Cardiology Practice Questions

Q: Which of the following is a major criterion of Rheumatic fever according to Jones criteria? a) Chorea b) Erythema nodosum c) Arthritis d) Fever e) Carditis

Carditis. ***Carditis*** - **Carditis** is one of the major manifestations of rheumatic fever [1], indicating inflammation of the heart muscle, valves, or pericardium. - It is a serious complication and can lead to **rheumatic heart disease**. *Erythema nodosum* - **Erythema nodosum** is a non-specific inflammatory condition of the subcutaneous fat and is not a major or minor criterion for rheumatic fever. - It is often associated with other systemic diseases or medications. *Fever* - **Fever** is considered a minor manifestation in the Jones criteria for rheumatic fever [1]. - While common, it is less specific than major criteria like carditis or chorea [1]. *Erythema marginatum* - **Erythema marginatum** is a characteristic rash seen in rheumatic fever and is a major criterion [1]. - It is a distinctive fleeting, non-pruritic rash with red margins and a clear center. *Prolonged PR interval* - A **prolonged PR interval** on an ECG is a minor criterion for rheumatic fever, indicating first-degree AV block. - It reflects cardiac involvement but is not as severe or specific an indicator as overt carditis [1].

Q: A previously healthy patient presents with dyspnea and low grade fever since 4 months. His lungs are clear. JVP is normal. ECG showed low voltage complexes. What is the possible diagnosis?

Tuberculous pericardial effusion. ***Tuberculous pericardial effusion*** - **Dyspnea** and a **low-grade fever** persisting for several months are suggestive of **tuberculosis** [1]. - **Low voltage complexes on ECG** are characteristic of a **pericardial effusion**, where fluid dampens electrical activity [1]. *Rheumatic mitral stenosis* - While it can cause **dyspnea**, the absence of **JVP elevation** and **clear lungs** make significant heart failure less likely [2]. - ECG in mitral stenosis would typically show **left atrial enlargement** and potentially **atrial fibrillation**, not widespread low voltage. *Hypertrophic cardiomyopathy* - This condition presents with **dyspnea** and can cause **abnormal ECG findings** (e.g., left ventricular hypertrophy, Q waves), but not typically **low voltage complexes**. - **Clear lungs** and normal JVP are inconsistent with severe heart failure from the condition [3]. *Syphilitic aortic aneurysm* - This condition affects the **aorta** and can lead to **aortic regurgitation** or **aortic dissection**, but usually presents differently. - While it can cause **dyspnea** due to heart failure or mass effect, it does not typically cause **low voltage complexes on ECG** or **low-grade fever** for months as the primary presentation.

Q: Most common cause of death in Rheumatoid Arthritis?

Ischemic heart disease. ***Ischemic heart disease*** - Patients with **rheumatoid arthritis (RA)** have a significantly increased risk of developing **cardiovascular diseases**, including ischemic heart disease. [1] - This heightened risk is due to chronic systemic inflammation, accelerated atherosclerosis, and potential side effects of RA treatments contributing to **endothelial dysfunction**. [1] *Hepatic failure* - While certain medications used to treat RA, such as **methotrexate**, can cause liver toxicity, hepatic failure is not the most common cause of death in RA patients. [2] - Regular **liver enzyme monitoring** helps in detecting and managing medication-induced liver issues. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** can occur in severely ill patients, but it is not a direct or most common complication of rheumatoid arthritis nor a primary cause of death. [2] - RA can affect the lungs (e.g., interstitial lung disease), but ARDS is typically a severe, acute event triggered by other conditions like **sepsis** or trauma. *Pulmonary fibrosis* - **Interstitial lung disease (ILD)**, including pulmonary fibrosis, is a known extra-articular manifestation of RA and can be a significant cause of morbidity and mortality. [2] - However, **cardiovascular events**, particularly ischemic heart disease, still surpass pulmonary fibrosis as the leading cause of death in RA patients.

Q: Most common cause of death in adults with PDA is?

Infective endocarditis. ***Infective endocarditis*** - The abnormal blood flow and turbulent swirling within a **patent ductus arteriosus (PDA)** create an environment prone to bacterial colonization, making infective endocarditis the most common cause of death in adults with PDA. - The risk of **infective endocarditis** in adults with an untreated PDA is significant, leading to severe downstream complications. *Rupture* - While rupture is a rare complication, it is not the most common cause of death in adults with an isolated PDA, particularly when compared to infectious complications. - Rupture may be associated with other underlying cardiovascular conditions or very large PDAs, but it is not the leading cause of mortality. *Embolism* - Embolism can occur in PDA, especially paradoxical emboli in the rare event of severe pulmonary hypertension with right-to-left shunting. - However, it is less common than infective endocarditis as a primary cause of death in adults with a typical PDA. *CCF* - **Congestive cardiac failure (CCF)** is a significant complication of PDA, particularly in large shunts, leading to symptoms like dyspnea and fatigue. - While CCF can contribute to morbidity and mortality, **infective endocarditis** is generally considered the more common direct cause of death in adults with an untreated PDA.

Q: Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by

ECHO. ***ECHO*** - **Echocardiography (ECHO)** is the primary and most widely used non-invasive method for detecting cardiotoxicity due to its ability to assess **left ventricular ejection fraction (LVEF)**, a key indicator of cardiac function, and structural changes. - It is crucial for **baseline assessment**, monitoring during treatment, and follow-up, identifying both systolic and diastolic dysfunction effectively. *Endomyocardial Biopsy* - While **endomyocardial biopsy** is considered the gold standard for definitive diagnosis of some cardiomyopathies (e.g., myocarditis), it is **invasive** and carries risks such as perforation, tamponade, and arrhythmias. - It is usually reserved for cases where other non-invasive tests are inconclusive and there's a strong clinical suspicion of severe cardiac disease, or for research, not routine monitoring of cardiotoxicity. *ECG* - An **ECG** can detect arrhythmias and ischemic changes but is **not sensitive or specific** enough to reliably detect early or subtle changes in cardiac function characteristic of cardiotoxicity. - It may show changes secondary to heart failure, but it does not directly measure ejection fraction or assess overall cardiac mechanical function. *Radionuclide Scan* - **Radionuclide scans**, specifically **MUGA (Multigated Acquisition)** scans, can accurately measure **LVEF** and are an alternative to ECHO, particularly when ECHO images are suboptimal [1]. - However, they involve **radiation exposure**, making them less ideal for frequent monitoring compared to echocardiography, especially in cancer patients who are already exposed to radiation.

Q: Essential criteria for TOF includes all except ?

Ventricular septal defect. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is one of the four cardinal features of **Tetralogy of Fallot (TOF)**, not an exclusion criterion. - The VSD in TOF is typically **large and unrestrictive**, allowing for mixing of oxygenated and deoxygenated blood. *Infundibular stenosis* - **Infundibular stenosis** (pulmonary outflow tract obstruction) is a fundamental component of TOF, causing restricted blood flow to the pulmonary artery. - The degree of **right ventricular outflow tract obstruction** is the primary determinant of the clinical severity of TOF. *Overriding of aorta* - The **overriding aorta**, where the aortic root originates above both ventricles and the VSD, is a key anatomical feature of TOF. - This position allows deoxygenated blood from the right ventricle to directly enter the **systemic circulation**. *RVH* - **Right ventricular hypertrophy (RVH)** is a compensatory response to the increased pressure load on the right ventricle due to the **pulmonary stenosis** in TOF. - This **thickening of the right ventricular muscle** is an expected and essential criterion for the diagnosis of TOF.

Q: A young female presents with chest pain not associated with exercise. Auscultation reveals multiple ejection clicks with a murmur. The most important investigation for diagnosis is:

Echocardiography. ***Echocardiography*** - **Echocardiography** is the gold standard for visualizing cardiac structures and valve function, allowing direct assessment of **mitral valve prolapse (MVP)** [1]. - The presence of **multiple ejection clicks** and a murmur in a young female with non-exertional chest pain strongly suggests MVP, which can be confirmed by echocardiography [3]. *ECG* - An **ECG** can detect arrhythmias or signs of ischemia, but it cannot directly visualize the heart valves or diagnose **mitral valve prolapse** [2]. - While some MVP patients may have T-wave abnormalities or QT prolongation, these findings are non-specific and not diagnostic. *Thallium 201 scan* - A **Thallium 201 scan** is a nuclear imaging test primarily used to assess myocardial perfusion and detect areas of ischemia, usually in the context of **coronary artery disease** [4]. - It does not provide detailed anatomical information about heart valves or cardiac chamber morphology, making it unsuitable for diagnosing **mitral valve prolapse**. *Tc pyrophosphate scan* - A **Tc pyrophosphate scan** is primarily used to diagnose **amyloidosis** or evaluate myocardial infarction, particularly for detecting late-phase complications or right ventricular involvement. - It does not offer direct visualization of valvular structures and is not indicated for the diagnosis of **mitral valve prolapse**.

Q: Obstruction in pulmonary stenosis may occur at the following sites ___________

All of the options. ***All of the options*** - Pulmonary stenosis refers to an obstruction of blood flow from the **right ventricle to the pulmonary artery**, which can occur at multiple levels. - The obstruction can be **valvular, subvalvular, or supravalvular**, affecting different anatomical locations within the right ventricular outflow tract and pulmonary artery. *Subvalvular* - This form of obstruction occurs **below the pulmonary valve**, often due to muscle bundles or an aberrant septal band. - An example is a **double-chambered right ventricle**, where an abnormal muscle band divides the right ventricle. *Valvular* - The most common site of pulmonary stenosis is at the **level of the pulmonary valve itself**, due to commissural fusion or dysplastic leaflets. - This leads to restricted opening of the valve, creating a pressure gradient during **systole**. *Supravalvular* - This obstruction occurs **above the pulmonary valve**, typically in the main pulmonary artery or its branches. - It can be an isolated lesion or associated with certain syndromes like **Alagille syndrome**.

Q: Which lipid parameter is most useful for cardiovascular risk stratification in hypertensive patients?

Cholesterol/HDL<3.5. ***Cholesterol/HDL<3.5*** - The **total cholesterol to HDL ratio** is a strong predictor of cardiovascular risk, particularly in hypertensive patients, as it integrates both pro-atherogenic (total cholesterol) and anti-atherogenic (HDL) lipid fractions [1]. - A ratio of **<3.5** generally indicates a lower cardiovascular risk, while higher ratios are associated with increased risk. *Triglycerides <150mg/dL* - While high triglycerides are an independent risk factor, a level of **<150 mg/dL** is considered normal and does not provide comprehensive cardiovascular risk stratification on its own. - High triglycerides are often associated with other metabolic abnormalities, but this single value does not reflect the balance of pro- and anti-atherogenic particles as effectively as the cholesterol/HDL ratio. *LDL cholesterol <100mg/dL* - **LDL cholesterol** is a primary target for lipid-lowering therapy, and a level of **<100 mg/dL** is generally desirable for cardiovascular health [1]. - However, relying solely on LDL might miss patients with high cardiovascular risk due to low HDL or other dyslipidemias not fully captured by LDL alone [1]. *HDL <30mg%* - **Low HDL** is an independent risk factor for cardiovascular disease [1]. However, simply using a low threshold like **<30 mg%** only identifies a subset of high-risk individuals. - This parameter doesn't account for total cholesterol levels, making the **ratio of total cholesterol to HDL** a more robust and comprehensive indicator of overall lipid-related cardiovascular risk.

Question 1

Which of the following is a major criterion of Rheumatic fever according to Jones criteria?
a) Chorea
b) Erythema nodosum
c) Arthritis
d) Fever
e) Carditis

Accepted Answer

Carditis

Answer

Erythema nodosum

Answer

Fever

Answer

Prolonged PR interval

Answer

Erythema marginatum

Question 2

A previously healthy patient presents with dyspnea and low grade fever since 4 months. His lungs are clear. JVP is normal. ECG showed low voltage complexes. What is the possible diagnosis?

Accepted Answer

Tuberculous pericardial effusion

Answer

Rheumatic mitral stenosis

Answer

Hypertrophic cardiomyopathy

Answer

Syphilitic aortic aneurysm

Question 3

Most common cause of death in Rheumatoid Arthritis?

Accepted Answer

Ischemic heart disease

Answer

Hepatic failure

Answer

ARDS

Answer

Pulmonary fibrosis

Question 4

Most common cause of death in adults with PDA is?

Accepted Answer

Infective endocarditis

Answer

Rupture

Answer

Embolism

Answer

CCF

Question 5

Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by

Accepted Answer

ECHO

Answer

Endomyocardial Biopsy

Answer

ECG

Answer

Radionuclide Scan

Question 6

Essential criteria for TOF includes all except ?

Accepted Answer

Ventricular septal defect

Answer

Infundibular stenosis

Answer

Overriding of aorta

Answer

RVH

Question 7

A 30 year old male was brought to the ER after a car crash. On admission, pulse is weak with BP=80/60 mmHg. Jugular venous pressure is elevated, heart sounds are muffled, and bedside echocardiography reveals a pericardial effusion with right ventricular diastolic collapse consistent with cardiac tamponade. A right-heart catheter is placed. Which is the most consistent value with patient's diagnosis?

Accepted Answer

RA pressure: 16 mmHg | Pulmonary artery pressure: 34/16 mmHg | PCWP: 16 mmHg

Answer

RA pressure: 16 mmHg | Pulmonary artery pressure: 100/30 mmHg | PCWP: 28 mmHg

Answer

RA pressure: 16 mmHg | Pulmonary artery pressure: 45/22 mmHg | PCWP: 20 mmHg

Answer

RA pressure: 16 mmHg | Pulmonary artery pressure: 75/30 mmHg | PCWP: 11 mmHg

Question 8

A young female presents with chest pain not associated with exercise. Auscultation reveals multiple ejection clicks with a murmur. The most important investigation for diagnosis is:

Accepted Answer

Echocardiography

Answer

ECG

Answer

Thallium 201 scan

Answer

Tc pyrophosphate scan

Question 9

Obstruction in pulmonary stenosis may occur at the following sites ___________

Accepted Answer

All of the options

Answer

Subvalvular

Answer

Valvular

Answer

Supravalvular

Question 10

Which lipid parameter is most useful for cardiovascular risk stratification in hypertensive patients?

Accepted Answer

Cholesterol/HDL<3.5

Answer

Triglycerides <150mg/dL

Answer

LDL cholesterol <100mg/dL

Answer

HDL <30mg%

Cardiology — MCQs

Cardiology — MCQs

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