Cardiology Practice Questions

Q: What is the most common cause of death in acute rheumatic fever?

Myocarditis. ***Myocarditis*** - **Myocarditis**, or inflammation of the heart muscle, is the most serious manifestation of **acute rheumatic fever** and the most common cause of death. - Severe myocarditis can lead to **heart failure**, arrhythmias, and cardiogenic shock, which are often fatal during the acute phase [1]. *Streptococcal sepsis* - While acute rheumatic fever is triggered by a **Group A Streptococcus (GAS)** infection, death is typically due to the autoimmune response attacking the heart, not direct overwhelming sepsis [1]. - **Sepsis** would be a more direct consequence of an uncontrolled bacterial infection, whereas rheumatic fever is a post-infectious sequela. *Pericarditis* - **Pericarditis**, or inflammation of the sac surrounding the heart, can occur in acute rheumatic fever [1]. - While it can cause chest pain and effusions, isolated pericarditis is rarely fatal compared to the direct impact of myocardial damage. *Endocarditis* - **Endocarditis** in acute rheumatic fever refers to inflammation of the heart valves, resulting in damage that can lead to chronic rheumatic heart disease. - While severe valvular damage can occur, death during the **acute phase** is more commonly due to the global dysfunction of the heart muscle (**myocarditis**) rather than the immediate effects of valvular inflammation [1].

Q: For Rx of ventricular fibrillation in an adult, DC shock of what joules should be started with?

200J. 200J - For monophasic defibrillators, the initial dose for ventricular fibrillation (VF) in an adult is generally 200 joules [1]. - This dosage aims to deliver a sufficient electrical shock to depolarize the entire myocardium and terminate the arrhythmia so that the heart’s natural pacemaker can resume normal rhythm [2]. 250J - This is not the standard initial energy dose recommended for the first shock in adult ventricular fibrillation with a monophasic defibrillator. - While higher energy levels may be used for subsequent shocks if the initial lower dose is ineffective, 250J is not the typical starting point. 360J - A 360J shock is typically the maximum dose used with a monophasic defibrillator and is often reserved for subsequent shocks if initial lower energy shocks fail to convert ventricular fibrillation. - Starting with the maximum dose is not recommended due to increased risk of myocardial damage and post-shock arrhythmias. 300J - This energy level is not the standard initial dose for the first shock in adult ventricular fibrillation using a monophasic defibrillator. - While higher than 200J, it's not the recommended starting point and would typically be considered for subsequent shocks in some protocols, especially if 200J fails.

Q: Which of the following is a high pitched sound:

Opening Snap. ***Opening Snap*** - An opening snap is a **high-pitched** heart sound heard in early diastole, often associated with **mitral stenosis** [1]. - It occurs due to the abrupt opening of a **stenosed mitral valve** and is best heard with the diaphragm of the stethoscope [1]. *4th heart sound* - The fourth heart sound (**S4**) is a **low-frequency** sound, sometimes called an "atrial gallop." - It is best heard with the **bell** of the stethoscope and occurs due to atrial contraction into a stiff ventricle. *Tumour plop* - A tumour plop is a **low-pitched** sound, typically associated with an atrial myxoma. - It results from the tumor prolapsing into the ventricle during **diastole**, *1st heart sound* - The first heart sound (**S1**) is caused by the closure of the **mitral and tricuspid valves** at the beginning of systole. - While audible, it is generally considered a **mid-frequency** sound, not typically as high-pitched as an opening snap.

Q: Which of the following is a major criterion of Rheumatic fever according to Jones criteria? a) Chorea b) Erythema nodosum c) Arthritis d) Fever e) Carditis

Carditis. ***Carditis*** - **Carditis** is one of the major manifestations of rheumatic fever [1], indicating inflammation of the heart muscle, valves, or pericardium. - It is a serious complication and can lead to **rheumatic heart disease**. *Erythema nodosum* - **Erythema nodosum** is a non-specific inflammatory condition of the subcutaneous fat and is not a major or minor criterion for rheumatic fever. - It is often associated with other systemic diseases or medications. *Fever* - **Fever** is considered a minor manifestation in the Jones criteria for rheumatic fever [1]. - While common, it is less specific than major criteria like carditis or chorea [1]. *Erythema marginatum* - **Erythema marginatum** is a characteristic rash seen in rheumatic fever and is a major criterion [1]. - It is a distinctive fleeting, non-pruritic rash with red margins and a clear center. *Prolonged PR interval* - A **prolonged PR interval** on an ECG is a minor criterion for rheumatic fever, indicating first-degree AV block. - It reflects cardiac involvement but is not as severe or specific an indicator as overt carditis [1].

Q: A previously healthy patient presents with dyspnea and low grade fever since 4 months. His lungs are clear. JVP is normal. ECG showed low voltage complexes. What is the possible diagnosis?

Tuberculous pericardial effusion. ***Tuberculous pericardial effusion*** - **Dyspnea** and a **low-grade fever** persisting for several months are suggestive of **tuberculosis** [1]. - **Low voltage complexes on ECG** are characteristic of a **pericardial effusion**, where fluid dampens electrical activity [1]. *Rheumatic mitral stenosis* - While it can cause **dyspnea**, the absence of **JVP elevation** and **clear lungs** make significant heart failure less likely [2]. - ECG in mitral stenosis would typically show **left atrial enlargement** and potentially **atrial fibrillation**, not widespread low voltage. *Hypertrophic cardiomyopathy* - This condition presents with **dyspnea** and can cause **abnormal ECG findings** (e.g., left ventricular hypertrophy, Q waves), but not typically **low voltage complexes**. - **Clear lungs** and normal JVP are inconsistent with severe heart failure from the condition [3]. *Syphilitic aortic aneurysm* - This condition affects the **aorta** and can lead to **aortic regurgitation** or **aortic dissection**, but usually presents differently. - While it can cause **dyspnea** due to heart failure or mass effect, it does not typically cause **low voltage complexes on ECG** or **low-grade fever** for months as the primary presentation.

Q: Most common cause of death in Rheumatoid Arthritis?

Ischemic heart disease. ***Ischemic heart disease*** - Patients with **rheumatoid arthritis (RA)** have a significantly increased risk of developing **cardiovascular diseases**, including ischemic heart disease. [1] - This heightened risk is due to chronic systemic inflammation, accelerated atherosclerosis, and potential side effects of RA treatments contributing to **endothelial dysfunction**. [1] *Hepatic failure* - While certain medications used to treat RA, such as **methotrexate**, can cause liver toxicity, hepatic failure is not the most common cause of death in RA patients. [2] - Regular **liver enzyme monitoring** helps in detecting and managing medication-induced liver issues. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** can occur in severely ill patients, but it is not a direct or most common complication of rheumatoid arthritis nor a primary cause of death. [2] - RA can affect the lungs (e.g., interstitial lung disease), but ARDS is typically a severe, acute event triggered by other conditions like **sepsis** or trauma. *Pulmonary fibrosis* - **Interstitial lung disease (ILD)**, including pulmonary fibrosis, is a known extra-articular manifestation of RA and can be a significant cause of morbidity and mortality. [2] - However, **cardiovascular events**, particularly ischemic heart disease, still surpass pulmonary fibrosis as the leading cause of death in RA patients.

Q: Most common cause of death in adults with PDA is?

Infective endocarditis. ***Infective endocarditis*** - The abnormal blood flow and turbulent swirling within a **patent ductus arteriosus (PDA)** create an environment prone to bacterial colonization, making infective endocarditis the most common cause of death in adults with PDA. - The risk of **infective endocarditis** in adults with an untreated PDA is significant, leading to severe downstream complications. *Rupture* - While rupture is a rare complication, it is not the most common cause of death in adults with an isolated PDA, particularly when compared to infectious complications. - Rupture may be associated with other underlying cardiovascular conditions or very large PDAs, but it is not the leading cause of mortality. *Embolism* - Embolism can occur in PDA, especially paradoxical emboli in the rare event of severe pulmonary hypertension with right-to-left shunting. - However, it is less common than infective endocarditis as a primary cause of death in adults with a typical PDA. *CCF* - **Congestive cardiac failure (CCF)** is a significant complication of PDA, particularly in large shunts, leading to symptoms like dyspnea and fatigue. - While CCF can contribute to morbidity and mortality, **infective endocarditis** is generally considered the more common direct cause of death in adults with an untreated PDA.

Q: Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by

ECHO. ***ECHO*** - **Echocardiography (ECHO)** is the primary and most widely used non-invasive method for detecting cardiotoxicity due to its ability to assess **left ventricular ejection fraction (LVEF)**, a key indicator of cardiac function, and structural changes. - It is crucial for **baseline assessment**, monitoring during treatment, and follow-up, identifying both systolic and diastolic dysfunction effectively. *Endomyocardial Biopsy* - While **endomyocardial biopsy** is considered the gold standard for definitive diagnosis of some cardiomyopathies (e.g., myocarditis), it is **invasive** and carries risks such as perforation, tamponade, and arrhythmias. - It is usually reserved for cases where other non-invasive tests are inconclusive and there's a strong clinical suspicion of severe cardiac disease, or for research, not routine monitoring of cardiotoxicity. *ECG* - An **ECG** can detect arrhythmias and ischemic changes but is **not sensitive or specific** enough to reliably detect early or subtle changes in cardiac function characteristic of cardiotoxicity. - It may show changes secondary to heart failure, but it does not directly measure ejection fraction or assess overall cardiac mechanical function. *Radionuclide Scan* - **Radionuclide scans**, specifically **MUGA (Multigated Acquisition)** scans, can accurately measure **LVEF** and are an alternative to ECHO, particularly when ECHO images are suboptimal [1]. - However, they involve **radiation exposure**, making them less ideal for frequent monitoring compared to echocardiography, especially in cancer patients who are already exposed to radiation.

Q: Essential criteria for TOF includes all except ?

Ventricular septal defect. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is one of the four cardinal features of **Tetralogy of Fallot (TOF)**, not an exclusion criterion. - The VSD in TOF is typically **large and unrestrictive**, allowing for mixing of oxygenated and deoxygenated blood. *Infundibular stenosis* - **Infundibular stenosis** (pulmonary outflow tract obstruction) is a fundamental component of TOF, causing restricted blood flow to the pulmonary artery. - The degree of **right ventricular outflow tract obstruction** is the primary determinant of the clinical severity of TOF. *Overriding of aorta* - The **overriding aorta**, where the aortic root originates above both ventricles and the VSD, is a key anatomical feature of TOF. - This position allows deoxygenated blood from the right ventricle to directly enter the **systemic circulation**. *RVH* - **Right ventricular hypertrophy (RVH)** is a compensatory response to the increased pressure load on the right ventricle due to the **pulmonary stenosis** in TOF. - This **thickening of the right ventricular muscle** is an expected and essential criterion for the diagnosis of TOF.

Question 1

What is the most common cause of death in acute rheumatic fever?

Accepted Answer

Myocarditis

Answer

Streptococcal sepsis

Answer

Pericarditis

Answer

Endocarditis

Question 2

For Rx of ventricular fibrillation in an adult, DC shock of what joules should be started with?

Accepted Answer

200J

Answer

250J

Answer

360J

Answer

300J

Question 3

Which of the following is a high pitched sound:

Accepted Answer

Opening Snap

Answer

4th heart sound

Answer

Tumour plop

Answer

1st heart sound

Question 4

A 42-year-old woman is admitted to the emergency department after a fall from the balcony of her apartment. During physical examination there is an absence of heart sounds, reduced systolic pressure, reduced cardiac output, and engorged jugular veins. Which condition is most likely characterized by these signs?

Accepted Answer

Cardiac tamponade

Answer

Hemothorax

Answer

Pneumothorax

Answer

Hemopneumothorax

Question 5

Which of the following is a major criterion of Rheumatic fever according to Jones criteria?
a) Chorea
b) Erythema nodosum
c) Arthritis
d) Fever
e) Carditis

Accepted Answer

Carditis

Answer

Erythema nodosum

Answer

Fever

Answer

Prolonged PR interval

Answer

Erythema marginatum

Question 6

A previously healthy patient presents with dyspnea and low grade fever since 4 months. His lungs are clear. JVP is normal. ECG showed low voltage complexes. What is the possible diagnosis?

Accepted Answer

Tuberculous pericardial effusion

Answer

Rheumatic mitral stenosis

Answer

Hypertrophic cardiomyopathy

Answer

Syphilitic aortic aneurysm

Question 7

Most common cause of death in Rheumatoid Arthritis?

Accepted Answer

Ischemic heart disease

Answer

Hepatic failure

Answer

ARDS

Answer

Pulmonary fibrosis

Question 8

Most common cause of death in adults with PDA is?

Accepted Answer

Infective endocarditis

Answer

Rupture

Answer

Embolism

Answer

CCF

Question 9

Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by

Accepted Answer

ECHO

Answer

Endomyocardial Biopsy

Answer

ECG

Answer

Radionuclide Scan

Question 10

Essential criteria for TOF includes all except ?

Accepted Answer

Ventricular septal defect

Answer

Infundibular stenosis

Answer

Overriding of aorta

Answer

RVH

Cardiology — MCQs

Cardiology — MCQs

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