Cardiology Practice Questions

Q: Which of the following is a complication of Takayasu's arteritis?

Renal hypertension. Renal hypertension - Takayasu's arteritis often causes stenosis of the renal arteries, leading to renovascular hypertension [2]. - This complication arises from the inflammatory thickening and narrowing of large arteries, including those supplying the kidneys [3]. Intimal fibrosis - While intimal fibrosis is a pathological feature seen in Takayasu's arteritis due to chronic inflammation, it is part of the disease process rather than a direct clinical complication. - The fibrosis itself contributes to the stenosis and occlusion that cause clinical complications [1], but it is not a standalone complication. Coronary aneurysm - Though Takayasu's arteritis can affect coronary arteries, it typically causes stenosis or occlusion rather than aneurysm formation. - Coronary aneurysms are more characteristic of diseases like Kawasaki disease [3]. None of the options - This option is incorrect as renal hypertension is a well-known and significant complication of Takayasu's arteritis.

Q: Which of the following statements about continuous murmurs is incorrect?

Seen with coarctation of aorta. ***Seen with coarctation of aorta*** - While coarctation of the aorta can produce a murmur, it is typically a **systolic ejection murmur**, not a continuous murmur [3]. - A continuous murmur implies flow throughout both systole and diastole, which is not characteristic of the pressure gradient across a coarctation. *Peaks at S2* - Continuous murmurs indeed often **peak around the second heart sound (S2)** [1] because the pressure gradient driving the flow is usually maximal during this period. - This peak intensity at S2 helps differentiate them from other types of murmurs. *Heard both in systole and diastole* - By definition, a continuous murmur is heard throughout **both systole and diastole**, without a clear break [2]. - This characteristic indicates a persistent pressure gradient allowing blood flow across a defect or vessel throughout the cardiac cycle. *Increase on squatting* - Squatting increases **venous return** and **systemic vascular resistance**, which generally intensifies most murmurs by increasing cardiac output and pressure gradients. - This maneuver is often used to assess the nature and severity of various cardiac murmurs [3], including continuous ones.

Q: Low QRS voltage on ECG indicates ?

Pericardial effusion. ***Pericardial effusion*** - A significant **pericardial effusion** can lead to low QRS voltage on ECG because the fluid surrounding the heart acts as an electrical insulator, dampening the electrical signals [1]. - This dampening effect reduces the amplitude of the QRS complexes recorded on the electrocardiogram [1]. *Pulmonary embolism* - While pulmonary embolism can cause various ECG changes (e.g., **S1Q3T3 pattern**, right axis deviation), it typically does not directly cause low QRS voltage. - The primary hemodynamic impact is on the right side of the heart and does not involve fluid accumulation around the heart to dampen electrical signals. *Cor pulmonale* - **Cor pulmonale** is right ventricular hypertrophy secondary to lung disease; ECG usually shows signs of **right ventricular hypertrophy** (e.g., tall R waves in V1, right axis deviation). - This condition is associated with increased electrical activity in the right ventricle, generally leading to larger, not smaller, QRS complexes in relevant leads. *Infective endocarditis* - **Infective endocarditis** affects heart valves and can cause rhythm disturbances or conduction blocks due to myocardial involvement or abscess formation. - It does not directly affect the electrical conductivity of the heart in a way that would cause generalized low QRS voltage.

Q: In Left Ventricular Hypertrophy (LVH), what is the minimum value of SV1 + RV6 in mm that suggests the presence of LVH?

35 mm. 35 mm - A combined amplitude of **SV1 + RV6 ≥ 35 mm** on an ECG is a commonly used **Sokolow-Lyon criterion** for diagnosing LVH. - This criterion demonstrates a degree of **specificity** for LVH, although its sensitivity can be limited. 25 mm - This value is **too low** and would lead to a high number of **false positives** for LVH. - While some criteria consider smaller amplitudes, **25 mm is not a standard threshold** for the Sokolow-Lyon criteria. 30 mm - This value is **below the standard threshold** for the Sokolow-Lyon criteria, potentially leading to underdiagnosis. - The accepted cut-off for **SV1 + RV6** in adults is generally higher than 30 mm. 45 mm - While a value of **45 mm** would strongly suggest LVH, it is **not the minimum threshold** for the Sokolow-Lyon criteria. - Using this higher threshold would decrease sensitivity, potentially **missing some cases** of LVH.

Q: LBBB is seen with all except

Hypokalemia (low potassium levels). ***Hypokalemia (low potassium levels)*** - **Hypokalemia** does not typically cause LBBB. Instead, it can lead to **QT prolongation**, **U waves**, and flattened T waves, and may predispose to arrhythmias like **torsades de pointes** [3]. - While electrolyte imbalances can affect cardiac conduction, LBBB is primarily associated with structural heart disease or conditions that directly impact the left bundle branch [1]. *Acute Myocardial Infarction (MI)* - **Acute MI**, particularly anterior or septal MIs, can damage the **left bundle branch**, leading to new-onset LBBB [2]. - New LBBB in the setting of acute MI often indicates a **large infarction** and is associated with a worse prognosis [2]. *Hyperkalemia (high potassium levels)* - **Severe hyperkalemia** can cause a variety of ECG changes, including **widening of the QRS complex**, which can mimic LBBB or lead to other intraventricular conduction delays. - As potassium levels rise, the ECG can progress from tall peaked T waves to a wide QRS, flattened P waves, and ultimately a **sine wave pattern** and asystole. *Ashman phenomenon (aberrant conduction in atrial fibrillation)* - The **Ashman phenomenon** is a form of aberrant ventricular conduction, typically seen during **atrial fibrillation**. It refers to a wide QRS complex that occurs after a short R-R interval preceded by a long R-R interval. - This phenomenon often exhibits a morphology consistent with **right bundle branch block (RBBB)**, but can occasionally present with a LBBB-like morphology due to differences in refractory periods of the bundle branches.

Q: What does a -30 to -90 degree axis deviation indicate?

Left Axis Deviation. ***Left Axis Deviation*** - A cardiac axis between **-30 and -90 degrees** is defined as **Left Axis Deviation (LAD)** [1]. - LAD is typically caused by conditions such as **left ventricular hypertrophy**, **inferior myocardial infarction**, or **left anterior fascicular block**. *Right Axis Deviation* - Right Axis Deviation generally refers to an axis between **+90 and +180 degrees**. - It is often associated with conditions like **right ventricular hypertrophy** or **left posterior fascicular block**. *Extreme Right Axis Deviation* - **Extreme Right Axis Deviation**, sometimes called "Northwest axis," indicates an axis between **-90 and -180 degrees**. - This is a rare finding, usually associated with severe conditions such as **ventricular tachycardia** or **pulmonary embolism**. *Normal Cardiac Axis* - A **normal cardiac axis** typically falls between **-30 and +90 degrees** [1]. - The given range of **-30 to -90 degrees** extends beyond the normal range, indicating an abnormal deviation.

Q: A patient in regular rhythm presents with absent P waves on ECG. Which of the following is the most likely diagnosis based on the ECG findings?

Atrial Flutter with Variable Block. ***Atrial Flutter with Variable Block*** - The ECG shows a **sawtooth pattern** of atrial activity, characteristic of atrial flutter, with **variable R-R intervals** indicating a variable AV block. - While **P waves are absent**, the discrete, regular flutter waves (F waves) at a rate typically around 300 bpm are visible, with ventricular responses occurring irregularly. *Atrial Fibrillation* - This rhythm is characterized by **irregularly irregular R-R intervals** and the absence of discrete P waves, with **fibrillatory waves** (f waves) that are chaotic and variable in morphology. - The provided ECG clearly shows distinct, regular **F waves** (sawtooth pattern), which is not typical for atrial fibrillation. *Multifocal Atrial Tachycardia* - Identified by at least **three different P wave morphologies** and irregular R-R intervals, with an atrial rate typically over 100 bpm. - The ECG in question shows uniform atrial waves (F waves), not multiple P wave morphologies. *Atrial Flutter with Fixed Block* - This would present with a **regular ventricular rhythm** (regular R-R intervals) because the AV node blocks a consistent number of flutter waves (e.g., 2:1, 3:1 conduction). - The ECG clearly demonstrates **irregular R-R intervals**, ruling out a fixed block.

Q: Which of the following arrhythmias is most commonly associated with alcohol binge in alcoholics?

Atrial fibrillation. ***Atrial fibrillation*** - **Atrial fibrillation** is the most common arrhythmia associated with alcohol binge, often referred to as **"holiday heart syndrome"** [1]. - Alcohol can trigger AF by affecting **autonomic tone**, causing **electrolyte imbalances**, and direct **myocardial toxicity**, leading to electrical instability in the atria. *Ventricular fibrillations* - **Ventricular fibrillation** is a life-threatening arrhythmia that leads to cardiac arrest and is typically associated with **acute myocardial infarction** or severe **structural heart disease**, not commonly alcohol binge alone [3]. - While alcohol can increase the risk of other cardiac events, VF is not the primary arrhythmia directly induced by an alcohol binge [3]. *Ventricular premature contractions* - **Ventricular premature contractions (VPCs)** are common and can be triggered by various factors including stress, caffeine, and alcohol, but they are generally benign and not the most commonly reported serious arrhythmia from alcohol binge. - While an increase in VPCs might occur, they do not carry the same clinical significance or prevalence as AF in the context of acute alcohol consumption. *Atrial flutter* - **Atrial flutter** is another atrial arrhythmia that can be seen in patients with structural heart disease or hypertension, and can be precipitated by alcohol [2]. - However, **atrial fibrillation** is far more prevalent in acute alcohol-induced arrhythmias, making it a more common association than atrial flutter [1].

Q: Low QRS voltage on ECG with left ventricular hypertrophy on Echocardiography suggests a diagnosis of:

Cardiac Amyloidosis. ***Cardiac Amyloidosis*** - **Low QRS voltage** on ECG despite echocardiographic evidence of **left ventricular hypertrophy** is a classic paradox seen in cardiac amyloidosis. - Amyloid deposits infiltrate the myocardium, increasing wall thickness but **reducing electrical activity transmission**. *Cor pulmonale* - Cor pulmonale involves **right ventricular hypertrophy** due to pulmonary hypertension, not primarily left ventricular hypertrophy. - While it can cause changes in ECG findings, the combination of low QRS voltage with LVH is not characteristic. *Infective endocarditis* - Infective endocarditis primarily affects heart valves and can cause vegetations, but it does not typically lead to **left ventricular hypertrophy** or **low QRS voltage** on ECG. - ECG findings in endocarditis are often related to conduction abnormalities or ischemia if embolization occurs. *Pericardial effusion* - A significant pericardial effusion can cause **low QRS voltage** on ECG due to the dampening effect of fluid around the heart [1]. - However, it does not typically cause **left ventricular hypertrophy**; rather, it can be associated with signs of tamponade or inflammation [1].

Q: Erb's Point in cardiology refers to:

Left sternal border at 3rd intercostal space. ***Left sternal border at 3rd intercostal space*** - **Erb's point** is a key auscultation site located at the **third intercostal space** along the **left sternal border**. - This location is particularly important because sounds from the **aortic** and **pulmonic valves** can often be heard here, as well as murmurs like the murmur of **aortic regurgitation**. *Right 2nd intercostal space* - The **right second intercostal space** at the sternal border is the primary auscultation site for the **aortic valve**. - While aortic sounds are heard at Erb's point, this specific location is not referred to as Erb's point. *Left 2nd intercostal space* - The **left second intercostal space** at the sternal border is the primary auscultation site for the **pulmonic valve**. - It is used to best hear sounds related to the pulmonary circulation, rather than being Erb's point. *Right 3rd intercostal space* - The **right third intercostal space** at the sternal border is not a primary or named auscultation point in the standard set of cardiology landmarks. - Auscultation in this area would primarily involve sounds transmitted from adjacent valve areas.

Question 1

Which of the following is a complication of Takayasu's arteritis?

Accepted Answer

Renal hypertension

Answer

None of the options

Answer

Intimal fibrosis

Answer

Coronary aneurysm

Question 2

Which of the following statements about continuous murmurs is incorrect?

Accepted Answer

Seen with coarctation of aorta

Answer

Heard both in systole and diastole

Answer

Peaks at S2

Answer

Increase on squatting

Question 3

Low QRS voltage on ECG indicates ?

Accepted Answer

Pericardial effusion

Answer

Pulmonary embolism

Answer

Cor pulmonale

Answer

Infective endocarditis

Question 4

In Left Ventricular Hypertrophy (LVH), what is the minimum value of SV1 + RV6 in mm that suggests the presence of LVH?

Accepted Answer

35 mm

Answer

25 mm

Answer

30 mm

Answer

45 mm

Question 5

LBBB is seen with all except

Accepted Answer

Hypokalemia (low potassium levels)

Answer

Acute Myocardial Infarction (MI)

Answer

Hyperkalemia (high potassium levels)

Answer

Ashman phenomenon (aberrant conduction in atrial fibrillation)

Question 6

What does a -30 to -90 degree axis deviation indicate?

Accepted Answer

Left Axis Deviation

Answer

Right Axis Deviation

Answer

Normal Cardiac Axis

Answer

Extreme Right Axis Deviation

Question 7

A patient in regular rhythm presents with absent P waves on ECG. Which of the following is the most likely diagnosis based on the ECG findings?

Accepted Answer

Atrial Flutter with Variable Block

Answer

Atrial Fibrillation

Answer

Multifocal Atrial Tachycardia

Answer

Atrial Flutter with Fixed Block

Question 8

Which of the following arrhythmias is most commonly associated with alcohol binge in alcoholics?

Accepted Answer

Atrial fibrillation

Answer

Ventricular fibrillations

Answer

Ventricular premature contractions

Answer

Atrial flutter

Question 9

Low QRS voltage on ECG with left ventricular hypertrophy on Echocardiography suggests a diagnosis of:

Accepted Answer

Cardiac Amyloidosis

Answer

Infective endocarditis

Answer

Cor pulmonale

Answer

Pericardial effusion

Question 10

Erb's Point in cardiology refers to:

Accepted Answer

Left sternal border at 3rd intercostal space

Answer

Right 2nd intercostal space

Answer

Left 2nd intercostal space

Answer

Right 3rd intercostal space

Cardiology — MCQs

Cardiology — MCQs

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