Cardiology Practice Questions

Q: In which of the following conditions is a constant PR interval observed?

First degree AV block. ***First degree AV block*** - In **first-degree AV block**, every P wave is followed by a QRS complex, but the **PR interval** is consistently prolonged (usually > 0.20 seconds) [1]. - This simply indicates a **delayed conduction** through the AV node, not a missed beat or a variable PR interval [1]. *Third degree AV block* - Characterized by **complete AV dissociation**, where P waves and QRS complexes occur independently with no relationship between them. - The **PR interval is not constant** or even definable, as there is no consistent conduction from atria to ventricles. *Second degree AV block - Mobitz type I* - Also known as **Wenckebach phenomenon**, it shows a **progressive prolongation of the PR interval** until a QRS complex is dropped [1]. - Therefore, a constant PR interval is not observed; instead, it gradually lengthens over a few beats [1]. *Second degree AV block - Mobitz type II* - Involves **intermittent dropped QRS complexes** without prior PR interval prolongation [1]. - While the PR intervals of the conducted beats are constant, the **overall pattern is not one of a continuously constant PR interval** due to the dropped beats [1].

Q: A patient with native aortic valve disease presents with right hemiparesis. What is the most appropriate management to prevent further stroke?

Start dual antiplatelet therapy. Start dual antiplatelet therapy - For patients with **native aortic valve disease** and cerebral ischemia, **dual antiplatelet therapy** is recommended to prevent future embolic events due to the increased risk of thrombus formation on the diseased valve surface [1]. - This approach aims to reduce platelet aggregation and subsequent clot formation, which is the primary mechanism of stroke in this context [1]. *Initiate intravenous anticoagulation* - **Intravenous anticoagulation** is generally reserved for acute ischemic stroke in the setting of atrial fibrillation [1] or in very specific circumstances where there is a high suspicion of a cardioembolic source not amenable to antiplatelets, but it carries a higher risk of hemorrhagic transformation in acute stroke. - In valvular heart disease, long-term anticoagulation is typically with warfarin for mechanical valves, and not usually initiated acutely for native valve disease with stroke. *Start warfarin therapy* - **Warfarin** is indicated for long-term anticoagulation in patients with **mechanical prosthetic heart valves** or in specific cases of native valve disease with atrial fibrillation, but it is not the primary choice for acute stroke prevention in native aortic valve disease without other indications. - Starting warfarin acutely requires careful monitoring and takes several days to achieve therapeutic levels, making it unsuitable for immediate stroke prevention. *Administer one dose of low molecular weight heparin* - A **single dose of low molecular weight heparin (LMWH)** is insufficient for effective long-term stroke prevention in the context of native aortic valve disease. - LMWH may be used in specific situations like bridging before warfarin or for VTE prophylaxis, but not as a primary strategy for preventing recurrent cardioembolic stroke from native valve disease.

Q: A 45-year-old woman who underwent a modified radical mastectomy 4 years ago and was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months is complaining of exertional dyspnea, swelling of the legs, and periorbital edema in the morning. On examination, she has bilateral rales in the lungs, and her cardiovascular examination reveals a palpable S1, S2, S3, and S4 gallop. Her blood pressure is 149/117 mmHg, pulse rate is 80/min, and respiratory rate is 18/min. What is the most likely cause of her cardiac condition?

Drug induced cardiac toxicity. ***Drug induced cardiac toxicity*** - The patient's history of treatment with **doxorubicin**, an **anthracycline**, is a significant risk factor for **dose-dependent cardiotoxicity** that can manifest years after treatment cessation. - Clinical presentation of **exertional dyspnea**, **bilateral leg edema**, **periorbital edema**, **rales**, and **S3/S4 gallops** is classic for **dilated cardiomyopathy** secondary to anthracycline toxicity. *Pneumonia* - Lacks typical signs of **pneumonia** such as **fever**, **productive cough**, **leukocytosis**, or **consolidation** on chest examination. - The **chronic nature** of symptoms and **cardiac gallops** suggest a **chronic cardiac condition** rather than an acute infectious process. *Hypertensive cardiomyopathy* - While **hypertension** (149/117 mmHg) is present, it's likely **secondary** to heart failure rather than the primary cause given her significant **anthracycline exposure**. - **Doxorubicin-induced cardiomyopathy** typically presents as **dilated cardiomyopathy** with systolic dysfunction, which is the more likely primary etiology. *Cardiac metastasis from breast cancer* - **Cardiac metastases** from breast cancer are relatively **uncommon** and rarely present as isolated **heart failure** without other metastatic symptoms. - The **temporal relationship** with anthracycline therapy and classic presentation of **drug-induced cardiomyopathy** makes this a less likely cause of her cardiac condition.

Q: Most common complication of cardiac catheterization is:

Vascular Access Site Bleeding. ***Vascular Access Site Bleeding*** - This is the **most common complication** of cardiac catheterization, occurring in 2-6% of procedures due to the invasive nature of puncturing an artery or vein for catheter insertion. - Complications can range from a **small hematoma or bruising** to more serious issues like pseudoaneurysm formation or arteriovenous fistula. - Risk factors include larger sheath size, anticoagulation, and femoral access (compared to radial access). *Arrhythmia* - While rhythm disturbances can occur during catheterization, especially when the catheter irritates the myocardium, they are **less frequent** than access site complications. - Most arrhythmias are **transient** and resolve spontaneously without intervention. - Common types include PVCs, NSVT, and rarely sustained ventricular arrhythmias. *Contrast reaction* - Reactions to contrast media can occur, ranging from mild (e.g., rash, itching) to severe (e.g., anaphylaxis). - However, with modern non-ionic, low-osmolar contrast agents and careful patient screening, these are **not the most common complications**. - Incidence of severe reactions is less than 0.1% with modern agents. *Perforation of heart chamber* - This is a **rare but serious complication** (incidence <0.1%) that can lead to cardiac tamponade. - It is typically associated with complex procedures, stiff guidewires, or difficult anatomical features. - Its incidence is significantly lower than access site bleeding.

Q: Which of the following procedures is contraindicated in Wolff-Parkinson-White syndrome?

Procainamide. ### Procainamide - While **procainamide** can be used in Wolff-Parkinson-White (WPW) syndrome for certain **pre-excited arrhythmias**, it is generally **contraindicated** if there is an **atrial fibrillation with rapid ventricular response** because it can paradoxically shorten the refractory period of the accessory pathway. - Shortening the refractory period of the accessory pathway can lead to a **faster conduction** of atrial impulses to the ventricles, potentially causing **ventricular fibrillation** and sudden cardiac death. ### Treadmill test - A **treadmill test** is a common diagnostic tool used to evaluate the presence of **ischemic heart disease** or to assess exercise-induced arrhythmias, and is not contraindicated in WPW [2]. - It can help in risk stratification in patients with WPW by assessing the **response of the accessory pathway** to exercise [2]. ### Electrophysiological studies - **Electrophysiological studies (EPS)** are not only safe but also the **gold standard** for diagnosing and risk stratifying Wolff-Parkinson-White syndrome [1]. - EPS pinpoint the location and characteristics of the **accessory pathway**, and are often performed as a precursor to **catheter ablation** [2]. ### Oral beta blocker - Beta-blockers are generally **contraindicated** in patients with **WPW syndrome** who experience **atrial fibrillation with rapid conduction** over the accessory pathway [3]. - Similar to other AV nodal blocking agents, beta-blockers can block the normal conduction pathway, leading to an **increased reliance on the accessory pathway** and potentially dangerous ventricular rates [3].

Q: A 34-year-old man presents with dyspnea and increasing peripheral edema, following a "flu-like" illness with intermittent sharp left-sided chest pain. On examination, his jugular venous pressure is elevated at 8 cm, heart sounds are soft, and the blood pressure is 104/76 mm Hg, with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. Which of the following is the most likely diagnosis?

cardiac tamponade. ***cardiac tamponade*** - The combination of **elevated JVP**, **soft heart sounds**, and **pulsus paradoxus** (20 mmHg decrease in systolic BP during inspiration) constitutes **Beck's triad**, highly suggestive of cardiac tamponade [1]. - The history of a preceding **"flu-like" illness** could indicate a viral pericarditis, which can progress to pericardial effusion and tamponade [1]. *pulmonary hypertension* - While it can cause **dyspnea** and **peripheral edema**, it does not typically present with **pulsus paradoxus** or acutely develop after a flu-like illness with sharp chest pain in this manner. - Heart sounds would generally include a **loud P2** and may have a right-sided S3, not necessarily soft heart sounds. *ventricular septal defect* - A VSD is a **congenital heart defect** usually discovered earlier in life, although smaller defects can present in adulthood. - Its typical presentation involves a **pansystolic murmu**r and, if large, signs of heart failure, but not the acute constellation of symptoms suggesting tamponade. *coarctation of the aorta* - This condition is characterized by **differences in blood pressure** and pulses between the upper and lower extremities. - It would not typically cause **global heart sound softening** or the presence of **pulsus paradoxus**.

Q: Which of the following is a characteristic EKG finding of ventricular premature beats?

Wide QRS complex. Focusing on the characteristics of ventricular premature beats (VPBs), the EKG typically demonstrates broad, bizarre QRS complexes with no preceding P wave [1]. ***Wide QRS complex*** - A **ventricular premature beat (VPB)** originates in the ventricles, bypassing the normal His-Purkinje system [1]. - This abnormal conduction pathway through ventricular muscle causes a **delayed and wide QRS complex** (typically > 0.12 seconds) on EKG [1]. *Narrow QRS complex* - A **narrow QRS complex** (typically < 0.12 seconds) indicates that ventricular depolarization occurred through the normal His-Purkinje system. - This is characteristic of beats originating above the ventricles, such as **supraventricular premature beats** or normal sinus beats. *Fusion beat* - A **fusion beat** occurs when a beat from the sinoatrial node (or another supraventricular source) and a ventricular beat simultaneously activate the ventricles [1]. - This results in a QRS complex that is a **hybrid** of a normal QRS and a wide, aberrant QRS, but it's not the primary characteristic of a VPB itself. *AV dissociation* - **AV dissociation** refers to the atria and ventricles beating independently [1]. - While it can be seen in various arrhythmias, including some ventricular tachycardias, it is **not a characteristic finding of an isolated ventricular premature beat**.

Q: Which of the following statements is false regarding restrictive cardiomyopathy?

Filling pressure is decreased.. Filling pressure is decreased. - In restrictive cardiomyopathy, the ventricles become stiff and noncompliant, impairing filling. - This leads to increased filling pressures (e.g., elevated left and right atrial pressures) as the heart attempts to fill adequately. Left ventricular hypertrophy is present. - Left ventricular hypertrophy is common in restrictive cardiomyopathy, particularly in conditions like amyloidosis and sarcoidosis, where infiltrative processes thicken the ventricular walls. - While the chambers are not dilated, the walls can be abnormally thick due to underlying pathology. In the early phase, systolic function is impaired. - In the early stages of restrictive cardiomyopathy, systolic function is typically preserved. The primary defect is diastolic dysfunction—impaired ventricular filling. - Systolic dysfunction may develop in later stages as the underlying disease progresses or due to severe volume overload. Heart failure is predominantly right-sided. - Right-sided heart failure symptoms (e.g., peripheral edema, ascites, jugular venous distension) are often prominent in restrictive cardiomyopathy. - Due to the rigid and non-compliant ventricles inhibiting filling, both ventricles are affected, but systemic venous congestion often dominates the clinical picture.

Q: What is the characteristic feature of pain experienced in intermittent claudication?

Brought on by walking and relieved by rest.. **Brought on by walking and relieved by rest.** - **Intermittent claudication** is classically described as muscle pain or cramping in the lower extremities that is **triggered by exercise** (e.g., walking) and consistently **relieved by rest** within a few minutes [1]. - This pattern occurs due to an imbalance between the oxygen supply (limited by **atherosclerotic** narrowing of arteries) and the metabolic demand of the exercising muscles [1]. *Can occur after a few steps.* - While the pain can indeed occur after a few steps in severe cases, this statement alone does not fully define the **characteristic pattern** of intermittent claudication, which crucially includes relief with rest. - The distance at which pain occurs (claudication distance) varies with the severity of the **peripheral artery disease** [1]. *Relieved by standing still.* - For intermittent claudication, it is the cessation of muscle activity (rest), not just standing still, that provides relief. For example, a patient may stand still and still experience pain if the muscle demand has not sufficiently decreased. - Pain relief by standing still is more characteristic of **neurogenic claudication**, such as that caused by **spinal stenosis**, where positional changes can alleviate nerve compression.

Question 1

In which of the following conditions is a constant PR interval observed?

Accepted Answer

First degree AV block

Answer

Third degree AV block

Answer

Second degree AV block - Mobitz type I

Answer

Second degree AV block - Mobitz type II

Question 2

A patient with native aortic valve disease presents with right hemiparesis. What is the most appropriate management to prevent further stroke?

Accepted Answer

Start dual antiplatelet therapy

Answer

Start warfarin therapy

Answer

Initiate intravenous anticoagulation

Answer

Administer one dose of low molecular weight heparin

Question 3

A 45-year-old woman who underwent a modified radical mastectomy 4 years ago and was treated for multiple bone metastases with cyclophosphamide, doxorubicin, and fluorouracil for 6 months is complaining of exertional dyspnea, swelling of the legs, and periorbital edema in the morning. On examination, she has bilateral rales in the lungs, and her cardiovascular examination reveals a palpable S1, S2, S3, and S4 gallop. Her blood pressure is 149/117 mmHg, pulse rate is 80/min, and respiratory rate is 18/min. What is the most likely cause of her cardiac condition?

Accepted Answer

Drug induced cardiac toxicity

Answer

Pneumonia

Answer

Hypertensive cardiomyopathy

Answer

Cardiac metastasis from breast cancer

Question 4

Most common complication of cardiac catheterization is:

Accepted Answer

Vascular Access Site Bleeding

Answer

Arrhythmia

Answer

Contrast reaction

Answer

Perforation of heart chamber

Question 5

Which of the following procedures is contraindicated in Wolff-Parkinson-White syndrome?

Accepted Answer

Procainamide

Answer

Treadmill test

Answer

Electrophysiological studies

Answer

Oral beta blocker

Question 6

A 34-year-old man presents with dyspnea and increasing peripheral edema, following a "flu-like" illness with intermittent sharp left-sided chest pain. On examination, his jugular venous pressure is elevated at 8 cm, heart sounds are soft, and the blood pressure is 104/76 mm Hg, with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. Which of the following is the most likely diagnosis?

Accepted Answer

cardiac tamponade

Answer

pulmonary hypertension

Answer

ventricular septal defect

Answer

coarctation of the aorta

Question 7

In non-rheumatic atrial fibrillation, which of the following statements is true?

Accepted Answer

Paroxysmal atrial fibrillation is associated with a similar risk of stroke as persistent atrial fibrillation

Answer

Excess alcohol intake is an unlikely cause

Answer

Cardioversion may be performed without anticoagulation if a transthoracic echocardiogram is normal

Answer

The risk of stroke is less than in atrial fibrillation due to rheumatic valve disease

Question 8

Which of the following is a characteristic EKG finding of ventricular premature beats?

Accepted Answer

Wide QRS complex

Answer

Narrow QRS complex

Answer

Fusion beat

Answer

AV dissociation

Question 9

Which of the following statements is false regarding restrictive cardiomyopathy?

Accepted Answer

Filling pressure is decreased.

Answer

Left ventricular hypertrophy is present.

Answer

In the early phase, systolic function is impaired.

Answer

Heart failure is predominantly right-sided.

Question 10

What is the characteristic feature of pain experienced in intermittent claudication?

Accepted Answer

Brought on by walking and relieved by rest.

Answer

Can occur after a few steps.

Answer

Relieved by standing still.

Answer

None of the options.

Cardiology — MCQs

Cardiology — MCQs

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