Cardiology Practice Questions

Q: A young female presents with chest pain not associated with exercise. Auscultation reveals multiple ejection clicks with a murmur. The most important investigation for diagnosis is:

Echocardiography. ***Echocardiography*** - **Echocardiography** is the gold standard for visualizing cardiac structures and valve function, allowing direct assessment of **mitral valve prolapse (MVP)** [1]. - The presence of **multiple ejection clicks** and a murmur in a young female with non-exertional chest pain strongly suggests MVP, which can be confirmed by echocardiography [3]. *ECG* - An **ECG** can detect arrhythmias or signs of ischemia, but it cannot directly visualize the heart valves or diagnose **mitral valve prolapse** [2]. - While some MVP patients may have T-wave abnormalities or QT prolongation, these findings are non-specific and not diagnostic. *Thallium 201 scan* - A **Thallium 201 scan** is a nuclear imaging test primarily used to assess myocardial perfusion and detect areas of ischemia, usually in the context of **coronary artery disease** [4]. - It does not provide detailed anatomical information about heart valves or cardiac chamber morphology, making it unsuitable for diagnosing **mitral valve prolapse**. *Tc pyrophosphate scan* - A **Tc pyrophosphate scan** is primarily used to diagnose **amyloidosis** or evaluate myocardial infarction, particularly for detecting late-phase complications or right ventricular involvement. - It does not offer direct visualization of valvular structures and is not indicated for the diagnosis of **mitral valve prolapse**.

Q: Obstruction in pulmonary stenosis may occur at the following sites ___________

All of the options. ***All of the options*** - Pulmonary stenosis refers to an obstruction of blood flow from the **right ventricle to the pulmonary artery**, which can occur at multiple levels. - The obstruction can be **valvular, subvalvular, or supravalvular**, affecting different anatomical locations within the right ventricular outflow tract and pulmonary artery. *Subvalvular* - This form of obstruction occurs **below the pulmonary valve**, often due to muscle bundles or an aberrant septal band. - An example is a **double-chambered right ventricle**, where an abnormal muscle band divides the right ventricle. *Valvular* - The most common site of pulmonary stenosis is at the **level of the pulmonary valve itself**, due to commissural fusion or dysplastic leaflets. - This leads to restricted opening of the valve, creating a pressure gradient during **systole**. *Supravalvular* - This obstruction occurs **above the pulmonary valve**, typically in the main pulmonary artery or its branches. - It can be an isolated lesion or associated with certain syndromes like **Alagille syndrome**.

Q: Which lipid parameter is most useful for cardiovascular risk stratification in hypertensive patients?

Cholesterol/HDL<3.5. ***Cholesterol/HDL<3.5*** - The **total cholesterol to HDL ratio** is a strong predictor of cardiovascular risk, particularly in hypertensive patients, as it integrates both pro-atherogenic (total cholesterol) and anti-atherogenic (HDL) lipid fractions [1]. - A ratio of **<3.5** generally indicates a lower cardiovascular risk, while higher ratios are associated with increased risk. *Triglycerides <150mg/dL* - While high triglycerides are an independent risk factor, a level of **<150 mg/dL** is considered normal and does not provide comprehensive cardiovascular risk stratification on its own. - High triglycerides are often associated with other metabolic abnormalities, but this single value does not reflect the balance of pro- and anti-atherogenic particles as effectively as the cholesterol/HDL ratio. *LDL cholesterol <100mg/dL* - **LDL cholesterol** is a primary target for lipid-lowering therapy, and a level of **<100 mg/dL** is generally desirable for cardiovascular health [1]. - However, relying solely on LDL might miss patients with high cardiovascular risk due to low HDL or other dyslipidemias not fully captured by LDL alone [1]. *HDL <30mg%* - **Low HDL** is an independent risk factor for cardiovascular disease [1]. However, simply using a low threshold like **<30 mg%** only identifies a subset of high-risk individuals. - This parameter doesn't account for total cholesterol levels, making the **ratio of total cholesterol to HDL** a more robust and comprehensive indicator of overall lipid-related cardiovascular risk.

Q: Which of the following is NOT true about Erythrocyanosis?

Palpable pulses. ***Palpable pulses*** - Erythrocyanosis is characterized by **vasospasm** and **vasoconstriction**, yet the large arteries typically maintain patency, allowing pulses to remain palpable. - The disease primarily affects the **small cutaneous vessels**, leading to color changes and temperature abnormalities, without usually compromising the main arterial supply to the point of unpalpable pulses. *Affects young girls* - **Erythrocyanosis** (specifically chilblain lupus or perniosis) typically affects **young women** and girls, often presenting in colder climates. - Hormonal factors and a higher prevalence of **autoimmune conditions** in females may contribute to its occurrence. *Cold peripheries* - The condition is characterized by **poor peripheral circulation** and **vasoconstriction**, leading to cold extremities, especially in response to cold exposure. - This symptom is a hallmark of erythrocyanosis and differentiates it from conditions with improved warmth or arterial insufficiency. *Ulceration and gangrene of fingers* - Although erythrocyanosis involves significant microvascular dysfunction, **ulceration and gangrene are uncommon** in this condition, differentiating it from severe forms of vasculitis or Raynaud's phenomenon. - The changes are predominantly **vasospastic** and inflammatory, rather than overtly thrombotic or ischemic, which would lead to tissue loss.

Q: True about Ebstein anomaly is ?

Right atrial dilatation. Right atrial dilatation - Ebstein anomaly is characterized by the **apical displacement** of the tricuspid valve leaflets, which incorporates a portion of the right ventricle into the right atrium, functionally increasing its size. - This **atrialization of the right ventricle** leads to significant **right atrial dilatation** as it has to handle a larger volume [1]. *Right ventricular dilatation* - While there is a functional impairment of the right ventricle due to the displaced tricuspid valve, the **working part of the right ventricle** is often small and hypoplastic, not dilated. - The "atrialized" part of the right ventricle contributes to **right atrial dilatation**, not ventricular dilatation [1]. *Left atrial dilatation* - Ebstein anomaly primarily affects the **right side of the heart**, specifically the **tricuspid valve** and right ventricle. - There is no direct anatomical or physiological mechanism in Ebstein anomaly that would typically cause **left atrial dilatation**. *Left ventricular dilatation* - Similar to left atrial dilatation, Ebstein anomaly is a **right-sided heart defect**. - **Left ventricular morphology and function** are generally preserved in Ebstein anomaly, and dilatation is not a characteristic feature.

Q: Which of the following represents a desired lipid parameter for cardiovascular risk control in hypertension?

Cholesterol/HDL 10 mg% - This option is unclear and likely misphrased, as LDL cholesterol is typically measured independently, not as a ratio to total cholesterol in this manner [1]. - Desired LDL levels are typically much lower than 100 mg/dL for high-risk individuals, and a ratio of LDL to total cholesterol greater than 0.1 (or 10%) is generally observed, but not a specific target for reduction [1]. HDL < 30 mg% - An HDL level less than 40 mg/dL (or 30 mg% for some contexts) is considered low and undesirable, as high HDL is protective against cardiovascular disease [1]. - This value would indicate increased cardiovascular risk, contrary to a desired parameter. HDL / cholesterol ratio < 3.5 - This ratio, as stated, is the inverse of the commonly used and desirable total cholesterol-to-HDL ratio. - If the HDL/cholesterol ratio were less than 3.5, it would imply a relatively low HDL compared to total cholesterol, which is an undesirable cardiovascular risk factor [1].

Q: Which of the following is not a prominent risk factor for stroke?

Moderate alcohol consumption. ***Moderate alcohol consumption*** - While excessive alcohol intake is a risk factor for stroke, **moderate alcohol consumption** (e.g., one drink per day for women, two for men) has not been consistently shown to be a prominent risk factor; some studies even suggest a potential protective effect, though this remains controversial. - The impact of moderate alcohol on stroke risk is complex and often confounded by other lifestyle factors, making it less direct and prominent compared to other listed risk factors. *Smoking* - **Smoking** is a major modifiable risk factor for stroke, significantly increasing the risk of both ischemic and hemorrhagic stroke [2]. - It damages **blood vessels**, promotes **atherosclerosis**, and increases **blood clotting**, all of which contribute to stroke. *Elevated cholesterol* - **High cholesterol levels**, particularly high low-density lipoprotein (LDL) cholesterol, contribute to the development of **atherosclerosis**, which can narrow and harden arteries in the brain and neck [3]. - This narrowing significantly increases the risk of **ischemic stroke** by forming plaques that can rupture or lead to clot formation [1]. *High blood pressure* - **High blood pressure (hypertension)** is the single most important modifiable risk factor for stroke, increasing the risk of both ischemic and hemorrhagic strokes [2]. - It directly damages **blood vessel walls**, leading to **atherosclerosis** and making vessels more prone to **rupture** (hemorrhagic stroke) or obstruction (ischemic stroke).

Q: 18 year old girl with rheumatic carditis, with mitral insufficiency. Which of the following will be seen?

Decreased functional residual capacity. Decreased functional residual capacity - **Mitral insufficiency** leads to increased left atrial pressure, which can cause **pulmonary congestion** and **edema** [1]. - This fluid accumulation in the lungs reduces lung compliance and restricts alveolar expansion, leading to a **decreased functional residual capacity (FRC)** [3]. *Increased residual volume* - **Increased residual volume** is typically seen in **obstructive lung diseases**, where air trapping occurs due to difficulty in exhaling [2]. - Mitral insufficiency, however, causes **restrictive lung physiology** due to pulmonary congestion, which would tend to decrease lung volumes, including residual volume. *Increased vital capacity* - **Increased vital capacity** indicates greater lung functional reserve, which is usually seen in healthy individuals or athletes with well-developed lung mechanics. - In cases of **pulmonary congestion** due to mitral insufficiency, lung compliance is reduced, leading to a **decrease** in vital capacity [1]. *Increased peak expiratory flow rate* - An **increased peak expiratory flow rate (PEFR)** is a measure of how fast a person can exhale air, often seen in healthy individuals or after bronchodilator use in obstructive diseases if reversible. - **Pulmonary congestion** from mitral insufficiency would instead lead to **decreased lung mechanics** and potentially a lower PEFR due to reduced lung compliance and potential airway narrowing from edema [3].

Q: Pericardial calcification is caused by all except:

Radiotherapy to the mediastinum. ***Methysergide therapy*** - **Methysergide** is known to cause **retroperitoneal fibrosis**, which can extend to the pericardium, leading to constrictive pericarditis but typically not calcification. - While it can cause pericardial fibrosis and constriction, **calcification** is not a characteristic feature of methysergide-induced pericardial disease. *Benign pericarditis* - **Benign pericarditis** (often viral) usually resolves without sequelae and does not lead to **pericardial calcification** [1]. - Recurrent inflammation rarely results in calcification unless there are specific co-morbidities or chronic effusions. *Radiotherapy to the mediastinum* - **Radiotherapy** can cause severe, **constrictive pericarditis** often accompanied by calcification, due to chronic inflammation and fibrosis [2]. - The radiation induces damage to pericardial tissues, leading to chronic inflammation and subsequent scarring and calcification. *Anticoagulant therapy* - **Anticoagulant therapy** itself does not directly cause **pericardial calcification**. - While patients on anticoagulants might develop **hemopericardium**, this does not typically progress to calcification unless there is chronic inflammation or a pre-existing condition.

Question 1

A 30 year old male was brought to the ER after a car crash. On admission, pulse is weak with BP=80/60 mmHg. ECG is shown below. Right hea catheter is placed. Which is the most consistent value with patient's diagnosis?

Accepted Answer

RA pressure Pulmonary aery pressure PCWP 16 100/30 28

Answer

RA pressure Pulmonary aery pressure PCWP 16 34/16 16

Answer

RA pressure Pulmonary aery pressure PCWP 16 45/22 20

Answer

RA pressure Pulmonary aery pressure PCWP 16 75/30 11

Question 2

A young female presents with chest pain not associated with exercise. Auscultation reveals multiple ejection clicks with a murmur. The most important investigation for diagnosis is:

Accepted Answer

Echocardiography

Answer

ECG

Answer

Thallium 201 scan

Answer

Tc pyrophosphate scan

Question 3

Obstruction in pulmonary stenosis may occur at the following sites ___________

Accepted Answer

All of the options

Answer

Subvalvular

Answer

Valvular

Answer

Supravalvular

Question 4

Which lipid parameter is most useful for cardiovascular risk stratification in hypertensive patients?

Accepted Answer

Cholesterol/HDL<3.5

Answer

Triglycerides <150mg/dL

Answer

LDL cholesterol <100mg/dL

Answer

HDL <30mg%

Question 5

Which of the following is NOT true about Erythrocyanosis?

Accepted Answer

Palpable pulses

Answer

Affects young girls

Answer

Cold peripheries

Answer

Ulceration and gangrene of fingers

Question 6

True about Ebstein anomaly is ?

Accepted Answer

Right atrial dilatation

Answer

Right ventricular dilatation

Answer

Left atrial dilatation

Answer

Left ventricular dilatation

Question 7

Which of the following represents a desired lipid parameter for cardiovascular risk control in hypertension?

Accepted Answer

Cholesterol/HDL < 3.5

Answer

LDL / cholesterol > 10 mg%

Answer

HDL < 30 mg%

Answer

HDL / cholesterol ratio < 3.5

Question 8

Which of the following is not a prominent risk factor for stroke?

Accepted Answer

Moderate alcohol consumption

Answer

Smoking

Answer

Elevated cholesterol

Answer

High blood pressure

Question 9

18 year old girl with rheumatic carditis, with mitral insufficiency. Which of the following will be seen?

Accepted Answer

Decreased functional residual capacity

Answer

Increased residual volume

Answer

Increased vital capacity

Answer

Increased peak expiratory flow rate

Question 10

Pericardial calcification is caused by all except:

Accepted Answer

Radiotherapy to the mediastinum

Answer

Benign pericarditis

Answer

Methysergide therapy

Answer

Anticoagulant therapy

Cardiology — MCQs

Cardiology — MCQs

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