Cardiology Practice Questions

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: 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: The normal range for Ankle Brachial Pressure Index (ABI) is:

1.0-1.3 (Normal). **1.0-1.3 (Normal)** - An **ABI** value between 1.0 and 1.3 is considered the normal range, indicating adequate blood flow to the lower extremities. - This range signifies that the **blood pressure** in the ankles is similar to or slightly higher than the blood pressure in the arms, as expected in healthy individuals [1]. * >1.3 (Calcified arteries)* - An **ABI** value greater than 1.3 usually suggests **calcification** and hardening of the arteries, making them incompressible. - This high reading often occurs in patients with **diabetes** or **chronic kidney disease** and can falsely elevate the ABI, potentially masking underlying peripheral artery disease. *0.8-0.9 (Mild PAD)* - An **ABI** in this range indicates **mild peripheral artery disease (PAD)**, where there is some reduction in blood flow, but symptoms might be subtle or only present with exertion. - Patients may experience claudication, but it's typically less severe and could improve with conservative management [1]. *0.5-0.8 (Moderate PAD)* - This range suggests **moderate peripheral artery disease (PAD)**, indicating a more significant blockage or narrowing of the arteries. - Patients often experience **intermittent claudication** and may have discomfort with less strenuous activity [1].

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 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: A patient in regular rhythm presents with absent P waves on ECG. Which of the following is the most likely diagnosis based on the ECG findings?

Atrial Flutter with Variable Block. ***Atrial Flutter with Variable Block*** - The ECG shows a **sawtooth pattern** of atrial activity, characteristic of atrial flutter, with **variable R-R intervals** indicating a variable AV block. - While **P waves are absent**, the discrete, regular flutter waves (F waves) at a rate typically around 300 bpm are visible, with ventricular responses occurring irregularly. *Atrial Fibrillation* - This rhythm is characterized by **irregularly irregular R-R intervals** and the absence of discrete P waves, with **fibrillatory waves** (f waves) that are chaotic and variable in morphology. - The provided ECG clearly shows distinct, regular **F waves** (sawtooth pattern), which is not typical for atrial fibrillation. *Multifocal Atrial Tachycardia* - Identified by at least **three different P wave morphologies** and irregular R-R intervals, with an atrial rate typically over 100 bpm. - The ECG in question shows uniform atrial waves (F waves), not multiple P wave morphologies. *Atrial Flutter with Fixed Block* - This would present with a **regular ventricular rhythm** (regular R-R intervals) because the AV node blocks a consistent number of flutter waves (e.g., 2:1, 3:1 conduction). - The ECG clearly demonstrates **irregular R-R intervals**, ruling out a fixed block.

Q: LBBB is seen with all except

Hypokalemia (low potassium levels). ***Hypokalemia (low potassium levels)*** - **Hypokalemia** does not typically cause LBBB. Instead, it can lead to **QT prolongation**, **U waves**, and flattened T waves, and may predispose to arrhythmias like **torsades de pointes** [3]. - While electrolyte imbalances can affect cardiac conduction, LBBB is primarily associated with structural heart disease or conditions that directly impact the left bundle branch [1]. *Acute Myocardial Infarction (MI)* - **Acute MI**, particularly anterior or septal MIs, can damage the **left bundle branch**, leading to new-onset LBBB [2]. - New LBBB in the setting of acute MI often indicates a **large infarction** and is associated with a worse prognosis [2]. *Hyperkalemia (high potassium levels)* - **Severe hyperkalemia** can cause a variety of ECG changes, including **widening of the QRS complex**, which can mimic LBBB or lead to other intraventricular conduction delays. - As potassium levels rise, the ECG can progress from tall peaked T waves to a wide QRS, flattened P waves, and ultimately a **sine wave pattern** and asystole. *Ashman phenomenon (aberrant conduction in atrial fibrillation)* - The **Ashman phenomenon** is a form of aberrant ventricular conduction, typically seen during **atrial fibrillation**. It refers to a wide QRS complex that occurs after a short R-R interval preceded by a long R-R interval. - This phenomenon often exhibits a morphology consistent with **right bundle branch block (RBBB)**, but can occasionally present with a LBBB-like morphology due to differences in refractory periods of the bundle branches.

Q: Erb's Point in cardiology refers to:

Left sternal border at 3rd intercostal space. ***Left sternal border at 3rd intercostal space*** - **Erb's point** is a key auscultation site located at the **third intercostal space** along the **left sternal border**. - This location is particularly important because sounds from the **aortic** and **pulmonic valves** can often be heard here, as well as murmurs like the murmur of **aortic regurgitation**. *Right 2nd intercostal space* - The **right second intercostal space** at the sternal border is the primary auscultation site for the **aortic valve**. - While aortic sounds are heard at Erb's point, this specific location is not referred to as Erb's point. *Left 2nd intercostal space* - The **left second intercostal space** at the sternal border is the primary auscultation site for the **pulmonic valve**. - It is used to best hear sounds related to the pulmonary circulation, rather than being Erb's point. *Right 3rd intercostal space* - The **right third intercostal space** at the sternal border is not a primary or named auscultation point in the standard set of cardiology landmarks. - Auscultation in this area would primarily involve sounds transmitted from adjacent valve areas.

Q: Which of the following is the MOST common complication of untreated hypertension?

Stroke. ***Stroke*** - **Untreated hypertension** is a major risk factor for both **ischemic** and **hemorrhagic strokes**, damaging blood vessels in the brain [1]. - Sustained high blood pressure can lead to **atherosclerosis** and weakened blood vessel walls, increasing the likelihood of a stroke [1]. *Heart failure* - While hypertension is a leading cause of **heart failure**, it typically develops over a longer period as the heart works harder against elevated pressure, leading to remodeling and dysfunction [2]. - In terms of acute, severe complications, a stroke is often considered more immediately catastrophic. *Kidney damage* - **Hypertensive nephropathy** is a significant long-term complication where high blood pressure damages the small blood vessels in the kidneys, impairing their function. - This process is gradual and contributes to **chronic kidney disease**, but stroke often emerges as a more common and acute serious event. *Vision loss* - **Hypertensive retinopathy** involves damage to the blood vessels in the retina, which can lead to vision problems including **vision loss** or **blindness**. - This is a serious complication, but **stroke** generally has a higher prevalence and more immediate impact in terms of overall morbidity and mortality associated with untreated hypertension.

Q: A hypertensive patient who is non-compliant with medication presents to you with sudden onset breathlessness. A chest x-ray was done, which is shown below. How will you manage this patient?

Intravenous nitroglycerin. ***Intravenous nitroglycerin*** - The chest X-ray shows diffuse bilateral infiltrates and **cardiomegaly**, consistent with **pulmonary edema** due to **acute decompensated heart failure** in a hypertensive patient. - **Intravenous nitroglycerin** is crucial for patients with acute cardiogenic pulmonary edema, as it **reduces preload and afterload**, thereby decreasing pulmonary congestion and improving breathlessness. *Intravenous salbutamol* - **Salbutamol** is a **bronchodilator** used for bronchospasm in conditions like asthma or COPD. - It would not address the underlying pathology of **pulmonary edema** and could potentially worsen the condition by causing **tachycardia** and increasing myocardial oxygen demand. *Nebulization with salbutamol* - Similar to intravenous salbutamol, nebulized salbutamol is used for **bronchospasm** and is ineffective in treating **cardiogenic pulmonary edema**. - There is no indication of airway constriction, and its systemic effects could paradoxically **exacerbate heart failure**. *Oxygen and antibiotics* - While **oxygen** is always indicated for hypoxemia, it alone is insufficient to manage severe **pulmonary edema**. - **Antibiotics** are used to treat bacterial infections, but there are no signs of infection (e.g., fever, purulent sputum) to suggest **pneumonia** as the primary cause of breathlessness; the X-ray findings are more typical of edema.

Question 1

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 2

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 3

The normal range for Ankle Brachial Pressure Index (ABI) is:

Accepted Answer

1.0-1.3 (Normal)

Answer

0.8-0.9 (Mild PAD)

Answer

0.5-0.8 (Moderate PAD)

Answer

>1.3 (Calcified arteries)

Question 4

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 5

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 6

A patient in regular rhythm presents with absent P waves on ECG. Which of the following is the most likely diagnosis based on the ECG findings?

Accepted Answer

Atrial Flutter with Variable Block

Answer

Atrial Fibrillation

Answer

Multifocal Atrial Tachycardia

Answer

Atrial Flutter with Fixed Block

Question 7

LBBB is seen with all except

Accepted Answer

Hypokalemia (low potassium levels)

Answer

Acute Myocardial Infarction (MI)

Answer

Hyperkalemia (high potassium levels)

Answer

Ashman phenomenon (aberrant conduction in atrial fibrillation)

Question 8

Erb's Point in cardiology refers to:

Accepted Answer

Left sternal border at 3rd intercostal space

Answer

Right 2nd intercostal space

Answer

Left 2nd intercostal space

Answer

Right 3rd intercostal space

Question 9

Which of the following is the MOST common complication of untreated hypertension?

Accepted Answer

Stroke

Answer

Kidney damage

Answer

Heart failure

Answer

Vision loss

Question 10

A hypertensive patient who is non-compliant with medication presents to you with sudden onset breathlessness. A chest x-ray was done, which is shown below. How will you manage this patient?

Accepted Answer

Intravenous nitroglycerin

Answer

Intravenous salbutamol

Answer

Nebulization with salbutamol

Answer

Oxygen and antibiotics

Cardiology — MCQs

Cardiology — MCQs

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