Cardiology Practice Questions

Q: In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Mitral stenosis. ***Mitral stenosis*** - **Mitral stenosis** leads to an obstruction of blood flow from the **left atrium to the left ventricle**, causing pressure buildup in the left atrium [1]. - This increased pressure over time results in **left atrial enlargement** as the chamber struggles to push blood through the narrowed valve [1]. *Tricuspid regurgitation* - **Tricuspid regurgitation** involves the backflow of blood from the **right ventricle to the right atrium**. - This condition primarily affects the **right side of the heart**, leading to **right atrial enlargement**, not left. *AR* - **Aortic regurgitation (AR)** is the backflow of blood from the **aorta into the left ventricle**. - While AR can cause **left ventricular enlargement** and eventually lead to left atrial dilation, it is not the most common direct cause of *primary* left atrial enlargement compared to mitral stenosis [2]. *None of the options* - **Mitral stenosis** is a well-established cause of significant left atrial enlargement due to the direct pressure overload it imposes on the left atrium [1].

Q: Refer to the provided ECG image. It demonstrates which of the following?

Ventricular fibrillation (VF). ***Ventricular fibrillation (VF)*** - The ECG shows a chaotic, **irregular electrical activity** with no distinguishable P waves, QRS complexes, or T waves. - This disorganized electrical pattern is characteristic of VF, indicating a severe cardiac emergency. *Supraventricular tachycardia (SVT)* - SVT is characterized by a **rapid, regular rhythm** with narrow QRS complexes, which are absent in this chaotic tracing. - While fast, SVT typically maintains some degree of organized electrical activity, unlike the provided ECG. *Atrial fibrillation (AF)* - AF presents with irregularly irregular rhythm and **absent P waves**, but it still has identifiable **narrow QRS complexes**. - The provided ECG lacks any discernible QRS complexes, making AF an unlikely diagnosis. *Wolff-Parkinson-White (WPW) syndrome* - WPW syndrome is characterized by a **short PR interval** and a **delta wave** on the ECG due to an accessory pathway. - It involves an organized rhythm, although it can predispose to tachyarrhythmias, and doesn't present as the chaotic rhythm shown.

Q: In which of the following conditions is differential cyanosis observed?

PDA with reversal of shunt. ***PDA with reversal of shunt*** - **Differential cyanosis** is characteristic of a **patent ductus arteriosus (PDA)** with **Eisenmenger syndrome**, where the shunt reverses due to pulmonary hypertension [1]. - Deoxygenated blood from the pulmonary artery shunts into the **descending aorta** distal to the origin of the subclavian arteries, resulting in cyanosis of the lower extremities while the upper extremities remain pink [1]. *VSD with reversal of shunt* - A **ventricular septal defect (VSD)** with reversed shunt typically causes **generalized cyanosis** because deoxygenated blood is shunted from the right ventricle to the left ventricle, affecting both systemic circulations [2]. - It does not produce differential cyanosis unless accompanied by coexisting cardiac anomalies that selectively affect blood flow to different parts of the body. *ASD with reversal of shunt* - An **atrial septal defect (ASD)** with reversed shunt leads to **generalized cyanosis**, as deoxygenated blood from the right atrium enters the left atrium and mixes with oxygenated blood, distributing cyanosis throughout the body [2]. - The mixing of blood occurs at the atrial level, affecting systemic circulation uniformly rather than differentially. *Tetralogy of Fallot* - **Tetralogy of Fallot** causes **generalized cyanosis** due to the right-to-left shunt through a large VSD, forcing deoxygenated blood into the systemic circulation [3]. - The degree of cyanosis depends on the severity of the right ventricular outflow tract obstruction, but it is not typically differential [3].

Q: Torsades de pointes is seen in all except

Hyponatremia. ***Hyponatremia*** - **Hyponatremia** (low sodium levels) primarily affects neuronal function and can lead to neurological symptoms like seizures and altered mental status [1]. - It does not directly cause **QT prolongation** or **Torsades de Pointes (TdP)**, which are typically associated with electrolyte imbalances affecting cardiac repolarization. *Hypocalcemia* - **Hypocalcemia** (low calcium levels) can prolong the **QT interval** on an electrocardiogram. - Prolongation of the QT interval increases the risk of developing **Torsades de Pointes**, a life-threatening polymorphic ventricular tachycardia [2]. *Hypomagnesemia* - **Hypomagnesemia** (low magnesium levels) is a common cause and aggravator of **Torsades de Pointes**. - Magnesium plays a crucial role in cardiac ion channel function, and its deficiency can lead to significant **QT prolongation** and ventricular arrhythmias. *Hypokalemia* - **Hypokalemia** (low potassium levels) can prolong the **QT interval** and increase the risk of developing ventricular arrhythmias, including **Torsades de Pointes** [1]. - Potassium channels are essential for cardiac repolarization, and their dysfunction due to low potassium can destabilize myocardial electrical activity [1].

Q: This patient came to the casualty with palpitations. His ECG has been shown below. What is your diagnosis?

Sinus tachycardia. ***Sinus tachycardia*** - The ECG shows a **narrow QRS complex tachycardia** with a **regular rhythm** and a **rapid ventricular rate**. Distinct **P waves are visible preceding each QRS complex**, with normal sinus P-wave morphology (upright in leads I and II) and a normal P-wave axis, confirming a sinus origin. - The consistent 1:1 P-to-QRS relationship with normal sinus P-wave morphology and axis confirms sinus tachycardia rather than a reentrant supraventricular tachyarrhythmia. *Ventricular tachycardia* - **Ventricular tachycardia** is characterized by a **wide QRS complex** (> 0.12 seconds) tachycardia, which is not seen in the provided ECG. - It often presents with **AV dissociation** (P waves dissociated from QRS complexes) and fusion beats, which are absent here. *A-V dissociation* - **AV dissociation** refers to the atria and ventricles beating independently, which can be seen in VT or complete heart block. - It is a specific ECG finding and not a primary diagnosis, especially in the context of a narrow complex tachycardia like the one shown. *AVNRT* - **AVNRT** typically presents with a narrow QRS complex tachycardia where **P waves are hidden within or immediately after the QRS complex** and the rate is often 150-250 bpm. - In the given ECG, P waves with normal sinus morphology and axis precede each QRS complex with a consistent P-to-QRS relationship, which supports sinus tachycardia rather than AVNRT.

Q: Subclavian steal syndrome is

Reversal of blood flow in the ipsilateral vertebral artery. ***Reversal of blood flow in the ipsilateral vertebral artery*** - Subclavian steal syndrome occurs due to a **proximal stenosis** or **occlusion of the subclavian artery**. - This causes blood to be "stolen" from the **ipsilateral vertebral artery**, flowing retrograde to supply the arm and thereby reducing blood flow to the brainstem. *Reversal of blood flow in the contralateral carotid artery* - The carotid arteries supply blood to the brain directly and are typically not directly involved in thesteal phenomenon in this specific syndrome. - Reversal of flow in the carotid artery would indicate a much more severe and different pathology, not characteristic of subclavian steal. *Reversal of blood flow in the contralateral vertebral artery* - The steal phenomenon specifically involves the vertebral artery on the **same side (ipsilateral)** as the subclavian artery obstruction. - The contralateral vertebral artery would typically continue to supply blood to the brain without a reversed flow in this syndrome. *B/L reversal of blood flow in vertebral arteries* - Subclavian steal syndrome is generally a **unilateral phenomenon**, affecting the vertebral artery ipsilateral to the subclavian artery stenosis. - Bilateral reversal would imply bilateral subclavian artery obstruction or other severe cerebrovascular disease, which is not the definition of subclavian steal syndrome itself.

Q: Graham Steell murmur is associated with which of the following conditions?

Pulmonary Regurgitation (PR). ***Pulmonary Regurgitation (PR)*** - The **Graham Steell murmur** is a high-pitched, decrescendo early diastolic murmur heard best at the left sternal border associated with **pulmonary hypertension**. [1] - It results from dilation of the pulmonary artery due to **elevated pulmonary pressures**, leading to functional pulmonary valve regurgitation. [1] *Tricuspid Regurgitation (TR)* - TR typically presents as a **holosystolic murmur** best heard at the left lower sternal border, often increasing with inspiration (Carvallo's sign). - It is caused by improper coaptation of the tricuspid valve leaflets, often due to **right ventricular dilation**. *Tricuspid Stenosis (TS)* - TS is characterized by a **diastolic rumble** heard best at the lower left sternal border, often with an opening snap. [2] - It is relatively rare and often associated with **rheumatic heart disease**. *Pulmonary Stenosis (PS)* - PS typically produces a **systolic ejection murmur** heard at the upper left sternal border, often radiating to the back. - It is caused by **obstruction to blood flow** from the right ventricle to the pulmonary artery.

Q: Which of the following is associated with WPW syndrome?

Ebstein anomaly. ***Ebstein anomaly*** - **Ebstein anomaly** is a congenital heart defect characterized by apical displacement of the septal and posterior leaflets of the tricuspid valve, which is strongly associated with **Wolff-Parkinson-White (WPW) syndrome.** - WPW syndrome, involving an **accessory pathway** that bypasses the AV node [1], is found in 5-25% of patients with Ebstein anomaly, predisposing them to re-entrant tachycardias [3]. *TOF* - **Tetralogy of Fallot (TOF)** is a complex cyanotic congenital heart defect that includes four main features: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [2]. - There is no direct or strong association between TOF and WPW syndrome. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect where there is an opening in the interventricular septum, allowing blood to flow between the ventricles [4]. - While VSDs can occur with other cardiac anomalies, there is no specific or frequent association with WPW syndrome. *TAPVC* - **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a rare congenital heart defect where all four pulmonary veins connect to the systemic venous circulation instead of the left atrium. - This condition does not have a recognized association with WPW syndrome.

Q: Under which condition are steroids administered in rheumatic fever?

Presence of carditis. **Presence of carditis** - **Carditis** is the most serious manifestation of **rheumatic fever**, as it can lead to permanent **rheumatic heart disease** [1]. - **Corticosteroids** are administered to reduce the inflammation of the heart in cases of moderate to severe carditis, preventing or minimizing long-term damage [1]. *Presence of subcutaneous nodules* - **Subcutaneous nodules** are a minor manifestation of **rheumatic fever** and do not typically require steroid administration. - They are generally **painless** and resolve spontaneously, and their presence alone does not indicate the need for such aggressive anti-inflammatory treatment. *Presence of multiple symptoms* - The presence of **multiple minor symptoms** or asymptomatic major symptoms (other than **carditis**) does not warrant steroid use. - Steroid administration is reserved for situations with high potential for **morbidity** or **mortality**, such as severe **cardiac inflammation** [1]. *Presence of chorea* - **Sydenham's chorea** is a neurological manifestation of **rheumatic fever** and is usually managed with **antidopaminergic drugs** (e.g., haloperidol) or sedatives. - While it can be distressing, **corticosteroids** are generally not indicated for chorea unless there is co-existing **carditis** [1].

Question 1

In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Accepted Answer

Mitral stenosis

Answer

Tricuspid regurgitation

Answer

AR

Answer

None of the options

Question 2

Refer to the provided ECG image. It demonstrates which of the following?

Accepted Answer

Ventricular fibrillation (VF)

Answer

Supraventricular tachycardia (SVT)

Answer

Atrial fibrillation (AF)

Answer

Wolff-Parkinson-White (WPW) syndrome

Question 3

In which of the following conditions is differential cyanosis observed?

Accepted Answer

PDA with reversal of shunt

Answer

VSD with reversal of shunt

Answer

ASD with reversal of shunt

Answer

Tetralogy of Fallot

Question 4

Torsades de pointes is seen in all except

Accepted Answer

Hyponatremia

Answer

Hypomagnesemia

Answer

Hypokalemia

Answer

Hypocalcemia

Question 5

This patient came to the casualty with palpitations. His ECG has been shown below. What is your diagnosis?

Accepted Answer

Sinus tachycardia

Answer

AVNRT

Answer

Ventricular tachycardia

Answer

A-V dissociation

Question 6

Subclavian steal syndrome is

Accepted Answer

Reversal of blood flow in the ipsilateral vertebral artery

Answer

Reversal of blood flow in the contralateral carotid artery

Answer

Reversal of blood flow in the contralateral vertebral artery

Answer

B/L reversal of blood flow in vertebral arteries

Question 7

What is the most likely cause of fluid overload in a patient presenting with shortness of breath?

Accepted Answer

Cardiac failure

Answer

Nephritic syndrome

Answer

TB

Answer

Portal hypertension

Question 8

Graham Steell murmur is associated with which of the following conditions?

Accepted Answer

Pulmonary Regurgitation (PR)

Answer

Tricuspid Regurgitation (TR)

Answer

Tricuspid Stenosis (TS)

Answer

Pulmonary Stenosis (PS)

Question 9

Which of the following is associated with WPW syndrome?

Accepted Answer

Ebstein anomaly

Answer

TOF

Answer

VSD

Answer

TAPVC

Question 10

Under which condition are steroids administered in rheumatic fever?

Accepted Answer

Presence of carditis

Answer

Presence of subcutaneous nodules

Answer

Presence of multiple symptoms

Answer

Presence of chorea

Cardiology — MCQs

Cardiology — MCQs

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