Congenital Heart Disease: ABFM practice questions

4 board-style questions on congenital heart disease in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 35-year-old woman is referred for evaluation of an incidentally discovered heart murmur. Physical examination reveals a fixed split S2 and a grade 2/6 systolic ejection murmur at the left upper sternal border. ECG shows an incomplete right bundle branch block pattern. Transthoracic echocardiography reveals a secundum atrial septal defect (ASD) with a Qp:Qs ratio of 2.0:1 and mild right ventricular dilation. Right ventricular systolic pressure is estimated at 35 mmHg. Which of the following is the most appropriate management?

  1. Referral for percutaneous or surgical closure of the ASD
  2. Medical therapy with diuretics to reduce the right ventricular volume overload
  3. Reassurance and observation with echocardiographic follow-up every 5 years
  4. Initiation of pulmonary vasodilator therapy to reduce right ventricular pressure

Sample question 2

A 26-year-old man is evaluated for newly diagnosed hypertension resistant to two medications. On examination, his blood pressure is 165/95 mmHg in the right arm and 118/72 mmHg in the right leg. Femoral pulses are delayed compared to radial pulses. A continuous murmur is heard over the left interscapular area. Chest X-ray shows rib notching of the posterior third through eighth ribs bilaterally. Echocardiography demonstrates a bicuspid aortic valve. Which of the following is the most likely diagnosis?

  1. Mid-aortic syndrome
  2. Coarctation of the aorta
  3. Takayasu arteritis
  4. Renal artery stenosis due to fibromuscular dysplasia

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