Cardiology Practice Questions

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.

Q: Which of the following is NOT true about Erythrocyanosis?

Palpable pulses. ***Palpable pulses*** - Erythrocyanosis is characterized by **vasospasm** and **vasoconstriction**, yet the large arteries typically maintain patency, allowing pulses to remain palpable. - The disease primarily affects the **small cutaneous vessels**, leading to color changes and temperature abnormalities, without usually compromising the main arterial supply to the point of unpalpable pulses. *Affects young girls* - **Erythrocyanosis** (specifically chilblain lupus or perniosis) typically affects **young women** and girls, often presenting in colder climates. - Hormonal factors and a higher prevalence of **autoimmune conditions** in females may contribute to its occurrence. *Cold peripheries* - The condition is characterized by **poor peripheral circulation** and **vasoconstriction**, leading to cold extremities, especially in response to cold exposure. - This symptom is a hallmark of erythrocyanosis and differentiates it from conditions with improved warmth or arterial insufficiency. *Ulceration and gangrene of fingers* - Although erythrocyanosis involves significant microvascular dysfunction, **ulceration and gangrene are uncommon** in this condition, differentiating it from severe forms of vasculitis or Raynaud's phenomenon. - The changes are predominantly **vasospastic** and inflammatory, rather than overtly thrombotic or ischemic, which would lead to tissue loss.

Q: True about Ebstein anomaly is ?

Right atrial dilatation. Right atrial dilatation - Ebstein anomaly is characterized by the **apical displacement** of the tricuspid valve leaflets, which incorporates a portion of the right ventricle into the right atrium, functionally increasing its size. - This **atrialization of the right ventricle** leads to significant **right atrial dilatation** as it has to handle a larger volume [1]. *Right ventricular dilatation* - While there is a functional impairment of the right ventricle due to the displaced tricuspid valve, the **working part of the right ventricle** is often small and hypoplastic, not dilated. - The "atrialized" part of the right ventricle contributes to **right atrial dilatation**, not ventricular dilatation [1]. *Left atrial dilatation* - Ebstein anomaly primarily affects the **right side of the heart**, specifically the **tricuspid valve** and right ventricle. - There is no direct anatomical or physiological mechanism in Ebstein anomaly that would typically cause **left atrial dilatation**. *Left ventricular dilatation* - Similar to left atrial dilatation, Ebstein anomaly is a **right-sided heart defect**. - **Left ventricular morphology and function** are generally preserved in Ebstein anomaly, and dilatation is not a characteristic feature.

Q: Which of the following represents a desired lipid parameter for cardiovascular risk control in hypertension?

Cholesterol/HDL 10 mg% - This option is unclear and likely misphrased, as LDL cholesterol is typically measured independently, not as a ratio to total cholesterol in this manner [1]. - Desired LDL levels are typically much lower than 100 mg/dL for high-risk individuals, and a ratio of LDL to total cholesterol greater than 0.1 (or 10%) is generally observed, but not a specific target for reduction [1]. HDL < 30 mg% - An HDL level less than 40 mg/dL (or 30 mg% for some contexts) is considered low and undesirable, as high HDL is protective against cardiovascular disease [1]. - This value would indicate increased cardiovascular risk, contrary to a desired parameter. HDL / cholesterol ratio < 3.5 - This ratio, as stated, is the inverse of the commonly used and desirable total cholesterol-to-HDL ratio. - If the HDL/cholesterol ratio were less than 3.5, it would imply a relatively low HDL compared to total cholesterol, which is an undesirable cardiovascular risk factor [1].

Q: Which of the following is not a prominent risk factor for stroke?

Moderate alcohol consumption. ***Moderate alcohol consumption*** - While excessive alcohol intake is a risk factor for stroke, **moderate alcohol consumption** (e.g., one drink per day for women, two for men) has not been consistently shown to be a prominent risk factor; some studies even suggest a potential protective effect, though this remains controversial. - The impact of moderate alcohol on stroke risk is complex and often confounded by other lifestyle factors, making it less direct and prominent compared to other listed risk factors. *Smoking* - **Smoking** is a major modifiable risk factor for stroke, significantly increasing the risk of both ischemic and hemorrhagic stroke [2]. - It damages **blood vessels**, promotes **atherosclerosis**, and increases **blood clotting**, all of which contribute to stroke. *Elevated cholesterol* - **High cholesterol levels**, particularly high low-density lipoprotein (LDL) cholesterol, contribute to the development of **atherosclerosis**, which can narrow and harden arteries in the brain and neck [3]. - This narrowing significantly increases the risk of **ischemic stroke** by forming plaques that can rupture or lead to clot formation [1]. *High blood pressure* - **High blood pressure (hypertension)** is the single most important modifiable risk factor for stroke, increasing the risk of both ischemic and hemorrhagic strokes [2]. - It directly damages **blood vessel walls**, leading to **atherosclerosis** and making vessels more prone to **rupture** (hemorrhagic stroke) or obstruction (ischemic stroke).

Q: 18 year old girl with rheumatic carditis, with mitral insufficiency. Which of the following will be seen?

Decreased functional residual capacity. Decreased functional residual capacity - **Mitral insufficiency** leads to increased left atrial pressure, which can cause **pulmonary congestion** and **edema** [1]. - This fluid accumulation in the lungs reduces lung compliance and restricts alveolar expansion, leading to a **decreased functional residual capacity (FRC)** [3]. *Increased residual volume* - **Increased residual volume** is typically seen in **obstructive lung diseases**, where air trapping occurs due to difficulty in exhaling [2]. - Mitral insufficiency, however, causes **restrictive lung physiology** due to pulmonary congestion, which would tend to decrease lung volumes, including residual volume. *Increased vital capacity* - **Increased vital capacity** indicates greater lung functional reserve, which is usually seen in healthy individuals or athletes with well-developed lung mechanics. - In cases of **pulmonary congestion** due to mitral insufficiency, lung compliance is reduced, leading to a **decrease** in vital capacity [1]. *Increased peak expiratory flow rate* - An **increased peak expiratory flow rate (PEFR)** is a measure of how fast a person can exhale air, often seen in healthy individuals or after bronchodilator use in obstructive diseases if reversible. - **Pulmonary congestion** from mitral insufficiency would instead lead to **decreased lung mechanics** and potentially a lower PEFR due to reduced lung compliance and potential airway narrowing from edema [3].

Q: Pericardial calcification is caused by all except:

Radiotherapy to the mediastinum. ***Methysergide therapy*** - **Methysergide** is known to cause **retroperitoneal fibrosis**, which can extend to the pericardium, leading to constrictive pericarditis but typically not calcification. - While it can cause pericardial fibrosis and constriction, **calcification** is not a characteristic feature of methysergide-induced pericardial disease. *Benign pericarditis* - **Benign pericarditis** (often viral) usually resolves without sequelae and does not lead to **pericardial calcification** [1]. - Recurrent inflammation rarely results in calcification unless there are specific co-morbidities or chronic effusions. *Radiotherapy to the mediastinum* - **Radiotherapy** can cause severe, **constrictive pericarditis** often accompanied by calcification, due to chronic inflammation and fibrosis [2]. - The radiation induces damage to pericardial tissues, leading to chronic inflammation and subsequent scarring and calcification. *Anticoagulant therapy* - **Anticoagulant therapy** itself does not directly cause **pericardial calcification**. - While patients on anticoagulants might develop **hemopericardium**, this does not typically progress to calcification unless there is chronic inflammation or a pre-existing condition.

Q: True about VSD is all except -

Pulmonary Oligemia in chest x-ray. ***Pulmonary Oligemia in chest x-ray*** - **Ventricular Septal Defects (VSDs)** with a significant left-to-right shunt typically cause **pulmonary plethora** (increased pulmonary vascular markings) due to increased blood flow to the lungs, not oligemia. - **Pulmonary oligemia** (decreased pulmonary vascular markings) is seen in conditions with reduced pulmonary blood flow, such as severe pulmonary stenosis or tetralogy of Fallot [2]. *Small hole closes spontaneously* - Many **small, restrictive VSDs**, particularly those in the muscular septum, close spontaneously within the first few years of life. - This spontaneous closure is observed in up to 30-50% of VSDs, making it a common outcome for smaller defects. *Defect is usually in membranous part* - The **membranous portion of the interventricular septum** is the most common site for VSDs, accounting for approximately 80% of all defects [1]. - VSDs in this region are often referred to as perimembranous VSDs [1]. *Endocarditis is a common complication* - Patients with VSDs, especially those with smaller or moderate defects where there is a turbulent flow and high-velocity jet, are at an increased risk of developing **infective endocarditis**. - The turbulent blood flow at the site of the VSD can damage the endocardial lining, making it more susceptible to bacterial colonization.

Q: Swan Ganz catheter is used for what ?

Pulmonary capillary pressure. ***Pulmonary capillary pressure*** - A Swan-Ganz catheter, when properly wedged, measures the **pulmonary capillary wedge pressure (PCWP)**, which is an indirect estimate of the left atrial pressure [1] and, consequently, the **left ventricular end-diastolic pressure (LVEDP)** or **preload**. - This measurement helps in assessing left heart function and fluid status [1]. *saturation in mixed venous blood* - While a Swan-Ganz catheter can measure **mixed venous oxygen saturation (SvO2)** from the distal port positioned in the pulmonary artery, this is not its primary or most unique diagnostic application. - SvO2 reflects the balance between oxygen delivery and consumption, providing insights into overall tissue perfusion and oxygen utilization. *LV filling pressure* - The Swan-Ganz catheter does not directly measure the **left ventricular (LV) filling pressure**. Instead, it estimates it indirectly via the **pulmonary capillary wedge pressure (PCWP)**, which is typically a good surrogate for LVEDP [1]. - Direct measurement of LV filling pressure would require a catheter to be placed within the left ventricle. *Pulmonary artery occlusion pressure* - **Pulmonary artery occlusion pressure (PAOP)** is the technical term for the pressure measured when the balloon at the tip of the Swan-Ganz catheter is inflated, occluding a branch of the pulmonary artery [1]. This pressure is synonymous with the **pulmonary capillary wedge pressure (PCWP)**. - Therefore, while the Swan-Ganz catheter measures PAOP, PCWP is a more common and direct description of the physiological parameter being assessed, which represents the pulmonary capillary pressure.

Question 1

Obstruction in pulmonary stenosis may occur at the following sites ___________

Accepted Answer

All of the options

Answer

Subvalvular

Answer

Valvular

Answer

Supravalvular

Question 2

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%

Question 3

Which of the following is NOT true about Erythrocyanosis?

Accepted Answer

Palpable pulses

Answer

Affects young girls

Answer

Cold peripheries

Answer

Ulceration and gangrene of fingers

Question 4

True about Ebstein anomaly is ?

Accepted Answer

Right atrial dilatation

Answer

Right ventricular dilatation

Answer

Left atrial dilatation

Answer

Left ventricular dilatation

Question 5

Which of the following represents a desired lipid parameter for cardiovascular risk control in hypertension?

Accepted Answer

Cholesterol/HDL < 3.5

Answer

LDL / cholesterol > 10 mg%

Answer

HDL < 30 mg%

Answer

HDL / cholesterol ratio < 3.5

Question 6

Which of the following is not a prominent risk factor for stroke?

Accepted Answer

Moderate alcohol consumption

Answer

Smoking

Answer

Elevated cholesterol

Answer

High blood pressure

Question 7

18 year old girl with rheumatic carditis, with mitral insufficiency. Which of the following will be seen?

Accepted Answer

Decreased functional residual capacity

Answer

Increased residual volume

Answer

Increased vital capacity

Answer

Increased peak expiratory flow rate

Question 8

Pericardial calcification is caused by all except:

Accepted Answer

Radiotherapy to the mediastinum

Answer

Benign pericarditis

Answer

Methysergide therapy

Answer

Anticoagulant therapy

Question 9

True about VSD is all except -

Accepted Answer

Pulmonary Oligemia in chest x-ray

Answer

Small hole closes spontaneously

Answer

Defect is usually in membranous part

Answer

Endocarditis is a common complication

Question 10

Swan Ganz catheter is used for what ?

Accepted Answer

Pulmonary capillary pressure

Answer

saturation in mixed venous blood

Answer

LV filling pressure

Answer

Pulmonary artery occlusion pressure

Cardiology — MCQs

Cardiology — MCQs

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