Cardiology Practice Questions

Q: Lutembacher's syndrome comprises of ?

Atrial septal defect with mitral stenosis. ***Atrial septal defect with mitral stenosis*** - **Lutembacher's syndrome** is classically defined as the combination of a **congenital atrial septal defect (ASD)** and acquired **mitral stenosis (MS)**. [1] - The ASD allows for shunting of blood from the left to the right atrium, while the stenotic mitral valve impedes blood flow from the left atrium to the left ventricle. [1]*Complete common atrioventricular canal* - A **complete atrioventricular (AV) canal defect** involves a large defect in both atrial and ventricular septa, with a common AV valve, which is distinct from Lutembacher's syndrome. - This condition is also known as a **complete endocardial cushion defect**.*Ventricular septal defect with aortic stenosis* - This combination describes two separate cardiac anomalies: a **ventricular septal defect (VSD)** and **aortic stenosis**. - While both can occur, they do not constitute Lutembacher's syndrome, which specifically involves an ASD and mitral stenosis.*Ruptured sinus of valsalva aneurysm* - A **ruptured sinus of Valsalva aneurysm** typically causes a sudden onset of chest pain, dyspnea, and a continuous murmur due to a shunt from the aorta into a cardiac chamber, usually the right ventricle. - This condition is unrelated to the atrial and mitral valve pathology seen in Lutembacher's syndrome.

Q: Most common cause of death in aortic stenosis patients is:

Sudden cardiac death. ***Sudden cardiac death*** - **Sudden cardiac death** is a significant risk in patients with severe **aortic stenosis**, even before the onset of classic symptoms such as angina, syncope, or heart failure. - The mechanisms often involve ventricular arrhythmias due to **myocardial fibrosis**, hypertrophy, and increased wall stress stemming from the outflow obstruction. *Pulmonary edema* - While patients with severe **aortic stenosis** can develop **pulmonary edema** due to left ventricular failure, it is typically a marker of advanced disease and usually precedes or is associated with other symptoms. - **Sudden cardiac death** can occur without prior severe pulmonary edema, making it the most common immediate cause of death. *Cerebral embolism* - **Paradoxical embolism** can occur in patients with **aortic stenosis** if they also have a **patent foramen ovale** and right-to-left shunting, or if infective endocarditis is present, but it is not the most common cause of death. - Atheroembolization from a calcified aortic valve is also a possibility but ranks lower than sudden cardiac death. *Atrial flutter* - **Atrial arrhythmias** like **atrial flutter** can occur in **aortic stenosis** due to atrial dilation and fibrosis, which can lead to rapid ventricular rates and worsen symptoms. - However, **atrial flutter** itself is usually not a direct cause of death; rather, it can precipitate heart failure or contribute to stroke risk, but **sudden cardiac death** due to ventricular arrhythmias is more prevalent.

Q: Rheumatic activity mostly involves which valves?

Mitral & aortic. Mitral & aortic - **Rheumatic fever** most commonly affects the valves on the left side of the heart, with the **mitral valve** being the most frequently involved, followed by the **aortic valve** [1]. - This involvement often leads to **valvulitis**, which can result in **stenosis** or **regurgitation** over time, primarily affecting these two valves [1]. *Aortic & pulmonary* - While the **aortic valve** is commonly affected, the **pulmonary valve** is rarely involved in rheumatic heart disease. - Involvement of the pulmonary valve is typically seen in combination with more severe, widespread disease or in specific congenital conditions, distinguishing it from classic rheumatic fever. *Mitral & tricuspid* - While the **mitral valve** is the most commonly affected, the **tricuspid valve** is less frequently involved than the aortic valve in rheumatic heart disease. - When the tricuspid valve is affected, it usually occurs in conjunction with severe **mitral and aortic valve disease**, rather than as a primary isolated or predominant involvement. *Aortic & tricuspid* - The **aortic valve** is commonly affected, but the **tricuspid valve** is much less frequently involved compared to the mitral valve. - Combined prominent involvement of only these two valves is not the typical presentation or most common pattern of rheumatic heart disease.

Q: Which of the following does not occur in Tetralogy of Fallot ?

Congestive cardiac failure. ***Congestive cardiac failure*** - **Tetralogy of Fallot (ToF)** is characterized by **right-to-left shunting** and chronic hypoxemia, which leads to **polycythemia** and secondary complications, but typically avoids volume overload that causes congestive heart failure [1]. - While other congenital heart defects can lead to congestive heart failure, **ToF** usually presents with **cyanosis** and "tet spells" due to pulmonary outflow obstruction and ventricular septal defect, without the features of chronic volume overload [1]. *Brain abscess* - Patients with **ToF** are at increased risk of **brain abscess** due to the right-to-left shunt bypassing the pulmonary capillary filter, allowing bacteria from systemic venous circulation to reach the brain [2]. - This complication is more common in **cyanotic congenital heart diseases** where venous pathogens can directly enter the arterial circulation [2]. *Infective Endocarditis* - The abnormal blood flow and structural defects in **ToF**, particularly around the Ventricular Septal Defect (VSD) and pulmonary outflow tract, predispose patients to **infective endocarditis**. - Turbulent blood flow creates endothelial damage, making it easier for circulating bacteria to adhere and form vegetations. *Polycythemia* - **Chronic hypoxemia** in **ToF** stimulates erythropoietin production, leading to an increased red blood cell mass, known as **polycythemia**. - This compensatory mechanism aims to enhance oxygen-carrying capacity but can increase blood viscosity, leading to thrombotic complications.

Q: The commonest cardiac lesion in Tuberous sclerosis is

Rhabdomyoma. ***Rhabdomyoma*** - **Rhabdomyomas** are the most common cardiac tumors found in patients with **tuberous sclerosis complex (TSC)**. - These benign tumors of the heart muscle are present in 50-70% of individuals with TSC, often multiple and can cause **obstruction of blood flow** or arrhythmias. *ASD* - An **atrial septal defect (ASD)** is a congenital heart defect involving a hole in the septum between the **atria** of the heart. - While ASDs are common congenital heart defects, they are not specifically associated with **tuberous sclerosis** as a primary cardiac lesion. *VSD* - A **ventricular septal defect (VSD)** is a common congenital heart defect characterized by a hole in the septum separating the **ventricles** [1]. - Like ASDs, VSDs are general congenital defects but do not have a specific, strong association with **tuberous sclerosis** like cardiac rhabdomyomas do [1]. *Mitral stenosis* - **Mitral stenosis** is a narrowing of the **mitral valve**, typically caused by **rheumatic fever** or degenerative calcification. - It is an acquired valvular heart disease and is not a common cardiac lesion associated with **tuberous sclerosis**.

Q: Not a feature of TOF -

Patent foramen ovale. ***Patent foramen ovale*** - A **patent foramen ovale (PFO)** is a remnant of fetal circulation that may be associated with various cardiac conditions but is **not one of the four cardinal defects** that define Tetralogy of Fallot [1]. - While other **cardiac anomalies can coexist** with Tetralogy of Fallot, a PFO is not considered a primary feature of the syndrome itself. *RVH* - **Right ventricular hypertrophy (RVH)** is a direct consequence of the **pulmonary stenosis** and the large **ventricular septal defect (VSD)** in Tetralogy of Fallot [1]. - The right ventricle must pump against increased resistance, leading to hypertrophy as a compensatory mechanism. *Boot shaped heart* - The **boot-shaped heart (coeur en sabot)** on chest X-ray is a classic radiologic sign of Tetralogy of Fallot. - This appearance results from **right ventricular hypertrophy** and an **underdeveloped pulmonary artery segment**, causing an uplifted apex and concave pulmonary artery contour. *VSD* - A **ventricular septal defect (VSD)** is one of the **four primary defects** constituting Tetralogy of Fallot [1]. - It allows **blood to shunt from the right ventricle to the left ventricle**, leading to cyanosis, especially when pulmonary outflow obstruction is severe [1].

Q: If a patient with Raynaud’s disease immersed his hand in cold water, the hand will

Turn white. ***Turn white*** * **Raynaud's phenomenon** is characterized by **vasospasm** of the digital arteries in response to cold or stress, initially causing the digits to turn **white** due to reduced blood flow. * This pallor is a direct result of **ischemia** as the small arteries and arterioles constrict. *Remain unchanged* * **Raynaud's disease** involves an abnormal and exaggerated response to cold, so the hand would not remain unchanged. * The primary characteristic of the condition is a visible change in **color** and sensation upon cold exposure. *Become red* * **Redness (rubor)** typically occurs later in the Raynaud's attack, during the **reperfusion phase**, as blood flow returns to the affected digits. * This phase follows the initial pallor and cyanosis, as the blood vessels **dilate** to compensate for the earlier constriction. *Become blue* * **Cyanosis (bluish discoloration)** commonly follows the initial pallor in a Raynaud's attack. * It occurs due to the deoxygenation of residual blood in the capillaries as vasospasm persists, but **whiteness** is the first distinct color change.

Q: MC valve involved in Rheumatic fever -

Mitral. ***Mitral*** - The **mitral valve** is the most frequently affected valve in **rheumatic heart disease**, often leading to **mitral regurgitation** or **mitral stenosis** [1]. - Its susceptibility is attributed to high-pressure stress and inflammation during the acute rheumatic fever phase. *Tricuspid* - The **tricuspid valve** is rarely involved in rheumatic fever; when it is, it typically occurs in conjunction with severe mitral and/or aortic valve disease. - Isolated tricuspid valve disease due to rheumatic fever is exceptionally uncommon. *Aortic* - The **aortic valve** is the second most commonly affected valve in rheumatic heart disease, often leading to **aortic stenosis** or **aortic regurgitation** [1]. - While significant, its involvement is less frequent than that of the mitral valve. *Pulmonary* - The **pulmonary valve** is almost never affected by rheumatic fever, even in cases of severe pancarditis. - Its low-pressure environment and anatomical position likely contribute to its protection from inflammatory damage.

Q: What is the most common cause of death in acute rheumatic fever?

Myocarditis. ***Myocarditis*** - **Myocarditis**, or inflammation of the heart muscle, is the most serious manifestation of **acute rheumatic fever** and the most common cause of death. - Severe myocarditis can lead to **heart failure**, arrhythmias, and cardiogenic shock, which are often fatal during the acute phase [1]. *Streptococcal sepsis* - While acute rheumatic fever is triggered by a **Group A Streptococcus (GAS)** infection, death is typically due to the autoimmune response attacking the heart, not direct overwhelming sepsis [1]. - **Sepsis** would be a more direct consequence of an uncontrolled bacterial infection, whereas rheumatic fever is a post-infectious sequela. *Pericarditis* - **Pericarditis**, or inflammation of the sac surrounding the heart, can occur in acute rheumatic fever [1]. - While it can cause chest pain and effusions, isolated pericarditis is rarely fatal compared to the direct impact of myocardial damage. *Endocarditis* - **Endocarditis** in acute rheumatic fever refers to inflammation of the heart valves, resulting in damage that can lead to chronic rheumatic heart disease. - While severe valvular damage can occur, death during the **acute phase** is more commonly due to the global dysfunction of the heart muscle (**myocarditis**) rather than the immediate effects of valvular inflammation [1].

Q: For Rx of ventricular fibrillation in an adult, DC shock of what joules should be started with?

200J. 200J - For monophasic defibrillators, the initial dose for ventricular fibrillation (VF) in an adult is generally 200 joules [1]. - This dosage aims to deliver a sufficient electrical shock to depolarize the entire myocardium and terminate the arrhythmia so that the heart’s natural pacemaker can resume normal rhythm [2]. 250J - This is not the standard initial energy dose recommended for the first shock in adult ventricular fibrillation with a monophasic defibrillator. - While higher energy levels may be used for subsequent shocks if the initial lower dose is ineffective, 250J is not the typical starting point. 360J - A 360J shock is typically the maximum dose used with a monophasic defibrillator and is often reserved for subsequent shocks if initial lower energy shocks fail to convert ventricular fibrillation. - Starting with the maximum dose is not recommended due to increased risk of myocardial damage and post-shock arrhythmias. 300J - This energy level is not the standard initial dose for the first shock in adult ventricular fibrillation using a monophasic defibrillator. - While higher than 200J, it's not the recommended starting point and would typically be considered for subsequent shocks in some protocols, especially if 200J fails.

Question 1

Lutembacher's syndrome comprises of ?

Accepted Answer

Atrial septal defect with mitral stenosis

Answer

Complete common atrioventricular canal

Answer

Ventricular septal defect with aortic stenosis

Answer

Ruptured sinus of valsalva aneurysm

Question 2

Most common cause of death in aortic stenosis patients is:

Accepted Answer

Sudden cardiac death

Answer

Pulmonary edema

Answer

Cerebral embolism

Answer

Atrial flutter

Question 3

Rheumatic activity mostly involves which valves?

Accepted Answer

Mitral & aortic

Answer

Aortic & pulmonary

Answer

Mitral & tricuspid

Answer

Aortic & tricuspid

Question 4

Which of the following does not occur in Tetralogy of 
Fallot ?

Accepted Answer

Congestive cardiac failure

Answer

Brain abscess

Answer

Infective Endocarditis

Answer

Polycythemia

Question 5

The commonest cardiac lesion in Tuberous sclerosis is

Accepted Answer

Rhabdomyoma

Answer

ASD

Answer

VSD

Answer

Mitral stenosis

Question 6

Not a feature of TOF -

Accepted Answer

Patent foramen ovale

Answer

RVH

Answer

Boot shaped heart

Answer

VSD

Question 7

If a patient with Raynaud’s disease immersed his hand in cold water, the hand will

Accepted Answer

Turn white

Answer

Remain unchanged

Answer

Become red

Answer

Become blue

Question 8

MC valve involved in Rheumatic fever -

Accepted Answer

Mitral

Answer

Tricuspid

Answer

Aortic

Answer

Pulmonary

Question 9

What is the most common cause of death in acute rheumatic fever?

Accepted Answer

Myocarditis

Answer

Streptococcal sepsis

Answer

Pericarditis

Answer

Endocarditis

Question 10

For Rx of ventricular fibrillation in an adult, DC shock of what joules should be started with?

Accepted Answer

200J

Answer

250J

Answer

360J

Answer

300J

Cardiology — MCQs

Cardiology — MCQs

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