal defect with significant left-to-right shunting, left atrial and
ventricular enlargement, and elevated pulmonary blood flow. The infant has no
evidence of pulmonary vascular obstructive disease. Which physiological
abnormality is primarily responsible for the clinical manifestations?
A. Decreased pulmonary blood flow caused by right ventricular outflow
obstruction
B. Increased pulmonary blood flow and pulmonary venous return
C. Complete mixing of systemic and pulmonary venous blood
D. Fixed obstruction of systemic ventricular outflow
Answer: B. Increased pulmonary blood flow and pulmonary venous return
,2
3.
A 3-month-old infant presents with progressive cyanosis and episodes of marked
irritability during which the infant becomes deeply cyanotic and assumes a
squatting-like posture. Echocardiography reveals a large ventricular septal defect,
overriding aorta, right ventricular outflow tract obstruction, and right ventricular
hypertrophy. During a severe episode, which intervention is most appropriate as an
immediate bedside measure?
A. Place the infant in the knee-chest position and administer oxygen
B. Administer a large dose of intravenous digoxin
C. Restrict all fluids and administer oral hydrochlorothiazide
D. Administer indomethacin to close the ductus arteriosus
Answer: A. Place the infant in the knee-chest position and administer oxygen
4.
A newborn with suspected critical congenital heart disease develops profound
cyanosis shortly after birth. Echocardiography demonstrates pulmonary atresia
with an intact ventricular septum, severe tricuspid hypoplasia, and essentially
absent antegrade pulmonary blood flow. Which physiological mechanism is most
important for maintaining pulmonary circulation before definitive intervention?
A. Left-to-right flow through the ventricular septum
B. Ductus arteriosus–dependent pulmonary blood flow
C. Coronary artery–to–pulmonary artery collateral flow only
D. Increased pulmonary vascular resistance
Answer: B. Ductus arteriosus–dependent pulmonary blood flow
5.
A newborn with severe respiratory distress and cyanosis is diagnosed with total
anomalous pulmonary venous return in which all pulmonary veins drain into a
,3
vertical vein that ultimately reaches the innominate vein and superior vena cava.
Echocardiography shows marked pulmonary venous obstruction. Which clinical
presentation would be most characteristic of this obstructed form of the lesion?
A. Mild cyanosis with pulmonary oligemia
B. Severe cyanosis, respiratory distress, and pulmonary edema
C. Isolated systemic hypertension
D. Asymptomatic systolic murmur without cyanosis
Answer: B. Severe cyanosis, respiratory distress, and pulmonary edema
6.
A 4-year-old child is found to have a harsh systolic murmur during a routine
examination. Blood pressure measurements demonstrate significantly higher
pressures in both arms than in the legs, and femoral pulses are delayed and
diminished. Echocardiography confirms narrowing of the descending thoracic
aorta near the site of the ductal insertion. Which additional finding is most likely in
an older child with this condition?
A. Continuous machinery murmur throughout diastole
B. Rib notching on chest radiography
C. Severe pulmonary venous congestion
D. Marked peripheral cyanosis of the lower extremities
Answer: B. Rib notching on chest radiography
7.
A 7-year-old child is diagnosed with an atrial septal defect after evaluation of a
fixed, widely split second heart sound. Echocardiography demonstrates a moderate
secundum defect with significant left-to-right shunting and right ventricular
volume overload. The child has no pulmonary hypertension or ventricular
dysfunction. Which finding most strongly supports closure of the defect?
A. Presence of right ventricular volume overload
B. Presence of a soft innocent murmur
, 4
C. Normal pulmonary artery pressure
D. Normal left ventricular systolic function
Answer: A. Presence of right ventricular volume overload
8.
A newborn is diagnosed with pulmonary atresia with an intact ventricular septum.
Catheterization demonstrates severe right ventricular hypoplasia and significant
coronary sinusoids, with portions of the right coronary circulation dependent on
high right ventricular pressure. Which intervention should generally be avoided
because of the potential for myocardial ischemia?
A. Prostaglandin E1 infusion
B. Decompression of the right ventricle without assessing coronary dependence
C. Maintaining ductal patency
D. Careful coronary anatomy assessment
Answer: B. Decompression of the right ventricle without assessing coronary
dependence
9.
A 2-year-old child with tetralogy of Fallot has undergone complete surgical repair.
Several years later, the child develops exercise intolerance and echocardiography
demonstrates severe pulmonary regurgitation with progressive right ventricular
dilation. Cardiac MRI confirms substantial right ventricular enlargement. Which
intervention is most likely to be considered when ventricular size and function
reach clinically important thresholds?
A. Pulmonary valve replacement
B. Mitral valve replacement
C. Aortic coarctation repair
D. Closure of a patent foramen ovale
Answer: A. Pulmonary valve replacement
ABP PEDIATRIC CARDIOLOGY CERTIFICATION EXAMINATION FULL-
LENGTH PRACTICE EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF ...
1.
A term newborn develops severe cyanosis within the first several hours of life.
Physical examination reveals tachypnea, a single loud second heart sound, and
minimal cardiac murmur despite oxygen saturation remaining approximately 65%.
Echocardiography demonstrates atrial-level mixing, ventriculoarterial discordance,
and parallel rather than serial systemic and pulmonary circulations. The infant
becomes increasingly hypoxemic despite supplemental oxygen. Which immediate
intervention is most appropriate to improve systemic oxygenation while definitive
surgical correction is arranged?
A. Intravenous prostaglandin E1 infusion
B. Indomethacin infusion
C. Intravenous furosemide
D. Oral propranolol
Answer: A. Intravenous prostaglandin E1 infusion
2.
A 6-week-old infant is evaluated for poor weight gain, diaphoresis with feeding,
tachypnea, and recurrent respiratory symptoms. Echocardiography demonstrates a
large ventricular septal defect with significant left-to-right shunting, left atrial and
ventricular enlargement, and elevated pulmonary blood flow. The infant has no
evidence of pulmonary vascular obstructive disease. Which physiological
abnormality is primarily responsible for the clinical manifestations?
A. Decreased pulmonary blood flow caused by right ventricular outflow
obstruction
B. Increased pulmonary blood flow and pulmonary venous return
C. Complete mixing of systemic and pulmonary venous blood
D. Fixed obstruction of systemic ventricular outflow
Answer: B. Increased pulmonary blood flow and pulmonary venous return
,2
3.
A 3-month-old infant presents with progressive cyanosis and episodes of marked
irritability during which the infant becomes deeply cyanotic and assumes a
squatting-like posture. Echocardiography reveals a large ventricular septal defect,
overriding aorta, right ventricular outflow tract obstruction, and right ventricular
hypertrophy. During a severe episode, which intervention is most appropriate as an
immediate bedside measure?
A. Place the infant in the knee-chest position and administer oxygen
B. Administer a large dose of intravenous digoxin
C. Restrict all fluids and administer oral hydrochlorothiazide
D. Administer indomethacin to close the ductus arteriosus
Answer: A. Place the infant in the knee-chest position and administer oxygen
4.
A newborn with suspected critical congenital heart disease develops profound
cyanosis shortly after birth. Echocardiography demonstrates pulmonary atresia
with an intact ventricular septum, severe tricuspid hypoplasia, and essentially
absent antegrade pulmonary blood flow. Which physiological mechanism is most
important for maintaining pulmonary circulation before definitive intervention?
A. Left-to-right flow through the ventricular septum
B. Ductus arteriosus–dependent pulmonary blood flow
C. Coronary artery–to–pulmonary artery collateral flow only
D. Increased pulmonary vascular resistance
Answer: B. Ductus arteriosus–dependent pulmonary blood flow
5.
A newborn with severe respiratory distress and cyanosis is diagnosed with total
anomalous pulmonary venous return in which all pulmonary veins drain into a
,3
vertical vein that ultimately reaches the innominate vein and superior vena cava.
Echocardiography shows marked pulmonary venous obstruction. Which clinical
presentation would be most characteristic of this obstructed form of the lesion?
A. Mild cyanosis with pulmonary oligemia
B. Severe cyanosis, respiratory distress, and pulmonary edema
C. Isolated systemic hypertension
D. Asymptomatic systolic murmur without cyanosis
Answer: B. Severe cyanosis, respiratory distress, and pulmonary edema
6.
A 4-year-old child is found to have a harsh systolic murmur during a routine
examination. Blood pressure measurements demonstrate significantly higher
pressures in both arms than in the legs, and femoral pulses are delayed and
diminished. Echocardiography confirms narrowing of the descending thoracic
aorta near the site of the ductal insertion. Which additional finding is most likely in
an older child with this condition?
A. Continuous machinery murmur throughout diastole
B. Rib notching on chest radiography
C. Severe pulmonary venous congestion
D. Marked peripheral cyanosis of the lower extremities
Answer: B. Rib notching on chest radiography
7.
A 7-year-old child is diagnosed with an atrial septal defect after evaluation of a
fixed, widely split second heart sound. Echocardiography demonstrates a moderate
secundum defect with significant left-to-right shunting and right ventricular
volume overload. The child has no pulmonary hypertension or ventricular
dysfunction. Which finding most strongly supports closure of the defect?
A. Presence of right ventricular volume overload
B. Presence of a soft innocent murmur
, 4
C. Normal pulmonary artery pressure
D. Normal left ventricular systolic function
Answer: A. Presence of right ventricular volume overload
8.
A newborn is diagnosed with pulmonary atresia with an intact ventricular septum.
Catheterization demonstrates severe right ventricular hypoplasia and significant
coronary sinusoids, with portions of the right coronary circulation dependent on
high right ventricular pressure. Which intervention should generally be avoided
because of the potential for myocardial ischemia?
A. Prostaglandin E1 infusion
B. Decompression of the right ventricle without assessing coronary dependence
C. Maintaining ductal patency
D. Careful coronary anatomy assessment
Answer: B. Decompression of the right ventricle without assessing coronary
dependence
9.
A 2-year-old child with tetralogy of Fallot has undergone complete surgical repair.
Several years later, the child develops exercise intolerance and echocardiography
demonstrates severe pulmonary regurgitation with progressive right ventricular
dilation. Cardiac MRI confirms substantial right ventricular enlargement. Which
intervention is most likely to be considered when ventricular size and function
reach clinically important thresholds?
A. Pulmonary valve replacement
B. Mitral valve replacement
C. Aortic coarctation repair
D. Closure of a patent foramen ovale
Answer: A. Pulmonary valve replacement
