Cardiology — MCQs
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A 40-year-old woman who had several episodes of rheumatic fever as a child, is currently afebrile and feels well, and has come to a hospital for monitoring echocardiography. Which of the following findings would most likely be seen in this patient's mitral valve?
A patient presents with intense chest pain of 2 hours duration. ECG shows ST depression in leads I and V1 to V4. There is associated T inversion and CPK-MB is elevated. Which of the following should be included in his management?
Which vein is most commonly thrombosed?
Which of the following murmurs increase with a Valsalva maneuver?
DASH stands for:
All the following drugs are to be avoided in hypertrophic cardiomyopathy except beta blockers.
ECG of a patient shows more than three consecutive premature ventricular contractions (PVC) with a heart rate of less than 100 beats per minute. What is the diagnosis?
A 54-year-old man presents after a syncopal episode with no recollection of the event, and bystanders report that he regained consciousness approximately 45 seconds after falling. He has a history of bipolar disorder managed with quetiapine, and recently experienced prostatitis treated with ciprofloxacin. His other medications include lisinopril and hydrochlorothiazide for hypertension, and cyclobenzaprine and a hydrocodone/acetaminophen combination pill for low back pain. On examination, the patient is alert and oriented, with a nonfocal neurological examination and an unremarkable cardiac examination. Electrocardiogram shows nonspecific ST and T wave changes and a prolonged QT interval (QTc of 540 milliseconds). What is the best initial management approach?
A patient with new-onset syncope has a blood pressure of 110/95 mmHg and a harsh systolic ejection murmur at the base, radiating to both carotids. What finding may be revealed upon auscultation of the second heart sound at the base?
In which of the following situations is intensive management of diabetes typically avoided?
Cardiology Indian Medical PG Practice Questions and MCQs
Question 1561: A 40-year-old woman who had several episodes of rheumatic fever as a child, is currently afebrile and feels well, and has come to a hospital for monitoring echocardiography. Which of the following findings would most likely be seen in this patient's mitral valve?
- A. Ballooning of valve leaflets
- B. Fibrous bridging between thickened, calcified leaflets (Correct Answer)
- C. Irregular beads of calcification in annulus
- D. Large bulky vegetation with adjacent leaflet perforation
Explanation: A history of **rheumatic fever** typically leads to **chronic rheumatic heart disease**, resulting in **thickening and fibrosis of the mitral valve** [1]. The presence of **fibrous bridging** is characteristic of rheumatic valve disease, indicating scarring and adhesion of leaflets [1]. *Irregular beads of calcification in annulus* - This finding is more suggestive of **degenerative calcific changes** rather than changes due to rheumatic heart disease. - In rheumatic fever, the mitral valve typically shows **thickened leaflets** rather than calcification at the annulus [1]. *Large bulky vegetation with adjacent leaflet perforation* - This is indicative of **infective endocarditis**, not rheumatic heart disease, which would not present with bulky vegetations [2]. - Rheumatic heart disease leads to **structural valve dysfunction** without the presence of vegetations [2]. *Ballooning of valve leaflets* - Ballooning (or myxomatous degeneration) is associated with **mitral valve prolapse**, not rheumatic heart disease. - In rheumatic fever, the leaflets are usually **thickened and fused**, rather than ballooned or prolapsed [1].
Question 1562: A patient presents with intense chest pain of 2 hours duration. ECG shows ST depression in leads I and V1 to V4. There is associated T inversion and CPK-MB is elevated. Which of the following should be included in his management?
- A. IV metoprolol
- B. Aspirin
- C. Nitroglycerine drip
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - This patient presents with symptoms and ECG findings consistent with an **ST-elevation myocardial infarction (STEMI)** or **non-ST-elevation myocardial infarction (NSTEMI)**, given the ST depression and T-wave inversions with elevated CPK-MB [4]. - All listed medications (aspirin, IV metoprolol, and nitroglycerine drip) are standard and essential components of early management used to stabilize the patient, reduce myocardial oxygen demand, and prevent further cardiac events [1]. *Aspirin* - **Aspirin** is an antiplatelet agent used to inhibit platelet aggregation and prevent further thrombus formation in acute coronary syndromes [2]. - It is critical for immediate administration in suspected myocardial infarction to reduce mortality and recurrent ischemic events. *IV metoprolol* - **IV metoprolol** (a beta-blocker) reduces myocardial oxygen demand by decreasing heart rate, contractility, and blood pressure [3]. - It is indicated in acute coronary syndromes unless contraindicated, as it can limit infarct size and reduce the risk of arrhythmias. *Nitroglycerine drip* - The **nitroglycerine drip** is a vasodilator that reduces preload and dilates coronary arteries, improving myocardial blood flow and relieving ischemic chest pain [2]. - It is particularly useful for persistent chest pain and helps reduce myocardial oxygen demand.
Question 1563: Which vein is most commonly thrombosed?
- A. Posterior tibial
- B. Short saphenous
- C. Both
- D. Long saphenous (Correct Answer)
Explanation: ***Long saphenous*** - The **long saphenous vein** is the longest vein in the body and superficial, making it highly susceptible to injury and **thrombosis**. - Its superficial location and numerous **valvular incompetence** contribute to its frequent involvement in conditions like **superficial thrombophlebitis** and **venous insufficiency**. *Short saphenous* - The **short saphenous vein** is less commonly thrombosed compared to the long saphenous vein due to its shorter length and usually less extensive network of tributaries. - While it can be affected by thrombophlebitis, it's generally less prevalent than long saphenous vein involvement. *Both* - Although both veins can be thrombosed, the **long saphenous vein** is statistically more prone to **thrombosis** and related complications due to its anatomical characteristics and frequency of **valvular dysfunction**. - The risk is not equally distributed, with the long saphenous vein having a higher incidence. *Posterior tibial* - The **posterior tibial vein** is a **deep vein**, and deep vein thrombosis (DVT) in this location is a serious condition but is distinct from superficial venous thrombosis [1]. - While it can thrombose, the question refers to the most commonly thrombosed superficial vein, which is the long saphenous.
Question 1564: Which of the following murmurs increase with a Valsalva maneuver?
- A. MR
- B. VSD
- C. AS
- D. Hypertrophic cardiomyopathy (Correct Answer)
Explanation: ***Hypertrophic cardiomyopathy*** - The Valsalva maneuver decreases **preload**, leading to a reduction in left ventricular volume and an **increased outflow tract obstruction**. - This increased obstruction accentuates the murmur of hypertrophic cardiomyopathy, making it louder. *MR* - Mitral regurgitation (MR) murmur typically **decreases** or remains unchanged with the Valsalva maneuver due to reduced **venous return** and thus reduced left ventricular preload. - A decrease in preload lessens the volume of blood being regurgitated from the left ventricle into the left atrium. *VSD* - The murmur of a ventricular septal defect (VSD) usually **decreases** during the Valsalva maneuver because of the reduction in **venous return** and consequent decrease in left-to-right shunting. - Decreased systemic vascular resistance relative to pulmonary resistance also plays a role, reducing the pressure gradient for shunting. *AS* - Aortic stenosis (AS) murmur generally **decreases** during the Valsalva maneuver due to decreased **left ventricular volume** and reduced transvalvular flow. - The reduction in preload lessens the blood ejected through the stenotic aortic valve, thereby reducing the intensity of the murmur.
Question 1565: DASH stands for:
- A. Dietary approach to stop hypertension (Correct Answer)
- B. Direct approach to surgery of hernia
- C. Dietary approach to stop hemolysis
- D. Dietary approach to stop hemorrhage
Explanation: DASH stands for: ***Dietary approach to stop hypertension*** - DASH is an acronym that describes a specific dietary pattern designed to help **prevent and control hypertension** [1]. - The diet emphasizes fruits, vegetables, whole grains, and lean proteins while limiting saturated and total fats, cholesterol, and sodium [1]. *Dietary approach to stop hemorrhage* - This option is incorrect as DASH specifically targets **blood pressure regulation**, not the prevention or treatment of hemorrhage. - While diet can influence clotting factors, the DASH diet's primary focus is on cardiovascular health through blood pressure control. *Direct approach to surgery of hernia* - This option is completely unrelated to the acronym DASH. DASH refers to a **dietary intervention**, not a surgical procedure or an approach to hernia repair. - The acronym has no medical relevance in the context of surgery. *Dietary approach to stop hemolysis* - This option is incorrect, as hemolysis refers to the **destruction of red blood cells**, which is not the primary target of the DASH diet. - While overall nutrition is important for red blood cell health, DASH is specifically formulated to lower blood pressure.
Question 1566: All the following drugs are to be avoided in hypertrophic cardiomyopathy except beta blockers.
- A. Diuretics
- B. Digitalis
- C. Nitrates
- D. Beta blockers (Correct Answer)
Explanation: ***Beta blockers*** - **Beta-blockers** are a cornerstone in the management of hypertrophic cardiomyopathy because they reduce **heart rate**, improve diastolic filling, and decrease the **outflow tract obstruction**. - They alleviate symptoms such as **chest pain** and **dyspnea** by decreasing myocardial oxygen demand and contractility. *Diuretics* - **Diuretics** should generally be avoided in hypertrophic cardiomyopathy as they can reduce **preload**, which exacerbates the **left ventricular outflow tract obstruction**. - A decrease in ventricular volume caused by diuretics can worsen symptoms and increase the risk of **syncope**. *Digitalis* - **Digitalis (digoxin)** is contraindicated in hypertrophic cardiomyopathy because its **positive inotropic effect** increases myocardial contractility. - This increased contractility can worsen the **left ventricular outflow tract obstruction** and exacerbate symptoms. *Nitrates* - **Nitrates** cause systemic **vasodilation**, which reduces both preload and afterload. - The reduction in **preload** can worsen **left ventricular outflow tract obstruction**, making nitrates generally contraindicated in HCM.
Question 1567: ECG of a patient shows more than three consecutive premature ventricular contractions (PVC) with a heart rate of less than 100 beats per minute. What is the diagnosis?
- A. Accelerated idioventricular rhythm (Correct Answer)
- B. Ventricular tachycardia with a heart rate >100 bpm
- C. Rapid ventricular rhythm with chaotic electrical activity
- D. Ventricular tachycardia resolving spontaneously with a heart rate >100 bpm
Explanation: ***Accelerated idioventricular rhythm*** - This condition is defined by three or more consecutive **premature ventricular contractions (PVCs)**, with a ventricular rate between **40 and 100 bpm**. The question specifies a heart rate less than 100 bpm, which aligns with this definition. - It often occurs in the setting of **reperfusion** after myocardial infarction or digitalis toxicity, presenting as a wide QRS rhythm that is typically benign and self-limiting [1]. *Ventricular tachycardia with a heart rate >100 bpm* - **Ventricular tachycardia (VT)** is characterized by three or more consecutive **PVCs** with a heart rate greater than 100 bpm [1]. - The patient's heart rate being less than 100 bpm excludes VT as the primary diagnosis [1]. *Rapid ventricular rhythm with chaotic electrical activity* - A rapid ventricular rhythm with **chaotic electrical activity** typically describes **ventricular fibrillation (VF)**, which is a life-threatening arrhythmia [2]. - VF involves disorganized electrical activity and lack of distinct QRS complexes, which is distinct from the structured consecutive PVCs described [2]. *Ventricular tachycardia resolving spontaneously with a heart rate >100 bpm* - While ventricular tachycardia can resolve spontaneously, its definition requires a heart rate **greater than 100 bpm** [1]. - The given heart rate of less than 100 bpm means this is not ventricular tachycardia, even if it were to resolve spontaneously.
Question 1568: A 54-year-old man presents after a syncopal episode with no recollection of the event, and bystanders report that he regained consciousness approximately 45 seconds after falling. He has a history of bipolar disorder managed with quetiapine, and recently experienced prostatitis treated with ciprofloxacin. His other medications include lisinopril and hydrochlorothiazide for hypertension, and cyclobenzaprine and a hydrocodone/acetaminophen combination pill for low back pain. On examination, the patient is alert and oriented, with a nonfocal neurological examination and an unremarkable cardiac examination. Electrocardiogram shows nonspecific ST and T wave changes and a prolonged QT interval (QTc of 540 milliseconds). What is the best initial management approach?
- A. Admit for permanent implantable cardioverter-defibrillator (ICD)
- B. Admit and begin amiodarone infusion
- C. Refer for genetic counseling
- D. Admit the patient for telemetry and evaluate for reversible causes of QT prolongation (Correct Answer)
Explanation: ***Admit the patient for telemetry and evaluate for reversible causes of QT prolongation*** * The patient experienced a **syncopal episode** with a **prolonged QT interval (QTc of 540 ms)**, which significantly increases the risk of **Torsade de Pointes (TdP)** and sudden cardiac death [1]. * **Telemetry monitoring** is crucial to detect arrhythmias, and identifying and removing **QT-prolonging medications** (quetiapine, ciprofloxacin, hydrocodone) and correcting **electrolyte imbalances** are essential initial steps [1]. *Admit for permanent implantable cardioverter-defibrillator (ICD)* * While an ICD is used for prevention of sudden cardiac death in high-risk patients, it's generally considered after **reversible causes of QT prolongation** have been addressed and the patient remains at high risk or has recurrent **life-threatening arrhythmias**. * Implanting an ICD without first attempting to manage the modifiable risk factors like certain medications or electrolyte imbalances would be premature. *Admit and begin amiodarone infusion* * **Amiodarone** is an **antiarrhythmic drug** that itself can **prolong the QT interval**, which would exacerbate the patient's existing risk for TdP. * This medication would be contraindicated in the presence of an already prolonged QT interval due to the increased risk of potentially fatal arrhythmias. *Refer for genetic counseling* * While **congenital long QT syndrome** can cause profound QT prolongation, **acquired causes** (medications, electrolyte abnormalities) are far more common, especially given the patient's extensive medication list. * Genetic counseling may be considered if reversible causes are ruled out or if there's a strong family history, but it is not the immediate best management for an acute syncopal episode with acquired QT prolongation.
Question 1569: A patient with new-onset syncope has a blood pressure of 110/95 mmHg and a harsh systolic ejection murmur at the base, radiating to both carotids. What finding may be revealed upon auscultation of the second heart sound at the base?
- A. It is accentuated.
- B. It is diminished. (Correct Answer)
- C. It is normal in character.
- D. It is widely split due to delayed ventricular ejection.
Explanation: ***It is diminished.*** - A **harsh systolic ejection murmur** radiating to the carotids, new-onset syncope, and a narrow pulse pressure (110/95 mmHg) are highly suggestive of **severe aortic stenosis** [1]. - In **severe aortic stenosis**, the aortic valve leaflets are rigid and fail to open properly, causing a significant reduction in the **aortic component of the second heart sound (A2)** due to decreased mobility and calcification [1], [2]. *It is accentuated.* - An **accentuated S2** (specifically A2) would indicate conditions like systemic hypertension or an increased closing pressure of the aortic valve, which is not consistent with severe aortic stenosis. - In **aortic stenosis**, the valve is *stiff* and *calcified*, leading to a weakened rather than an accentuated closing sound [1]. *It is normal in character.* - A **normal S2** would suggest that the aortic valve is functioning adequately or that any stenosis is mild and not significantly impacting valve closure, which contradicts the patient's symptoms and the harsh murmur. - The presence of **syncope** and a **harsh systolic murmur** strongly implies hemodynamically significant valvular disease [1]. *It is widely split due to delayed ventricular ejection.* - A **widely split S2** with delayed ventricular ejection is characteristic of **right bundle branch block** or **pulmonic stenosis**, neither of which fits the clinical picture of a harsh systolic ejection murmur radiating to the carotids. - In severe aortic stenosis, there can be a **paradoxical splitting of S2** (P2 preceding A2) due to prolonged left ventricular ejection time, but a widely split S2 due to delayed right ventricular ejection is incorrect.
Question 1570: In which of the following situations is intensive management of diabetes typically avoided?
- A. Stable diabetes with no complications
- B. Diabetes in a well-controlled state
- C. Diabetes with stable renal function post-transplant
- D. Diabetes with acute myocardial infarction (Correct Answer)
Explanation: Diabetes with acute myocardial infarction - In the setting of **acute myocardial infarction (AMI)**, aggressive **glucose lowering** can increase the risk of **hypoglycemia** and is generally avoided due to potential for worse outcomes [1]. - The primary focus in AMI is on cardiovascular stabilization, and overly tight glycemic control can lead to **metabolic stress** and adverse events, particularly in patients with a high prevalence of cardiovascular disease [1]. *Stable diabetes with no complications* - Patients with **stable diabetes** and no complications are often candidates for **intensive management** to prevent long-term microvascular and macrovascular complications [1]. - The goal is to maintain near-normal glucose levels to reduce the risk of future disease progression [1]. *Diabetes in a well-controlled state* - **Well-controlled diabetes** usually indicates that current management is effective, but further **intensification** might be considered to achieve optimal glycemic targets and minimize long-term risks if there's room for improvement. - This scenario does not inherently contraindicate intensive management, as it could still benefit from fine-tuning to achieve even tighter control without undue risk. *Diabetes with stable renal function post-transplant* - Patients with **diabetes** and stable **renal function post-transplant** often require careful but often intensive diabetes management to preserve graft function and prevent cardiovascular complications. - While medication adjustments are necessary due to altered renal clearance, the goal remains to achieve good glycemic control, potentially through intensive strategies.
Practice by Chapter
Coronary Artery Disease and Angina
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Acute Coronary Syndromes
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Heart Failure
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Cardiac Arrhythmias
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Valvular Heart Diseases
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Cardiomyopathies
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Pericardial Diseases
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Congenital Heart Disease in Adults
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Hypertension and Hypertensive Emergencies
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Pulmonary Hypertension
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Non-invasive Cardiac Diagnostics
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Preventive Cardiology
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