Cardiology Practice Questions

Q: Which of the following flow recording is shown below?

Aorta flow recording. ***Aorta flow recording*** - This tracing depicts the typical **phasic flow in the aorta**, with a rapid increase during **systole** as blood is ejected from the left ventricle, followed by a decrease during **diastole**. - The graph clearly labels "Systole" and "Diastole," and the y-axis shows pressure in **mm/Hg**, which is characteristic of arterial pressure recordings. *Left ventricular flow recording* - Left ventricular (LV) pressure recordings typically show a rapid rise during **isovolumetric contraction**, a sustained peak during ejection, and a rapid fall during **isovolumetric relaxation**. - LV flow (or volume) recordings would specifically show changes in the amount of blood within the ventricle, which is not what this graph represents. *Swan Ganz catheter tracing* - A Swan-Ganz catheter, or pulmonary artery catheter, measures pressures in the **right atrium, right ventricle, pulmonary artery**, and **pulmonary capillary wedge pressure**. - The waveform associated with a Swan-Ganz catheter varies depending on its location and would not display the characteristic aortic pressure waveform shown. *Coronary blood flow* - **Coronary blood flow** refers to the blood supply to the heart muscle itself and typically has a pattern where flow is highest during **diastole** (due to ventricular compression of coronary arteries during systole). - The presented graph shows flow peaking during systole, which is inconsistent with coronary blood flow dynamics. *Pulmonary artery flow recording* - **Pulmonary artery flow** would show a similar systolic peak but with significantly **lower pressures** (typically 25/10 mm Hg) compared to the aorta (120/80 mm Hg). - The pressure magnitude shown in this tracing is consistent with **systemic arterial pressure**, not pulmonary arterial pressure.

Q: The ECG shows presence of ST elevation from V2-V5. What is the diagnosis?

Anterior wall MI. ***Anterior wall MI*** - **ST elevation** in leads **V2-V5** is indicative of an anterior myocardial infarction, as these leads primarily reflect the electrical activity of the anterior wall of the left ventricle. - The **anterior wall** is supplied by the **left anterior descending artery (LAD)**, and occlusion of this vessel typically results in these ECG changes. - The contiguous lead pattern from V2-V5 confirms extensive anterior wall involvement. *Inferior wall MI* - **Inferior wall MIs** are characterized by **ST elevation** in leads **II, III, and aVF**. - These leads are not primarily affected with ST elevation in the given scenario (V2-V5). *Lateral wall MI* - **Lateral wall MIs** typically show **ST elevation** in leads **I, aVL, V5, and V6**. While V5 is included, the primary elevation pattern across V2-V5 points more broadly to an anterior infarction. - Absence of ST elevation in I and aVL makes isolated lateral MI less likely. *Posterior wall MI* - A **posterior wall MI** is diagnosed by **ST depression** in leads **V1-V3** (reciprocal changes) and tall R waves in V1-V2, not ST elevation. - To confirm, posterior leads (V7-V9) would show ST elevation. *Anteroseptal MI* - **Anteroseptal MI** typically shows **ST elevation** in leads **V1-V4**, focusing on the septal region. - While there is overlap with V2-V4, the extension to V5 indicates more extensive anterior wall involvement rather than isolated anteroseptal territory.

Question 1

A 61-year-old man with a 45-pack-year smoking history presents with a 4-month history of progressive exertional dyspnea and a productive cough. He has no fever, hemoptysis, or weight loss. Spirometry is performed. Post-bronchodilator FEV1/FVC ratio is 0.58, and FEV1 is 52% of predicted. Lung volumes show a TLC of 128% predicted and RV of 185% predicted. Which of the following additional findings would most strongly support the underlying diagnosis over a restrictive pattern?

Accepted Answer

Increased residual volume with a concave expiratory limb on the flow-volume loop

Answer

Decreased DLCO with normal lung volumes on repeat plethysmography

Answer

Reduced TLC below 80% predicted with a preserved FEV1/FVC ratio above 0.70

Answer

Normal FEV1/FVC ratio that normalizes to above 0.70 after bronchodilator administration

Answer

Diffuse ground-glass opacities on high-resolution CT without air trapping

Question 2

A 67-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with 2 hours of substernal chest pressure radiating to his left arm, diaphoresis, and nausea. His BP is 88/60 mmHg, HR is 110 bpm, RR is 22/min, and O₂ saturation is 94% on room air. Lung auscultation reveals bibasilar crackles. A 12-lead ECG shows ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL, consistent with an acute inferior STEMI. The nearest cardiac catheterization laboratory is 45 minutes away by transfer, yielding an estimated first medical contact-to-device time of approximately 90 minutes and a door-in-door-out time target of ≤30 minutes. Which of the following is the most appropriate next step in management?

Accepted Answer

Arrange immediate transfer to the nearest PCI-capable facility for primary percutaneous coronary intervention

Answer

Administer intravenous alteplase and arrange urgent transfer to the catheterization laboratory

Answer

Administer intravenous metoprolol to reduce myocardial oxygen demand and stabilize the patient

Answer

Initiate intravenous heparin infusion and obtain urgent echocardiography to assess wall motion

Answer

Administer sublingual nitroglycerin and reassess hemodynamic response before further intervention

Question 3

Which of the following flow recording is shown below?

Accepted Answer

Aorta flow recording

Answer

Left ventricular flow recording

Answer

Swan Ganz catheter tracing

Answer

Coronary blood flow

Answer

Pulmonary artery flow recording

Question 4

A hypokalemic patient develops syncope with hypotension in ICU. Name the ECG abnormality with preferred drug to be used. (Recent NEET Pattern 2016-17)

Accepted Answer

Torsades de pointes, Magnesium sulfate

Answer

Ventricular fibrillation, Bretylium

Answer

Ventricular tachycardia, lignocaine

Answer

Paroxysmal ventricular tachycardia, Adenosine

Answer

Atrial fibrillation, Diltiazem

Question 5

The ECG shows presence of ST elevation from V2-V5. What is the diagnosis?

Accepted Answer

Anterior wall MI

Answer

Inferior wall MI

Answer

Lateral wall MI

Answer

Posterior wall MI

Answer

Anteroseptal MI

Cardiology — MCQs

Cardiology — MCQs

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