Cardiology Practice Questions

Q: RULE OF HALVES RELATED TO-

HYPERTENSION. ***HYPERTENSION*** - The **rule of halves** in hypertension refers to the observation that often **only half of people** with hypertension are diagnosed, only half of those diagnosed are treated, and only half of those treated achieve adequate control. - This rule highlights challenges in the **diagnosis, treatment, and management** of hypertension at a population level. *OBESITY* - While obesity is a significant public health issue, the **rule of halves** is not a commonly used principle to describe its diagnosis and management. - Obesity is typically assessed using **Body Mass Index (BMI)** and associated health risks. *BLINDNESS* - The **rule of halves** is not a recognized concept in the context of blindness or visual impairment. - Blindness is often addressed through efforts in **prevention, treatment, and rehabilitation**. *BURNS* - The **rule of halves** is unrelated to the assessment or management of burns. - The severity of burns is commonly assessed using the **Rule of Nines** (Wallace Rule of Nines) [1] to estimate the percentage of total body surface area affected.

Q: The most common presentation of radiation carditis is:

Pericardial effusion. ***Pericardial effusion*** - **Pericardial effusion** is the most common and earliest manifestation of **radiation carditis**, often occurring within months to a few years after radiation exposure. - This is due to inflammation and damage to the **pericardial cells**, leading to fluid accumulation in the pericardial sac. *Pyogenic pericarditis* - **Pyogenic pericarditis** is typically caused by bacterial infection, not radiation therapy. - It usually presents with signs of acute infection and pus formation, distinct from radiation-induced changes. *Myocardial fibrosis* - **Myocardial fibrosis** is a long-term complication of radiation carditis, occurring years after exposure. - While radiation can cause fibrosis, it's not the most common initial presentation; pericardial issues tend to manifest earlier. *Atheromatous plaques* - **Atheromatous plaques** are characteristic of coronary artery disease, which can be accelerated by radiation but is not the most common direct or early presentation of radiation carditis. - Radiation-induced large vessel disease typically manifests as accelerated atherosclerosis, but it's not the primary or most common carditis presentation.

Q: True about VSD are all except -

Reverse splitting of S2. ***Reverse splitting of S2*** - **Reverse splitting of S2** occurs when the aortic valve closes *after* the pulmonic valve, typically seen in conditions like **aortic stenosis** or **left bundle branch block**. [2] - In VSD, the increased flow through the pulmonary circulation typically causes a **widened and fixed splitting of S2**, rather than reverse splitting, due to delayed pulmonic valve closure and earlier aortic valve closure. *Left to right shunt* - A **ventricular septal defect (VSD)** creates an opening between the left and right ventricles, leading to blood flowing from the higher pressure left ventricle to the lower pressure right ventricle. [1] - This **left-to-right shunt** is the hallmark hemodynamic feature of a VSD in the absence of pulmonary hypertension. [1] *Pansystolic murmur* - The continuous flow of blood across the VSD during systole produces a characteristic **pansystolic (holosystolic) murmur** that starts with S1 and extends to S2. [3] - This murmur is typically heard best at the **left lower sternal border**. [3] *Left atrial hypertrophy* - A significant left-to-right shunt in VSD increases blood flow into the pulmonary circulation, which then returns to the left atrium through the pulmonary veins. - The increased volume load on the left atrium can lead to **left atrial dilatation and hypertrophy** over time. [1]

Q: Rheumatic activity mostly involves which valves?

Mitral & aortic. Mitral & aortic - **Rheumatic fever** most commonly affects the valves on the left side of the heart, with the **mitral valve** being the most frequently involved, followed by the **aortic valve** [1]. - This involvement often leads to **valvulitis**, which can result in **stenosis** or **regurgitation** over time, primarily affecting these two valves [1]. *Aortic & pulmonary* - While the **aortic valve** is commonly affected, the **pulmonary valve** is rarely involved in rheumatic heart disease. - Involvement of the pulmonary valve is typically seen in combination with more severe, widespread disease or in specific congenital conditions, distinguishing it from classic rheumatic fever. *Mitral & tricuspid* - While the **mitral valve** is the most commonly affected, the **tricuspid valve** is less frequently involved than the aortic valve in rheumatic heart disease. - When the tricuspid valve is affected, it usually occurs in conjunction with severe **mitral and aortic valve disease**, rather than as a primary isolated or predominant involvement. *Aortic & tricuspid* - The **aortic valve** is commonly affected, but the **tricuspid valve** is much less frequently involved compared to the mitral valve. - Combined prominent involvement of only these two valves is not the typical presentation or most common pattern of rheumatic heart disease.

Q: A 9 year old boy with Fallot's tetralogy, had high grade fever followed by focal seizure 2 days prior to hospital admission. His blood counts were increased and predominantly polymorphs. CT scan of the head showed a focal lesion suggestive of an abscess. Where would be the commonest location of brain abscess in this patient?

Cerebellum. **Cerebellum** - In patients with **cyanotic congenital heart disease** like Fallot's tetralogy, brain abscesses are typically supplied by the **posterior circulation**, making the **cerebellum** the most common location. [1] - The **right-to-left shunt** allows bacteria to bypass pulmonary filtration and directly enter systemic circulation, increasing the risk of infection in the brain, predominantly in areas supplied by the vertebral and basilar arteries. [1], [3] *Parietal lobe* - While brain abscesses can occur in the parietal lobe, it is more commonly associated with spread from a **frontal or sphenoid sinusitis** or direct trauma, not typically from cyanotic heart disease. - Abscesses in the parietal lobe are more often seen in **immunocompromised patients** or those with endocarditis causing septic emboli. [2] *Temporal lobe* - Temporal lobe abscesses are frequently a complication of **otitis media** or **mastoiditis**, with infection spreading directly or via venous drainage. - This patient's presentation does not suggest an ear infection as the primary source. *Thalamus* - Thalamic abscesses are rare and usually occur as a result of **hematogenous spread** from distant infections, particularly in immunocompromised individuals. - While possible, they are not the most common location for brain abscesses in patients with cyanotic congenital heart disease.

Q: Which of the following does not occur in Tetralogy of Fallot ?

Congestive cardiac failure. ***Congestive cardiac failure*** - **Tetralogy of Fallot (ToF)** is characterized by **right-to-left shunting** and chronic hypoxemia, which leads to **polycythemia** and secondary complications, but typically avoids volume overload that causes congestive heart failure [1]. - While other congenital heart defects can lead to congestive heart failure, **ToF** usually presents with **cyanosis** and "tet spells" due to pulmonary outflow obstruction and ventricular septal defect, without the features of chronic volume overload [1]. *Brain abscess* - Patients with **ToF** are at increased risk of **brain abscess** due to the right-to-left shunt bypassing the pulmonary capillary filter, allowing bacteria from systemic venous circulation to reach the brain [2]. - This complication is more common in **cyanotic congenital heart diseases** where venous pathogens can directly enter the arterial circulation [2]. *Infective Endocarditis* - The abnormal blood flow and structural defects in **ToF**, particularly around the Ventricular Septal Defect (VSD) and pulmonary outflow tract, predispose patients to **infective endocarditis**. - Turbulent blood flow creates endothelial damage, making it easier for circulating bacteria to adhere and form vegetations. *Polycythemia* - **Chronic hypoxemia** in **ToF** stimulates erythropoietin production, leading to an increased red blood cell mass, known as **polycythemia**. - This compensatory mechanism aims to enhance oxygen-carrying capacity but can increase blood viscosity, leading to thrombotic complications.

Q: The commonest cardiac lesion in Tuberous sclerosis is

Rhabdomyoma. ***Rhabdomyoma*** - **Rhabdomyomas** are the most common cardiac tumors found in patients with **tuberous sclerosis complex (TSC)**. - These benign tumors of the heart muscle are present in 50-70% of individuals with TSC, often multiple and can cause **obstruction of blood flow** or arrhythmias. *ASD* - An **atrial septal defect (ASD)** is a congenital heart defect involving a hole in the septum between the **atria** of the heart. - While ASDs are common congenital heart defects, they are not specifically associated with **tuberous sclerosis** as a primary cardiac lesion. *VSD* - A **ventricular septal defect (VSD)** is a common congenital heart defect characterized by a hole in the septum separating the **ventricles** [1]. - Like ASDs, VSDs are general congenital defects but do not have a specific, strong association with **tuberous sclerosis** like cardiac rhabdomyomas do [1]. *Mitral stenosis* - **Mitral stenosis** is a narrowing of the **mitral valve**, typically caused by **rheumatic fever** or degenerative calcification. - It is an acquired valvular heart disease and is not a common cardiac lesion associated with **tuberous sclerosis**.

Q: Not a feature of TOF -

Patent foramen ovale. ***Patent foramen ovale*** - A **patent foramen ovale (PFO)** is a remnant of fetal circulation that may be associated with various cardiac conditions but is **not one of the four cardinal defects** that define Tetralogy of Fallot [1]. - While other **cardiac anomalies can coexist** with Tetralogy of Fallot, a PFO is not considered a primary feature of the syndrome itself. *RVH* - **Right ventricular hypertrophy (RVH)** is a direct consequence of the **pulmonary stenosis** and the large **ventricular septal defect (VSD)** in Tetralogy of Fallot [1]. - The right ventricle must pump against increased resistance, leading to hypertrophy as a compensatory mechanism. *Boot shaped heart* - The **boot-shaped heart (coeur en sabot)** on chest X-ray is a classic radiologic sign of Tetralogy of Fallot. - This appearance results from **right ventricular hypertrophy** and an **underdeveloped pulmonary artery segment**, causing an uplifted apex and concave pulmonary artery contour. *VSD* - A **ventricular septal defect (VSD)** is one of the **four primary defects** constituting Tetralogy of Fallot [1]. - It allows **blood to shunt from the right ventricle to the left ventricle**, leading to cyanosis, especially when pulmonary outflow obstruction is severe [1].

Q: All of the following arteries are common sites of occlusion by a thrombus except:

Marginal. ***Marginal*** - The **marginal arteries** are typically small and supply a smaller portion of the right ventricle, making them less likely sites for **major clinical occlusion** compared to larger, more critical coronary vessels. - While occlusion can occur, it usually causes less extensive damage and is therefore **less common** as a primary site of acute thrombus-related myocardial infarction. *Posterior interventricular* - The **posterior interventricular artery (PDA)** is a major coronary artery, responsible for supplying the posterior walls of the ventricles and the posterior one-third of the interventricular septum. - Occlusion of the PDA, often a branch of the right coronary artery (RCA) or circumflex artery, can lead to **significant infarction** in these critical areas, making it a common site of thrombus formation. *Circumflex* - The **circumflex artery (Cx)** is a major branch of the left main coronary artery that supplies the left atrium and the posterior and lateral walls of the left ventricle. - Occlusion of the circumflex artery can result in **lateral or posterior myocardial infarction**, making it a frequent site for thrombus formation. *Anterior interventricular* - The **anterior interventricular artery (LAD)**, also known as the left anterior descending artery, is the most common site of coronary artery occlusion. - It supplies the anterior wall of the left ventricle and the anterior two-thirds of the interventricular septum, and its occlusion is often referred to as the **"widowmaker"** due to the extensive damage and high mortality associated with it.

Q: If a patient with Raynaud’s disease immersed his hand in cold water, the hand will

Turn white. ***Turn white*** * **Raynaud's phenomenon** is characterized by **vasospasm** of the digital arteries in response to cold or stress, initially causing the digits to turn **white** due to reduced blood flow. * This pallor is a direct result of **ischemia** as the small arteries and arterioles constrict. *Remain unchanged* * **Raynaud's disease** involves an abnormal and exaggerated response to cold, so the hand would not remain unchanged. * The primary characteristic of the condition is a visible change in **color** and sensation upon cold exposure. *Become red* * **Redness (rubor)** typically occurs later in the Raynaud's attack, during the **reperfusion phase**, as blood flow returns to the affected digits. * This phase follows the initial pallor and cyanosis, as the blood vessels **dilate** to compensate for the earlier constriction. *Become blue* * **Cyanosis (bluish discoloration)** commonly follows the initial pallor in a Raynaud's attack. * It occurs due to the deoxygenation of residual blood in the capillaries as vasospasm persists, but **whiteness** is the first distinct color change.

Question 1

RULE OF HALVES RELATED TO-

Accepted Answer

HYPERTENSION

Answer

OBESITY

Answer

BLINDNESS

Answer

BURNS

Question 2

The most common presentation of radiation carditis is:

Accepted Answer

Pericardial effusion

Answer

Pyogenic pericarditis

Answer

Myocardial fibrosis

Answer

Atheromatous plaques

Question 3

True about VSD are all except -

Accepted Answer

Reverse splitting of S2

Answer

Left to right shunt

Answer

Pansystolic murmur

Answer

Left atrial hypertrophy

Question 4

Rheumatic activity mostly involves which valves?

Accepted Answer

Mitral & aortic

Answer

Aortic & pulmonary

Answer

Mitral & tricuspid

Answer

Aortic & tricuspid

Question 5

A 9 year old boy with Fallot's tetralogy, had high grade fever followed by focal seizure 2 days prior to hospital admission. His blood counts were increased and predominantly polymorphs. CT scan of the head showed a focal lesion suggestive of an abscess. Where would be the commonest location of brain abscess in this patient?

Accepted Answer

Cerebellum

Answer

Parietal lobe

Answer

Temporal lobe

Answer

Thalamus

Question 6

Which of the following does not occur in Tetralogy of 
Fallot ?

Accepted Answer

Congestive cardiac failure

Answer

Brain abscess

Answer

Infective Endocarditis

Answer

Polycythemia

Question 7

The commonest cardiac lesion in Tuberous sclerosis is

Accepted Answer

Rhabdomyoma

Answer

ASD

Answer

VSD

Answer

Mitral stenosis

Question 8

Not a feature of TOF -

Accepted Answer

Patent foramen ovale

Answer

RVH

Answer

Boot shaped heart

Answer

VSD

Question 9

All of the following arteries are common sites of occlusion by a thrombus except:

Accepted Answer

Marginal

Answer

Posterior interventricular

Answer

Circumflex

Answer

Anterior interventricular

Question 10

If a patient with Raynaud’s disease immersed his hand in cold water, the hand will

Accepted Answer

Turn white

Answer

Remain unchanged

Answer

Become red

Answer

Become blue

Cardiology — MCQs

Cardiology — MCQs

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