Cardiology Practice Questions

Q: A 55-year-old hypertensive patient presents with severe chest pain radiating to the back. What does a CT scan of the thorax typically reveal?

Type B Aortic dissection. ***Type B Aortic dissection*** - A CT scan of the thorax would show a **tear in the descending aorta**, typically distal to the left subclavian artery, consistent with a type B dissection. - The combination of **hypertension** and **severe chest pain radiating to the back** is highly suggestive of an aortic dissection, and involvement of the descending aorta (Type B) often presents with radiating back pain. *Type A Aortic dissection* - A type A dissection involves the **ascending aorta**, which would typically present with chest pain radiating to the neck or jaw, or acute onset of symptoms suggestive of a stroke or myocardial infarction. - While it's also an aortic dissection, its location is different, and the pain typically radiates to different areas. *Pulmonary Embolism* - A **pulmonary embolism** would appear as a filling defect in the pulmonary arteries on a CT angiogram, not a tear in the aorta. - Though it can cause chest pain, it's typically pleuritic and not usually described as severe and radiating to the back in the same manner as an aortic dissection. *Thoracic Aortic Aneurysm* - A **thoracic aortic aneurysm** is a localized dilation of the aorta, not a tear, and it typically presents with chronic or less acute symptoms unless it ruptures or causes compression. - While an aneurysm can be present, the acute and severe nature of the pain described points more strongly to an acute event like dissection rather than a stable aneurysm.

Q: What electrolyte imbalance is most commonly associated with prominent U waves on ECG?

Hypokalemia. ***Hypokalemia*** - **Prominent U waves** on an ECG are a classic sign of **hypokalemia**, indicating delayed repolarization of ventricular myocardial cells. - Other ECG changes associated with hypokalemia include **ST-segment depression**, **flattened T waves**, and a prolonged QT interval. *Hyponatremia* - **Hyponatremia** primarily affects neurological function and can lead to symptoms like confusion and seizures [1]. - It does not typically cause specific characteristic ECG changes such as **prominent U waves**. *Hypocalcemia* - **Hypocalcemia** is often associated with a **prolonged QT interval** on an ECG, which reflects delayed ventricular repolarization [2]. - However, it is not primarily linked to the appearance of prominent U waves. *Hypercalcemia* - **Hypercalcemia** is known to cause a **shortened QT interval** on the ECG due to accelerated repolarization. - It does not typically manifest with prominent U waves.

Q: What does the CEAP score classify?

Chronic venous disorder. ***Chronic venous disorder*** - The **CEAP classification** is a standardized system for classifying **chronic venous disorders** [1]. - It stands for **Clinical, Etiological, Anatomical, and Pathophysiological**, providing a comprehensive description of the disease. *Atrial disorders* - **Atrial disorders** refer to conditions affecting the atria of the heart, such as atrial fibrillation, and are classified using different systems. - The CEAP score has **no relevance** to cardiac conditions. *Neurological disorders* - **Neurological disorders** pertain to conditions of the nervous system and are classified by systems tailored to their specific characteristics. - The CEAP score is **not applicable** to neurological diagnoses. *Traumatic disorders* - **Traumatic disorders** result from physical injury and are classified based on the nature and severity of the injury. - The CEAP score is **irrelevant** for assessing or classifying traumatic injuries.

Q: Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Amiodarone infusion. ***Amiodarone infusion*** - **Amiodarone** is a **Class III antiarrhythmic** drug commonly used in advanced cardiac life support (ACLS) protocols for refractory **ventricular fibrillation (VF)** or **pulseless ventricular tachycardia (VT)** that persists despite defibrillation and epinephrine [1]. - It works by blocking potassium channels, prolonging repolarization and the refractory period, which helps to stabilize the electrical activity of the heart. *Atropine* - **Atropine** is an anticholinergic drug primarily used to treat **symptomatic bradycardia** by increasing heart rate. - It is not indicated for the treatment of **ventricular fibrillation** or **ventricular tachycardia** during cardiac arrest. *High dose vasopressin* - **Vasopressin** was previously included in some ACLS algorithms as an alternative to epinephrine for **vasoconstrictive effects**, but recent guidelines do not support its routine use in cardiac arrest. - While it can cause **vasoconstriction**, there is no evidence that high-dose vasopressin improves outcomes in refractory VF/VT over epinephrine. *Adenosine* - **Adenosine** is an antiarrhythmic drug used to treat **supraventricular tachycardias (SVTs)** by transiently blocking the AV node. - It is not effective for **ventricular fibrillation** or **ventricular tachycardia** and can even be harmful in these rhythms.

Q: In a patient presenting with an ECG that shows ST-segment elevation but with a myocardial stunning pattern that does not correspond to a single coronary artery territory, what is the most likely diagnosis?

Takotsubo cardiomyopathy. **Takotsubo cardiomyopathy** - This condition is often triggered by **severe emotional or physical stress** and presents with acute chest pain, mimicking an MI, but with a distinctive pattern of **apical ballooning** or other regional wall motion abnormalities that do not correspond to a single coronary artery territory. - The ECG findings of **ST-segment elevation** associated with a myocardial stunning pattern that does not follow a specific coronary artery distribution are classic for Takotsubo cardiomyopathy, which is also known as **stress-induced cardiomyopathy**. *Restrictive cardiomyopathy* - This is characterized by **stiff, non-compliant ventricular walls** causing impaired diastolic filling, often leading to heart failure symptoms. - While it can cause abnormal ECG findings, it typically does not present with **acute ST-segment elevation** or a myocardial stunning pattern in a non-coronary distribution. *Brugada syndrome* - This is a **genetic channelopathy** associated with characteristic **ECG patterns (ST-segment elevation in V1-V3)** and an increased risk of ventricular arrhythmias and sudden cardiac death. - It is primarily an **electrical disorder** and does not involve myocardial stunning or wall motion abnormalities that mimic an acute myocardial infarction without corresponding coronary artery disease. *Pericarditis* - This condition involves **inflammation of the pericardium**, presenting with chest pain that often improves when leaning forward and widespread, **concave ST-segment elevation** on ECG. - While it causes ST-segment elevation, it does not typically show the specific **myocardial stunning pattern** or regional wall motion abnormalities that are characteristic of Takotsubo cardiomyopathy.

Q: Roth spots are associated with which of the following conditions?

Acute leukaemia. **Acute leukaemia** - **Roth spots** are commonly observed in patients with **leukaemia**, characterized by **retinal hemorrhages** with pale centers due to leukemic cell infiltrates [1]. - The presence of these lesions is often an indicator of severe systemic disease [1]. *Bacterial endocarditis* - While **bacterial endocarditis** can cause various **ophthalmologic manifestations** like splinter hemorrhages and Janeway lesions, **Roth spots** are distinctly identified as hemorrhages with pale centers, which, though they can occur, are less characteristically associated than with leukaemia. - These hemorrhages in endocarditis are usually attributed to **immune complex deposition** or **septic emboli**. *Severe Hypertension* - **Severe hypertension** can lead to **hypertensive retinopathy**, presenting as **retinal hemorrhages**, cotton wool spots, and papilledema. - However, the classic description of **Roth spots** with their pale centers is not a direct or prominent feature of hypertensive retinopathy. *None of the options* - This option is incorrect because **Acute leukaemia** is clearly associated with **Roth spots**.

Q: In which of the following conditions is the implantation of an Automatic Implantable Cardioverter Defibrillator (AICD) indicated?

Ventricular tachycardia with structural heart disease. ***Ventricular tachycardia with structural heart disease*** - An **AICD** is strongly indicated for patients with **sustained ventricular tachycardia (VT)** in the presence of **structural heart disease** due to the high risk of sudden cardiac death [1]. - In these cases, the AICD can deliver **therapy (antitachycardia pacing or defibrillation)** to terminate life-threatening arrhythmias [1]. *Syncope due to arrhythmias* - While syncope due to arrhythmias can be serious, an **AICD** is not always the first or only treatment and its indication depends on the specific arrhythmia and underlying cause. - Other treatments like **ablation**, **antiarrhythmic medications**, or a **pacemaker** might be more appropriate depending on the type of arrhythmia (e.g., bradycardia). *None of the options* - This option is incorrect because **ventricular tachycardia with structural heart disease** is a clear and well-established indication for AICD implantation [1]. - AICDs are a cornerstone in the secondary prevention of sudden cardiac death in high-risk patients. *Brugada syndrome* - While **Brugada syndrome** carries a risk of sudden cardiac death, AICD implantation is typically reserved for patients who have experienced **symptomatic arrhythmias** (e.g., syncope, aborted sudden cardiac death) or have certain high-risk features, not for all asymptomatic cases. - Risk stratification in Brugada syndrome is complex, and an AICD is not universally indicated for every diagnosed individual.

Q: What are the potential causes of cardiogenic shock excluding myocardial infarction?

acute mitral regurgitation. ***acute mitral regurgitation*** - Severe acute mitral regurgitation can lead to **cardiogenic shock** by causing a sudden increase in left atrial pressure and pulmonary edema, reducing effective forward flow [1]. - This condition can result from **papillary muscle rupture** or dysfunction, often due to ischemia even in the absence of a large MI, or from infective endocarditis [1]. *ventricular septal rupture* - A ventricular septal rupture (VSR) is a mechanical complication of **myocardial infarction (MI)**, which is explicitly excluded in the question. - VSR creates a **left-to-right shunt**, leading to pulmonary overload and reduced systemic cardiac output, but it's fundamentally post-MI. *right heart failure* - While right heart failure can cause circulatory collapse, it is typically a component of **biventricular failure** or isolated in cases like severe pulmonary embolism [2]. - The question asks for causes of cardiogenic shock excluding MI, and pure **right heart failure** as a sole cause of global cardiogenic shock (affecting systemic perfusion) is less common without significant left heart involvement or severe pulmonary vascular disease. *All of the options* - This option is incorrect because **ventricular septal rupture** is almost exclusively a complication of myocardial infarction, which the question explicitly excludes. - Therefore, not all listed conditions are potential causes of cardiogenic shock *excluding MI*.

Q: The severity of mitral stenosis can be judged by-

Loud S1. ***Loud S1*** - A **loud S1** in mitral stenosis indicates that the **mitral valve leaflets are still mobile** and able to snap shut forcefully, which is characteristic of early to moderate stenosis [2]. - As mitral stenosis becomes more severe and the valve becomes calcified and rigid, the S1 sound may become diminished or even absent due to reduced leaflet mobility [1]. *Intensity of murmur* - The **intensity (loudness)** of the diastolic murmur in mitral stenosis **does not directly correlate with the severity** of the stenosis. - A loud murmur can be heard with mild stenosis, while a soft murmur in severe stenosis may be due to reduced cardiac output or left atrial pressure. *Duration of murmur* - While a **longer duration of the diastolic murmur** can coincide with more severe mitral stenosis, it is not as reliable a single indicator as other findings. - The duration is influenced by the pressure gradient across the valve and the length of diastole [2]. *Presence of left ventricular S3* - A **left ventricular S3** is typically associated with **left ventricular dysfunction** and volume overload, as seen in conditions like mitral regurgitation or dilated cardiomyopathy [3]. - It is **not a feature of mitral stenosis**, where the primary issue is obstruction to left ventricular filling.

Q: Which of the following is not typically used for secondary prevention of myocardial infarction?

Warfarin. ***Warfarin*** - While Warfarin is an **anticoagulant**, its primary role is in preventing *thromboembolism* in conditions like **atrial fibrillation** [1] or **mechanical heart valves**, not routinely for general **secondary prevention of MI** unless specific indications exist. - Unlike the other options, it doesn't directly address the underlying plaque rupture or reduce the workload of the heart in the typical post-MI patient. *Aspirin* - **Aspirin** is a cornerstone of secondary prevention after MI due to its **antiplatelet** effects, which help prevent future clot formation [2]. - It reduces the risk of recurrent MI, stroke, and cardiovascular death by inhibiting **platelet aggregation** [2]. *Statins* - **Statins** are crucial for secondary prevention as they aggressively lower **LDL cholesterol** levels, stabilizing existing plaques and preventing further plaque progression. - They have pleiotropic effects beyond lipid lowering, including **anti-inflammatory** and **endothelial function improvement**. *Beta blockers* - **Beta blockers** reduce myocardial oxygen demand by decreasing heart rate and contractility, which helps prevent recurrent ischemic events and improves survival post-MI [3]. - They are particularly beneficial in patients with **left ventricular dysfunction** or **hypertension** following an MI [1].

Question 1

A 55-year-old hypertensive patient presents with severe chest pain radiating to the back. What does a CT scan of the thorax typically reveal?

Accepted Answer

Type B Aortic dissection

Answer

Type A Aortic dissection

Answer

Pulmonary Embolism

Answer

Thoracic Aortic Aneurysm

Question 2

What electrolyte imbalance is most commonly associated with prominent U waves on ECG?

Accepted Answer

Hypokalemia

Answer

Hyponatremia

Answer

Hypocalcemia

Answer

Hypercalcemia

Question 3

What does the CEAP score classify?

Accepted Answer

Chronic venous disorder

Answer

Atrial disorders

Answer

Neurological disorders

Answer

Traumatic disorders

Question 4

Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Accepted Answer

Amiodarone infusion

Answer

Atropine

Answer

Adenosine

Answer

High dose vasopressin

Question 5

In a patient presenting with an ECG that shows ST-segment elevation but with a myocardial stunning pattern that does not correspond to a single coronary artery territory, what is the most likely diagnosis?

Accepted Answer

Takotsubo cardiomyopathy

Answer

Restrictive cardiomyopathy

Answer

Brugada syndrome

Answer

Pericarditis

Question 6

Roth spots are associated with which of the following conditions?

Accepted Answer

Acute leukaemia

Answer

Bacterial endocarditis

Answer

Severe Hypertension

Answer

None of the options

Question 7

In which of the following conditions is the implantation of an Automatic Implantable Cardioverter Defibrillator (AICD) indicated?

Accepted Answer

Ventricular tachycardia with structural heart disease

Answer

None of the options

Answer

Syncope due to arrhythmias

Answer

Brugada syndrome

Question 8

What are the potential causes of cardiogenic shock excluding myocardial infarction?

Accepted Answer

acute mitral regurgitation

Answer

All of the options

Answer

ventricular septal rupture

Answer

right heart failure

Question 9

The severity of mitral stenosis can be judged by-

Accepted Answer

Loud S1

Answer

Duration of murmur

Answer

Intensity of murmur

Answer

Presence of left ventricular S3

Question 10

Which of the following is not typically used for secondary prevention of myocardial infarction?

Accepted Answer

Warfarin

Answer

Aspirin

Answer

Statins

Answer

Beta blockers

Cardiology — MCQs

Cardiology — MCQs

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