Cardiology Practice Questions

Q: Which of the following is NOT a cause of restrictive cardiomyopathy (RCM)?

Fatty infiltration of myocardium. ***Fatty infiltration of myocardium*** - While fatty infiltration can occur in the heart, it is typically associated with **arrhythmogenic right ventricular cardiomyopathy (ARVC)**, a dilated cardiomyopathy [1], rather than restrictive cardiomyopathy. - **Restrictive cardiomyopathy** is characterized by stiff, non-compliant ventricular walls that impair diastolic filling, which is not the primary mechanism of fatty infiltration. *Amyloidosis* - **Amyloidosis** is a common cause of restrictive cardiomyopathy due to the deposition of **insoluble amyloid fibrils** in the myocardial interstitium [2]. - This deposition leads to **increased myocardial stiffness** and impaired diastolic function. *Sarcoidosis* - **Cardiac sarcoidosis** can cause restrictive cardiomyopathy by the infiltration of **non-caseating granulomas** into the myocardium [2]. - These granulomas lead to **fibrosis and thickening** of the ventricular walls, restricting ventricular filling. *Carcinoid syndrome* - **Carcinoid heart disease**, occurring in patients with carcinoid syndrome, can manifest as restrictive cardiomyopathy due to the deposition of **fibrous plaques** on the endocardium, particularly on the right side of the heart. - This fibrosis primarily affects the **valves and endocardial surface**, hindering ventricular filling and function.

Q: Which of the following is not a symptom of carotid atherosclerosis?

Contralateral retinal infarction. ***Contralateral retinal infarction*** - Retinal infarction, or **ocular stroke**, specifically affects the **ipsilateral eye** (the eye on the same side as the affected carotid artery), as the ophthalmic artery branches off the internal carotid artery. - A contralateral retinal infarction would imply the blockage is in the opposite carotid artery or a different circulatory issue. *Ipsilateral retinal infarction* - This is a direct consequence of **carotid stenosis**, as emboli from the carotid artery can travel up the **ophthalmic artery** to cause infarction in the retina of the same-sided eye. - Presents as sudden, painless **loss of vision** in one eye, often in a specific field. *Contralateral body TIA* - **Transient ischemic attacks (TIAs)** resulting from carotid atherosclerosis typically cause neurological deficits on the **contralateral side of the body** due to the decussation of motor and sensory pathways in the brain. - Symptoms like temporary weakness, numbness, or speech difficulties on the opposite side of the body are characteristic. *Ipsilateral amaurosis fugax* - **Amaurosis fugax** is a classic symptom of carotid atherosclerosis, characterized by a **transient monocular vision loss** (often described as a curtain coming down) in the eye on the *same side* as the affected carotid artery. - This occurs due to **retinal emboli** originating from the carotid plaque.

Q: What is the recommended management approach for uncomplicated essential hypertension?

Lifestyle changes with medication as needed. Lifestyle changes with medication as needed - For uncomplicated essential hypertension, initial management often involves lifestyle modification [1], [3], with the addition of pharmacotherapy if blood pressure targets are not met [1]. - This approach balances the benefits of self-management with the efficacy of medication in preventing cardiovascular complications [1], [2]. Lifestyle changes alone are sufficient - While lifestyle changes are crucial, they are usually not sufficient for many patients to achieve and maintain target blood pressure levels, especially as hypertension progresses. - Relying solely on lifestyle changes might lead to uncontrolled hypertension, increasing the risk of organ damage and cardiovascular events [2]. Combination of lifestyle changes and medication - This approach is typically recommended for patients with higher blood pressure readings or those with additional cardiovascular risk factors [2], where immediate and more aggressive blood pressure control is needed. - For uncomplicated hypertension, starting with medication immediately might be considered too aggressive for all patients, as some can achieve control with lifestyle changes first. Medication alone - Managing hypertension with medication alone overlooks the significant benefits of lifestyle modifications such as diet, exercise, and stress reduction [3]. - This approach may require higher doses or multiple medications, potentially increasing side effects and reducing patient adherence without addressing underlying lifestyle contributors.

Q: A 22-year-old woman is evaluated in the emergency department because of symptoms of prolonged palpitations. She complains of no associated chest discomfort, shortness of breath, or lightheadedness. The palpitations have occurred twice before, but they always stopped spontaneously after 5 minutes, and she cannot associate them with any triggers. The past health history is negative and she is not on any medications. On physical examination, the blood pressure is 110/70 mm Hg, heart rate is 160/min and regular. The heart and lung examinations are normal, and the ECG is shown in Figure below. After applying carotid sinus pressure, the tachycardia terminates abruptly and sinus rhythm is restored at a heart rate of 72/min. Which of the following is the most likely diagnosis?

Paroxysmal supraventricular tachycardia (PSVT). ***Paroxysmal supraventricular tachycardia (PSVT)*** - The abrupt onset and termination of palpitations, a regular rapid heart rate, and the response to **carotid sinus massage** are classic features of PSVT. - ECG typically shows a **narrow complex tachycardia** without clear P waves, which is consistent with the general description of the provided ECG. *Sinus tachycardia* - Sinus tachycardia typically has a **gradual onset and offset**, unlike the abrupt changes noted in the patient. - P waves would be visible and precede each QRS complex, which is not characteristic of the rapid, undifferentiated rhythm implied. *Paroxysmal atrial fibrillation* - Atrial fibrillation is characterized by an **irregularly irregular rhythm**, which contradicts the patient's regular heart rate of 160/min. - The ECG would show **absent P waves** and chaotic atrial activity, unlike the regular rhythm mentioned. *Paroxysmal atrial flutter* - Atrial flutter typically presents with a **sawtooth pattern of P waves** (flutter waves) on ECG, often with a fixed conduction ratio (e.g., 2:1, 3:1). - While it can be a regular tachycardia, the distinct flutter waves are a key diagnostic feature, and the described response to carotid massage leading to abrupt termination is less typical than with PSVT, which more often breaks the re-entrant circuit. - Importantly, carotid massage in atrial flutter typically increases AV block and transiently slows the ventricular rate without terminating the atrial rhythm, rather than producing complete termination and restoration of sinus rhythm as observed in this patient.

Q: Orthostatic hypotension is said to be present if the systolic blood pressure falls by how much while assuming a standing posture from a sitting posture.

>20 mm Hg. ***>20 mm Hg*** - Orthostatic hypotension is clinically defined as a drop of **at least 20 mmHg** in **systolic blood pressure**, or at least 10 mmHg in diastolic blood pressure, within three minutes of standing [1]. - This drop signifies a failure of the **baroreflex mechanism** to adequately compensate for the gravitational pooling of blood. *>10 mm Hg* - A systolic blood pressure drop of **10 mmHg or less** when standing is typically considered within normal physiological response limits. - A 10 mmHg drop in systolic pressure, while notable, is more specifically the threshold for **diastolic blood pressure** when diagnosing orthostatic hypotension [1]. *>30 mm Hg* - While a drop of **30 mmHg or more** in systolic blood pressure would certainly indicate orthostatic hypotension, it is beyond the established minimum diagnostic criteria. - Such a significant drop often points to more severe cardiovascular dysregulation or autonomic dysfunction. *>40 mm Hg* - A drop of **40 mmHg or more** in systolic blood pressure is an extreme manifestation of orthostatic hypotension and would usually be associated with profound symptoms. - This degree of blood pressure change is well past the diagnostic threshold and indicative of severe compromise in **orthostatic regulation**.

Q: Abdominojugular reflex appears after compressing the abdomen for how long?

10 sec. ***10 sec*** - The **abdominojugular reflex (AJR)** is observed by compressing the abdomen for at least **10 seconds** to assess for a sustained rise in **jugular venous pressure (JVP)**. - A positive AJR indicates a **right ventricular (RV)** dysfunction or conditions causing elevated right heart pressures, like **tricuspid regurgitation**. *5 sec* - Compressing the abdomen for only 5 seconds may not be a sufficient duration to elicit a **sustained rise** in **JVP** for the abdominojugular reflex. - This shorter duration might lead to a **false negative result** as the venous return may not be significantly altered and sustained to cause a measurable change. *15 sec* - While compressing the abdomen for 15 seconds would likely elicit the reflex if present, it is longer than the **standard recommended duration** of 10 seconds. - Prolonged compression beyond the standard 10 seconds does not add significant diagnostic value and may lead to patient discomfort without enhancing sensitivity. *30 sec* - Compressing the abdomen for 30 seconds is unnecessarily long and does not adhere to the **standardized procedure** for eliciting the abdominojugular reflex. - Such an extended compression time can cause **significant patient discomfort** and is not required for an accurate assessment of the reflex.

Q: A systolic thrill in the left 2nd or 3rd intercostal space is heard in which of the following conditions?

Pulmonary stenosis. ***Pulmonary stenosis*** - A **systolic thrill** in the **left 2nd or 3rd intercostal space** is characteristic of significant **pulmonary stenosis**, where turbulent blood flow occurs across the narrowed pulmonary valve [1]. - The thrill is palpable over the **pulmonic area**, indicating high-velocity flow and pressure gradients [2]. *Tetralogy of Fallot (TOF)* - While TOF includes **pulmonary stenosis**, the primary thrill felt is typically due to the **right ventricular outflow tract obstruction** and is often accompanied by other findings like cyanosis [3]. - The thrill in TOF can be in the pulmonic area but is part of a more complex clinical picture, including a **ventricular septal defect** [3]. *Ebstein's anomaly (EA)* - **Ebstein's anomaly** involves the **tricuspid valve**, leading to tricuspid regurgitation and right atrial enlargement. - A thrill is not a typical finding; instead, auscultation might reveal a **holosystolic murmur of tricuspid regurgitation** at the lower left sternal border. *Subpulmonic ventricular septal defect (VSD)* - A **subpulmonic VSD** typically produces a **holosystolic murmur** best heard at the left sternal border, often accompanied by a thrill directly over the VSD [4]. - The thrill location for a VSD is generally more medial and lower than the pulmonic area [4].

Q: All of the following may cause ST segment elevation on an EKG, except which of the following?

Constrictive pericarditis. ***Constrictive pericarditis*** - While **pericarditis** can cause ST elevation due to inflammation of the epicardial layer [1], **constrictive pericarditis** primarily leads to **reduced diastolic filling** and rarely causes ST elevation. - ECG findings in constrictive pericarditis typically include **low voltage QRS complexes** and **T-wave flattening or inversion**, not ST elevation. *Early repolarization variant* - This is a **benign ECG finding** often seen in young, healthy individuals, characterized by **notching or slurring** at the end of the QRS complex (J-point elevation) with upwardly concave ST segments [1]. - It's a **normal variant** and not indicative of myocardial injury, despite the ST elevation. *Ventricular aneurysm* - A **ventricular aneurysm**, a non-contractile area of myocardial scar tissue, typically results in **persistent ST elevation** after an acute myocardial infarction in the leads corresponding to the aneurysm. - The ST elevation is usually **fixed** and observed in the setting of prior MI. *Prizmetal angina* - Also known as **vasospastic angina**, this condition involves **coronary artery spasm** causing transient myocardial ischemia, which manifests as **ST segment elevation** during episodes of chest pain. - The ST elevation resolves once the spasm ceases, differentiating it from an STEMI.

Q: Which of the following is true about the bicuspid aortic valve?

Diagnosis is made by echocardiography. ### Diagnosis is made by echocardiography - **Echocardiography** is the gold standard for diagnosing a bicuspid aortic valve, as it allows direct visualization of the valve's morphology and assessment of its function (stenosis or regurgitation). - This imaging modality can identify the **two cusps** instead of the usual three, quantify blood flow, and assess for associated abnormalities. *It is more common in females than in males* - The bicuspid aortic valve is actually **more common in males** than in females, with a male-to-female ratio of about 2:1 to 4:1. - It is one of the **most common congenital heart defects**, affecting approximately 1-2% of the general population. *Usually undetected in early life* - While some cases might be asymptomatic early on, many individuals with a bicuspid aortic valve are diagnosed in **childhood or adolescence** due to associated murmurs or symptoms like chest pain or shortness of breath during exertion. - Its presence often predisposes individuals to complications like **aortic stenosis** [1] or regurgitation [2], which can manifest at any age [2]. *Post-stenotic dilatation of ascending aorta can be seen* - While **post-stenotic dilatation** of the ascending aorta can indeed be seen in patients with a bicuspid aortic valve, this statement on its own is not the most definitive truth about the diagnosis because it describes a complication or associated finding, not the primary method of diagnosis. - Aortic dilatation is a common finding due to **abnormal wall stress** and intrinsic medial weakness, often observed in conjunction with the bicuspid valve.

Question 1

Which of the following is NOT a cause of restrictive cardiomyopathy (RCM)?

Accepted Answer

Fatty infiltration of myocardium

Answer

Carcinoid syndrome

Answer

Sarcoidosis

Answer

Amyloidosis

Question 2

Which of the following is not a symptom of carotid atherosclerosis?

Accepted Answer

Contralateral retinal infarction

Answer

Contralateral body TIA

Answer

Ipsilateral retinal infarction

Answer

Ipsilateral amaurosis fugax

Question 3

What is the recommended management approach for uncomplicated essential hypertension?

Accepted Answer

Lifestyle changes with medication as needed

Answer

Lifestyle changes alone are sufficient

Answer

Medication alone

Answer

Combination of lifestyle changes and medication

Question 4

A 22-year-old woman is evaluated in the emergency department because of symptoms of prolonged palpitations. She complains of no associated chest discomfort, shortness of breath, or lightheadedness. The palpitations have occurred twice before, but they always stopped spontaneously after 5 minutes, and she cannot associate them with any triggers. The past health history is negative and she is not on any medications. On physical examination, the blood pressure is 110/70 mm Hg, heart rate is 160/min and regular. The heart and lung examinations are normal, and the ECG is shown in Figure below. After applying carotid sinus pressure, the tachycardia terminates abruptly and sinus rhythm is restored at a heart rate of 72/min. Which of the following is the most likely diagnosis?

Accepted Answer

Paroxysmal supraventricular tachycardia (PSVT)

Answer

Sinus tachycardia

Answer

Paroxysmal atrial fibrillation

Answer

Paroxysmal atrial flutter

Question 5

Orthostatic hypotension is said to be present if the systolic blood pressure falls by how much while assuming a standing posture from a sitting posture.

Accepted Answer

>20 mm Hg

Answer

>10 mm Hg

Answer

>30 mm Hg

Answer

>40 mm Hg

Question 6

Abdominojugular reflex appears after compressing the abdomen for how long?

Accepted Answer

10 sec

Answer

30 sec

Answer

5 sec

Answer

15 sec

Question 7

Which of the following statements about physiological murmurs is false?

Accepted Answer

Physiological murmurs are always audible without a stethoscope.

Answer

Midsystolic murmurs are common in children.

Answer

Physiological murmurs can be present in children with anemia.

Answer

Only diastolic murmurs are present in adults with heart disease.

Question 8

A systolic thrill in the left 2nd or 3rd intercostal space is heard in which of the following conditions?

Accepted Answer

Pulmonary stenosis

Answer

Tetralogy of Fallot (TOF)

Answer

Ebstein's anomaly (EA)

Answer

Subpulmonic ventricular septal defect (VSD)

Question 9

All of the following may cause ST segment elevation on an EKG, except which of the following?

Accepted Answer

Constrictive pericarditis

Answer

Ventricular aneurysm

Answer

Prizmetal angina

Answer

Early repolarization variant

Question 10

Which of the following is true about the bicuspid aortic valve?

Accepted Answer

Diagnosis is made by echocardiography

Answer

It is more common in females than in males

Answer

Post-stenotic dilatation of ascending aorta can be seen

Answer

Usually undetected in early life

Cardiology — MCQs

Cardiology — MCQs

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