Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 1201: Which of the following is a non-modifiable risk factor for coronary heart disease ?

A. Elevated serum cholesterol
B. Age (Correct Answer)
C. Alcoholism
D. Cigarette smoking

Explanation: ***Age*** - Age is a **non-modifiable risk factor** for coronary heart disease because it cannot be changed or controlled. As people age, their risk of developing CHD naturally increases due to physiological changes and increased exposure to other risk factors over time. [1] - The older an individual is, especially for men over 45 and women over 55, the higher their risk for developing **atherosclerosis** and its complications, including CHD. [1] *Elevated serum cholesterol* - **Elevated serum cholesterol**, particularly high levels of LDL cholesterol, is a **modifiable risk factor** because it can be lowered through diet, exercise, and medication. [1] - Reducing cholesterol levels can significantly decrease the risk of **atherosclerosis** and subsequent CHD. [1] *Alcoholism* - **Alcoholism** is a **modifiable risk factor** as it represents a lifestyle choice that can be changed through behavioral interventions and support. - Excessive alcohol consumption can contribute to high blood pressure, **cardiomyopathy**, and increased triglyceride levels, all of which raise the risk of CHD. *Cigarette smoking* - **Cigarette smoking** is a major **modifiable risk factor** for CHD because it is a habit that individuals can choose to stop. [1] - Smoking damages blood vessels, increases **blood clotting**, and reduces oxygen delivery to the heart, significantly accelerating the development of atherosclerosis. [1]

Question 1202: In a 30-year-old male smoker, the commonest cause of dry gangrene of foot will be

A. Diabetes mellitus
B. Embolism
C. Atherosclerosis
D. Buerger's disease (Correct Answer)

Explanation: Buerger's disease - **Buerger's disease** (**thromboangiitis obliterans**) is strongly associated with **heavy smoking** and typically affects young to middle-aged adult males, leading to dry gangrene in the extremities. - It involves **inflammation and thrombosis** of small and medium-sized arteries and veins, predominantly in the limbs, often manifesting as **ischemic pain**, ulcerations, and gangrene. *Diabetes mellitus* - While **diabetes** can cause dry gangrene due to **peripheral artery disease** and small vessel disease, it is more commonly associated with **wet gangrene** due to increased infection risk, and the age and smoking history point away from it being the *commonest* cause in this specific demographic for dry gangrene [1]. - Diabetic neuropathy can also mask symptoms, leading to delayed presentation and worsening tissue damage [1]. *Embolism* - An **embolic event** would typically present with **sudden onset** severe pain, pallor, pulselessness, paresthesia, and paralysis (the "6 Ps"), leading to acute limb ischemia rather than the progressive dry gangrene described implied in the question. - While it can cause tissue necrosis, it's usually an acute event rather than a chronic process leading to gradual gangrene. *Atherosclerosis* - While **atherosclerosis** is a significant cause of peripheral artery disease and gangrene, especially in smokers, it typically affects an **older population** than the 30-year-old male described [2]. - In younger smokers with gangrene, **Buerger's disease** is a more specific and common diagnosis, as atherosclerosis tends to manifest later in life unless other significant risk factors are present [2].

Question 1203: The "Subclavian steal syndrome" occurs due to

A. Occlusion/stenosis of the carotid artery
B. Occlusion/stenosis of the vertebral artery
C. Occlusion of the subclavian artery proximal to origin of vertebral artery (Correct Answer)
D. Occlusion of the subclavian artery distal to origin of vertebral artery

Explanation: ***Occlusion of the subclavian artery proximal to origin of vertebral artery*** - Subclavian steal syndrome occurs due to severe **stenosis or occlusion of the subclavian artery** **proximal** to the origin of the vertebral artery. - This causes **retrograde flow** in the vertebral artery to supply the arm, "stealing" blood from the vertebrobasilar circulation and potentially leading to **cerebral ischemic symptoms** when the arm is exercised. *Occlusion/stenosis of the carotid artery* - This typically causes symptoms related to **cerebral ischemia** (e.g., stroke, transient ischemic attacks) affecting the anterior circulation, not "stealing" from the vertebrobasilar system [1]. - Carotid artery disease leads to reduced blood flow to the **brain's anterior circulation**, without directly affecting subclavian-vertebral artery dynamics in the same way [1]. *Occlusion/stenosis of the vertebral artery* - Unilateral vertebral artery occlusion or stenosis can cause **vertebrobasilar insufficiency** symptoms but typically does not lead to retrograde flow from the contralateral vertebral artery down the ipsilateral vertebral artery to supply the arm. - It would primarily impair blood supply to the **posterior circulation of the brain** rather than causing blood to be diverted from the brain to the arm [1]. *Occlusion of the subclavian artery distal to origin of vertebral artery* - If the subclavian artery is occluded **distal** to the origin of the vertebral artery, blood flow to the arm is reduced, but the **vertebral artery flow remains antegrade** and supplies the brain. - There would be no "steal" phenomenon because the vertebral artery is not called upon to provide collateral flow to the arm; its natural path to the brain remains undisturbed in terms of competition with the subclavian artery for arm supply.

Question 1204: When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...

A. 0.7
B. 1.0
C. 0.9
D. 0.3 (Correct Answer)

Explanation: ***0.3*** - A value of **less than 0.3** indicates **severe blood flow impairment**, consistent with critical limb ischemia, necessitating urgent intervention [1]. - This extremely low ABPI reflects a profound decrease in perfusion to the lower extremity [1]. *0.7* - An ABPI of **less than 0.7** typically suggests **moderate peripheral artery disease (PAD)**, which could cause claudication but is not usually indicative of critical limb ischemia [1]. - While concerning, it does not represent the severe, limb-threatening ischemia implied by the term "critical." *1.0* - An ABPI of around **1.0 (0.9-1.3)** is considered **normal**, indicating healthy blood flow without significant arterial obstruction. - This value would rule out any significant peripheral artery disease, including critical limb ischemia. *0.9* - An ABPI of **less than 0.9** generally suggests **peripheral artery disease (PAD)**, which can cause symptoms like intermittent claudication [1]. - However, it is not low enough to diagnose critical limb ischemia, which represents a more severe state of arterial insufficiency [1].

Question 1205: The normal ankle brachial pressure index (ABPI) is 1.0. A value of 0.8 suggests

A. impending gangrene
B. presence of collaterals
C. some degree of arterial obstruction (Correct Answer)
D. good flow

Explanation: ***some degree of arterial obstruction*** - An **ABPI of 0.8** indicates a reduction in blood flow to the lower extremities compared to the upper limbs [1]. - This value is generally considered to signify **mild to moderate peripheral artery disease (PAD)**, suggesting the presence of arterial narrowing or obstruction [1]. *impending gangrene* - **Impending gangrene** or critical limb ischemia is typically associated with a much lower ABPI, usually **below 0.4** or even 0.3 [1]. - At an ABPI of 0.8, severe tissue damage and gangrene are not imminent, although careful monitoring is still warranted. *presence of collaterals* - While **collateral arteries** can develop in response to chronic arterial obstruction, an ABPI of 0.8 primarily reflects the overall net blood flow, which is still reduced despite collaterals [1]. - The presence of collaterals can actually help to maintain tissue viability and prevent more severe symptoms, but they don't normalize the ABPI in the presence of significant disease [1]. *good flow* - A value of **1.0 to 1.4** is generally considered a normal ABPI, indicating good arterial flow. - An ABPI of **0.8 is significantly below normal** and suggests impaired rather than good blood flow [1].

Question 1206: A patient presents with claudication in both buttocks and has impotence. The clinical examination reveals bruit over lower abdomen. What is the clinical diagnosis?

A. Bilateral iliofemoral occlusion
B. Aortoiliac occlusion (Correct Answer)
C. Bilateral iliac artery occlusion
D. Bilateral femoropopliteal occlusion

Explanation: Aortoiliac occlusion - The triad of **buttock claudication**, **impotence**, and **absent or diminished femoral pulses** (often associated with an abdominal bruit) is classic for **Leriche syndrome**, which is caused by aortoiliac occlusion [2], [3]. - This occlusion impairs blood flow to both lower extremities and the internal iliac arteries, affecting erectile function [1]. Bilateral iliofemoral occlusion - While this would cause bilateral lower limb symptoms, it typically would not explain the **impotence** as clearly as an aortoiliac occlusion which affects the internal iliac arteries that supply the penis [2], [3]. - An iliofemoral occlusion is distal to the aorta, and the symptom complex provided points to a more **proximal lesion**. Bilateral iliac artery occlusion - This would cause similar symptoms to aortoiliac occlusion including **buttock claudication** and **impotence** [2]. - However, the presence of a **bruit over the lower abdomen** often indicates a more proximal lesion involving the aorta, making aortoiliac occlusion a more comprehensive diagnosis for these findings. Bilateral femoropopliteal occlusion - This would primarily cause **calf and thigh claudication**, less commonly buttock claudication, as the occlusion is more distal [1]. - **Impotence** is not a typical symptom of isolated femoropopliteal occlusion, as the internal iliac arteries are usually unaffected.

Question 1207: Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of aorta (Leriche syndrome)?

A. Claudication of the calf (Correct Answer)
B. Sexual impotence
C. Claudication of the buttock and thigh
D. Gangrene localised to the feet

Explanation: ***Claudication of the calf*** - In Leriche syndrome, the occlusion is at the **aortic bifurcation**, affecting blood flow to the iliac arteries and their branches, typically presenting with **buttock and thigh claudication** [1]. - **Calf claudication** alone is usually indicative of more distal occlusive disease, such as in the popliteal or tibial arteries, and not typically the primary or most characteristic symptom of Leriche syndrome [1]. *Sexual impotence* - **Atherosclerotic occlusive disease** at the aortic bifurcation often reduces blood flow to the internal iliac arteries, which supply the penile arteries. - This results in **erectile dysfunction** due to insufficient blood supply during erection, making sexual impotence a characteristic symptom of Leriche syndrome. *Claudication of the buttock and thigh* - The partial or complete blockage of the **aortic bifurcation** impairs blood flow to both common iliac arteries, leading to ischemia in the major muscle groups of the buttocks and thighs [1]. - This **ischemia** manifests as pain, cramping, or fatigue during exercise, which is relieved by rest, making it a classic symptom of Leriche syndrome [1]. *Gangrene localised to the feet* - Severe and chronic **ischemia** resulting from significant atherosclerotic occlusion at the aortic bifurcation can lead to critical limb ischemia, especially in the lower extremities [1]. - Reduced blood flow to the feet can cause tissue necrosis, ultimately leading to **gangrene**, particularly in advanced stages of Leriche syndrome [1].

Question 1208: Patients with phlebographically confirmed deep vein thrombosis of the calf:

A. can expect asymptomatic recovery if treated promptly with anticoagulant
B. are at risk for significant pulmonary embolism (Correct Answer)
C. may be effectively treated with low-dose heparin
D. may be effectively treated with pneumatic compression stockings

Explanation: ***are at risk for significant pulmonary embolism*** - While calf DVT is often considered less severe than proximal DVT, it still carries a definite risk of extending proximally [1] and subsequently leading to **pulmonary embolism (PE)**, especially if untreated. - Approximately **10-20% of calf DVTs extend proximally**, increasing the risk of potentially fatal PE. *can expect asymptomatic recovery if treated promptly with anticoagulant* - Even with prompt anticoagulant treatment, a significant percentage of patients with DVT experience **post-thrombotic syndrome (PTS)**, characterized by pain, swelling, and skin changes. - While anticoagulants [2] prevent clot extension and PE, they do not guarantee an **asymptomatic recovery** or fully prevent long-term sequelae. *may be effectively treated with low-dose heparin* - **Low-dose heparin** is typically used for DVT prophylaxis, not for treating acute DVT. - Treatment of acute DVT, including calf DVT, requires **therapeutic anticoagulation** with unfractionated heparin, low molecular weight heparin, or oral anticoagulants [2] to prevent clot propagation and embolism. *may be effectively treated with pneumatic compression stockings* - **Pneumatic compression stockings** are primarily used for DVT prevention in high-risk patients, especially post-surgery. - They are not a primary treatment for an **established acute DVT**, where anticoagulation is the cornerstone of therapy to prevent complications.

Question 1209: The "DASH diet" is a lifestyle modification for management of which of these conditions ?

A. Hypertension (Correct Answer)
B. Diabetes
C. Cancer
D. Anemia

Explanation: ***Hypertension*** - The **DASH (Dietary Approaches to Stop Hypertension) diet** was specifically developed and promoted to lower **blood pressure**. [1] - It emphasizes foods rich in **potassium, calcium, and magnesium**, and low in sodium, saturated fat, and cholesterol. [1] *Diabetes* - While a healthy diet is crucial for **diabetes management**, the DASH diet is primarily designed for blood pressure control, though it can benefit individuals with diabetes due to its overall healthy composition. - The primary dietary focus for diabetes is on **carbohydrate control** and glycemic index management. *Cancer* - While a healthy diet can reduce **cancer risk**, the DASH diet is not specifically tailored as a cancer management or prevention strategy. - Cancer prevention diets often highlight **antioxidants** and avoidance of processed foods, which overlap but are not identical to DASH principles. *Anemia* - **Anemia** is typically managed by addressing nutrient deficiencies, most commonly **iron**, or underlying medical conditions. - The DASH diet does not primarily focus on increasing **iron absorption** or other nutrients critical for anemia.

Question 1210: A 45 year old man sustains trauma in a road traffic accident and develops engorgement of neck veins, pallor, rapid pulse rate, and chest pain. What is the most likely diagnosis?

A. Cardiac tamponade (Correct Answer)
B. Haemothorax
C. Pulmonary laceration
D. Rupture of spleen

Explanation: ***Cardiac tamponade*** - The classic triad of **Beck's triad** (engorged neck veins, muffled heart sounds, and hypotension) along with **tachycardia** and **pallor** in a trauma setting is highly indicative of cardiac tamponade [1]. - **Chest pain** due to pressure on the heart and surrounding structures further supports this diagnosis. *Haemothorax* - While blunt trauma can cause **haemothorax**, it typically presents with **diminished or absent breath sounds** on the affected side and **respiratory distress**, not prominently with engorged neck veins unless it's very large and significantly compromises venous return. - The primary sign would be **hypotension** and **tachycardia** from hypovolemia, but without the JVD. *Pulmonary laceration* - A pulmonary laceration would primarily cause **pneumothorax** or **haemothorax**, leading to signs like **dyspnea**, **chest pain**, and potentially **subcutaneous emphysema**. - **Engorged neck veins** are not a primary feature unless the resulting pneumothorax is tension type, which would also present with tracheal deviation. *Rupture of spleen* - A ruptured spleen causes **internal bleeding** (hypovolemic shock) presenting as **abdominal pain**, **left upper quadrant tenderness**, **tachycardia**, and **hypotension**. - **Engorged neck veins** are not a characteristic symptom of splenic rupture because it is a source of blood loss leading to hypovolemia.

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Cardiology — MCQs

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