How cardiology is examined
The RACP Divisional Written Examination for Paediatrics & Child Health has two papers: Clinical Applications (100 questions, 3 hours 10 minutes) and Medical Sciences (70 questions, 2 hours 10 minutes). Most questions are single-answer MCQs with four options, plus a small number of extended matching questions, and some use images such as X-rays or ECGs. The score is combined across both papers, and the pass mark is set with the modified Angoff method; the RACP notes it has historically ranged between 55% and 65%. The paediatric blueprint sets a target number of items for each specialty, so check the current blueprint on the RACP website.
Congenital heart disease
| Lesion | Key features |
|---|---|
| VSD | Pansystolic murmur at lower left sternal edge; large lesions cause heart failure at 4 to 6 weeks |
| ASD | Fixed split second heart sound, ejection murmur |
| PDA | Continuous murmur; common in preterm infants |
| Tetralogy of Fallot | Cyanosis, hypercyanotic spells, boot-shaped heart |
| Transposition | Cyanosis in the first days; prostaglandin to keep the duct open |
| Coarctation | Weak femoral pulses, upper limb hypertension |
Innocent versus pathological murmurs
- Innocent murmurs: soft, systolic, short, vary with posture, no symptoms or signs.
- Pathological: diastolic, loud (grade 3 or more), thrill, symptoms, abnormal pulses or cyanosis.
- A duct-dependent lesion can present with shock as the duct closes in the first weeks.
Kawasaki disease and rheumatic fever
| Condition | Key points |
|---|---|
| Kawasaki disease | Fever 5 days plus 4 of 5 features; IVIG and aspirin; echocardiography for coronary aneurysms |
| Acute rheumatic fever | Jones criteria; benzathine benzylpenicillin secondary prophylaxis; high risk in Aboriginal and Torres Strait Islander and Maori and Pacific children |
Worked questions
Worked question 1 · Kawasaki
A 3-year-old has 6 days of fever, conjunctival injection, red cracked lips, a polymorphous rash and swollen hands. What is the most important treatment?
- A Oral amoxicillin
- B IVIG with aspirin
- C Oral prednisolone alone
- D Supportive care only
- E Intravenous ceftriaxone
Show the reasoning
Answer B. This meets criteria for Kawasaki disease. IVIG within 10 days of fever onset reduces the risk of coronary artery aneurysms; echocardiography is needed.
Worked question 2 · Cyanosis
A 2-day-old is cyanosed, with oxygen saturations not improving on 100% oxygen. What is the most appropriate immediate treatment while awaiting cardiology?
- A Intravenous prostaglandin E1
- B Intravenous furosemide bolus
- C Indomethacin
- D Adenosine
- E High-flow oxygen alone for 24 hours
Show the reasoning
Answer A. Cyanotic heart disease that fails the hyperoxia test may be duct-dependent. Prostaglandin E1 keeps the ductus arteriosus open until definitive care. Indomethacin would close it.
A 4-week cardiology revision block
| Week | Focus |
|---|---|
| 1 | Congenital heart disease |
| 2 | Murmurs, ECGs and arrhythmias |
| 3 | Kawasaki disease and rheumatic fever |
| 4 | Heart failure and mixed questions |
Pair each week with 25 timed questions a day and review every explanation, including the options you ruled out.
Common traps
- Giving indomethacin in duct-dependent lesions.
- Missing incomplete Kawasaki disease.
- Ignoring femoral pulses.
- Forgetting rheumatic fever risk groups.
Free sample cardiology questions
Questions from our Paediatrics (RACP) bank. Choose your answer, then open the explanation.
Which feature suggests an innocent murmur in a well child?
- AFixed split S2
- BLoud harsh pansystolic with thrill
- CSoft systolic, changes with posture
- DDiastolic murmur heard at the left sternal edge
- EAssociated failure to thrive
Show answer and explanation
Answer C. Innocent murmurs are soft, systolic, short, often vary with posture or breathing, with no thrill or symptoms. Diastolic murmurs, thrills, loud murmurs and symptoms need echocardiography.
Learning point: Innocent murmur: soft, systolic, variable, asymptomatic; 7 S features.
Which defects make up tetralogy of Fallot?
- AASD, PDA, coarctation, AS
- BCoarctation, bicuspid aortic valve and mitral stenosis
- CTransposition and VSD
- DVSD, ASD, PDA, MR
- EVSD, RVOT obstruction, overriding aorta, RVH
Show answer and explanation
Answer E. Tetralogy of Fallot: VSD, right ventricular outflow tract obstruction, overriding aorta, right ventricular hypertrophy. "Tet spells" are treated with knee-chest position, oxygen, morphine and fluids.
Learning point: TOF: VSD, RVOTO, overriding aorta, RVH; tet spells: knee-chest.
A 4-day-old becomes grey and shocked with weak femoral pulses. What is the immediate drug?
- AOral digoxin
- BIV indomethacin to close the ductus arteriosus
- CIV adenosine
- DProstaglandin E1 (alprostadil) infusion
- EIV frusemide only
Show answer and explanation
Answer D. Collapse in the first week with poor femoral pulses suggests a duct-dependent systemic lesion (coarctation, critical AS, hypoplastic left heart) as the duct closes. Prostaglandin E1 reopens the duct; watch for apnoea.
Learning point: Neonatal collapse with weak femorals: start prostaglandin E1 (watch apnoea).
Practise more cardiology questions free
Every cardiology subtopic in our bank
The bank holds 15 cardiology questions across 15 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Acute rheumatic fever1
- Coarctation signs1
- Duct-dependent lesions1
- Heart failure in infants1
- Hypercyanotic spells1
- Infective endocarditis prophylaxis1
- Innocent murmur1
- Kawasaki complication1
- Long QT1
- Myocarditis1
- Supraventricular tachycardia treatment1
- SVT in infants1
- Syncope with exercise1
- Tetralogy of Fallot1
- VSD1
Common questions
Is ECG interpretation tested?
The RACP notes some questions require interpreting ECGs and images.
When should IVIG be given in Kawasaki disease?
Ideally within 10 days of fever onset, with aspirin.
What is the key test for cyanotic heart disease?
Echocardiography; the hyperoxia test helps distinguish cardiac from respiratory causes.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.