Cardiology Practice Questions

Q: Which of the following is a PRIMARY component of Tetralogy of Fallot?

Pulmonary stenosis. ***Pulmonary stenosis*** - **Pulmonary stenosis** is one of the four primary defects that define Tetralogy of Fallot, specifically an **obstruction to right ventricular outflow** [1]. - The severity of this stenosis largely determines the clinical presentation and degree of cyanosis in patients with Tetralogy of Fallot [1]. *ASD* - An **Atrial Septal Defect (ASD)** is not considered a primary component of Tetralogy of Fallot [2], although it can coexist in some patients. - The four classic defects of Tetralogy of Fallot are **pulmonary stenosis**, **ventricular septal defect (VSD)**, **overriding aorta**, and **right ventricular hypertrophy** [1]. *Right ventricular hypertrophy* - **Right ventricular hypertrophy** is a consequence of the increased workload on the right ventricle due to severe pulmonary stenosis and the **ventricular septal defect (VSD)** [1]. - While it is a characteristic finding, it technically develops secondary to the other primary defects, rather than being an initiating structural malformation itself. *None of the options* - This option is incorrect because **pulmonary stenosis** is a definitive and primary component of Tetralogy of Fallot [1]. - The disease is defined by a specific set of four defects, one of which is pulmonary stenosis [1].

Q: All are minor Jones Criteria except ?

Chorea. ***Chorea*** - **Sydenham's chorea** is considered a **major manifestation** in the modified Jones Criteria for acute rheumatic fever [1]. - It involves involuntary, purposeless movements, and is a strong indicator of the disease [1]. *Prolonged PR Interval* - A prolonged **PR interval** on EKG is a **minor manifestation** in the modified Jones Criteria, reflecting carditis [1]. - It indicates delayed conduction through the AV node, a common finding in acute rheumatic fever [1]. *Fever* - **Fever** is a **minor manifestation** as per the modified Jones Criteria [1]. - While common in many infections, in the context of preceding streptococcal infection, it supports a diagnosis of acute rheumatic fever. *Arthralgia* - **Arthralgia** (joint pain) without objective signs of inflammation is a **minor manifestation** in the modified Jones Criteria [1]. - This differentiates it from arthritis (a major criterion) where there is objective evidence of inflammation.

Q: Which of the following is the most appropriate initial antihypertensive treatment for an elderly patient with isolated systolic hypertension?

Amlodipine. Amlodipine - **Calcium channel blockers (CCBs)**, especially dihydropyridines like amlodipine, are recommended as initial therapy for isolated systolic hypertension in the elderly due to their effectiveness in reducing elevated systolic pressure [2]. - They are well-tolerated and can reduce the risk of cardiovascular events in this population. *Lisinopril* - **ACE inhibitors** like lisinopril are effective antihypertensives but are generally not the first-line choice for isolated systolic hypertension, particularly in elderly patients where a decrease in diastolic pressure might be detrimental [1]. - They are associated with side effects such as **cough** and can cause **acute kidney injury**, which can be a concern in older adults [1]. Atenolol - **Beta-blockers** like atenolol are generally not recommended as first-line therapy for isolated systolic hypertension due to their limited efficacy in lowering systolic blood pressure compared to other drug classes. - They may also worsen certain conditions common in the elderly, such as **peripheral vascular disease** and **bronchospastic lung disease**. *Losartan* - **Angiotensin receptor blockers (ARBs)** like losartan are effective for hypertension but are not typically favored over CCBs or thiazide diuretics as initial monotherapy for isolated systolic hypertension in the elderly [1]. - They share similar side effects and contraindications with ACE inhibitors, including the risk of **renal dysfunction** [1].

Q: Wide fixed S2 is seen in __________

ASD. ***ASD*** - A **wide fixed split S2** is a classic auscultatory finding in an **atrial septal defect (ASD)** due to continuous volume overload of the right ventricle, which delays pulmonic valve closure irrespective of respiration. - The constant shunting from left to right atrium maintains a sustained increase in pulmonary blood flow, causing the persistent delay in P2. *VSD* - A **ventricular septal defect (VSD)** typically presents with a **loud holosystolic murmur** at the left lower sternal border, not primarily a wide fixed split S2. - While VSD can cause pulmonary hypertension and affect S2, it doesn't usually result in a fixed split. *PDA* - A **patent ductus arteriosus (PDA)** is characterized by a **continuous, machinery-like murmur** best heard below the left clavicle. - While it can cause pulmonary hypertension, it does not typically produce a wide fixed S2 split, which is more specific to ASD. *All of the options* - This option is incorrect because a wide fixed S2 is a highly specific finding for **atrial septal defect (ASD)**, not common to all listed conditions. - While other conditions can affect S2, they do not produce the characteristic **fixed and wide splitting** seen in ASD.

Q: Which valve is least affected in Rheumatic fever ?

Pulmonary valve. ***Pulmonary valve*** - The **pulmonary valve** is considered the **least commonly affected** heart valve in rheumatic fever. - This is thought to be due to the relatively lower pressure on the right side of the heart, making it less susceptible to inflammatory damage. *Aortic valve* - The **aortic valve** is the **second most commonly affected** valve in rheumatic fever, often leading to **aortic stenosis** or regurgitation [1]. - Inflammation can cause thickening, calcification, and fusion of the leaflets. *Mitral valve* - The **mitral valve** is the **most frequently affected** heart valve in rheumatic fever, almost always involved to some degree [1]. - Chronic inflammation typically leads to **mitral stenosis**, but regurgitation can also occur. *Tricuspid valve* - The **tricuspid valve** is affected in a significant number of cases, though less often than the mitral and aortic valves [2]. - When involved, it typically presents as **tricuspid regurgitation** due to leaflet damage and annular dilation [2].

Q: Balloon valvotomy is successful in all of the following cases except –

Calcified mitral stenosis. ***Calcified mitral stenosis*** - **Heavily calcified valves** are generally considered a contraindication for balloon valvotomy due to the high risk of **valve tearing**, embolism, and suboptimal results. - The rigid, non-compliant nature of heavily calcified valves prevents effective leaflet separation, reducing the chances of a successful procedure and increasing the risk of adverse events. *Congenital pulmonary stenosis* - **Balloon pulmonary valvotomy** is the treatment of choice for most cases of symptomatic congenital pulmonary stenosis with a significant gradient. - It effectively dilates the stenotic valve, leading to a good prognosis and long-term results. *Congenital aortic stenosis* - **Balloon aortic valvotomy** is often performed for severe congenital aortic stenosis, especially in infants and young children, to relieve obstruction. - While it can be associated with some risk of aortic regurgitation, it is a viable option to improve hemodynamics. *Mitral stenosis in pregnancy* - **Balloon mitral valvotomy** is a safe and effective treatment for symptomatic severe mitral stenosis during pregnancy, especially if medical management fails. - It can significantly improve maternal and fetal outcomes by reducing pulmonary congestion and improving cardiac output.

Q: What is the MOST common radiographic manifestation of acute papillary muscle rupture?

Pulmonary edema. ***Pulmonary edema*** - Acute **papillary muscle rupture** leads to severe **mitral regurgitation**, causing a sudden increase in left atrial pressure. - This rapid rise in pressure is directly transmitted to the **pulmonary veins and capillaries**, resulting in the extravasation of fluid into the lungs, manifesting as **pulmonary edema** on chest X-ray. - This is the **most common radiographic finding** because the acute nature of the rupture causes immediate hemodynamic consequences affecting the pulmonary circulation. *Left atrial enlargement* - **Left atrial enlargement** typically develops over time in chronic mitral regurgitation due to sustained volume overload. - In acute papillary muscle rupture, the onset of mitral regurgitation is sudden, and there isn't sufficient time for the left atrium to undergo **significant remodeling and enlargement**. *Left ventricular enlargement* - **Left ventricular enlargement** is also a feature of chronic volume overload (e.g., chronic mitral regurgitation or aortic regurgitation). - Acute papillary muscle rupture causes sudden pressure overload on the left atrium and pulmonary circulation, and the **left ventricle has not yet had time to dilate** in response to the acute insult. *Pericardial effusion* - **Pericardial effusion** is an accumulation of fluid in the pericardial sac and is not a direct consequence of papillary muscle rupture. - While other cardiac pathologies like **myocardial infarction** (which can cause papillary muscle rupture) can sometimes be complicated by a small pericardial effusion, it is not the most common or direct radiographic manifestation of the rupture itself.

Q: Which of the following defines Pentalogy of Fallot?

TOF with ASD. ***TOF with ASD*** - **Pentalogy of Fallot** is a rare congenital heart defect that includes the **four classic defects of Tetralogy of Fallot (TOF)** plus an **atrial septal defect (ASD)**. - The four defects in TOF are **ventricular septal defect (VSD)**, **pulmonary stenosis**, **right ventricular hypertrophy**, and **overriding aorta** [1]. *TOF with Polysplenia* - **Polysplenia** is a developmental anomaly characterized by multiple small spleens, often associated with other complex congenital abnormalities, but not a defining feature of Pentalogy of Fallot. - While it can occur with congenital heart defects, it's not one of the five specific components that define the pentalogy. *TOF with COA* - **Coarctation of the aorta (COA)** is a narrowing of the aorta, often seen with other congenital heart defects but is not part of the defining criteria for Pentalogy of Fallot. - It involves a separate anatomical abnormality that is not included in the "pentalogy." *TOF with PDA* - A **patent ductus arteriosus (PDA)** is a persistence of the fetal connection between the aorta and pulmonary artery. While it can coexist with TOF, it is not one of the defining features of Pentalogy of Fallot. - The fifth defect defining the pentalogy is specifically an **atrial septal defect (ASD)**, not a PDA.

Q: Differential cyanosis is seen in –

PDA. ***PDA*** - **Differential cyanosis** occurs in **patent ductus arteriosus (PDA)** with severe **pulmonary hypertension** leading to **right-to-left shunting** (reversed PDA/Eisenmenger syndrome). - Since the PDA connects the pulmonary artery to the descending aorta **below the origin of the left subclavian artery**, deoxygenated blood from the pulmonary artery perfuses the **lower body** (lower limbs cyanosed) while the **upper body** receives oxygenated blood from the left ventricle (upper limbs and head pink). - This creates the classic pattern: **pink upper extremities, cyanosed lower extremities**. *VSD* - A **ventricular septal defect (VSD)** typically causes **left-to-right shunting**, leading to increased pulmonary blood flow, and does not result in differential cyanosis. - While VSD can eventually lead to **Eisenmenger syndrome** with **generalized cyanosis** (affecting entire body uniformly), it does not specifically cause differential cyanosis because the shunt occurs before blood reaches the systemic circulation. *TAPVC* - **Total anomalous pulmonary venous connection (TAPVC)** is a congenital heart defect where all pulmonary veins drain into the systemic venous circulation, leading to **generalized cyanosis** as mixed blood is delivered throughout the body. - It does not present with differential cyanosis, as the venous return is uniformly deoxygenated and mixes before systemic distribution. *TGV* - **Transposition of the great vessels (TGV)** involves the aorta originating from the right ventricle and the pulmonary artery from the left ventricle, creating two parallel circulations. - This condition presents with **severe generalized cyanosis** shortly after birth unless there is mixing between the two circulations (via PDA, ASD, or VSD), and does not cause differential cyanosis.

Q: A “Potential Anastomosis” seen in

Coronary artery. A “Potential Anastomosis” seen in ***Coronary artery*** - Coronary arteries are classic examples of **functional end arteries** that have potential anastomoses, meaning these connections are normally non-functional but can become patent in cases of **ischemia**, such as occurs with a gradual occlusion [1]. - While small collateral vessels exist, they are usually insufficient to prevent myocardial damage if a major coronary artery is suddenly occluded. *Intercostal artery* - Intercostal arteries form extensive **anastomoses** with each other and with branches of the internal thoracic and musculophrenic arteries, providing a rich collateral circulation. - They are typically considered true end arteries but their abundant connections allow them to maintain tissue perfusion even if one segment is blocked. *Arterial arcades of mesentery* - The arterial arcades in the mesentery, formed by the **jejunal and ileal arteries**, are extensive and provide excellent collateral circulation to the small intestine. - This robust network ensures that obstruction of a single mesenteric artery often does not lead to **ischemia** of the corresponding bowel segment. *Labial branch of facial artery* - The labial branches of the facial artery extensively **anastomose** with corresponding branches from the opposite side and with branches of the infraorbital and mental arteries. - This rich network provides a robust blood supply to the lips and perioral region, making this a region with **true anastomoses** rather than just potential ones.

Question 1

Which of the following is a PRIMARY component of Tetralogy of Fallot?

Accepted Answer

Pulmonary stenosis

Answer

ASD

Answer

Right ventricular hypertrophy

Answer

None of the options

Question 2

All are minor Jones Criteria except ?

Accepted Answer

Chorea

Answer

Prolonged PR Interval

Answer

Fever

Answer

Arthralgia

Question 3

Which of the following is the most appropriate initial antihypertensive treatment for an elderly patient with isolated systolic hypertension?

Accepted Answer

Amlodipine

Answer

Lisinopril

Answer

Atenolol

Answer

Losartan

Question 4

Wide fixed S2 is seen in __________

Accepted Answer

ASD

Answer

VSD

Answer

PDA

Answer

All of the options

Question 5

Which valve is least affected in Rheumatic fever ?

Accepted Answer

Pulmonary valve

Answer

Aortic valve

Answer

Mitral valve

Answer

Tricuspid valve

Question 6

Balloon valvotomy is successful in all of the following cases except –

Accepted Answer

Calcified mitral stenosis

Answer

Congenital pulmonary stenosis

Answer

Congenital aortic stenosis

Answer

Mitral stenosis in pregnancy

Question 7

What is the MOST common radiographic manifestation of acute papillary muscle rupture?

Accepted Answer

Pulmonary edema

Answer

Left atrial enlargement

Answer

Left ventricular enlargement

Answer

Pericardial effusion

Question 8

Which of the following defines Pentalogy of Fallot?

Accepted Answer

TOF with ASD

Answer

TOF with Polysplenia

Answer

TOF with COA

Answer

TOF with PDA

Question 9

Differential cyanosis is seen in –

Accepted Answer

PDA

Answer

VSD

Answer

TAPVC

Answer

TGV

Question 10

A “Potential Anastomosis” seen in

Accepted Answer

Coronary artery

Answer

Intercostal artery

Answer

Arterial arcades of mesentery

Answer

Labial branch of facial artery

Cardiology — MCQs

Cardiology — MCQs

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