Cardiology Practice Questions

Q: Which of the following is not a high-pitched heart sound?

Tumor plop sound. ***Tumor plop sound*** - This sound, often associated with a **left atrial myxoma**, is typically a **low-pitched, thudding sound** caused by the tumor prolapsing into the left ventricle during diastole. - Its **low frequency** differentiates it from other high-pitched clicks or snaps. *Mid-systolic click* - This sound is a **high-pitched** event, commonly associated with the sudden tensing of **chordae tendineae** or abnormal leaflet motion in **mitral valve prolapse** [1]. - Its high frequency is characteristic of rapid tensing of intracardiac structures. *Opening snap* - An **opening snap** is a **high-pitched** diastolic sound caused by the abrupt opening of a **stenotic mitral valve** [1]. - The sound is generated by the sudden tensing of the fused valve leaflets, which creates a sharp sound. *Pericardial friction rub* - A **pericardial friction rub** is characterized by a high-pitched, scratchy, and often **creaky sound** heard in pericarditis. - It is created as inflamed visceral and parietal pericardial layers rub against each other, producing a high-frequency sound.

Q: Which of the following arrhythmias is most commonly associated with alcohol binge in alcoholics?

Atrial fibrillation. ***Atrial fibrillation*** - **Atrial fibrillation** is the most common arrhythmia associated with alcohol binge, often referred to as **"holiday heart syndrome"** [1]. - Alcohol can trigger AF by affecting **autonomic tone**, causing **electrolyte imbalances**, and direct **myocardial toxicity**, leading to electrical instability in the atria. *Ventricular fibrillations* - **Ventricular fibrillation** is a life-threatening arrhythmia that leads to cardiac arrest and is typically associated with **acute myocardial infarction** or severe **structural heart disease**, not commonly alcohol binge alone [3]. - While alcohol can increase the risk of other cardiac events, VF is not the primary arrhythmia directly induced by an alcohol binge [3]. *Ventricular premature contractions* - **Ventricular premature contractions (VPCs)** are common and can be triggered by various factors including stress, caffeine, and alcohol, but they are generally benign and not the most commonly reported serious arrhythmia from alcohol binge. - While an increase in VPCs might occur, they do not carry the same clinical significance or prevalence as AF in the context of acute alcohol consumption. *Atrial flutter* - **Atrial flutter** is another atrial arrhythmia that can be seen in patients with structural heart disease or hypertension, and can be precipitated by alcohol [2]. - However, **atrial fibrillation** is far more prevalent in acute alcohol-induced arrhythmias, making it a more common association than atrial flutter [1].

Q: Wide QRS complex (≥ 0.12 seconds) can be seen in various conditions. Which of the following is least likely to present with a wide QRS complex?

Left Anterior Fascicular Block. ***Left Anterior Fascicular Block*** - While a **Left Anterior Fascicular Block (LAFB)** does affect ventricular depolarization, it typically causes a **left axis deviation** and only *slight widening* of the QRS complex, usually less than 0.12 seconds. - The delay in conduction is primarily through one of the fascicles of the left bundle branch, not the entire ventricular conduction system. *Hyperkalemia* - Severe **hyperkalemia** can significantly impair myocardial conduction, leading to a **diffuse slowing of ventricular depolarization**. - This results in a **widened QRS complex** as the potassium levels increase, along with peaked T waves and eventually sine wave patterns. *Wolf Parkinson White Syndrome* - **Wolff-Parkinson-White (WPW) syndrome** involves an **accessory pathway** that bypasses the AV node, leading to pre-excitation of the ventricles [1, 2]. - This abnormal conduction pathway results in a **short PR interval** and a **delta wave**, which combines with normal ventricular activation to produce a **wide QRS complex** [2]. *Ventricular Tachycardia* - **Ventricular tachycardia (VT)** originates in the ventricles, bypassing the normal His-Purkinje system [3]. - This abnormal ventricular activation sequence leads to a **markedly widened QRS complex** (typically > 0.12 seconds) due to slow, muscle-to-muscle conduction [3].

Q: Low QRS voltage on ECG indicates ?

Pericardial effusion. ***Pericardial effusion*** - A significant **pericardial effusion** can lead to low QRS voltage on ECG because the fluid surrounding the heart acts as an electrical insulator, dampening the electrical signals [1]. - This dampening effect reduces the amplitude of the QRS complexes recorded on the electrocardiogram [1]. *Pulmonary embolism* - While pulmonary embolism can cause various ECG changes (e.g., **S1Q3T3 pattern**, right axis deviation), it typically does not directly cause low QRS voltage. - The primary hemodynamic impact is on the right side of the heart and does not involve fluid accumulation around the heart to dampen electrical signals. *Cor pulmonale* - **Cor pulmonale** is right ventricular hypertrophy secondary to lung disease; ECG usually shows signs of **right ventricular hypertrophy** (e.g., tall R waves in V1, right axis deviation). - This condition is associated with increased electrical activity in the right ventricle, generally leading to larger, not smaller, QRS complexes in relevant leads. *Infective endocarditis* - **Infective endocarditis** affects heart valves and can cause rhythm disturbances or conduction blocks due to myocardial involvement or abscess formation. - It does not directly affect the electrical conductivity of the heart in a way that would cause generalized low QRS voltage.

Q: In Left Ventricular Hypertrophy (LVH), what is the minimum value of SV1 + RV6 in mm that suggests the presence of LVH?

35 mm. 35 mm - A combined amplitude of **SV1 + RV6 ≥ 35 mm** on an ECG is a commonly used **Sokolow-Lyon criterion** for diagnosing LVH. - This criterion demonstrates a degree of **specificity** for LVH, although its sensitivity can be limited. 25 mm - This value is **too low** and would lead to a high number of **false positives** for LVH. - While some criteria consider smaller amplitudes, **25 mm is not a standard threshold** for the Sokolow-Lyon criteria. 30 mm - This value is **below the standard threshold** for the Sokolow-Lyon criteria, potentially leading to underdiagnosis. - The accepted cut-off for **SV1 + RV6** in adults is generally higher than 30 mm. 45 mm - While a value of **45 mm** would strongly suggest LVH, it is **not the minimum threshold** for the Sokolow-Lyon criteria. - Using this higher threshold would decrease sensitivity, potentially **missing some cases** of LVH.

Q: What is the most common cause of sudden death in patients with sarcoidosis?

Arrhythmias. ***Arrhythmias*** - **Cardiac sarcoidosis** can lead to granulomatous infiltration of the myocardium, disrupting the **cardiac conduction system**. - This disruption can result in various **arrhythmias**, including **ventricular tachycardia** and **ventricular fibrillation**, which are frequent causes of sudden cardiac death [2]. *Pneumonia* - While sarcoidosis can affect the lungs, leading to **pulmonary fibrosis** and increased susceptibility to infection, **pneumonia** is not the most common cause of sudden death in these patients. - Death from pneumonia is typically due to **respiratory failure** which is often preceded by a period of illness rather than being sudden. *Cor pulmonale* - **Cor pulmonale** (right heart failure due to lung disease) can develop in advanced pulmonary sarcoidosis due to **pulmonary hypertension**. - While a serious complication, it generally leads to a more **gradual decline** in cardiac function rather than sudden death. *Liver failure* - **Hepatic involvement** in sarcoidosis is common, with granulomas found in the liver, but **liver failure** as a direct cause of sudden death is rare [1]. - Significant liver dysfunction usually progresses over time, leading to more chronic symptoms.

Q: What does a -30 to -90 degree axis deviation indicate?

Left Axis Deviation. ***Left Axis Deviation*** - A cardiac axis between **-30 and -90 degrees** is defined as **Left Axis Deviation (LAD)** [1]. - LAD is typically caused by conditions such as **left ventricular hypertrophy**, **inferior myocardial infarction**, or **left anterior fascicular block**. *Right Axis Deviation* - Right Axis Deviation generally refers to an axis between **+90 and +180 degrees**. - It is often associated with conditions like **right ventricular hypertrophy** or **left posterior fascicular block**. *Extreme Right Axis Deviation* - **Extreme Right Axis Deviation**, sometimes called "Northwest axis," indicates an axis between **-90 and -180 degrees**. - This is a rare finding, usually associated with severe conditions such as **ventricular tachycardia** or **pulmonary embolism**. *Normal Cardiac Axis* - A **normal cardiac axis** typically falls between **-30 and +90 degrees** [1]. - The given range of **-30 to -90 degrees** extends beyond the normal range, indicating an abnormal deviation.

Q: Which of the following is least likely to be associated with broad complex tachycardia due to ventricular tachycardia?

Termination of tachycardia by carotid sinus massage. ***Termination of tachycardia by carotid sinus massage*** - **Carotid sinus massage** typically slows or terminates **supraventricular tachycardias (SVTs)** by increasing vagal tone to the AV node. - While it might occasionally slow the ventricular rate in VT (if the SA node is still firing normally), it is very **unlikely to terminate** a re-entrant ventricular tachycardia itself [2]. *Fusion beats* - These occur when an impulse from the ventricles (VT) and an impulse from the atria (often sinus) depolarize the ventricles **simultaneously**, creating a QRS complex that is a blend of the two [1]. - Their presence is a strong indicator of **ventricular tachycardia** [1]. *AV dissociation* - This refers to the atria and ventricles beating independently, where the atrial rate is usually slower than the ventricular rate in VT [1]. - It is a **hallmark sign** of ventricular tachycardia, distinguishing it from most SVTs with aberrancy [1]. *Capture beats* - A capture beat occurs when an atrial impulse (often a sinus beat) successfully conducts through the AV node and depolarizes the ventricles during VT. - This results in a **narrower QRS complex** appearing periodically within the broad complex tachycardia, providing strong evidence for VT.

Q: Which of the following is a complication of Takayasu's arteritis?

Renal hypertension. Renal hypertension - Takayasu's arteritis often causes stenosis of the renal arteries, leading to renovascular hypertension [2]. - This complication arises from the inflammatory thickening and narrowing of large arteries, including those supplying the kidneys [3]. Intimal fibrosis - While intimal fibrosis is a pathological feature seen in Takayasu's arteritis due to chronic inflammation, it is part of the disease process rather than a direct clinical complication. - The fibrosis itself contributes to the stenosis and occlusion that cause clinical complications [1], but it is not a standalone complication. Coronary aneurysm - Though Takayasu's arteritis can affect coronary arteries, it typically causes stenosis or occlusion rather than aneurysm formation. - Coronary aneurysms are more characteristic of diseases like Kawasaki disease [3]. None of the options - This option is incorrect as renal hypertension is a well-known and significant complication of Takayasu's arteritis.

Q: Which of the following conditions is a known cause of Right Bundle Branch Block (RBBB)?

Cor pulmonale. ### Question Which of the following conditions is a known cause of Right Bundle Branch Block (RBBB)? ### Original Explanation ***Cor pulmonale*** - **Cor pulmonale** is **right ventricular hypertrophy** with or without dilation due to pulmonary hypertension, impacting the right ventricle's conduction system and causing **RBBB** [1]. - The increased pressure and strain on the right side of the heart can damage the right bundle branch, leading to a conduction delay visible as **RBBB** on an ECG [1]. *Normal aging process* - While the **normal aging process** can lead to some degenerative changes in the heart's conduction system, it more commonly causes **Left Anterior Fascicular Block** or **Left Bundle Branch Block (LBBB)**, rather than isolated RBBB. - Significant **RBBB** in an elderly individual often points to an underlying structural or physiological cause rather than mere aging. *Pulmonary embolism* - A **pulmonary embolism** can cause acute **right ventricular strain** and dilation, which can mimic **RBBB** or cause a transient RBBB pattern [1]. - However, **RBBB** is not a direct consequence of the physical obstruction but rather an effect of the resulting **acute pulmonary hypertension** and right heart strain [2]. *Myocardial infarction* - A **myocardial infarction** affecting the **septum** or the **right ventricle** can damage the right bundle branch, leading to **RBBB**. - However, the most classic ECG finding of a myocardial infarction is **ST-segment elevation** or **new Q waves**, with **RBBB** being a potential complication rather than a direct cause [3].

Question 1

Which of the following is not a high-pitched heart sound?

Accepted Answer

Tumor plop sound

Answer

Mid-systolic click

Answer

Opening snap

Answer

Pericardial friction rub

Question 2

Which of the following arrhythmias is most commonly associated with alcohol binge in alcoholics?

Accepted Answer

Atrial fibrillation

Answer

Ventricular fibrillations

Answer

Ventricular premature contractions

Answer

Atrial flutter

Question 3

Wide QRS complex (≥ 0.12 seconds) can be seen in various conditions. Which of the following is least likely to present with a wide QRS complex?

Accepted Answer

Left Anterior Fascicular Block

Answer

Hyperkalemia

Answer

Wolf Parkinson White Syndrome

Answer

Ventricular Tachycardia

Question 4

Low QRS voltage on ECG indicates ?

Accepted Answer

Pericardial effusion

Answer

Pulmonary embolism

Answer

Cor pulmonale

Answer

Infective endocarditis

Question 5

In Left Ventricular Hypertrophy (LVH), what is the minimum value of SV1 + RV6 in mm that suggests the presence of LVH?

Accepted Answer

35 mm

Answer

25 mm

Answer

30 mm

Answer

45 mm

Question 6

What is the most common cause of sudden death in patients with sarcoidosis?

Accepted Answer

Arrhythmias

Answer

Pneumonia

Answer

Cor pulmonale

Answer

Liver failure

Question 7

What does a -30 to -90 degree axis deviation indicate?

Accepted Answer

Left Axis Deviation

Answer

Right Axis Deviation

Answer

Normal Cardiac Axis

Answer

Extreme Right Axis Deviation

Question 8

Which of the following is least likely to be associated with broad complex tachycardia due to ventricular tachycardia?

Accepted Answer

Termination of tachycardia by carotid sinus massage

Answer

Fusion beats

Answer

Capture beats

Answer

AV dissociation

Question 9

Which of the following is a complication of Takayasu's arteritis?

Accepted Answer

Renal hypertension

Answer

None of the options

Answer

Intimal fibrosis

Answer

Coronary aneurysm

Question 10

Which of the following conditions is a known cause of Right Bundle Branch Block (RBBB)?

Accepted Answer

Cor pulmonale

Answer

Myocardial infarction

Answer

Normal aging process

Answer

Pulmonary embolism

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?