Cardiology Practice Questions

Q: A 16-year-old boy has a history of recurrent episodes of fainting in school assembly. ECG was done. Which is incorrect about the condition?

Pacemaker is treatment of choice. ***Pacemaker is treatment of choice*** - The ECG shows features of **Wolff-Parkinson-White (WPW) syndrome**, which is a type of **pre-excitation syndrome**. The primary treatment for symptomatic WPW syndrome, especially in a young person with recurrent syncope, is typically **catheter ablation** of the accessory pathway, not a pacemaker. - A pacemaker is generally indicated for bradyarrhythmias or certain types of heart block, neither of which is the primary issue in WPW syndrome. *Pre-excitation syndrome* - The ECG demonstrates characteristic findings of pre-excitation syndrome, specifically Wolff-Parkinson-White syndrome, where an **accessory pathway** bypasses the AV node, leading to early ventricular activation. - This is a **correct statement** about the condition shown in the ECG. *Wide QRS* - The ECG shows a **widened QRS complex** (greater than 0.10 seconds), which is a common feature of WPW syndrome due to the fusion of ventricular activation via the normal conduction system and the accessory pathway. - This broadens the QRS duration as ventricular depolarization starts earlier. This is a **correct statement**. *Delta wave* - A **delta wave**, which is a slurred upstroke of the QRS complex, is evident in the ECG and represents the initial, slow ventricular activation through the accessory pathway. - The delta wave is a hallmark of WPW syndrome. This is a **correct statement**. *Short PR interval* - The ECG demonstrates a **short PR interval** (less than 0.12 seconds), which is a characteristic finding of pre-excitation syndrome. - This occurs because the accessory pathway allows rapid conduction that bypasses the normal AV nodal delay. This is a **correct statement**.

Q: A 70-year-old hypertension patient presents with complaints of palpitations and presyncope. On examination, his heart rate is 72 bpm and BP is 150/100, ECG done shows:

Atrial fibrillation. ***Atrial fibrillation*** - The ECG shows **irregularly irregular R-R intervals** and the **absence of distinct P waves**, which are classic hallmarks of atrial fibrillation. - The disorganized atrial activity results in a fibrillatory baseline, especially visible in leads like V1, and is consistent with the patient's complaints of palpitations and presyncope in the setting of hypertension. *Atrial flutter* - Characterized by distinct **sawtooth flutter waves**, typically in leads II, III, and aVF, and usually regular atrial activity with a fixed AV conduction ratio. - While atrial activity is rapid, it is organized, unlike the chaotic rhythm seen in this ECG. *Multifocal atrial tachycardia* - Defined by at least **three different P wave morphologies** and an irregular rhythm. - Although the rhythm is irregular, the absence of clear, distinct P waves rules out multifocal atrial tachycardia. *PSVT* - Paroxysmal supraventricular tachycardia (PSVT) typically presents with a **regular, narrow-complex tachycardia** with an abrupt onset and termination. - The ECG in question exhibits an **irregular ventricular rhythm** and lacks the regular P waves or pseudo-R' waves often seen in typical PSVT. *Sinus rhythm with premature atrial contractions* - While PACs can cause an irregular rhythm, they occur against a background of **regular sinus rhythm with identifiable P waves**. - In this ECG, there is complete absence of organized P waves and a continuously irregular baseline, which distinguishes atrial fibrillation from occasional PACs.

Q: A 50-year-old dilated cardiomyopathy patient underwent a procedure shown below. What is it known as?

Cardiac resynchronization therapy. ***Cardiac resynchronization therapy*** - The image shows three leads: one in the **right atrium**, one in the **right ventricle**, and crucially, one in a **coronary vein** overlying the **left ventricle**. - This configuration with **biventricular pacing** (right and left ventricular leads) is characteristic of CRT, designed to improve cardiac synchrony in patients with heart failure and ventricular dyssynchrony. *Cardiac resynchronization therapy with defibrillator* - CRT-D combines biventricular pacing with defibrillation capabilities, featuring leads similar to CRT but with **shock coil electrodes** for high-energy defibrillation. - The leads shown in the image appear to be standard thin pacing leads without the characteristic **large coil electrodes** seen in defibrillator systems. *Implantable cardioverter defibrillator* - While an ICD also involves leads inserted into the heart, it typically includes leads with large **coil electrodes** capable of delivering high-energy shocks for defibrillation. - The depicted leads are thin pacing leads, not characteristic of high-energy defibrillation leads, though some ICDs can also provide pacing. *Direct cardioversion* - Direct cardioversion is an **external procedure** using paddles or patches to deliver an electric shock to the chest wall. - It does not involve surgically implanted leads within the heart chambers. *Transvenous pacemaker* - A standard transvenous pacemaker typically has one or two leads, commonly placed in the **right atrium** and/or **right ventricle**. - It lacks the dedicated **left ventricular lead** (often placed via the coronary sinus) seen in the image, which is essential for resynchronization.

Q: A patient suffers from STEMI. He was taken to cath lab. What is the name of the Catheter shown below?

Judkin's catheter. ***Judkin's catheter*** - The image displays the characteristic pre-formed curved tip of a **Judkin's catheter** designed to selectively engage the **coronary arteries** from the ascending aorta. - Judkin's catheters come in different curves (e.g., JL for left, JR for right) to optimally cannulate the specific coronary ostia for angiography or intervention. *Amplatz catheter* - An **Amplatz catheter** is another type of pre-formed coronary catheter with different curve configurations (e.g., AL for left, AR for right) used for selective coronary engagement. - Amplatz catheters have a wider, more circular primary curve compared to Judkin's catheters and are particularly useful when Judkin's catheters fail to engage or in cases of unusual coronary anatomy. - The catheter shown has the characteristic Judkin's curve rather than the Amplatz configuration. *Aubaniac catheter* - The term "Aubaniac catheter" is not a standard or recognized catheter type used in modern interventional cardiology. - This option is likely a distractor and does not correspond to any known catheter morphology or function. *Pig tail catheter* - A **pigtail catheter** has a distinctive curved tip with multiple side holes, resembling a pig's tail, primarily used for **LV ventriculography** or non-selective angiography in large vessels. - Its design is for safe, high-volume contrast injection in a chamber like the left ventricle, not for selective coronary cannulation as depicted. *Malecot catheter* - A **Malecot catheter** is a type of self-retaining catheter with wing-like side flanges near the tip, commonly used for **drainage purposes** in urology or gastroenterology (e.g., nephrostomy, gastrostomy). - Its structure and function are entirely different from the catheter shown, which is used for vascular access and cannulation.

Q: The tracing shows normal sinus rhythm alternating with premature ventricular contraction. This is diagnostic of:

Ventricular bigeminy. ***Ventricular bigeminy*** - This rhythm is characterized by a **normal sinus beat** followed by a premature **ventricular contraction (PVC)**, and this pattern then repeats. - The provided ECG tracing clearly shows this alternating pattern, with a narrow QRS complex (sinus beat) followed by a wide, bizarre QRS complex (PVC). *Ventricular couplets* - This term refers to **two consecutive PVCs** occurring together, which is not the pattern seen in the tracing. - In a couplet, there would be no intervening normal sinus beat between the PVCs. *Ventricular trigeminy* - This rhythm involves **two normal sinus beats** followed by a single PVC, and this sequence repeats. - The tracing shows a 1:1 ratio of normal beats to PVCs, not a 2:1 ratio. *Ventricular quadrigeminy* - This rhythm pattern consists of **three normal sinus beats** followed by a single PVC, and this sequence repeats. - The tracing shows a 1:1 alternating pattern, not a 3:1 ratio characteristic of quadrigeminy. *Ventricular tachycardia* - This is defined as **three or more consecutive PVCs** occurring at a rapid rate, leading to a sustained rhythm of wide QRS complexes. - The tracing shows isolated PVCs alternating with normal beats, not a sustained run of wide QRS complexes.

Q: A 65-year-old pensioner in ESI dispensary complains of exercise intolerance. On auscultation a systolic murmur grade 3 is heard. What does the ECG show?

Left ventricular hypertrophy. ***Left ventricular hypertrophy*** - The ECG shows significantly **tall R waves** in leads V4-V6 and deep S waves in V1-V2, indicating increased left ventricular mass. - This finding is consistent with **left ventricular hypertrophy (LVH)**, which often develops in patients with aortic stenosis, a condition that can cause a systolic murmur and exercise intolerance. *Normal tracing* - A normal ECG would not exhibit such pronounced voltage criteria for LVH or significant ST-T wave changes. - The elevated R wave amplitude in lateral leads and deep S waves in precordial leads are beyond normal limits. *Atrial fibrillation* - Atrial fibrillation is characterized by an **irregularly irregular rhythm** and absence of distinct P waves, neither of which is present on this ECG. - The rhythm here appears regular with clear P waves preceding each QRS complex. *Left bundle branch block* - Left bundle branch block (LBBB) is characterized by a **widened QRS complex** (>0.12 seconds) and a dominant S wave in V1, with broad, notched R waves in lateral leads (I, aVL, V5, V6). - While there are tall R waves in lateral leads, the QRS duration is not significantly widened, and the characteristic morphology of LBBB is absent. *Right ventricular hypertrophy* - Right ventricular hypertrophy (RVH) typically shows **tall R waves in V1-V2** with deep S waves in V5-V6, which is the opposite pattern of what is seen here. - RVH is associated with conditions like pulmonary stenosis or chronic lung disease, and would present with right axis deviation, not the left-sided voltage criteria seen in this ECG.

Q: An 89-year-old man with hypertension presents for routine follow-up. ECG shows:

LBBB. ***LBBB*** - This ECG shows **broad QRS complexes (>0.12 seconds)**, consistent with a bundle branch block. - The presence of a **dominant S wave in V1** and broad, notched R waves (or monophasic R waves) in **leads I, aVL, V5, and V6** are characteristic features of Left Bundle Branch Block (LBBB). *RBBB* - RBBB typically presents with **wide QRS complexes**, but with an **RSR' pattern in V1** and wide S waves in leads I and V6, which is not seen here. - The **dominant S wave in V1** observed in the given ECG rules out typical RBBB. *ST elevation* - While there is some **ST-segment deviation** in several leads (e.g., depression in V1-V3, elevation in V5-V6), these are often **secondary repolarization abnormalities** associated with LBBB and do not represent primary ST elevation of myocardial infarction unless there are specific, unequivocal Sgarbossa criteria. - The primary and most striking finding is the wide QRS morphology, not significant ST elevation indicative of acute injury. *Extreme axis deviation* - The mean QRS axis appears to be within the normal range, or perhaps slightly leftward, but not an **extreme axis deviation** (e.g., superior axis > -90 degrees) which would manifest as dominant negative QRS complexes in leads I, II, and III. - While LBBB can sometimes shift the electrical axis, this ECG does not demonstrate the specific criteria for extreme axis deviation. *Left ventricular hypertrophy* - LVH can present with **increased QRS voltage** in precordial leads and may show ST-T wave changes, which could be seen in a hypertensive patient. - However, LVH does not typically produce the **markedly widened QRS complexes (>0.12 seconds)** with the characteristic LBBB morphology (dominant S in V1, broad R in I, aVL, V5-V6) seen in this ECG. - While LVH and LBBB can coexist, the dominant finding here is the bundle branch block pattern.

Question 1

A 16-year-old boy has a history of recurrent episodes of fainting in school assembly. ECG was done. Which is incorrect about the condition?

Accepted Answer

Pacemaker is treatment of choice

Answer

Pre-excitation syndrome

Answer

Wide QRS

Answer

Delta wave

Answer

Short PR interval

Question 2

A 65-year-old man presents with crushing chest pain for 2 hours. On examination, BP = 80/60 mm Hg and JVP is elevated 4 cm above the sternal angle. All are true about the condition shown except:

Accepted Answer

ST segment depression in lead II, III, aVF

Answer

ST elevation in V4R

Answer

Right ventricular infarction

Answer

Cardiogenic shock

Answer

Proximal right coronary artery occlusion

Question 3

A 40-year-old man who had recently joined a gym collapsed on the treadmill. He was rushed to the hospital where an ECG shows presence of:

Accepted Answer

Catecholamine-sensitive ventricular tachycardia

Answer

Acute extensive anterior wall MI

Answer

Brugada syndrome

Answer

Arrhythmogenic right ventricular dysplasia

Answer

Long QT syndrome

Question 4

A 70-year-old hypertension patient presents with complaints of palpitations and presyncope. On examination, his heart rate is 72 bpm and BP is 150/100, ECG done shows:

Accepted Answer

Atrial fibrillation

Answer

Atrial flutter

Answer

Multifocal atrial tachycardia

Answer

PSVT

Answer

Sinus rhythm with premature atrial contractions

Question 5

A 50-year-old dilated cardiomyopathy patient underwent a procedure shown below. What is it known as?

Accepted Answer

Cardiac resynchronization therapy

Answer

Implantable cardioverter defibrillator

Answer

Direct cardioversion

Answer

Transvenous pacemaker

Answer

Cardiac resynchronization therapy with defibrillator

Question 6

This 50-year-old patient developed syncope after having a coffee. ECG was done .Which is the most appropriate therapy for a patient suffering from the condition shown below?

Accepted Answer

DC shock

Answer

Lignocaine

Answer

Amiodarone

Answer

Esmolol

Answer

Magnesium sulfate

Question 7

A patient suffers from STEMI. He was taken to cath lab. What is the name of the Catheter shown below?

Accepted Answer

Judkin's catheter

Answer

Aubaniac catheter

Answer

Pig tail catheter

Answer

Malecot catheter

Answer

Amplatz catheter

Question 8

The tracing shows normal sinus rhythm alternating with premature ventricular contraction. This is diagnostic of:

Accepted Answer

Ventricular bigeminy

Answer

Ventricular couplets

Answer

Ventricular trigeminy

Answer

Ventricular tachycardia

Answer

Ventricular quadrigeminy

Question 9

A 65-year-old pensioner in ESI dispensary complains of exercise intolerance. On auscultation a systolic murmur grade 3 is heard. What does the ECG show?

Accepted Answer

Left ventricular hypertrophy

Answer

Normal tracing

Answer

Atrial fibrillation

Answer

Left bundle branch block

Answer

Right ventricular hypertrophy

Question 10

An 89-year-old man with hypertension presents for routine follow-up. ECG shows:

Accepted Answer

LBBB

Answer

RBBB

Answer

ST elevation

Answer

Extreme axis deviation

Answer

Left ventricular hypertrophy

Cardiology — MCQs

Cardiology — MCQs

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