Pre-Participation Cardiac Screening — RACP Paediatrics MCQ
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Correct answer: C — Suspend sport pending urgent review by an inherited-cardiac specialist service
Explanation lettering: E = shown as A · D = shown as B · B = shown as C · C = shown as D · A = shown as E
B is correct because exertional syncope during swimming plus young sudden death is an inherited-arrhythmia red flag; concealed long-QT syndrome or catecholaminergic polymorphic VT may have a normal resting ECG. A overstates the negative predictive value of one QTc. C examines structure but does not replace rhythm-focused specialist evaluation and temporary restriction. D lacks the typical trigger and prodrome of reflex syncope. E targets anomalous or atherosclerotic coronary anatomy but is not the principal first response to this inherited electrical phenotype. Specialist assessment can integrate repeat ECG, exercise testing, ambulatory monitoring, imaging and genetic counselling.
Reference: Royal Children’s Hospital Melbourne, Basic paediatric ECG interpretation: https://www.rch.org.au/clinicalguide/guideline_index/Basic_Paediatric_ECG_interpretation/; CSANZ Genetics Council Writing Group, Update on the Diagnosis and Management of Familial Long QT Syndrome: https://pubmed.ncbi.nlm.nih.gov/27262388/