Cardiology Practice Questions

Q: Most common cause of death in Rheumatoid Arthritis?

Ischemic heart disease. ***Ischemic heart disease*** - Patients with **rheumatoid arthritis (RA)** have a significantly increased risk of developing **cardiovascular diseases**, including ischemic heart disease. [1] - This heightened risk is due to chronic systemic inflammation, accelerated atherosclerosis, and potential side effects of RA treatments contributing to **endothelial dysfunction**. [1] *Hepatic failure* - While certain medications used to treat RA, such as **methotrexate**, can cause liver toxicity, hepatic failure is not the most common cause of death in RA patients. [2] - Regular **liver enzyme monitoring** helps in detecting and managing medication-induced liver issues. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** can occur in severely ill patients, but it is not a direct or most common complication of rheumatoid arthritis nor a primary cause of death. [2] - RA can affect the lungs (e.g., interstitial lung disease), but ARDS is typically a severe, acute event triggered by other conditions like **sepsis** or trauma. *Pulmonary fibrosis* - **Interstitial lung disease (ILD)**, including pulmonary fibrosis, is a known extra-articular manifestation of RA and can be a significant cause of morbidity and mortality. [2] - However, **cardiovascular events**, particularly ischemic heart disease, still surpass pulmonary fibrosis as the leading cause of death in RA patients.

Q: Most common cause of death in adults with PDA is?

Infective endocarditis. ***Infective endocarditis*** - The abnormal blood flow and turbulent swirling within a **patent ductus arteriosus (PDA)** create an environment prone to bacterial colonization, making infective endocarditis the most common cause of death in adults with PDA. - The risk of **infective endocarditis** in adults with an untreated PDA is significant, leading to severe downstream complications. *Rupture* - While rupture is a rare complication, it is not the most common cause of death in adults with an isolated PDA, particularly when compared to infectious complications. - Rupture may be associated with other underlying cardiovascular conditions or very large PDAs, but it is not the leading cause of mortality. *Embolism* - Embolism can occur in PDA, especially paradoxical emboli in the rare event of severe pulmonary hypertension with right-to-left shunting. - However, it is less common than infective endocarditis as a primary cause of death in adults with a typical PDA. *CCF* - **Congestive cardiac failure (CCF)** is a significant complication of PDA, particularly in large shunts, leading to symptoms like dyspnea and fatigue. - While CCF can contribute to morbidity and mortality, **infective endocarditis** is generally considered the more common direct cause of death in adults with an untreated PDA.

Q: Essential criteria for TOF includes all except ?

Ventricular septal defect. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is one of the four cardinal features of **Tetralogy of Fallot (TOF)**, not an exclusion criterion. - The VSD in TOF is typically **large and unrestrictive**, allowing for mixing of oxygenated and deoxygenated blood. *Infundibular stenosis* - **Infundibular stenosis** (pulmonary outflow tract obstruction) is a fundamental component of TOF, causing restricted blood flow to the pulmonary artery. - The degree of **right ventricular outflow tract obstruction** is the primary determinant of the clinical severity of TOF. *Overriding of aorta* - The **overriding aorta**, where the aortic root originates above both ventricles and the VSD, is a key anatomical feature of TOF. - This position allows deoxygenated blood from the right ventricle to directly enter the **systemic circulation**. *RVH* - **Right ventricular hypertrophy (RVH)** is a compensatory response to the increased pressure load on the right ventricle due to the **pulmonary stenosis** in TOF. - This **thickening of the right ventricular muscle** is an expected and essential criterion for the diagnosis of TOF.

Q: Buerger's disease affects all except -

Multiparity. ***Multiparity*** - **Multiparity** (having given birth multiple times) has no known association with **Buerger's disease**. - Buerger's disease is strongly linked to **smoking** and affects blood vessels, not reproductive states. [1] *Small veins* - **Buerger's disease** is a **thromboangiitis obliterans** that affects small and medium-sized arteries and veins. - Inflammation and thrombosis can be found in small veins, though arterial involvement is more prominent. [1] *Small arteries* - The disease primarily involves **inflammatory changes** and **thrombosis** of the **small and medium-sized arteries**. [1] - This leads to **ischemia** and potential **gangrene** in the affected extremities. *Medium-sized arteries* - **Medium-sized arteries** are characteristic sites of involvement, particularly in the **distal extremities**. - These vessels become occluded, causing pain, ulcers, and tissue loss.

Q: A young female presents with chest pain not associated with exercise. Auscultation reveals multiple ejection clicks with a murmur. The most important investigation for diagnosis is:

Echocardiography. ***Echocardiography*** - **Echocardiography** is the gold standard for visualizing cardiac structures and valve function, allowing direct assessment of **mitral valve prolapse (MVP)** [1]. - The presence of **multiple ejection clicks** and a murmur in a young female with non-exertional chest pain strongly suggests MVP, which can be confirmed by echocardiography [3]. *ECG* - An **ECG** can detect arrhythmias or signs of ischemia, but it cannot directly visualize the heart valves or diagnose **mitral valve prolapse** [2]. - While some MVP patients may have T-wave abnormalities or QT prolongation, these findings are non-specific and not diagnostic. *Thallium 201 scan* - A **Thallium 201 scan** is a nuclear imaging test primarily used to assess myocardial perfusion and detect areas of ischemia, usually in the context of **coronary artery disease** [4]. - It does not provide detailed anatomical information about heart valves or cardiac chamber morphology, making it unsuitable for diagnosing **mitral valve prolapse**. *Tc pyrophosphate scan* - A **Tc pyrophosphate scan** is primarily used to diagnose **amyloidosis** or evaluate myocardial infarction, particularly for detecting late-phase complications or right ventricular involvement. - It does not offer direct visualization of valvular structures and is not indicated for the diagnosis of **mitral valve prolapse**.

Q: Obstruction in pulmonary stenosis may occur at the following sites ___________

All of the options. ***All of the options*** - Pulmonary stenosis refers to an obstruction of blood flow from the **right ventricle to the pulmonary artery**, which can occur at multiple levels. - The obstruction can be **valvular, subvalvular, or supravalvular**, affecting different anatomical locations within the right ventricular outflow tract and pulmonary artery. *Subvalvular* - This form of obstruction occurs **below the pulmonary valve**, often due to muscle bundles or an aberrant septal band. - An example is a **double-chambered right ventricle**, where an abnormal muscle band divides the right ventricle. *Valvular* - The most common site of pulmonary stenosis is at the **level of the pulmonary valve itself**, due to commissural fusion or dysplastic leaflets. - This leads to restricted opening of the valve, creating a pressure gradient during **systole**. *Supravalvular* - This obstruction occurs **above the pulmonary valve**, typically in the main pulmonary artery or its branches. - It can be an isolated lesion or associated with certain syndromes like **Alagille syndrome**.

Q: Which lipid parameter is most useful for cardiovascular risk stratification in hypertensive patients?

Cholesterol/HDL<3.5. ***Cholesterol/HDL<3.5*** - The **total cholesterol to HDL ratio** is a strong predictor of cardiovascular risk, particularly in hypertensive patients, as it integrates both pro-atherogenic (total cholesterol) and anti-atherogenic (HDL) lipid fractions [1]. - A ratio of **<3.5** generally indicates a lower cardiovascular risk, while higher ratios are associated with increased risk. *Triglycerides <150mg/dL* - While high triglycerides are an independent risk factor, a level of **<150 mg/dL** is considered normal and does not provide comprehensive cardiovascular risk stratification on its own. - High triglycerides are often associated with other metabolic abnormalities, but this single value does not reflect the balance of pro- and anti-atherogenic particles as effectively as the cholesterol/HDL ratio. *LDL cholesterol <100mg/dL* - **LDL cholesterol** is a primary target for lipid-lowering therapy, and a level of **<100 mg/dL** is generally desirable for cardiovascular health [1]. - However, relying solely on LDL might miss patients with high cardiovascular risk due to low HDL or other dyslipidemias not fully captured by LDL alone [1]. *HDL <30mg%* - **Low HDL** is an independent risk factor for cardiovascular disease [1]. However, simply using a low threshold like **<30 mg%** only identifies a subset of high-risk individuals. - This parameter doesn't account for total cholesterol levels, making the **ratio of total cholesterol to HDL** a more robust and comprehensive indicator of overall lipid-related cardiovascular risk.

Q: Which of the following is NOT true about Erythrocyanosis?

Palpable pulses. ***Palpable pulses*** - Erythrocyanosis is characterized by **vasospasm** and **vasoconstriction**, yet the large arteries typically maintain patency, allowing pulses to remain palpable. - The disease primarily affects the **small cutaneous vessels**, leading to color changes and temperature abnormalities, without usually compromising the main arterial supply to the point of unpalpable pulses. *Affects young girls* - **Erythrocyanosis** (specifically chilblain lupus or perniosis) typically affects **young women** and girls, often presenting in colder climates. - Hormonal factors and a higher prevalence of **autoimmune conditions** in females may contribute to its occurrence. *Cold peripheries* - The condition is characterized by **poor peripheral circulation** and **vasoconstriction**, leading to cold extremities, especially in response to cold exposure. - This symptom is a hallmark of erythrocyanosis and differentiates it from conditions with improved warmth or arterial insufficiency. *Ulceration and gangrene of fingers* - Although erythrocyanosis involves significant microvascular dysfunction, **ulceration and gangrene are uncommon** in this condition, differentiating it from severe forms of vasculitis or Raynaud's phenomenon. - The changes are predominantly **vasospastic** and inflammatory, rather than overtly thrombotic or ischemic, which would lead to tissue loss.

Q: True about Ebstein anomaly is ?

Right atrial dilatation. Right atrial dilatation - Ebstein anomaly is characterized by the **apical displacement** of the tricuspid valve leaflets, which incorporates a portion of the right ventricle into the right atrium, functionally increasing its size. - This **atrialization of the right ventricle** leads to significant **right atrial dilatation** as it has to handle a larger volume [1]. *Right ventricular dilatation* - While there is a functional impairment of the right ventricle due to the displaced tricuspid valve, the **working part of the right ventricle** is often small and hypoplastic, not dilated. - The "atrialized" part of the right ventricle contributes to **right atrial dilatation**, not ventricular dilatation [1]. *Left atrial dilatation* - Ebstein anomaly primarily affects the **right side of the heart**, specifically the **tricuspid valve** and right ventricle. - There is no direct anatomical or physiological mechanism in Ebstein anomaly that would typically cause **left atrial dilatation**. *Left ventricular dilatation* - Similar to left atrial dilatation, Ebstein anomaly is a **right-sided heart defect**. - **Left ventricular morphology and function** are generally preserved in Ebstein anomaly, and dilatation is not a characteristic feature.

Q: Which of the following represents a desired lipid parameter for cardiovascular risk control in hypertension?

Cholesterol/HDL 10 mg% - This option is unclear and likely misphrased, as LDL cholesterol is typically measured independently, not as a ratio to total cholesterol in this manner [1]. - Desired LDL levels are typically much lower than 100 mg/dL for high-risk individuals, and a ratio of LDL to total cholesterol greater than 0.1 (or 10%) is generally observed, but not a specific target for reduction [1]. HDL < 30 mg% - An HDL level less than 40 mg/dL (or 30 mg% for some contexts) is considered low and undesirable, as high HDL is protective against cardiovascular disease [1]. - This value would indicate increased cardiovascular risk, contrary to a desired parameter. HDL / cholesterol ratio < 3.5 - This ratio, as stated, is the inverse of the commonly used and desirable total cholesterol-to-HDL ratio. - If the HDL/cholesterol ratio were less than 3.5, it would imply a relatively low HDL compared to total cholesterol, which is an undesirable cardiovascular risk factor [1].

Question 1

Most common cause of death in Rheumatoid Arthritis?

Accepted Answer

Ischemic heart disease

Answer

Hepatic failure

Answer

ARDS

Answer

Pulmonary fibrosis

Question 2

Most common cause of death in adults with PDA is?

Accepted Answer

Infective endocarditis

Answer

Rupture

Answer

Embolism

Answer

CCF

Question 3

Essential criteria for TOF includes all except ?

Accepted Answer

Ventricular septal defect

Answer

Infundibular stenosis

Answer

Overriding of aorta

Answer

RVH

Question 4

Buerger's disease affects all except -

Accepted Answer

Multiparity

Answer

Small veins

Answer

Small arteries

Answer

Medium-sized arteries

Question 5

A young female presents with chest pain not associated with exercise. Auscultation reveals multiple ejection clicks with a murmur. The most important investigation for diagnosis is:

Accepted Answer

Echocardiography

Answer

ECG

Answer

Thallium 201 scan

Answer

Tc pyrophosphate scan

Question 6

Obstruction in pulmonary stenosis may occur at the following sites ___________

Accepted Answer

All of the options

Answer

Subvalvular

Answer

Valvular

Answer

Supravalvular

Question 7

Which lipid parameter is most useful for cardiovascular risk stratification in hypertensive patients?

Accepted Answer

Cholesterol/HDL<3.5

Answer

Triglycerides <150mg/dL

Answer

LDL cholesterol <100mg/dL

Answer

HDL <30mg%

Question 8

Which of the following is NOT true about Erythrocyanosis?

Accepted Answer

Palpable pulses

Answer

Affects young girls

Answer

Cold peripheries

Answer

Ulceration and gangrene of fingers

Question 9

True about Ebstein anomaly is ?

Accepted Answer

Right atrial dilatation

Answer

Right ventricular dilatation

Answer

Left atrial dilatation

Answer

Left ventricular dilatation

Question 10

Which of the following represents a desired lipid parameter for cardiovascular risk control in hypertension?

Accepted Answer

Cholesterol/HDL < 3.5

Answer

LDL / cholesterol > 10 mg%

Answer

HDL < 30 mg%

Answer

HDL / cholesterol ratio < 3.5

Cardiology — MCQs

Cardiology — MCQs

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