Cardiology Practice Questions

Q: In a patient with subclavian steal syndrome, what is the most characteristic finding?

The BP is decreased on the ipsilateral side. ***The BP is decreased on the ipsilateral side*** - Subclavian steal syndrome is caused by a **stenosis** or **occlusion** of the **subclavian artery** proximal to the origin of the vertebral artery. This leads to reduced blood flow to the ipsilateral arm, resulting in a **decreased blood pressure** in that arm. [1] - The pressure difference between the unaffected and affected arm is typically **greater than 15-20 mmHg**, which is a key diagnostic clue. *The flow of blood in the vertebral arteries is normal* - In subclavian steal syndrome, the blood flow in the **ipsilateral vertebral artery** can be **reversed** or significantly reduced. - This reversal of flow occurs as the vertebral artery "steals" blood from the vertebrobasilar circulation to supply the ischemic arm. *The patients may present with claudication features in some cases.* - While patients can experience **arm claudication** (pain, fatigue, or numbness during exercise) due to reduced blood flow to the arm, this is a symptom rather than the **most characteristic finding** related to the underlying hemodynamics. - Arm claudication occurs when the **demand for blood flow** to the ipsilateral arm muscles exceeds the compromised supply, often during arm exercise. *The patients may present with neurological features.* - Neurological symptoms, such as **dizziness, vertigo, diplopia, or syncope**, can occur due to **vertebrobasilar insufficiency** when blood is "stolen" from the cerebral circulation. - However, the **most characteristic hemodynamic finding** directly reflecting the subclavian artery stenosis is the **blood pressure differential** in the arms.

Q: Extent of cardiotoxicity of chemotherapy and radiotherapy is best diagnosed by:

Echocardiogram. Echocardiogram - An echocardiogram is the most common and widely used non-invasive diagnostic tool to assess cardiac function and structure, including left ventricular ejection fraction (LVEF), which is crucial for monitoring cardiotoxicity [1]. - It can detect changes in ventricular size, wall motion abnormalities, and valvular function that may arise from chemotherapy or radiotherapy-induced damage [1]. Radionuclide scan - Radionuclide scans, such as MUGA (Multigated Acquisition) scans, can also assess LVEF but involve radiation exposure and are generally reserved for cases where echocardiography is suboptimal or yields equivocal results. - While sensitive, it's not the primary or initial diagnostic test due to its invasive nature and cost compared to echocardiography. ECG - An ECG (electrocardiogram) assesses the electrical activity of the heart but provides limited information about structural or functional changes indicative of cardiotoxicity [2]. - It can detect arrhythmias or ischemic changes but is not specific enough to determine the extent of myocardial damage from chemotherapy or radiotherapy [2]. Endomyocardial biopsy - Endomyocardial biopsy is an invasive procedure that provides a definitive histological diagnosis of myocardial damage but is rarely performed due to its invasiveness, risk of complications, and the availability of less invasive methods. - It is typically reserved for unexplained severe cardiac dysfunction or for specific research protocols, not routine monitoring of cardiotoxicity.

Q: Reversed Coarctation is seen in which of the following conditions?

Takayasu Arteritis. **Takayasu Arteritis** - **Reversed coarctation** (or paradoxical coarctation) is a characteristic feature of **Takayasu arteritis**, where narrowing or occlusion mainly affects the **aortic arch** and its branches, leading to a reversed pressure gradient in the upper extremities compared to the lower extremities. - This condition is a **large-vessel vasculitis** primarily affecting the aorta and its major branches, causing ischemia to the upper body and head. *Polyarteritis Nodosa* - This is a **medium-sized vessel vasculitis** that typically affects renal and visceral arteries, leading to aneurysms and occlusions. - It does not primarily affect the aortic arch or present with reversed coarctation. *Kawasaki Disease* - **Kawasaki disease** is a **medium-sized vessel vasculitis** predominantly affecting children, which can cause coronary artery aneurysms. - It does not involve the large vessels of the aortic arch to cause reversed coarctation. *Giant cell Arteritis* - **Giant cell arteritis (GCA)** is a **large-vessel vasculitis** primarily affecting the aorta and its major branches, but typically involves the **temporal arteries**. - While it can affect the aorta, it is more commonly associated with headaches and jaw claudication, and reversed coarctation is not a prominent feature.

Q: Which of the following is true about torsades de pointes?

Presence of prolonged QT interval on ECG. ***Presence of prolonged QT interval on ECG*** - Torsades de pointes is a polymorphic ventricular tachycardia associated with a **prolonged QT interval**, which often precedes the arrhythmia [1]. - A prolonged QT interval indicates a delayed repolarization of the ventricles, creating a vulnerable period for the development of aberrant electrical activity [2]. *Presence of polymorphic QRS complexes* - While torsades de pointes does exhibit **polymorphic QRS complexes**, this is a characteristic *feature* of the arrhythmia itself, not the primary predisposing factor or defining characteristic that initiates it [1]. - The key underlying condition leading to torsades is the **QT prolongation**. *It is a type of supraventricular tachycardia* - Torsades de pointes is a **ventricular tachycardia**, meaning it originates in the ventricles, not above them in the atria or AV node (supraventricular) [1]. - Its origin below the Bundle of His differentiates it from supraventricular arrhythmias. *QRS complexes appear to rotate around the isoelectric baseline of ECG* - This description accurately depicts the characteristic **"twisting of the points"** morphology of torsades de pointes, but it is a *description of the ECG appearance* during the arrhythmia itself, not the fundamental predisposing factor [1]. - The rotation is a consequence of the changing amplitudes and axes of the polymorphic QRS complexes [1].

Q: Ankle-brachial index is useful in prediction of:

Myocardial infarction. ***Myocardial infarction*** - A low **ankle-brachial index (ABI)** indicates broader **atherosclerotic disease**, which is a significant **risk factor** for **myocardial infarction** and other **cardiovascular events** [1]. - ABI measures arterial insufficiency in the lower extremities; a value less than 0.9 suggests **peripheral artery disease (PAD)**, independently predicting future cardiac events [1]. *Buerger's disease* - Not directly predicted by ABI in the context of general cardiovascular risk; **Buerger's disease** is an **inflammatory vasculitis** primarily affecting small and medium-sized arteries and veins. - While it causes digital ischemia, its etiology and pathophysiology are distinct from the general atherosclerotic burden measured by ABI. *Meconium ileus* - **Meconium ileus** is a **gastrointestinal obstruction** in newborns, typically associated with **cystic fibrosis**, and has no relationship with the **ankle-brachial index** measurement. - ABI is a vascular diagnostic tool, not relevant to pediatric gastrointestinal conditions. *All of the options* - This is incorrect because **meconium ileus** and **Buerger's disease** are not primarily or directly predicted by the ankle-brachial index. - ABI is a strong predictor of systemic atherosclerosis and associated events like myocardial infarction, but not unrelated conditions [1].

Q: A 28-year-old female presents with progressive dyspnea on exertion and palpitations for the past 6 months. She has a history of recurrent sore throat episodes during childhood. On examination, she has an irregularly irregular pulse, and auscultation reveals a mid-diastolic rumbling murmur at the apex. ECG shows atrial fibrillation with controlled ventricular rate and left atrial enlargement. Echocardiogram demonstrates mitral valve stenosis with commissural fusion, leaflet thickening, and a mitral valve area of 1.2 cm². What is the most likely diagnosis?

Rheumatic mitral stenosis. **Rheumatic mitral stenosis** - The clinical presentation (progressive **dyspnea** on exertion, **palpitations**, history of recurrent sore throat, **irregularly irregular pulse**) and auscultation findings (**mid-diastolic rumbling murmur** at the apex) are classic for **mitral stenosis**. - The echocardiogram findings of **mitral valve stenosis with commissural fusion**, leaflet thickening, and a reduced mitral valve area (1.2 cm²) are pathognomonic for **rheumatic heart disease**, which is a long-term complication of untreated streptococcal pharyngitis (sore throat). *Neovascularization of the valve leaflets* - This is not a primary cause of mitral stenosis and is more typically seen in conditions like infectious endocarditis, though it is not a direct diagnostic feature. - While neovascularization can occur in chronically diseased valves, it doesn't explain the specific valve morphology and clinical course described. *Vegetations on the mitral valve* - **Vegetations** are characteristic of **infective endocarditis** and would typically present with fever, new or changing murmurs, and signs of systemic embolization, none of which are mentioned here. - Although infective endocarditis can cause valve dysfunction, it doesn't typically result in the characteristic **commissural fusion** and leaflet thickening seen in rheumatic disease. *Myxomatous degeneration of the mitral valve* - This condition is the underlying pathology of **mitral valve prolapse** and typically leads to **mitral regurgitation**, not stenosis. - The echocardiographic features would show thickened, redundant leaflets that prolapse into the left atrium during systole, which contradicts the described **mitral stenosis** with **commissural fusion**.

Q: Which of the following conditions can lead to an abnormal increase in the amplitude of the 'U' wave on an ECG?

Hypokalemia. ***Hypokalemia*** - **Hypokalemia** is a common cause of prominent U waves due to delayed repolarization of **Purkinje fibers**. [1] - Other ECG changes in hypokalemia include **T-wave flattening or inversion** and prolongation of the **QT interval**. [1] *Amiodarone* - **Amiodarone** is an antiarrhythmic drug that primarily prolongs the **QT interval** due to its effect on potassium channels. - While it can affect repolarization, it does not typically cause a prominent U wave; instead, it may cause **bradycardia** and **Torsades de Pointes**. [2] *Quinidine* - **Quinidine** is a Class IA antiarrhythmic drug that prolongs the **QT interval** by blocking potassium channels. [2] - It is known for causing **QT prolongation** and increasing the risk of **Torsades de Pointes**, but not prominently increased U waves. [2] *None of the options* - This option is incorrect as **hypokalemia** is a well-established cause of abnormal U waves on an ECG.

Q: Recommended interventions to reduce the incidence of coronary artery disease include the following except which of the following?

Fat intake < 20% of total energy.. ***Fat intake < 20% of total energy.*** - While reducing unhealthy fat intake is crucial for cardiovascular health, recommending total fat intake to be less than 20% of total energy is generally **too restrictive** and not a standard recommendation for the general population. - Current guidelines focus on the *type* of fat (limiting saturated and trans fats) rather than a strict overall percentage, as healthy fats are essential for various bodily functions [3]. *Dietary cholesterol < 100 mg/1000kcal/d* - Reducing dietary cholesterol intake is a widely accepted recommendation to lower the risk of **coronary artery disease (CAD)**, as high cholesterol contributes to atherosclerosis [3]. - Limiting cholesterol intake to less than 100 mg per 1000 kcal per day aligns with strategies for managing blood lipid levels [1]. *Reduce salt intake to < 5g per day.* - Reducing salt intake to less than 5 grams per day is strongly recommended to lower **blood pressure**, a major risk factor for CAD [2]. - High sodium intake contributes to hypertension, which places increased strain on the cardiovascular system [2]. *No alcohol consumption.* - While excessive alcohol consumption is detrimental to cardiovascular health, a recommendation of **no alcohol consumption** is not universally made to reduce CAD risk. - Moderate alcohol intake (e.g., one drink per day for women, two for men) has been associated with a potential reduction in CAD risk in some studies, though this is debated.

Question 1

In a patient with subclavian steal syndrome, what is the most characteristic finding?

Accepted Answer

The BP is decreased on the ipsilateral side

Answer

The flow of blood in the vertebral arteries is normal

Answer

The patients may present with claudication features in some cases.

Answer

The patients may present with neurological features.

Question 2

Extent of cardiotoxicity of chemotherapy and radiotherapy is best diagnosed by:

Accepted Answer

Echocardiogram

Answer

Radionuclide scan

Answer

ECG

Answer

Endomyocardial biopsy

Question 3

Which of the following rhythms associated with cardiac arrest is considered shockable?

Accepted Answer

Ventricular fibrillation

Answer

Pulseless ventricular tachycardia

Answer

Asystole

Answer

Pulseless electrical activity

Question 4

Reversed Coarctation is seen in which of the following conditions?

Accepted Answer

Takayasu Arteritis

Answer

Polyarteritis Nodosa

Answer

Kawasaki Disease

Answer

Giant cell Arteritis

Question 5

Which of the following is true about torsades de pointes?

Accepted Answer

Presence of prolonged QT interval on ECG

Answer

Presence of polymorphic QRS complexes

Answer

It is a type of supraventricular tachycardia

Answer

QRS complexes appear to rotate around the isoelectric baseline of ECG

Question 6

Ankle-brachial index is useful in prediction of:

Accepted Answer

Myocardial infarction

Answer

All of the options

Answer

Buerger's disease

Answer

Meconium ileus

Question 7

A 28-year-old female presents with progressive dyspnea on exertion and palpitations for the past 6 months. She has a history of recurrent sore throat episodes during childhood. On examination, she has an irregularly irregular pulse, and auscultation reveals a mid-diastolic rumbling murmur at the apex. ECG shows atrial fibrillation with controlled ventricular rate and left atrial enlargement. Echocardiogram demonstrates mitral valve stenosis with commissural fusion, leaflet thickening, and a mitral valve area of 1.2 cm². What is the most likely diagnosis?

Accepted Answer

Rheumatic mitral stenosis

Answer

Myxomatous degeneration of the mitral valve

Answer

Vegetations on the mitral valve

Answer

Neovascularization of the valve leaflets

Question 8

Which of the following statements is true regarding the rheumatization of the mitral valve?

Accepted Answer

Rheumatization of the mitral valve can cause mitral stenosis or regurgitation.

Answer

Rheumatization of the mitral valve can lead to fibrosis and calcification.

Answer

Rheumatization of the mitral valve is always asymptomatic.

Answer

Rheumatization does not affect the mitral valve.

Question 9

Which of the following conditions can lead to an abnormal increase in the amplitude of the 'U' wave on an ECG?

Accepted Answer

Hypokalemia

Answer

Amiodarone

Answer

Quinidine

Answer

None of the options

Question 10

Recommended interventions to reduce the incidence of coronary artery disease include the following except which of the following?

Accepted Answer

Fat intake < 20% of total energy.

Answer

Reduce salt intake to < 5g per day.

Answer

No alcohol consumption.

Answer

Dietary cholesterol < 100 mg/1000kcal/d

Cardiology — MCQs

Cardiology — MCQs

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