Cardiology Practice Questions

Q: In which condition is paradoxical splitting of the second heart sound observed?

Left Bundle Branch Block (LBBB). ***Left Bundle Branch Block (LBBB)*** - In LBBB, the **left ventricle** depolarizes and contracts *after* the right ventricle, causing the **aortic valve (A2)** to close *after* the **pulmonic valve (P2)** [1]. - During inspiration, right ventricular ejection time is prolonged, which further delays P2. However, in LBBB, A2 is already delayed, and the inspiratory delay of P2 can bring P2 closer to A2, or even cause them to merge, making the splitting *less wide* or *disappear* on inspiration, which is paradoxical. *Right Bundle Branch Block (RBBB)* - RBBB causes a **delay in right ventricular depolarization**, leading to a **delayed P2** (pulmonic valve closure). - This typically results in **wide and fixed splitting of S2**, where the splitting persists during expiration and widens further with inspiration, which is not paradoxical. *Ventricular Septal Defect (VSD)* - A VSD can cause a **loud holosystolic murmur** and may lead to increased pulmonary blood flow. - While it can affect the timing of heart sounds, it does not typically cause paradoxical splitting of S2. *Atrial Septal Defect (ASD)* - An ASD causes a **left-to-right shunt**, leading to chronic volume overload of the right ventricle and increased pulmonary blood flow. - This often results in a **widely fixed splitting of S2**, where the split between A2 and P2 is constant regardless of respiration, which is different from paradoxical splitting.

Q: Tall T waves on ECG are seen in:

Hyperkalemia. ***Hyperkalemia*** - **Tall, peaked T waves** are a hallmark ECG finding in early to moderate **hyperkalemia**, reflecting altered repolarization due to elevated extracellular potassium [1]. - As potassium levels rise further, other ECG changes may include a **prolonged PR interval**, **widened QRS complex**, and ultimately a **sine wave pattern**, leading to ventricular arrhythmias [1]. *Hypokalemia* - This condition is typically associated with **flattened or inverted T waves**, prominent **U waves**, and a **prolonged QT interval** on the ECG [1]. - The ECG changes in hypokalemia reflect delayed repolarization and increased myocardial instability [1]. *Hypercalcemia* - **Hypercalcemia** is characterized by a **shortened QT interval** on the ECG due to accelerated ventricular repolarization. - T waves, if affected, are usually not tall or peaked but may be wider or slightly less prominent. *Hypocalcemia* - **Hypocalcemia** typically leads to a **prolonged QT interval** on the ECG, primarily due to a lengthened ST segment. - While it can manifest with various T wave morphologies, it does not typically cause the characteristic tall, peaked T waves seen in hyperkalemia.

Q: A 45-year-old patient presents with progressive dyspnea, orthopnea, and bilateral pedal edema. On examination, there is elevated JVP, S3 gallop, and hepatomegaly. What is the most likely underlying pathophysiology?

HALE. ***HALE*** - This acronym stands for **Heart-failure Associated Lung Edema**. The symptoms of **progressive dyspnea**, **orthopnea**, **bilateral pedal edema**, **elevated JVP**, **S3 gallop**, and **hepatomegaly** are classic signs of **congestive heart failure** leading to fluid overload and pulmonary congestion [1]. - The pathophysiology involves the heart's inability to pump blood effectively, causing a buildup of pressure in the pulmonary and systemic circulations, leading to the observed symptoms [1]. *DALEY* - This is not a recognized acronym in medical pathophysiology. The symptoms presented are strongly indicative of a specific cardiovascular condition. - There is no clinical scenario where "DALEY" would accurately describe the underlying pathophysiology of dyspnea, edema, and heart failure signs. *OALY* - This is not a recognized acronym in medical pathophysiology. The presented clinical picture requires a well-established and specific pathophysiological explanation. - Using an unrecognized term would not provide an accurate or helpful description of the patient's condition. *None of the options* - The acronym HALE (Heart-failure Associated Lung Edema) accurately captures the core pathophysiology evident from the patient's symptoms and signs. - Given the strong clinical presentation of congestive heart failure with pulmonary and systemic congestion, one of the provided options *does* accurately describe the situation.

Q: All of the following statements about the third heart sound (S3) are true, except:

Seen in Constrictive Pericarditis. ***Seen in Constrictive Pericarditis*** - While constrictive pericarditis can lead to a diastolic sound, it's typically a **pericardial knock**, which is sharper and occurs earlier than an S3, due to abrupt halting of ventricular filling. - A true S3 is a low-pitched sound caused by turbulent blood flow into an overly compliant or volume-overloaded ventricle, which is not the primary mechanism in constrictive pericarditis. *Occurs due to rapid filling of the ventricles during early diastole.* - The S3 heart sound is precisely caused by the **rapid inflow of blood** into a dilated or poorly compliant ventricle during the early, rapid filling phase of diastole [1]. - This rapid distension causes vibrations in the ventricular wall, audible as S3, and is often associated with conditions causing **volume overload** or **ventricular dysfunction**. *Seen in Atrial Septal Defect (ASD)* - Patients with a large ASD have increased blood flow through the tricuspid valve, leading to **right ventricular volume overload** [2]. - This increased volume can cause an **S3** sound, particularly a **right ventricular S3**, due to rapid filling of the overloaded right ventricle [2]. *Seen in Ventricular Septal Defect (VSD)* - A significant VSD leads to a **left-to-right shunt**, increasing blood flow to the pulmonary circulation and subsequently returning to the left atrium and left ventricle. - This **left ventricular volume overload** can result in an audible **left ventricular S3**, reflecting rapid filling of the dilated left ventricle.

Q: Which components of cigarette smoke are known to contribute to coronary artery disease?

Nicotine, carbon monoxide, and tar. ***Nicotine, carbon monoxide, and tar*** - **Nicotine** directly affects the cardiovascular system by increasing **heart rate**, **blood pressure**, and causing **vasoconstriction**, as well as promoting atherogenesis [2]. - **Carbon monoxide** binds to hemoglobin with higher affinity than oxygen, forming **carboxyhemoglobin**, which reduces oxygen delivery to tissues, leading to **endothelial damage** and contributing to atherosclerosis [1]. - **Tar** contains various **carcinogens** and toxic chemicals that contribute to inflammation, oxidative stress, and lipid peroxidation, all of which are implicated in the development and progression of **atherosclerosis**. *Carbon monoxide and tar* - While both contribute significantly, this option **omits nicotine**, which is a major contributor to the cardiovascular effects of smoking. - Nicotine's direct impact on **vasoconstriction** and **atherogenesis** is a critical factor in coronary artery disease [2]. *Carbon dioxide* - **Carbon dioxide** is a product of respiration and combustion but is not considered a primary direct contributor to the pathogenesis of **coronary artery disease** from cigarette smoke in the same way as nicotine, carbon monoxide, and tar. - Its presence in smoke primarily relates to its role in **respiratory physiology** rather than direct vascular damage. *Tar and nicotine* - This option correctly identifies **tar** and **nicotine** as contributors but **omits carbon monoxide**, which plays a crucial role in reducing oxygen-carrying capacity and directly damaging the endothelium [1]. - The impact of **carbon monoxide** on cardiac oxygen supply is a significant mechanism in smoking-related cardiovascular disease [1].

Q: What is the most common cause of dissecting hematoma?

Hypertension. ***Hypertension*** - **Chronic hypertension** is the most frequent cause of dissecting hematoma (aortic dissection) due to the constant high pressure stressing the arterial wall [1]. - It leads to **medial degeneration** and predisposition to intimal tear, allowing blood to enter the arterial wall [1]. *Marfan syndrome* - While Marfan syndrome is a significant risk factor for aortic dissection due to **connective tissue weakness** (cystic medial necrosis), it is much less common than hypertension [1]. - It primarily affects younger individuals with a genetic predisposition to **fibrillin-1 mutations**. *Iatrogenic causes* - These include complications from medical procedures like **cardiac catheterization** or surgery [1]. - Though a possible cause, iatrogenic dissection is relatively rare compared to spontaneous dissection due to hypertension [1]. *Kawasaki disease* - Kawasaki disease primarily causes **coronary artery aneurysms** in children. - It is not a common cause of aortic dissecting hematoma in adults.

Q: Which of the following complications is commonly associated with mitral valve prolapse?

Infective endocarditis. Mitral valve prolapse (MVP) involves myxomatous degeneration of the mitral valve leaflets, which can create a rough surface predisposing to bacterial adhesion and subsequent infective endocarditis [1]. While the overall risk is low, patients with MVP and accompanying mitral regurgitation or thickened leaflets are at higher risk [1]. Patients with valvular heart disease are generally susceptible to bacterial endocarditis, often associated with procedures or dental hygiene [2]. Stroke - Although MVP can sometimes be associated with embolic events (e.g., from thrombi forming on the prolapsing valve), stroke is not considered a commonly associated complication. - The risk of stroke is generally higher in MVP patients with concomitant atrial fibrillation or other cardiovascular risk factors. Mitral stenosis - Mitral valve prolapse is characterized by the displacement of mitral valve leaflets into the left atrium during systole, which can lead to mitral regurgitation [3], not stenosis. - Mitral stenosis involves narrowing of the mitral valve orifice, usually due to rheumatic fever, which is a different pathophysiology [4]. Ventricular arrhythmia - While palpitations (often benign supraventricular ectopy) are common in MVP, clinically significant ventricular arrhythmias are less common. - Severe ventricular arrhythmias are more typically seen with significant underlying myocardial disease or severe mitral regurgitation causing left ventricular dysfunction.

Q: A patient presents with intense chest pain of 2 hours duration. ECG shows ST depression in leads I and V1 to V4. There is associated T inversion and CPK-MB is elevated. Which of the following should be included in his management?

All of the options. ***All of the options*** - This patient presents with symptoms and ECG findings consistent with an **ST-elevation myocardial infarction (STEMI)** or **non-ST-elevation myocardial infarction (NSTEMI)**, given the ST depression and T-wave inversions with elevated CPK-MB [4]. - All listed medications (aspirin, IV metoprolol, and nitroglycerine drip) are standard and essential components of early management used to stabilize the patient, reduce myocardial oxygen demand, and prevent further cardiac events [1]. *Aspirin* - **Aspirin** is an antiplatelet agent used to inhibit platelet aggregation and prevent further thrombus formation in acute coronary syndromes [2]. - It is critical for immediate administration in suspected myocardial infarction to reduce mortality and recurrent ischemic events. *IV metoprolol* - **IV metoprolol** (a beta-blocker) reduces myocardial oxygen demand by decreasing heart rate, contractility, and blood pressure [3]. - It is indicated in acute coronary syndromes unless contraindicated, as it can limit infarct size and reduce the risk of arrhythmias. *Nitroglycerine drip* - The **nitroglycerine drip** is a vasodilator that reduces preload and dilates coronary arteries, improving myocardial blood flow and relieving ischemic chest pain [2]. - It is particularly useful for persistent chest pain and helps reduce myocardial oxygen demand.

Q: All the following drugs are to be avoided in hypertrophic cardiomyopathy except beta blockers.

Beta blockers. ***Beta blockers*** - **Beta-blockers** are a cornerstone in the management of hypertrophic cardiomyopathy because they reduce **heart rate**, improve diastolic filling, and decrease the **outflow tract obstruction**. - They alleviate symptoms such as **chest pain** and **dyspnea** by decreasing myocardial oxygen demand and contractility. *Diuretics* - **Diuretics** should generally be avoided in hypertrophic cardiomyopathy as they can reduce **preload**, which exacerbates the **left ventricular outflow tract obstruction**. - A decrease in ventricular volume caused by diuretics can worsen symptoms and increase the risk of **syncope**. *Digitalis* - **Digitalis (digoxin)** is contraindicated in hypertrophic cardiomyopathy because its **positive inotropic effect** increases myocardial contractility. - This increased contractility can worsen the **left ventricular outflow tract obstruction** and exacerbate symptoms. *Nitrates* - **Nitrates** cause systemic **vasodilation**, which reduces both preload and afterload. - The reduction in **preload** can worsen **left ventricular outflow tract obstruction**, making nitrates generally contraindicated in HCM.

Q: ECG of a patient shows more than three consecutive premature ventricular contractions (PVC) with a heart rate of less than 100 beats per minute. What is the diagnosis?

Accelerated idioventricular rhythm. ***Accelerated idioventricular rhythm*** - This condition is defined by three or more consecutive **premature ventricular contractions (PVCs)**, with a ventricular rate between **40 and 100 bpm**. The question specifies a heart rate less than 100 bpm, which aligns with this definition. - It often occurs in the setting of **reperfusion** after myocardial infarction or digitalis toxicity, presenting as a wide QRS rhythm that is typically benign and self-limiting [1]. *Ventricular tachycardia with a heart rate >100 bpm* - **Ventricular tachycardia (VT)** is characterized by three or more consecutive **PVCs** with a heart rate greater than 100 bpm [1]. - The patient's heart rate being less than 100 bpm excludes VT as the primary diagnosis [1]. *Rapid ventricular rhythm with chaotic electrical activity* - A rapid ventricular rhythm with **chaotic electrical activity** typically describes **ventricular fibrillation (VF)**, which is a life-threatening arrhythmia [2]. - VF involves disorganized electrical activity and lack of distinct QRS complexes, which is distinct from the structured consecutive PVCs described [2]. *Ventricular tachycardia resolving spontaneously with a heart rate >100 bpm* - While ventricular tachycardia can resolve spontaneously, its definition requires a heart rate **greater than 100 bpm** [1]. - The given heart rate of less than 100 bpm means this is not ventricular tachycardia, even if it were to resolve spontaneously.

Question 1

In which condition is paradoxical splitting of the second heart sound observed?

Accepted Answer

Left Bundle Branch Block (LBBB)

Answer

Right Bundle Branch Block (RBBB)

Answer

Ventricular Septal Defect (VSD)

Answer

Atrial Septal Defect (ASD)

Question 2

Tall T waves on ECG are seen in:

Accepted Answer

Hyperkalemia

Answer

Hypokalemia

Answer

Hypercalcemia

Answer

Hypocalcemia

Question 3

A 45-year-old patient presents with progressive dyspnea, orthopnea, and bilateral pedal edema. On examination, there is elevated JVP, S3 gallop, and hepatomegaly. What is the most likely underlying pathophysiology?

Accepted Answer

HALE

Answer

DALEY

Answer

OALY

Answer

None of the options

Question 4

All of the following statements about the third heart sound (S3) are true, except:

Accepted Answer

Seen in Constrictive Pericarditis

Answer

Seen in Atrial Septal Defect (ASD)

Answer

Seen in Ventricular Septal Defect (VSD)

Answer

Occurs due to rapid filling of the ventricles during early diastole.

Question 5

Which components of cigarette smoke are known to contribute to coronary artery disease?

Accepted Answer

Nicotine, carbon monoxide, and tar

Answer

Carbon monoxide and tar

Answer

Carbon dioxide

Answer

Tar and nicotine

Question 6

What is the most common cause of dissecting hematoma?

Accepted Answer

Hypertension

Answer

Marfan syndrome

Answer

Iatrogenic causes

Answer

Kawasaki disease

Question 7

Which of the following complications is commonly associated with mitral valve prolapse?

Accepted Answer

Infective endocarditis

Answer

Ventricular arrhythmia

Answer

Stroke

Answer

Mitral stenosis

Question 8

A patient presents with intense chest pain of 2 hours duration. ECG shows ST depression in leads I and V1 to V4. There is associated T inversion and CPK-MB is elevated. Which of the following should be included in his management?

Accepted Answer

All of the options

Answer

IV metoprolol

Answer

Aspirin

Answer

Nitroglycerine drip

Question 9

All the following drugs are to be avoided in hypertrophic cardiomyopathy except beta blockers.

Accepted Answer

Beta blockers

Answer

Diuretics

Answer

Digitalis

Answer

Nitrates

Question 10

ECG of a patient shows more than three consecutive premature ventricular contractions (PVC) with a heart rate of less than 100 beats per minute. What is the diagnosis?

Accepted Answer

Accelerated idioventricular rhythm

Answer

Ventricular tachycardia with a heart rate >100 bpm

Answer

Rapid ventricular rhythm with chaotic electrical activity

Answer

Ventricular tachycardia resolving spontaneously with a heart rate >100 bpm

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?