Cardiology Practice Questions

Q: What does the CEAP score classify?

Chronic venous disorder. ***Chronic venous disorder*** - The **CEAP classification** is a standardized system for classifying **chronic venous disorders** [1]. - It stands for **Clinical, Etiological, Anatomical, and Pathophysiological**, providing a comprehensive description of the disease. *Atrial disorders* - **Atrial disorders** refer to conditions affecting the atria of the heart, such as atrial fibrillation, and are classified using different systems. - The CEAP score has **no relevance** to cardiac conditions. *Neurological disorders* - **Neurological disorders** pertain to conditions of the nervous system and are classified by systems tailored to their specific characteristics. - The CEAP score is **not applicable** to neurological diagnoses. *Traumatic disorders* - **Traumatic disorders** result from physical injury and are classified based on the nature and severity of the injury. - The CEAP score is **irrelevant** for assessing or classifying traumatic injuries.

Q: Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Amiodarone infusion. ***Amiodarone infusion*** - **Amiodarone** is a **Class III antiarrhythmic** drug commonly used in advanced cardiac life support (ACLS) protocols for refractory **ventricular fibrillation (VF)** or **pulseless ventricular tachycardia (VT)** that persists despite defibrillation and epinephrine [1]. - It works by blocking potassium channels, prolonging repolarization and the refractory period, which helps to stabilize the electrical activity of the heart. *Atropine* - **Atropine** is an anticholinergic drug primarily used to treat **symptomatic bradycardia** by increasing heart rate. - It is not indicated for the treatment of **ventricular fibrillation** or **ventricular tachycardia** during cardiac arrest. *High dose vasopressin* - **Vasopressin** was previously included in some ACLS algorithms as an alternative to epinephrine for **vasoconstrictive effects**, but recent guidelines do not support its routine use in cardiac arrest. - While it can cause **vasoconstriction**, there is no evidence that high-dose vasopressin improves outcomes in refractory VF/VT over epinephrine. *Adenosine* - **Adenosine** is an antiarrhythmic drug used to treat **supraventricular tachycardias (SVTs)** by transiently blocking the AV node. - It is not effective for **ventricular fibrillation** or **ventricular tachycardia** and can even be harmful in these rhythms.

Q: A 55-year-old hypertensive patient presents with severe chest pain radiating to the back. What does a CT scan of the thorax typically reveal?

Type B Aortic dissection. ***Type B Aortic dissection*** - A CT scan of the thorax would show a **tear in the descending aorta**, typically distal to the left subclavian artery, consistent with a type B dissection. - The combination of **hypertension** and **severe chest pain radiating to the back** is highly suggestive of an aortic dissection, and involvement of the descending aorta (Type B) often presents with radiating back pain. *Type A Aortic dissection* - A type A dissection involves the **ascending aorta**, which would typically present with chest pain radiating to the neck or jaw, or acute onset of symptoms suggestive of a stroke or myocardial infarction. - While it's also an aortic dissection, its location is different, and the pain typically radiates to different areas. *Pulmonary Embolism* - A **pulmonary embolism** would appear as a filling defect in the pulmonary arteries on a CT angiogram, not a tear in the aorta. - Though it can cause chest pain, it's typically pleuritic and not usually described as severe and radiating to the back in the same manner as an aortic dissection. *Thoracic Aortic Aneurysm* - A **thoracic aortic aneurysm** is a localized dilation of the aorta, not a tear, and it typically presents with chronic or less acute symptoms unless it ruptures or causes compression. - While an aneurysm can be present, the acute and severe nature of the pain described points more strongly to an acute event like dissection rather than a stable aneurysm.

Q: What electrolyte imbalance is most commonly associated with prominent U waves on ECG?

Hypokalemia. ***Hypokalemia*** - **Prominent U waves** on an ECG are a classic sign of **hypokalemia**, indicating delayed repolarization of ventricular myocardial cells. - Other ECG changes associated with hypokalemia include **ST-segment depression**, **flattened T waves**, and a prolonged QT interval. *Hyponatremia* - **Hyponatremia** primarily affects neurological function and can lead to symptoms like confusion and seizures [1]. - It does not typically cause specific characteristic ECG changes such as **prominent U waves**. *Hypocalcemia* - **Hypocalcemia** is often associated with a **prolonged QT interval** on an ECG, which reflects delayed ventricular repolarization [2]. - However, it is not primarily linked to the appearance of prominent U waves. *Hypercalcemia* - **Hypercalcemia** is known to cause a **shortened QT interval** on the ECG due to accelerated repolarization. - It does not typically manifest with prominent U waves.

Q: A patient with first-degree heart block presents with dizziness. What is the most appropriate management for this patient?

Observation and investigation of other causes. ***Observation and investigation of other causes*** - **First-degree heart block** is usually **asymptomatic** and benign, rarely causing dizziness or other symptoms. - The dizziness experienced by the patient is likely due to another underlying condition and warrants **further investigation** rather than direct intervention for the heart block [2], [3]. *Pacemaker insertion* - **Pacemaker insertion** is reserved for **symptomatic heart blocks** of higher degrees (e.g., Mobitz II or complete heart block) or those with significant hemodynamic compromise [1]. - Given that first-degree heart block is typically asymptomatic, inserting a pacemaker would be an **overtreatment** and unnecessary for this condition alone. *Isoprenaline* - **Isoprenaline** is a **beta-agonist** that increases heart rate and AV conduction, sometimes used in certain bradyarrhythmias. - However, for first-degree heart block, which is generally benign, pharmacologic intervention with agents like **isoprenaline** is not typically indicated and carries risks of adverse effects [2]. *Atropine* - **Atropine** is an anticholinergic drug used to **increase heart rate** by blocking vagal stimulation of the SA and AV nodes. - While it can improve AV conduction, it is not indicated for **asymptomatic first-degree heart block** or when symptoms like dizziness are unlikely to be directly caused by the block itself.

Q: The severity of mitral stenosis can be judged by-

Loud S1. ***Loud S1*** - A **loud S1** in mitral stenosis indicates that the **mitral valve leaflets are still mobile** and able to snap shut forcefully, which is characteristic of early to moderate stenosis [2]. - As mitral stenosis becomes more severe and the valve becomes calcified and rigid, the S1 sound may become diminished or even absent due to reduced leaflet mobility [1]. *Intensity of murmur* - The **intensity (loudness)** of the diastolic murmur in mitral stenosis **does not directly correlate with the severity** of the stenosis. - A loud murmur can be heard with mild stenosis, while a soft murmur in severe stenosis may be due to reduced cardiac output or left atrial pressure. *Duration of murmur* - While a **longer duration of the diastolic murmur** can coincide with more severe mitral stenosis, it is not as reliable a single indicator as other findings. - The duration is influenced by the pressure gradient across the valve and the length of diastole [2]. *Presence of left ventricular S3* - A **left ventricular S3** is typically associated with **left ventricular dysfunction** and volume overload, as seen in conditions like mitral regurgitation or dilated cardiomyopathy [3]. - It is **not a feature of mitral stenosis**, where the primary issue is obstruction to left ventricular filling.

Q: Murmur heard in aortic stenosis

Right 2nd intercostal, high pitch systolic ejection murmur. ***Right 2nd intercostal, high pitch systolic ejection murmur*** - The murmur of **aortic stenosis** is classically heard loudest at the **right second intercostal space** (aortic area) due to turbulent flow through the stenosed aortic valve. - It is a **high-pitched, systolic ejection murmur** with a crescendo-decrescendo pattern, often radiating to the carotid arteries [2]. *Apex, low pitch murmur associated with mitral valve issues* - A murmur heard at the **apex** that is low-pitched typically suggests **mitral stenosis**, which is a diastolic rumble, not an aortic stenosis murmur [1]. - This option refers to characteristics associated with **mitral valve disease**, not aortic stenosis. *Pan-systolic murmur, high pitch murmur associated with mitral regurgitation* - A **pan-systolic murmur** is characteristic of conditions like **mitral regurgitation** or tricuspid regurgitation, where blood flows throughout the entire systole [3]. - While it can be high-pitched, its pan-systolic nature and association with mitral regurgitation make it distinct from aortic stenosis. *Left Sternal area, murmur indicating mitral regurgitation* - Murmurs heard primarily at the **left sternal area** can indicate various conditions, but this option specifically points to **mitral regurgitation**. - **Mitral regurgitation** is better heard at the apex and usually radiates to the axilla, and the description does not fit the typical presentation of aortic stenosis [3].

Q: Which one of the following is not an early complication of acute myocardial infarction?

Dressler's syndrome. ***Dressler's syndrome*** - **Dressler's syndrome** (post-myocardial infarction syndrome) is a **late complication** of acute myocardial infarction, typically occurring weeks to months after the event. - It is an **immune-mediated pericarditis**, characterized by chest pain, fever, and pericardial effusion, but is not seen immediately following an MI. *Papillary muscle dysfunction* - **Papillary muscle dysfunction** or rupture can occur as an **early complication** due to ischemia and necrosis of the muscle, leading to **mitral regurgitation** [1]. - This usually manifests within hours to days of the infarct, especially in **inferior MIs** affecting the posterior papillary muscle. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is an **early mechanical complication** resulting from necrosis and rupture of the interventricular septum. - It typically presents within the **first week** after an MI, causing a new **holosystolic murmur** and signs of heart failure. *Pericarditis* - **Early pericarditis** (within a few days of MI) results from inflammation overlying the necrotic myocardial tissue [1]. - It presents with **pleuritic chest pain** that improves with leaning forward and a **pericardial friction rub**, and is distinct from Dressler's syndrome.

Q: In the context of ventricular tachycardia, what do extra systoles appear as on an electrocardiogram (ECG)?

QRS complex. ***QRS complex*** - Extra systoles, particularly **premature ventricular contractions (PVCs)**, originate in the ventricles and result in a **wide and bizarre QRS complex** on an ECG [2]. - The QRS complex represents **ventricular depolarization**, and in ventricular tachycardia, the *ventricular activity* dominates the ECG tracing [2]. *P wave* - The **P wave** represents **atrial depolarization** and is typically either absent or dissociated from the QRS complex in ventricular tachycardia [1], [2]. - Its presence or absence helps differentiate supraventricular from ventricular arrhythmias. *T wave* - The **T wave** represents **ventricular repolarization**, which typically follows the QRS complex [1]. - While it will be present, it often appears abnormal or discordant in ventricular tachycardia due to the altered ventricular depolarization. *R wave* - The **R wave** is part of the QRS complex, specifically the first positive deflection. - While an R wave is present within the QRS complex of an extrasystole, referring to the entire **QRS complex** is more accurate as it encompasses the complete ventricular depolarization in an abnormal morphology.

Q: Wide pulse pressure is seen in all except which of the following?

Aortic stenosis. **Aortic stenosis** - In **aortic stenosis**, there is a fixed obstruction to left ventricular outflow, leading to a compensatory increase in systolic pressure to overcome the stenotic valve [2]. - The **reduced stroke volume** and impaired flow through the rigid valve cause a lower pulse pressure, often resulting in a **narrow pulse pressure**. *PDA (Patent Ductus Arteriosus)* - In **PDA**, blood flows from the aorta to the pulmonary artery during systole and diastole, causing a decrease in diastolic pressure. - This creates a **run-off phenomenon**, leading to a **wide pulse pressure** due to high systolic and low diastolic pressures. *Aortic Regurgitation* - **Aortic regurgitation** involves blood flowing back into the left ventricle during diastole, causing a rapid fall in diastolic pressure [1]. - The increased stroke volume from the left ventricle leads to a high systolic pressure, resulting in a **wide pulse pressure** [1]. *A.V. malformation (Arteriovenous Malformation)* - An **AV malformation** creates a shunt where arterial blood flows directly into the venous system, bypassing the capillary bed. - This leads to a **decrease in peripheral resistance** and an increased cardiac output, causing a higher systolic pressure and a lower diastolic pressure, thereby producing a **wide pulse pressure**.

Question 1

What does the CEAP score classify?

Accepted Answer

Chronic venous disorder

Answer

Atrial disorders

Answer

Neurological disorders

Answer

Traumatic disorders

Question 2

Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Accepted Answer

Amiodarone infusion

Answer

Atropine

Answer

Adenosine

Answer

High dose vasopressin

Question 3

A 55-year-old hypertensive patient presents with severe chest pain radiating to the back. What does a CT scan of the thorax typically reveal?

Accepted Answer

Type B Aortic dissection

Answer

Type A Aortic dissection

Answer

Pulmonary Embolism

Answer

Thoracic Aortic Aneurysm

Question 4

What electrolyte imbalance is most commonly associated with prominent U waves on ECG?

Accepted Answer

Hypokalemia

Answer

Hyponatremia

Answer

Hypocalcemia

Answer

Hypercalcemia

Question 5

A patient with first-degree heart block presents with dizziness. What is the most appropriate management for this patient?

Accepted Answer

Observation and investigation of other causes

Answer

Pacemaker insertion

Answer

Isoprenaline

Answer

Atropine

Question 6

The severity of mitral stenosis can be judged by-

Accepted Answer

Loud S1

Answer

Duration of murmur

Answer

Intensity of murmur

Answer

Presence of left ventricular S3

Question 7

Murmur heard in aortic stenosis

Accepted Answer

Right 2nd intercostal, high pitch systolic ejection murmur

Answer

Apex, low pitch murmur associated with mitral valve issues

Answer

Pan-systolic murmur, high pitch murmur associated with mitral regurgitation

Answer

Left Sternal area, murmur indicating mitral regurgitation

Question 8

Which one of the following is not an early complication of acute myocardial infarction?

Accepted Answer

Dressler's syndrome

Answer

Pericarditis

Answer

Papillary muscle dysfunction

Answer

Ventricular septal defect

Question 9

In the context of ventricular tachycardia, what do extra systoles appear as on an electrocardiogram (ECG)?

Accepted Answer

QRS complex

Answer

P wave

Answer

T wave

Answer

R wave

Question 10

Wide pulse pressure is seen in all except which of the following?

Accepted Answer

Aortic stenosis

Answer

Aortic Regurgitation

Answer

PDA

Answer

A.V. malformation

Cardiology — MCQs

Cardiology — MCQs

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