Cardiology Practice Questions

Q: The murmur of mitral regurgitation is best heard at

Cardiac apex. ***Cardiac apex*** - The **mitral valve** is located at the cardiac apex, and the murmur of **mitral regurgitation** is typically loudest at this point [1]. - Mitral regurgitation creates a **holosystolic murmur** that radiates to the axilla [1]. *Tricuspid area* - This area is located at the **lower left sternal border** and is where murmurs originating from the **tricuspid valve** are best heard, such as tricuspid regurgitation [2]. - Murmurs heard here are not characteristic of mitral valve dysfunction. *Aortic area* - The aortic area is at the **right upper sternal border**, primarily for auscultation of the **aortic valve**. - Conditions like **aortic stenosis** or **aortic regurgitation** are best heard here [3]. *Pulmonary area* - This area is located at the **left upper sternal border** and is where murmurs related to the **pulmonic valve** are best heard. - Examples include **pulmonic stenosis** or **pulmonic regurgitation**.

Q: Which one of the following is correct with regard to Carey Coombs murmur?

Soft mid-diastolic murmur due to mitral valvulitis. ***Soft mid-diastolic murmur due to mitral valvulitis*** - The **Carey Coombs murmur** is a soft, mid-diastolic murmur heard in acute rheumatic fever, characterized by inflammation of the mitral valve (mitral valvulitis) [4]. - It is distinct from the Austin Flint murmur and indicates active **rheumatic carditis** [4]. *Harsh early diastolic murmur due to aortic regurgitation* - An early diastolic murmur, especially a harsh one, typically indicates **aortic regurgitation**, which is a different valvular pathology [3]. - The Carey Coombs murmur is described as soft and mid-diastolic, not harsh and early diastolic. *Soft systolic murmur due to mitral regurgitation* - A soft systolic murmur suggests **mitral regurgitation**, which is a backflow of blood during systole [2]. - The Carey Coombs murmur is specifically a diastolic murmur, differentiating it from systolic murmurs [3]. *Blowing late systolic murmur due to aortic stenosis* - A blowing late systolic murmur is characteristic of **aortic stenosis**, where there is narrowing of the aortic valve. - The Carey Coombs murmur is an early to mid-diastolic murmur, related to mitral valve inflammation, not aortic stenosis [1].

Q: Consider the following statements for diagnosing ventricular aneurysm in a patient with recent myocardial infarction : I. Paradoxical impulse on chest wall II. Persistent ST elevation on ECG III. Unusual bulge from cardiac silhouette on X-ray IV. Presence of pulsus paradoxsus Which of the above are correct?

I, II and III. ***I, II and III*** - A **paradoxical impulse** on the chest wall (statement I) is a classic physical finding, indicating dyskinetic movement of the aneurysm during systole [1]. - **Persistent ST segment elevation** on ECG weeks to months after a myocardial infarction (statement II) is a hallmark sign, often reflecting the fibrous scar tissue of the aneurysm [1]. - An **unusual bulge** from the cardiac silhouette on X-ray (statement III) can indicate an enlarged left ventricular contour due to the aneurysm [1]. *II, III and IV* - While statements II and III are correct for diagnosing ventricular aneurysm, **pulsus paradoxus** (statement IV) is typically associated with **cardiac tamponade** or severe asthma/COPD, not directly with ventricular aneurysms. *I and II only* - Statements I and II are indeed correct indicators, but statement III, the **cardiac silhouette bulge on X-ray**, is also a valid and often observed finding for ventricular aneurysm [1]. *I and IV* - Statement I is correct, but **pulsus paradoxus** (statement IV) is not a diagnostic feature of ventricular aneurysm; it suggests conditions like **pericardial effusion** with tamponade.

Q: Which of the following heart sounds are best heard with the bell of stethoscope? I. Opening snap II. Systolic click III. Third heart sound IV. Mid diastolic murmur Select the correct answer using the code given below :

III and IV. ***III and IV*** - The **bell of the stethoscope** is designed to auscultate **low-pitched sounds** due to its larger surface area and lighter application to the skin. - The **third heart sound (S3)** and **mid-diastolic murmurs** (e.g., from mitral stenosis) are classic examples of low-pitched sounds best heard with the bell [2]. *II and III only* - While the **third heart sound (S3)** is correctly identified as being heard with the bell, the **systolic click** is a high-pitched sound [1]. - **Systolic clicks**, often associated with mitral valve prolapse, are best heard with the **diaphragm** of the stethoscope [1]. *I, II and III* - This option incorrectly includes both the **opening snap** and **systolic click** as being best heard with the bell. - The **opening snap** (related to mitral stenosis) and **systolic click** (related to mitral valve prolapse) are typically **high-pitched sounds** and are better heard with the **diaphragm** [1], [3]. *I and IV* - This option incorrectly states that the **opening snap** is best heard with the bell. - Although the **mid-diastolic murmur** is correctly identified as a low-pitched sound [2], the **opening snap** is a high-pitched sound [1], [3], making the entire option incorrect.

Q: Smoking is considered to be a modifiable risk factor for Coronary Heart Disease. Consider the following statements with regard to possible mechanisms on the basis of which it acts as a risk factor : 1. Nicotine stimulation of adrenergic drive raises the blood pressure and myocardial oxygen demand. 2. It increases carbon monoxide and induces atherogenesis. 3. It leads to fall in protective high density lipoproteins. 4. It reduces the apolipoprotein-B plasma levels. Which of the statements given above are correct ?

1, 2 and 3. **1, 2 and 3** - **Nicotine** in cigarette smoke stimulates the adrenergic nervous system, leading to increased heart rate, **vasoconstriction**, and elevated blood pressure, which **increases myocardial oxygen demand**. - **Carbon monoxide** from smoking binds to hemoglobin, reducing oxygen delivery to the myocardium, and also contributes to **endothelial damage** and **atherogenesis**. Smoking also **lowers HDL ("good" cholesterol)**, which normally helps remove cholesterol from arteries. *2, 3 and 4* - This option is incorrect because statement 4 is false; smoking typically **increases** apolipoprotein-B levels, associated with increased LDL cholesterol, not reduces them. - While statements 2 and 3 are correct mechanisms, the inclusion of statement 4 makes this option incorrect. *1 and 3 only* - This option is incomplete as it misses the crucial role of **carbon monoxide** in inducing atherogenesis (statement 2), which is a well-established mechanism of smoking-related CHD. - While statements 1 and 3 are correct mechanisms, the absence of statement 2 makes this option less comprehensive. *1 and 2 only* - This option omits the significant effect of smoking on **high-density lipoproteins (HDL)**; smoking is known to cause a **fall in protective HDL levels**, contributing to increased CHD risk. - While statements 1 and 2 are correct mechanisms, the exclusion of statement 3, which is also correct, makes this option incomplete.

Q: Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Muffled heart sounds. ***Muffled heart sounds*** - Pericardial tamponade involves an accumulation of fluid in the **pericardial sac**, which dampens sound transmission and results in **muffled heart sounds** [1]. - This is a key component of **Beck's triad**, indicating compromised cardiac filling. *Collapsed neck veins* - In pericardial tamponade, there is a significant increase in **intrapericardial pressure**, which impedes venous return to the heart [1]. - This typically leads to **distended neck veins** (elevated jugular venous pressure), not collapsed ones. *Tachycardia* - While **tachycardia** can be present as a compensatory mechanism due to reduced cardiac output in tamponade, it is a non-specific finding. - It is not considered part of the **classical Beck's triad**, which specifically focuses on the triad of muffled heart sounds, hypotension, and elevated jugular venous pressure. ***Decreased arterial pressure*** - The increased intrapericardial pressure in tamponade severely restricts **ventricular filling**, leading to a reduction in stroke volume and subsequently **decreased cardiac output** [1], [2]. - This reduction in cardiac output manifests as systemic **hypotension** (decreased arterial pressure), which is a critical finding in tamponade.

Q: Deep vein thrombosis of calf is best managed by :

anticoagulants. ***Anticoagulants*** - **Anticoagulation** therapy is the cornerstone of DVT management, preventing clot extension and reducing the risk of **pulmonary embolism** [1]. - Medications like **heparin**, **low molecular weight heparin**, or **direct oral anticoagulants (DOACs)** are commonly used [1]. *active physiotherapy* - While physical activity can prevent DVT, it is generally **contraindicated in acute DVT** due to the risk of dislodging the clot. - Mobilization is introduced gradually once anticoagulation is therapeutic and the risk of **embolization** is reduced. *thrombolysis* - **Thrombolysis** (clot dissolution) is usually reserved for **proximal, extensive DVT** [1] or DVT with **limb-threatening ischemia** [2]. - It carries a **higher risk of bleeding** compared to anticoagulation and is not typically necessary for isolated calf DVT [2]. *surgical venous thrombectomy* - **Surgical thrombectomy** is rarely performed for DVT and is generally reserved for **massive iliocaval thrombosis** with severe limb threat. - It is an **invasive procedure** with significant risks and is not indicated for typical calf DVT.

Q: When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...

0.3. ***0.3*** - A value of **less than 0.3** indicates **severe blood flow impairment**, consistent with critical limb ischemia, necessitating urgent intervention [1]. - This extremely low ABPI reflects a profound decrease in perfusion to the lower extremity [1]. *0.7* - An ABPI of **less than 0.7** typically suggests **moderate peripheral artery disease (PAD)**, which could cause claudication but is not usually indicative of critical limb ischemia [1]. - While concerning, it does not represent the severe, limb-threatening ischemia implied by the term "critical." *1.0* - An ABPI of around **1.0 (0.9-1.3)** is considered **normal**, indicating healthy blood flow without significant arterial obstruction. - This value would rule out any significant peripheral artery disease, including critical limb ischemia. *0.9* - An ABPI of **less than 0.9** generally suggests **peripheral artery disease (PAD)**, which can cause symptoms like intermittent claudication [1]. - However, it is not low enough to diagnose critical limb ischemia, which represents a more severe state of arterial insufficiency [1].

Question 1

The murmur of mitral regurgitation is best heard at

Accepted Answer

Cardiac apex

Answer

Tricuspid area

Answer

Aortic area

Answer

Pulmonary area

Question 2

Which of the following statements is correct regarding the Opening Snap (OS) in a patient of mitral stenosis?

Accepted Answer

OS moves closer to the second sound (S2) as the stenosis becomes more severe

Answer

OS is best heard at the second left intercostal space

Answer

OS is best heard with the bell of stethoscope

Answer

Intensity of OS becomes louder when the valve is calcified

Question 3

Which one of the following is correct with regard to Carey Coombs murmur?

Accepted Answer

Soft mid-diastolic murmur due to mitral valvulitis

Answer

Harsh early diastolic murmur due to aortic regurgitation

Answer

Soft systolic murmur due to mitral regurgitation

Answer

Blowing late systolic murmur due to aortic stenosis

Question 4

Consider the following statements for diagnosing ventricular aneurysm in a patient with recent myocardial infarction :
I. Paradoxical impulse on chest wall
II. Persistent ST elevation on ECG
III. Unusual bulge from cardiac silhouette on X-ray
IV. Presence of pulsus paradoxsus

Which of the above are correct?

Accepted Answer

I, II and III

Answer

II, III and IV

Answer

I and II only

Answer

I and IV

Question 5

Which of the following heart sounds are best heard with the bell of stethoscope?
I. Opening snap
II. Systolic click
III. Third heart sound
IV. Mid diastolic murmur

Select the correct answer using the code given below :

Accepted Answer

III and IV

Answer

II and III only

Answer

I, II and III

Answer

I and IV

Question 6

Smoking is considered to be a modifiable risk factor for Coronary Heart Disease. Consider the following statements with regard to possible mechanisms on the basis of which it acts as a risk factor :

1. Nicotine stimulation of adrenergic drive raises the blood pressure and myocardial oxygen demand.
2. It increases carbon monoxide and induces atherogenesis.
3. It leads to fall in protective high density lipoproteins.
4. It reduces the apolipoprotein-B plasma levels. Which of the statements given above are correct ?

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1 and 3 only

Answer

1 and 2 only

Question 7

Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Accepted Answer

Muffled heart sounds

Answer

Collapsed neck veins

Answer

Tachycardia

Question 8

Deep vein thrombosis of calf is best managed by :

Accepted Answer

anticoagulants

Answer

active physiotherapy

Answer

thrombolysis

Answer

surgical venous thrombectomy

Question 9

The "Subclavian steal syndrome" occurs due to

Accepted Answer

Occlusion of the subclavian artery proximal to origin of vertebral artery

Answer

Occlusion/stenosis of the carotid artery

Answer

Occlusion/stenosis of the vertebral artery

Answer

Occlusion of the subclavian artery distal to origin of vertebral artery

Question 10

When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...

Accepted Answer

0.3

Answer

0.7

Answer

1.0

Answer

0.9

Cardiology — MCQs

Cardiology — MCQs

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