Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 1491: Treatment of asymptomatic bradycardia is

A. No treatment is required (Correct Answer)
B. Give atropine
C. Isoprenaline
D. Cardiac pacing

Explanation: **No treatment is required** - **Asymptomatic bradycardia** generally indicates that the heart rate, though slow, is sufficient to meet the body's metabolic demands. - Intervening in the absence of symptoms could be unnecessary and potentially introduce risks without clear benefit [2]. *Give atropine* - **Atropine** is typically used for **symptomatic bradycardia** (e.g., hypotension, altered mental status, chest pain) to increase heart rate by blocking parasympathetic action. - In an asymptomatic patient, its use is not indicated and could lead to side effects like tachycardia or urinary retention. *Isoprenaline* - **Isoprenaline** is a non-selective beta-agonist used to increase heart rate and contractility, often in severe bradycardia or heart block. - Like atropine, its use is reserved for **symptomatic bradycardia** or specific emergency situations, not for asymptomatic conditions. *Cardiac pacing* - **Cardiac pacing** (either temporary or permanent) is indicated for **symptomatic bradycardia** that is refractory to pharmacological treatment or for certain types of heart block [1]. - It is an invasive procedure and is not appropriate for a patient who is asymptomatic.

Question 1492: What is the Ankle-Brachial Pressure Index (ABPI) value that indicates imminent risk of necrosis?

A. < 0.6
B. 0.3 (critical ischemia)
C. 0.6 - 0.9 (indicates moderate arterial disease)
D. < 0.3 (Correct Answer)

Explanation: ***< 0.3*** - An **ABPI value less than 0.3** signifies **severe critical limb ischemia**, indicating a very high risk of tissue necrosis and limb loss [1]. - At this level, **resting pain** is common, and spontaneous **ulceration or gangrene** is highly probable due to severely compromised blood flow [1]. *0.3 (critical ischemia)* - While 0.3 is generally considered a range of **critical limb ischemia**, an ABPI *strictly less than 0.3* implies an even more severe and acute risk of necrosis [1]. - This value represents a significant stage of arterial disease, but slightly higher than the most imminent risk scenario where necrosis is almost guaranteed. *< 0.6* - An ABPI of **less than 0.6** indicates **moderate to severe peripheral arterial disease (PAD)**, where intermittent claudication is common [1]. - While concerning, it does not typically represent the immediate threat of tissue necrosis as values closer to 0.3 or below do. *0.6 - 0.9 (indicates moderate arterial disease)* - An **ABPI between 0.6 and 0.9** suggests **moderate peripheral arterial disease**, often associated with **claudication symptoms** on exertion [1]. - This range typically does not indicate an imminent risk of necrosis; while blood flow is reduced, it is usually sufficient to prevent tissue death at rest.

Question 1493: Low QRS voltage on ECG indicates ?

A. Pulmonary embolism
B. Pericardial effusion (Correct Answer)
C. Cor pulmonale
D. Infective endocarditis

Explanation: ***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.

Question 1494: Which of the following is not a high-pitched heart sound?

A. Mid-systolic click
B. Opening snap
C. Tumor plop sound (Correct Answer)
D. Pericardial friction rub

Explanation: ***Tumor plop sound*** - This sound, often associated with a **left atrial myxoma**, is typically a **low-pitched, thudding sound** caused by the tumor prolapsing into the left ventricle during diastole. - Its **low frequency** differentiates it from other high-pitched clicks or snaps. *Mid-systolic click* - This sound is a **high-pitched** event, commonly associated with the sudden tensing of **chordae tendineae** or abnormal leaflet motion in **mitral valve prolapse** [1]. - Its high frequency is characteristic of rapid tensing of intracardiac structures. *Opening snap* - An **opening snap** is a **high-pitched** diastolic sound caused by the abrupt opening of a **stenotic mitral valve** [1]. - The sound is generated by the sudden tensing of the fused valve leaflets, which creates a sharp sound. *Pericardial friction rub* - A **pericardial friction rub** is characterized by a high-pitched, scratchy, and often **creaky sound** heard in pericarditis. - It is created as inflamed visceral and parietal pericardial layers rub against each other, producing a high-frequency sound.

Question 1495: What is the most common cause of sudden death in patients with sarcoidosis?

A. Pneumonia
B. Cor pulmonale
C. Liver failure
D. Arrhythmias (Correct Answer)

Explanation: ***Arrhythmias*** - **Cardiac sarcoidosis** can lead to granulomatous infiltration of the myocardium, disrupting the **cardiac conduction system**. - This disruption can result in various **arrhythmias**, including **ventricular tachycardia** and **ventricular fibrillation**, which are frequent causes of sudden cardiac death [2]. *Pneumonia* - While sarcoidosis can affect the lungs, leading to **pulmonary fibrosis** and increased susceptibility to infection, **pneumonia** is not the most common cause of sudden death in these patients. - Death from pneumonia is typically due to **respiratory failure** which is often preceded by a period of illness rather than being sudden. *Cor pulmonale* - **Cor pulmonale** (right heart failure due to lung disease) can develop in advanced pulmonary sarcoidosis due to **pulmonary hypertension**. - While a serious complication, it generally leads to a more **gradual decline** in cardiac function rather than sudden death. *Liver failure* - **Hepatic involvement** in sarcoidosis is common, with granulomas found in the liver, but **liver failure** as a direct cause of sudden death is rare [1]. - Significant liver dysfunction usually progresses over time, leading to more chronic symptoms.

Question 1496: LBBB is seen with all except

A. Acute Myocardial Infarction (MI)
B. Hypokalemia (low potassium levels) (Correct Answer)
C. Hyperkalemia (high potassium levels)
D. Ashman phenomenon (aberrant conduction in atrial fibrillation)

Explanation: ***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.

Question 1497: The S2 heart sound is best appreciated in:

A. 2nd right intercostal space (Correct Answer)
B. 4th left intercostal space
C. 5th left intercostal space
D. 3rd left intercostal space

Explanation: ***2nd right intercostal space*** - The **S2 heart sound** is produced primarily by the closure of the **aortic and pulmonic valves** [1]. - The **aortic component (A2)** is best heard at the **right upper sternal border** (2nd right intercostal space), where the aorta is closest to the chest wall [2]. *4th left intercostal space* - This area is typically associated with the **tricuspid valve area**, where tricuspid murmurs and S3/S4 sounds related to the right ventricle can be more prominent. - While heart sounds can be heard here, it is not the primary location for appreciating the S2 sound. *5th left intercostal space* - This is the **mitral area** or **apex**, where the apical impulse is felt and the S1 heart sound (mitral component) is best heard [2]. - The S2 sound is much less prominent here compared to the base of the heart. *3rd left intercostal space* - This is often referred to as **Erb's point**, where murmurs of both aortic and pulmonic origin can sometimes be heard. - While S2 can be heard here, the **2nd right intercostal space** is superior for primarily appreciating the aortic component of S2, and the 2nd left intercostal space for the pulmonic component [2].

Question 1498: Most common cause of unilateral pedal edema

A. Pregnancy
B. Lymphedema
C. Venous insufficiency (Correct Answer)
D. Milroy disease

Explanation: ***Venous insufficiency*** - Chronic venous insufficiency is characterized by impaired venous return, leading to **increased hydrostatic pressure** in the capillaries of the lower extremities [2]. - This increased pressure forces fluid out of the capillaries into the interstitial space, causing **unilateral edema, especially in the ankle and foot** [1], [2]. *Pregnancy* - Pregnancy typically causes **bilateral pedal edema** due to increased blood volume, venous compression by the gravid uterus, and hormonal changes. - It would not usually present as a primary cause of *unilateral* pedal edema. *Lymphedema* - Lymphedema results from impaired lymphatic drainage, leading to the **accumulation of protein-rich fluid** in the interstitial space. - While it can be unilateral and cause significant swelling, **venous insufficiency is more common** as a primary cause of unilateral pedal edema. *Milroy disease* - Milroy disease is a **rare, inherited form of primary lymphedema** that typically presents at birth or in early childhood. - It is characterized by **congenital aplasia or hypoplasia of lymphatic vessels** and is not the most common cause of unilateral pedal edema in the general population.

Question 1499: The normal range for Ankle Brachial Pressure Index (ABI) is:

A. 0.8-0.9 (Mild PAD)
B. 0.5-0.8 (Moderate PAD)
C. >1.3 (Calcified arteries)
D. 1.0-1.3 (Normal) (Correct Answer)

Explanation: **1.0-1.3 (Normal)** - An **ABI** value between 1.0 and 1.3 is considered the normal range, indicating adequate blood flow to the lower extremities. - This range signifies that the **blood pressure** in the ankles is similar to or slightly higher than the blood pressure in the arms, as expected in healthy individuals [1]. * >1.3 (Calcified arteries)* - An **ABI** value greater than 1.3 usually suggests **calcification** and hardening of the arteries, making them incompressible. - This high reading often occurs in patients with **diabetes** or **chronic kidney disease** and can falsely elevate the ABI, potentially masking underlying peripheral artery disease. *0.8-0.9 (Mild PAD)* - An **ABI** in this range indicates **mild peripheral artery disease (PAD)**, where there is some reduction in blood flow, but symptoms might be subtle or only present with exertion. - Patients may experience claudication, but it's typically less severe and could improve with conservative management [1]. *0.5-0.8 (Moderate PAD)* - This range suggests **moderate peripheral artery disease (PAD)**, indicating a more significant blockage or narrowing of the arteries. - Patients often experience **intermittent claudication** and may have discomfort with less strenuous activity [1].

Question 1500: Which of the following conditions is a known cause of Right Bundle Branch Block (RBBB)?

A. Myocardial infarction
B. Cor pulmonale (Correct Answer)
C. Normal aging process
D. Pulmonary embolism

Explanation: ### Question Which of the following conditions is a known cause of Right Bundle Branch Block (RBBB)? ### Original Explanation ***Cor pulmonale*** - **Cor pulmonale** is **right ventricular hypertrophy** with or without dilation due to pulmonary hypertension, impacting the right ventricle's conduction system and causing **RBBB** [1]. - The increased pressure and strain on the right side of the heart can damage the right bundle branch, leading to a conduction delay visible as **RBBB** on an ECG [1]. *Normal aging process* - While the **normal aging process** can lead to some degenerative changes in the heart's conduction system, it more commonly causes **Left Anterior Fascicular Block** or **Left Bundle Branch Block (LBBB)**, rather than isolated RBBB. - Significant **RBBB** in an elderly individual often points to an underlying structural or physiological cause rather than mere aging. *Pulmonary embolism* - A **pulmonary embolism** can cause acute **right ventricular strain** and dilation, which can mimic **RBBB** or cause a transient RBBB pattern [1]. - However, **RBBB** is not a direct consequence of the physical obstruction but rather an effect of the resulting **acute pulmonary hypertension** and right heart strain [2]. *Myocardial infarction* - A **myocardial infarction** affecting the **septum** or the **right ventricle** can damage the right bundle branch, leading to **RBBB**. - However, the most classic ECG finding of a myocardial infarction is **ST-segment elevation** or **new Q waves**, with **RBBB** being a potential complication rather than a direct cause [3].

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Cardiomyopathies

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Congenital Heart Disease in Adults

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Cardiology — MCQs

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