Cardiology — MCQs
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Isolated systolic hypertension is defined as:
Which of the following is a PRIMARY component of Tetralogy of Fallot?
All are minor Jones Criteria except ?
In point-of-care ultrasound assessment, an aortic diameter less than--cm at the level of the renal arteries should raise the suspicion of hypovolemic shock
Wide fixed S2 is seen in __________
In a Down's syndrome patient posted for surgery, the necessary preoperative investigation to be done is –
In rheumatic heart disease, infective endocarditis is detected by echocardiogram and the largest vegetations seen are due to -
Which valve is least affected in Rheumatic fever ?
Which of the following defines Pentalogy of Fallot?
A “Potential Anastomosis” seen in
Cardiology Indian Medical PG Practice Questions and MCQs
Question 1251: Isolated systolic hypertension is defined as:
- A. SBP>140, DBP<80
- B. SBP>140, DBP<90 (Correct Answer)
- C. SBP>150, DBP<90
- D. SBP>160, DBP<90
Explanation: SBP>140, DBP<90 - Isolated systolic hypertension is defined by a **systolic blood pressure (SBP)** of 140 mmHg or higher, with a **diastolic blood pressure (DBP)** remaining below 90 mmHg. - This condition is common, especially in older adults [1], due to **increased arterial stiffness**. *SBP>140, DBP<80* - While this option includes a systolic blood pressure above 140 mmHg, a **DBP below 80 mmHg** is stricter than the general definition for isolated systolic hypertension, which typically uses 90 mmHg as the upper DBP limit. - This combination represents a form of isolated systolic hypertension, but the DBP threshold of 90 mmHg is more inclusive for its definition. *SBP>150, DBP<90* - This option incorrectly raises the lower limit for **systolic blood pressure** when defining isolated systolic hypertension. - An SBP of 140 mmHg is the accepted threshold, making this an overly stringent criterion [1]. *SBP>160, DBP<90* - This option also incorrectly raises the lower limit for **systolic blood pressure** significantly higher than the accepted definition of 140 mmHg. - Such high systolic readings would fall under **Stage 2 hypertension** in addition to isolated systolic hypertension, but the threshold for the diagnosis itself remains SBP > 140 mmHg.
Question 1252: Which of the following is a PRIMARY component of Tetralogy of Fallot?
- A. ASD
- B. Right ventricular hypertrophy
- C. Pulmonary stenosis (Correct Answer)
- D. None of the options
Explanation: ***Pulmonary stenosis*** - **Pulmonary stenosis** is one of the four primary defects that define Tetralogy of Fallot, specifically an **obstruction to right ventricular outflow** [1]. - The severity of this stenosis largely determines the clinical presentation and degree of cyanosis in patients with Tetralogy of Fallot [1]. *ASD* - An **Atrial Septal Defect (ASD)** is not considered a primary component of Tetralogy of Fallot [2], although it can coexist in some patients. - The four classic defects of Tetralogy of Fallot are **pulmonary stenosis**, **ventricular septal defect (VSD)**, **overriding aorta**, and **right ventricular hypertrophy** [1]. *Right ventricular hypertrophy* - **Right ventricular hypertrophy** is a consequence of the increased workload on the right ventricle due to severe pulmonary stenosis and the **ventricular septal defect (VSD)** [1]. - While it is a characteristic finding, it technically develops secondary to the other primary defects, rather than being an initiating structural malformation itself. *None of the options* - This option is incorrect because **pulmonary stenosis** is a definitive and primary component of Tetralogy of Fallot [1]. - The disease is defined by a specific set of four defects, one of which is pulmonary stenosis [1].
Question 1253: All are minor Jones Criteria except ?
- A. Prolonged PR Interval
- B. Fever
- C. Chorea (Correct Answer)
- D. Arthralgia
Explanation: ***Chorea*** - **Sydenham's chorea** is considered a **major manifestation** in the modified Jones Criteria for acute rheumatic fever [1]. - It involves involuntary, purposeless movements, and is a strong indicator of the disease [1]. *Prolonged PR Interval* - A prolonged **PR interval** on EKG is a **minor manifestation** in the modified Jones Criteria, reflecting carditis [1]. - It indicates delayed conduction through the AV node, a common finding in acute rheumatic fever [1]. *Fever* - **Fever** is a **minor manifestation** as per the modified Jones Criteria [1]. - While common in many infections, in the context of preceding streptococcal infection, it supports a diagnosis of acute rheumatic fever. *Arthralgia* - **Arthralgia** (joint pain) without objective signs of inflammation is a **minor manifestation** in the modified Jones Criteria [1]. - This differentiates it from arthritis (a major criterion) where there is objective evidence of inflammation.
Question 1254: In point-of-care ultrasound assessment, an aortic diameter less than--cm at the level of the renal arteries should raise the suspicion of hypovolemic shock
- A. 20 mm
- B. 25 mm
- C. 12 mm (Correct Answer)
- D. 15 mm
Explanation: ***12 mm*** - An aortic diameter less than **12 mm** at the level of the renal arteries is considered a strong indicator of **hypovolemia** in point-of-care ultrasound. - This finding suggests a **reduced circulating blood volume**, leading to a smaller caliber of the aorta detected during the ultrasound. *20 mm* - An aortic diameter of **20 mm** (2.0 cm) is generally considered within the **normal range** for the infrarenal aorta in adults. - It does not typically indicate **hypovolemia** and would not trigger suspicion for hypovolemic shock. *25 mm* - An aortic diameter of **25 mm** (2.5 cm) is also typically within the **normal adult range** for the infrarenal aorta. - This measurement would not suggest **hypovolemic shock** and, if anything, would be closer to the upper limits of normal for some individuals. *15 mm* - While 15 mm is smaller than 20-25 mm, it is still generally within the **lower end of the normal range** or a mild reduction. - It is **not as sensitive or specific** for hypovolemic shock as a measurement of less than 12 mm.
Question 1255: Wide fixed S2 is seen in __________
- A. ASD (Correct Answer)
- B. VSD
- C. PDA
- D. All of the options
Explanation: ***ASD*** - A **wide fixed split S2** is a classic auscultatory finding in an **atrial septal defect (ASD)** due to continuous volume overload of the right ventricle, which delays pulmonic valve closure irrespective of respiration. - The constant shunting from left to right atrium maintains a sustained increase in pulmonary blood flow, causing the persistent delay in P2. *VSD* - A **ventricular septal defect (VSD)** typically presents with a **loud holosystolic murmur** at the left lower sternal border, not primarily a wide fixed split S2. - While VSD can cause pulmonary hypertension and affect S2, it doesn't usually result in a fixed split. *PDA* - A **patent ductus arteriosus (PDA)** is characterized by a **continuous, machinery-like murmur** best heard below the left clavicle. - While it can cause pulmonary hypertension, it does not typically produce a wide fixed S2 split, which is more specific to ASD. *All of the options* - This option is incorrect because a wide fixed S2 is a highly specific finding for **atrial septal defect (ASD)**, not common to all listed conditions. - While other conditions can affect S2, they do not produce the characteristic **fixed and wide splitting** seen in ASD.
Question 1256: In a Down's syndrome patient posted for surgery, the necessary preoperative investigation to be done is –
- A. CT Brain
- B. X-ray cervical spine (Correct Answer)
- C. Ultrasound Abdomen
- D. Echocardiography
Explanation: X-ray cervical spine - Patients with Down syndrome have an increased risk of **atlantoaxial instability (AAI)** due to ligamentous laxity and bony abnormalities, which can lead to spinal cord compression during neck manipulation for intubation. - A **preoperative X-ray of the cervical spine** (flexion/extension views) is crucial to assess for AAI and guide anesthetic management to prevent neurological damage. *CT Brain* - While some Down syndrome patients may have structural brain differences, a **CT brain** is not a routine preoperative investigation for all surgeries unless specific neurological symptoms are present. - It is not primarily indicated for assessing the immediate surgical risks associated with conditions common in Down syndrome, such as atlantoaxial instability. *Echocardiography* - Many Down syndrome patients have congenital heart defects (e.g., **AV canal defects**), and an echocardiogram is essential to evaluate cardiac function and structure, especially for major surgeries. - However, compared to the immediate risk of spinal cord injury during airway management, assessing **atlantoaxial instability** with a cervical spine X-ray takes precedence as a necessary and specific preoperative investigation for general surgery. *Ultrasound Abdomen* - Down syndrome patients have a higher incidence of certain gastrointestinal anomalies (e.g., **duodenal atresia**, Hirshsprung's disease) and often develop premature aging of organs. - An **abdominal ultrasound** is not a standard preoperative screening test unless there are specific abdominal symptoms or indications for evaluating potential anomalies or complications.
Question 1257: In rheumatic heart disease, infective endocarditis is detected by echocardiogram and the largest vegetations seen are due to -
- A. Candida albicans
- B. Staphylococcus aureus (Correct Answer)
- C. Salmonella typhi
- D. Streptococcus viridans
Explanation: Staphylococcus aureus - Staphylococcus aureus is well-known for causing aggressive infective endocarditis with large, destructive vegetations due to its virulence factors [1]. - These large vegetations are easily detectable by echocardiogram and are associated with a higher risk of embolic events and valve destruction [1]. Candida albicans - While Candida albicans can cause endocarditis, often in immunocompromised individuals or IV drug users, its vegetations are typically larger and more friable than most bacterial causes but S. aureus still produces larger bacterial vegetations due to its rapid colonization and biofilm formation. - Fungal endocarditis generally has a poorer prognosis and requires prolonged antifungal therapy. Salmonella typhi - Salmonella typhi is a less common cause of infective endocarditis; when it does occur, it is often associated with immunocompromised states or pre-existing cardiac lesions. - The vegetations caused by Salmonella are generally not as large or rapidly destructive as those seen with S. aureus. Streptococcus viridans - Streptococcus viridans is a frequent cause of subacute infective endocarditis, particularly on previously damaged valves [1]. - The vegetations are typically small to medium-sized and less destructive than those caused by S. aureus, leading to more indolent disease [1].
Question 1258: Which valve is least affected in Rheumatic fever ?
- A. Pulmonary valve (Correct Answer)
- B. Aortic valve
- C. Mitral valve
- D. Tricuspid valve
Explanation: ***Pulmonary valve*** - The **pulmonary valve** is considered the **least commonly affected** heart valve in rheumatic fever. - This is thought to be due to the relatively lower pressure on the right side of the heart, making it less susceptible to inflammatory damage. *Aortic valve* - The **aortic valve** is the **second most commonly affected** valve in rheumatic fever, often leading to **aortic stenosis** or regurgitation [1]. - Inflammation can cause thickening, calcification, and fusion of the leaflets. *Mitral valve* - The **mitral valve** is the **most frequently affected** heart valve in rheumatic fever, almost always involved to some degree [1]. - Chronic inflammation typically leads to **mitral stenosis**, but regurgitation can also occur. *Tricuspid valve* - The **tricuspid valve** is affected in a significant number of cases, though less often than the mitral and aortic valves [2]. - When involved, it typically presents as **tricuspid regurgitation** due to leaflet damage and annular dilation [2].
Question 1259: Which of the following defines Pentalogy of Fallot?
- A. TOF with Polysplenia
- B. TOF with COA
- C. TOF with ASD (Correct Answer)
- D. TOF with PDA
Explanation: ***TOF with ASD*** - **Pentalogy of Fallot** is a rare congenital heart defect that includes the **four classic defects of Tetralogy of Fallot (TOF)** plus an **atrial septal defect (ASD)**. - The four defects in TOF are **ventricular septal defect (VSD)**, **pulmonary stenosis**, **right ventricular hypertrophy**, and **overriding aorta** [1]. *TOF with Polysplenia* - **Polysplenia** is a developmental anomaly characterized by multiple small spleens, often associated with other complex congenital abnormalities, but not a defining feature of Pentalogy of Fallot. - While it can occur with congenital heart defects, it's not one of the five specific components that define the pentalogy. *TOF with COA* - **Coarctation of the aorta (COA)** is a narrowing of the aorta, often seen with other congenital heart defects but is not part of the defining criteria for Pentalogy of Fallot. - It involves a separate anatomical abnormality that is not included in the "pentalogy." *TOF with PDA* - A **patent ductus arteriosus (PDA)** is a persistence of the fetal connection between the aorta and pulmonary artery. While it can coexist with TOF, it is not one of the defining features of Pentalogy of Fallot. - The fifth defect defining the pentalogy is specifically an **atrial septal defect (ASD)**, not a PDA.
Question 1260: A “Potential Anastomosis” seen in
- A. Intercostal artery
- B. Arterial arcades of mesentery
- C. Coronary artery (Correct Answer)
- D. Labial branch of facial artery
Explanation: A “Potential Anastomosis” seen in ***Coronary artery*** - Coronary arteries are classic examples of **functional end arteries** that have potential anastomoses, meaning these connections are normally non-functional but can become patent in cases of **ischemia**, such as occurs with a gradual occlusion [1]. - While small collateral vessels exist, they are usually insufficient to prevent myocardial damage if a major coronary artery is suddenly occluded. *Intercostal artery* - Intercostal arteries form extensive **anastomoses** with each other and with branches of the internal thoracic and musculophrenic arteries, providing a rich collateral circulation. - They are typically considered true end arteries but their abundant connections allow them to maintain tissue perfusion even if one segment is blocked. *Arterial arcades of mesentery* - The arterial arcades in the mesentery, formed by the **jejunal and ileal arteries**, are extensive and provide excellent collateral circulation to the small intestine. - This robust network ensures that obstruction of a single mesenteric artery often does not lead to **ischemia** of the corresponding bowel segment. *Labial branch of facial artery* - The labial branches of the facial artery extensively **anastomose** with corresponding branches from the opposite side and with branches of the infraorbital and mental arteries. - This rich network provides a robust blood supply to the lips and perioral region, making this a region with **true anastomoses** rather than just potential ones.
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Acute Coronary Syndromes
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Heart Failure
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Cardiac Arrhythmias
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Cardiomyopathies
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