Cardiology Practice Questions

Q: Which one of the following is not an early complication of acute myocardial infarction?

Dressler's syndrome. ***Dressler's syndrome*** - **Dressler's syndrome** (post-myocardial infarction syndrome) is a **late complication** of acute myocardial infarction, typically occurring weeks to months after the event. - It is an **immune-mediated pericarditis**, characterized by chest pain, fever, and pericardial effusion, but is not seen immediately following an MI. *Papillary muscle dysfunction* - **Papillary muscle dysfunction** or rupture can occur as an **early complication** due to ischemia and necrosis of the muscle, leading to **mitral regurgitation** [1]. - This usually manifests within hours to days of the infarct, especially in **inferior MIs** affecting the posterior papillary muscle. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is an **early mechanical complication** resulting from necrosis and rupture of the interventricular septum. - It typically presents within the **first week** after an MI, causing a new **holosystolic murmur** and signs of heart failure. *Pericarditis* - **Early pericarditis** (within a few days of MI) results from inflammation overlying the necrotic myocardial tissue [1]. - It presents with **pleuritic chest pain** that improves with leaning forward and a **pericardial friction rub**, and is distinct from Dressler's syndrome.

Q: Wide pulse pressure is seen in all except which of the following?

Aortic stenosis. **Aortic stenosis** - In **aortic stenosis**, there is a fixed obstruction to left ventricular outflow, leading to a compensatory increase in systolic pressure to overcome the stenotic valve [2]. - The **reduced stroke volume** and impaired flow through the rigid valve cause a lower pulse pressure, often resulting in a **narrow pulse pressure**. *PDA (Patent Ductus Arteriosus)* - In **PDA**, blood flows from the aorta to the pulmonary artery during systole and diastole, causing a decrease in diastolic pressure. - This creates a **run-off phenomenon**, leading to a **wide pulse pressure** due to high systolic and low diastolic pressures. *Aortic Regurgitation* - **Aortic regurgitation** involves blood flowing back into the left ventricle during diastole, causing a rapid fall in diastolic pressure [1]. - The increased stroke volume from the left ventricle leads to a high systolic pressure, resulting in a **wide pulse pressure** [1]. *A.V. malformation (Arteriovenous Malformation)* - An **AV malformation** creates a shunt where arterial blood flows directly into the venous system, bypassing the capillary bed. - This leads to a **decrease in peripheral resistance** and an increased cardiac output, causing a higher systolic pressure and a lower diastolic pressure, thereby producing a **wide pulse pressure**.

Q: In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Mitral stenosis. ***Mitral stenosis*** - **Mitral stenosis** leads to an obstruction of blood flow from the **left atrium to the left ventricle**, causing pressure buildup in the left atrium [1]. - This increased pressure over time results in **left atrial enlargement** as the chamber struggles to push blood through the narrowed valve [1]. *Tricuspid regurgitation* - **Tricuspid regurgitation** involves the backflow of blood from the **right ventricle to the right atrium**. - This condition primarily affects the **right side of the heart**, leading to **right atrial enlargement**, not left. *AR* - **Aortic regurgitation (AR)** is the backflow of blood from the **aorta into the left ventricle**. - While AR can cause **left ventricular enlargement** and eventually lead to left atrial dilation, it is not the most common direct cause of *primary* left atrial enlargement compared to mitral stenosis [2]. *None of the options* - **Mitral stenosis** is a well-established cause of significant left atrial enlargement due to the direct pressure overload it imposes on the left atrium [1].

Q: Refer to the provided ECG image. It demonstrates which of the following?

Ventricular fibrillation (VF). ***Ventricular fibrillation (VF)*** - The ECG shows a chaotic, **irregular electrical activity** with no distinguishable P waves, QRS complexes, or T waves. - This disorganized electrical pattern is characteristic of VF, indicating a severe cardiac emergency. *Supraventricular tachycardia (SVT)* - SVT is characterized by a **rapid, regular rhythm** with narrow QRS complexes, which are absent in this chaotic tracing. - While fast, SVT typically maintains some degree of organized electrical activity, unlike the provided ECG. *Atrial fibrillation (AF)* - AF presents with irregularly irregular rhythm and **absent P waves**, but it still has identifiable **narrow QRS complexes**. - The provided ECG lacks any discernible QRS complexes, making AF an unlikely diagnosis. *Wolff-Parkinson-White (WPW) syndrome* - WPW syndrome is characterized by a **short PR interval** and a **delta wave** on the ECG due to an accessory pathway. - It involves an organized rhythm, although it can predispose to tachyarrhythmias, and doesn't present as the chaotic rhythm shown.

Q: A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?

Early Revascularization with PCI. ***Early Revascularization with PCI*** - The patient presents with **NSTEMI** (ST depression, elevated troponins) and is already on antiplatelet and anticoagulant therapy. **Early revascularization** (ideally within 24 hours for high-risk NSTEMI) is indicated to restore blood flow and prevent further myocardial damage [1]. - Given the patient's history of prior **PCI** and the current NSTEMI presentation, this suggests possible **in-stent restenosis** or progression of coronary artery disease, making revascularization crucial. *Continue conservative management and monitoring of cardiac enzymes and ECG* - While initial conservative management with medications is appropriate, simply continuing monitoring without definitive intervention is insufficient for a **high-risk NSTEMI** patient. - The elevated troponins and ST depression indicate ongoing myocardial injury that requires active management beyond just observation [1]. *Continue conservative management and plan for outpatient follow-up* - This approach is entirely inappropriate for a patient presenting with an **acute coronary syndrome (NSTEMI)**. - Outpatient follow-up is for stable conditions, not for an ongoing cardiac event that requires urgent hospital-based intervention. *Immediate Revascularization with Coronary Angiography* - **Immediate revascularization** (within 90 minutes) is primarily indicated for **STEMI** (ST elevation myocardial infarction). - While coronary angiography will precede PCI, the term "immediate" in this context usually refers to the urgency seen in STEMI; NSTEMI typically warrants "early" rather than "immediate" intervention (within 12-24 hours for high-risk patients like this one) [1].

Q: Which of the following is associated with WPW syndrome?

Ebstein anomaly. ***Ebstein anomaly*** - **Ebstein anomaly** is a congenital heart defect characterized by apical displacement of the septal and posterior leaflets of the tricuspid valve, which is strongly associated with **Wolff-Parkinson-White (WPW) syndrome.** - WPW syndrome, involving an **accessory pathway** that bypasses the AV node [1], is found in 5-25% of patients with Ebstein anomaly, predisposing them to re-entrant tachycardias [3]. *TOF* - **Tetralogy of Fallot (TOF)** is a complex cyanotic congenital heart defect that includes four main features: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [2]. - There is no direct or strong association between TOF and WPW syndrome. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect where there is an opening in the interventricular septum, allowing blood to flow between the ventricles [4]. - While VSDs can occur with other cardiac anomalies, there is no specific or frequent association with WPW syndrome. *TAPVC* - **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a rare congenital heart defect where all four pulmonary veins connect to the systemic venous circulation instead of the left atrium. - This condition does not have a recognized association with WPW syndrome.

Q: Subclavian steal syndrome is

Reversal of blood flow in the ipsilateral vertebral artery. ***Reversal of blood flow in the ipsilateral vertebral artery*** - Subclavian steal syndrome occurs due to a **proximal stenosis** or **occlusion of the subclavian artery**. - This causes blood to be "stolen" from the **ipsilateral vertebral artery**, flowing retrograde to supply the arm and thereby reducing blood flow to the brainstem. *Reversal of blood flow in the contralateral carotid artery* - The carotid arteries supply blood to the brain directly and are typically not directly involved in thesteal phenomenon in this specific syndrome. - Reversal of flow in the carotid artery would indicate a much more severe and different pathology, not characteristic of subclavian steal. *Reversal of blood flow in the contralateral vertebral artery* - The steal phenomenon specifically involves the vertebral artery on the **same side (ipsilateral)** as the subclavian artery obstruction. - The contralateral vertebral artery would typically continue to supply blood to the brain without a reversed flow in this syndrome. *B/L reversal of blood flow in vertebral arteries* - Subclavian steal syndrome is generally a **unilateral phenomenon**, affecting the vertebral artery ipsilateral to the subclavian artery stenosis. - Bilateral reversal would imply bilateral subclavian artery obstruction or other severe cerebrovascular disease, which is not the definition of subclavian steal syndrome itself.

Q: Under which condition are steroids administered in rheumatic fever?

Presence of carditis. **Presence of carditis** - **Carditis** is the most serious manifestation of **rheumatic fever**, as it can lead to permanent **rheumatic heart disease** [1]. - **Corticosteroids** are administered to reduce the inflammation of the heart in cases of moderate to severe carditis, preventing or minimizing long-term damage [1]. *Presence of subcutaneous nodules* - **Subcutaneous nodules** are a minor manifestation of **rheumatic fever** and do not typically require steroid administration. - They are generally **painless** and resolve spontaneously, and their presence alone does not indicate the need for such aggressive anti-inflammatory treatment. *Presence of multiple symptoms* - The presence of **multiple minor symptoms** or asymptomatic major symptoms (other than **carditis**) does not warrant steroid use. - Steroid administration is reserved for situations with high potential for **morbidity** or **mortality**, such as severe **cardiac inflammation** [1]. *Presence of chorea* - **Sydenham's chorea** is a neurological manifestation of **rheumatic fever** and is usually managed with **antidopaminergic drugs** (e.g., haloperidol) or sedatives. - While it can be distressing, **corticosteroids** are generally not indicated for chorea unless there is co-existing **carditis** [1].

Q: This patient came to the casualty with palpitations. His ECG has been shown below. What is your diagnosis?

Supraventricular tachycardia. ***Supraventricular tachycardia*** - The ECG shows a **narrow QRS complex tachycardia** (QRS < 0.12 seconds) with a **regular rhythm** and a **rapid ventricular rate** of 150-250 bpm, which is characteristic of SVT. The P waves may be hidden within the QRS or T waves. - While specific findings for SVT types (e.g., AVNRT, AVRT) aren't detailed without more specific ECG leads or maneuvers, the overall morphology points to a supraventricular origin. *Ventricular tachycardia* - **Ventricular tachycardia** is characterized by a **wide QRS complex** (> 0.12 seconds) tachycardia, which is not seen in the provided ECG. - It often presents with **AV dissociation** (P waves dissociated from QRS complexes) and fusion beats, which are absent here. *A-V dissociation* - **AV dissociation** refers to the atria and ventricles beating independently, which can be seen in VT or complete heart block. - It is a specific ECG finding and not a primary diagnosis, especially in the context of a narrow complex tachycardia like the one shown. *Sinus tachycardia* - **Sinus tachycardia** also presents with a narrow QRS complex but is characterized by a **normal P wave morphology** preceding each QRS complex with a rate typically not exceeding 150 bpm in an adult. - The rate in the given ECG is significantly higher, and distinct P waves are likely not preceding every QRS complex, ruling out sinus tachycardia.

Q: In which of the following conditions is differential cyanosis observed?

PDA with reversal of shunt. ***PDA with reversal of shunt*** - **Differential cyanosis** is characteristic of a **patent ductus arteriosus (PDA)** with **Eisenmenger syndrome**, where the shunt reverses due to pulmonary hypertension [1]. - Deoxygenated blood from the pulmonary artery shunts into the **descending aorta** distal to the origin of the subclavian arteries, resulting in cyanosis of the lower extremities while the upper extremities remain pink [1]. *VSD with reversal of shunt* - A **ventricular septal defect (VSD)** with reversed shunt typically causes **generalized cyanosis** because deoxygenated blood is shunted from the right ventricle to the left ventricle, affecting both systemic circulations [2]. - It does not produce differential cyanosis unless accompanied by coexisting cardiac anomalies that selectively affect blood flow to different parts of the body. *ASD with reversal of shunt* - An **atrial septal defect (ASD)** with reversed shunt leads to **generalized cyanosis**, as deoxygenated blood from the right atrium enters the left atrium and mixes with oxygenated blood, distributing cyanosis throughout the body [2]. - The mixing of blood occurs at the atrial level, affecting systemic circulation uniformly rather than differentially. *Tetralogy of Fallot* - **Tetralogy of Fallot** causes **generalized cyanosis** due to the right-to-left shunt through a large VSD, forcing deoxygenated blood into the systemic circulation [3]. - The degree of cyanosis depends on the severity of the right ventricular outflow tract obstruction, but it is not typically differential [3].

Question 1

Which one of the following is not an early complication of acute myocardial infarction?

Accepted Answer

Dressler's syndrome

Answer

Pericarditis

Answer

Papillary muscle dysfunction

Answer

Ventricular septal defect

Question 2

Wide pulse pressure is seen in all except which of the following?

Accepted Answer

Aortic stenosis

Answer

Aortic Regurgitation

Answer

PDA

Answer

A.V. malformation

Question 3

In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Accepted Answer

Mitral stenosis

Answer

Tricuspid regurgitation

Answer

AR

Answer

None of the options

Question 4

Refer to the provided ECG image. It demonstrates which of the following?

Accepted Answer

Ventricular fibrillation (VF)

Answer

Supraventricular tachycardia (SVT)

Answer

Atrial fibrillation (AF)

Answer

Wolff-Parkinson-White (WPW) syndrome

Question 5

A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?

Accepted Answer

Early Revascularization with PCI

Answer

Continue conservative management and monitoring of cardiac enzymes and ECG

Answer

Continue conservative management and plan for outpatient follow-up

Answer

Immediate Revascularization with Coronary Angiography

Question 6

Which of the following is associated with WPW syndrome?

Accepted Answer

Ebstein anomaly

Answer

TOF

Answer

VSD

Answer

TAPVC

Question 7

Subclavian steal syndrome is

Accepted Answer

Reversal of blood flow in the ipsilateral vertebral artery

Answer

Reversal of blood flow in the contralateral carotid artery

Answer

Reversal of blood flow in the contralateral vertebral artery

Answer

B/L reversal of blood flow in vertebral arteries

Question 8

Under which condition are steroids administered in rheumatic fever?

Accepted Answer

Presence of carditis

Answer

Presence of subcutaneous nodules

Answer

Presence of multiple symptoms

Answer

Presence of chorea

Question 9

This patient came to the casualty with palpitations. His ECG has been shown below. What is your diagnosis?

Accepted Answer

Supraventricular tachycardia

Answer

Ventricular tachycardia

Answer

A-V dissociation

Answer

Sinus tachycardia

Question 10

In which of the following conditions is differential cyanosis observed?

Accepted Answer

PDA with reversal of shunt

Answer

VSD with reversal of shunt

Answer

ASD with reversal of shunt

Answer

Tetralogy of Fallot

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?