Cardiology — MCQs
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Pulmonary Plethora is seen in -
A 25-year-old female presented to ER unconscious. Her mother tells you about her having recurrent syncopal episodes. Her BP is 80/60 mm Hg and you order an ECG. Treatment is
Stunning of myocardium without any acute coronary syndrome is:-
A patient presents with palpitations, consciousness, fast pulse, and BP of 80/50 mmHg. After failed vagal maneuver and maximum dose of adenosine, what is the next step in management?
A patient presents with palpitations. On examination the patient was conscious, pulse was fast with BP of 80/50 mmHg. He was subjected to Vagal maneuver and was given intravenous adenosine. The rhythm remains refractory to maximum dose of adenosine. What is the next step in management of this patient?
Deep y descent in JVP is seen in all except:
What is indicated by an 'enlarged left atrium' on echocardiography?
Which condition is associated with 'prolonged PR interval' on an ECG?
A 30 year old patient has right upper limb BP of 180/95 mm Hg and left upper limb BP of 130/90 mm Hg. He also has early diastolic murmur in right 2nd intercostal space. Which of the following would be LEAST likely associated with these findings?
Patient shows ST depression, troponin rise 6h post-surgery. Next best step is:
Cardiology Indian Medical PG Practice Questions and MCQs
Question 1331: Pulmonary Plethora is seen in -
- A. Tricuspid Atresia
- B. TAPVC (Correct Answer)
- C. CoA
- D. TOF
Explanation: ***TAPVC*** - **Total Anomalous Pulmonary Venous Connection (TAPVC)** leads to all pulmonary veins draining into the systemic circulation, causing a left-to-right shunt at the atrial level back into the right atrium. - This persistent shunting results in increased blood flow to the lungs, manifesting as **pulmonary plethora** on chest X-ray due to engorged pulmonary vessels [3]. *Tricuspid Atresia* - **Tricuspid atresia** results in an absence of the tricuspid valve, severely limiting blood flow from the right atrium to the right ventricle. - This condition typically leads to **pulmonary oligemia** (reduced blood flow to the lungs), not pulmonary plethora. *CoA* - **Coarctation of the aorta (CoA)** is a narrowing of the aorta, typically distal to the left subclavian artery [2]. - While it can lead to complications like heart failure, it generally does not directly cause **pulmonary plethora** unless there are associated shunts. *TOF* - **Tetralogy of Fallot (TOF)** is characterized by four defects: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [1]. - The most significant hemodynamic feature is **pulmonary stenosis**, which reduces blood flow to the lungs, leading to **pulmonary oligemia**, often described as a "boot-shaped" heart on X-ray [1].
Question 1332: A 25-year-old female presented to ER unconscious. Her mother tells you about her having recurrent syncopal episodes. Her BP is 80/60 mm Hg and you order an ECG. Treatment is
- A. Cathether Ablation
- B. Adenosine
- C. DC shock (Correct Answer)
- D. Radiofrequency ablation
Explanation: ***DC shock*** - The ECG shows a **wide complex tachycardia** with alternating morphology in the QRS complex, consistent with **Torsades de Pointes**. - Given the patient's **unconsciousness** and **hypotension (80/60 mmHg)**, she is hemodynamically unstable, making immediate **electrical cardioversion (DC shock)** the treatment of choice irrespective of the cause. *Catheter Ablation* - **Catheter ablation** is an invasive procedure used for definitive treatment of recurrent arrhythmias, often considered in patients who are *hemodynamically stable*. - It is not an acute, emergency treatment for an **unstable patient** in a life-threatening arrhythmia. *Adenosine* - **Adenosine** is primarily used to terminate **supraventricular tachycardias (SVTs)** and can be harmful in wide complex tachycardias, especially if due to ventricular tachycardia or Wolff-Parkinson-White syndrome. - Its use is contraindicated in wide complex tachycardias like Torsades de Pointes, and it would not be effective in an **unstable patient** with Torsades de Pointes. *Radiofrequency ablation* - **Radiofrequency ablation** is a type of catheter ablation, which ablates or destroys abnormal electrical pathways in the heart. - Similar to other ablative therapies, it is a **definitive treatment** for recurrent arrhythmias in *stable patients*, not an emergency measure for an unconscious, hypotensive patient with an acute arrhythmia.
Question 1333: Stunning of myocardium without any acute coronary syndrome is:-
- A. Restrictive cardiomyopathy
- B. Subendocardial infarction
- C. Transmural infarction
- D. Takotsubo cardiomyopathy (Correct Answer)
Explanation: ***Takotsubo cardiomyopathy*** - This condition involves **transient systolic dysfunction** of the left ventricle, often triggered by severe emotional or physical stress, mimicking a heart attack but without **coronary artery obstruction**. - The apical and mid-ventricular segments of the left ventricle become akinetic or hypocinetic, causing the heart to take on a shape resembling an octopus trap (**takotsubo**). *Restrictive cardiomyopathy* - This is a condition where the walls of the ventricles become **stiff** and **lose their flexibility**, preventing the heart from filling properly. - It is typically caused by conditions like **amyloidosis** or **sarcoidosis**, leading to impaired diastolic function, not transient stunning. *Subendocardial infarction* - This refers to a **heart attack** that affects only the **inner layer** of the heart muscle (**subendocardium**) due to reduced blood flow [2]. - It is a form of **acute coronary syndrome** where there is irreversible myocardial necrosis, unlike the temporary dysfunction in stunning [1]. *Transmural infarction* - This is a **severe form of heart attack** where the entire thickness of the heart muscle wall is affected, usually due to a **complete blockage of a coronary artery** [2]. - This also represents **acute coronary syndrome** with widespread myocardial necrosis, which is fundamentally different from a reversible stunning of the myocardium [1].
Question 1334: A patient presents with palpitations, consciousness, fast pulse, and BP of 80/50 mmHg. After failed vagal maneuver and maximum dose of adenosine, what is the next step in management?
- A. Amiodarone
- B. Repeat adenosine
- C. Defibrillation
- D. Cardioversion (Correct Answer)
Explanation: ***Cardioversion*** - The patient presents with **symptomatic tachycardia** (palpitations, decreased consciousness, hypotension) refractory to **vagal maneuvers** and **adenosine**, indicating hemodynamic instability. - In such cases, **synchronized cardioversion** is the definitive treatment to restore sinus rhythm promptly and prevent further deterioration [1]. *Amiodarone* - **Amiodarone** is an antiarrhythmic drug used for stable wide complex tachycardia or as a second-line agent for unstable tachycardia after cardioversion. - It is not the immediate next step for an unstable patient who has failed adenosine, as its onset of action is slower than cardioversion [2]. *Repeat adenosine* - The question states that the patient has already received the **maximum dose of adenosine** and it has failed. - Administering more adenosine would be ineffective and delay definitive treatment for a hemodynamically unstable patient. *Defibrillation* - **Defibrillation** is used for **pulseless ventricular tachycardia/fibrillation** where there is no organized electrical activity [1]. - This patient has a pulse and an organized (though fast) rhythm, making synchronized cardioversion the appropriate electrical therapy.
Question 1335: A patient presents with palpitations. On examination the patient was conscious, pulse was fast with BP of 80/50 mmHg. He was subjected to Vagal maneuver and was given intravenous adenosine. The rhythm remains refractory to maximum dose of adenosine. What is the next step in management of this patient?
- A. Repeat adenosine
- B. Cardioversion (Correct Answer)
- C. Amiodarone
- D. Defibrillation
Explanation: ***Cardioversion*** - As the patient is **hemodynamically unstable** (BP 80/50 mmHg) and has a **tachyarrhythmia** refractory to vagal maneuvers and maximal adenosine, **synchronized cardioversion** is the immediate next step. - This intervention provides a rapid and effective way to restore sinus rhythm in unstable supraventricular tachycardias (SVTs). *Repeat adenosine* - Adenosine has a very short half-life and its effects are transient; **repeated doses** beyond the maximal recommended dose are unlikely to be effective and may carry increased risk without benefit in a refractory case [2]. - The patient's **hemodynamic instability** necessitates a more definitive and immediate intervention than further pharmacotherapy. *Amiodarone* - While amiodarone is an **antiarrhythmic drug** used for tachyarrhythmias, it acts more slowly than cardioversion and is typically reserved for **hemodynamically stable** patients or after electrical cardioversion if arrhythmia recurs. - Given the patient's **hypotension**, immediate electrical cardioversion is prioritized over pharmacologic therapy that takes time to act. *Defibrillation* - Defibrillation is used for **pulseless ventricular tachyarrhythmias** (VT/VF) or cardiac arrest, which does not match the clinical scenario described as the patient has a pulse [1]. - This patient is in a **tachycardia with a pulse** and is hemodynamically unstable, requiring synchronized cardioversion rather than unsynchronized defibrillation.
Question 1336: Deep y descent in JVP is seen in all except:
- A. RCM
- B. Constrictive pericarditis
- C. Tricuspid regurgitation
- D. Cardiac tamponade (Correct Answer)
Explanation: **Cardiac tamponade** - In **cardiac tamponade**, the heart’s filling is severely restricted by fluid in the pericardial sac, leading to an **elevated right atrial pressure** that impedes venous return and results in **blunting or absence of the y descent** in the JVP [1]. - The elevated pericardial pressure prevents the right ventricle from expanding during early diastole, which is the physiological basis for the **normal y descent**. *RCM* - **Restrictive cardiomyopathy (RCM)** is characterized by **impaired ventricular filling** during diastole, causing a rapid fall in atrial pressure after tricuspid valve opening, resulting in a **prominent and deep y descent**. - The rapid early diastolic filling during the y descent is abruptly halted as the stiff ventricle is unable to further accommodate blood, leading to a rapid rise in ventricular pressure. *Constrictive pericarditis* - In **constrictive pericarditis**, the rigid pericardium encases the heart, severely **restricting diastolic filling** and causing a rapid early diastolic drop in right atrial pressure, hence a **prominent and deep y descent** [2]. - Despite the rapid initial fall, the y descent is often followed by a rapid rise in pressure (square root sign on ventricular pressure tracing) as the heart reaches the limits of its constrained filling. *Tricuspid regurgitation* - While **tricuspid regurgitation** primarily impacts the **c-v wave** due to backflow into the atrium during ventricular systole, it can also present with an **exaggerated y descent** if there is significant diastolic dysfunction or associated conditions like right heart failure. - However, the most classic JVP finding in severe tricuspid regurgitation is a prominent **regurgitant c-v wave**, not necessarily a deep y descent as a primary feature.
Question 1337: What is indicated by an 'enlarged left atrium' on echocardiography?
- A. Chronic mitral regurgitation (Correct Answer)
- B. Tricuspid stenosis
- C. Acute mitral regurgitation
- D. Pulmonary embolism
Explanation: ***Chronic mitral regurgitation*** - Long-standing **mitral regurgitation** causes chronic volume overload in the left atrium, leading to its **dilatation** as a compensatory mechanism [1]. - This **atrial enlargement** is a key indicator of the chronicity and significant hemodynamic impact of the valve lesion. *Tricuspid stenosis* - **Tricuspid stenosis** primarily impacts the **right atrium**, causing its enlargement due to obstruction of blood flow into the right ventricle. - It does not directly affect the left atrium, although severe right-sided heart disease can sometimes indirectly influence left-sided filling. *Acute mitral regurgitation* - In **acute mitral regurgitation**, there is insufficient time for the left atrium to remodel and dilate significantly in response to the sudden volume overload [1]. - While left atrial pressure rises dramatically, the atrium itself typically appears **normal in size** or only mildly enlarged. *Pulmonary embolism* - A **pulmonary embolism** primarily affects the **right side of the heart**, leading to sudden increases in **pulmonary artery pressure** and right ventricular strain. - It does not directly cause left atrial enlargement, though severe acute right heart failure can impact left ventricular filling.
Question 1338: Which condition is associated with 'prolonged PR interval' on an ECG?
- A. Sinus bradycardia
- B. Second-degree AV block
- C. First-degree AV block (Correct Answer)
- D. Complete heart block
Explanation: ***First-degree AV block*** - First-degree AV block is defined by a consistent **prolongation of the PR interval** beyond 0.20 seconds, indicating delayed conduction through the AV node [1]. - While it is generally benign and asymptomatic, it reflects a **delay in electrical impulse transmission** from the atria to the ventricles [1], [3]. *Sinus bradycardia* - This condition is characterized by a **slow heart rate** (typically below 60 beats per minute) originating from the sinus node. - While the heart rate is slow, the **PR interval typically remains normal**, reflecting proper AV nodal conduction. *Second-degree AV block* - Second-degree AV block involves some **P waves not being conducted to the ventricules**, resulting in dropped QRS complexes [1]. - While PR intervals can be prolonged or progressively lengthen (Mobitz I), the key feature is **intermittent dropped beats**, not just blanket prolongation [1]. *Complete heart block* - Also known as third-degree AV block, this is a severe condition where **no atrial impulses are conducted to the ventricles**, leading to complete dissociation [2]. - The P waves and QRS complexes beat independently, meaning there is **no consistent PR interval** to measure as they are completely uncoupled [2].
Question 1339: A 30 year old patient has right upper limb BP of 180/95 mm Hg and left upper limb BP of 130/90 mm Hg. He also has early diastolic murmur in right 2nd intercostal space. Which of the following would be LEAST likely associated with these findings?
- A. Aortic dissection
- B. Coarctation of aorta
- C. Takayasu arteritis
- D. Supravalvular aortic Stenosis (Correct Answer)
Explanation: ***Supravalvular aortic Stenosis*** - **Supravalvular aortic stenosis** causes a pressure gradient above the aortic valve, leading to **left ventricular hypertrophy** and potentially differential blood pressures between the upper limbs, but typically with **higher pressures distally** from the stenosis. - The early diastolic murmur in the right 2nd intercostal space is more suggestive of **aortic regurgitation** [2], which is less directly caused by isolated supravalvular stenosis compared to other conditions listed. *Aortic dissection* - **Aortic dissection** can involve the great vessels originating from the aorta, leading to a significant **differential in blood pressure** between the upper limbs due to obstruction of flow to one arm [1]. - An early diastolic murmur, especially in the right 2nd intercostal space, can indicate **aortic regurgitation** [2] if the dissection extends to the aortic root. *Coarctation of aorta* - **Coarctation of the aorta** typically presents with **hypertension in the upper limbs** and lower or absent pulses in the lower limbs, but if the coarctation is pre-subclavian, it can cause a differential in arm blood pressures [1]. - A persistent **early diastolic murmur** can be heard in association with **bicuspid aortic valve**, which often co-exists with coarctation and can lead to aortic regurgitation [2]. *Takayasu arteritis* - **Takayasu arteritis** is a **vasculitis of large arteries**, commonly affecting the aorta and its main branches, which can lead to stenosis or occlusion of vessels supplying one arm, causing a **markedly different blood pressure** between the limbs. - Involvement of the aortic root can also lead to **aortic insufficiency**, manifesting as an early diastolic murmur [2].
Question 1340: Patient shows ST depression, troponin rise 6h post-surgery. Next best step is:
- A. 12-lead ECG
- B. Echocardiogram
- C. Cardiology consult (Correct Answer)
- D. Start heparin
Explanation: ***Cardiology consult*** - A cardiology consult is the most appropriate next step given the presence of **ST depression** and a **troponin rise** post-surgery, indicating a likely myocardial infarction (MI). - This allows for prompt comprehensive evaluation, risk stratification, and initiation of specialized cardiac management by an expert. *12-lead ECG* - While a 12-lead ECG is an important diagnostic tool, the patient's existing **ST depression** suggests it has already been performed or noted. - A repeat ECG might be useful for tracking changes, but it doesn't replace the need for expert cardiac evaluation and management. *Echocardiogram* - An echocardiogram can assess **cardiac function**, wall motion abnormalities, and valvular issues, which are relevant in MI. - However, it's a diagnostic test that should be ordered and interpreted in the context of a broader cardiac workup, which a cardiologist can best coordinate. *Start heparin* - **Heparin** is an anticoagulant that may be part of the management for an MI, especially in certain types or for prevention of clot extension. - However, initiating anticoagulation should be done after a thorough assessment of the patient's cardiac status, bleeding risk post-surgery, and in consultation with cardiology, rather than as the immediate next best step.
Practice by Chapter
Coronary Artery Disease and Angina
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Acute Coronary Syndromes
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Heart Failure
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Cardiac Arrhythmias
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Valvular Heart Diseases
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Cardiomyopathies
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Pericardial Diseases
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Congenital Heart Disease in Adults
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Hypertension and Hypertensive Emergencies
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Pulmonary Hypertension
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Non-invasive Cardiac Diagnostics
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Preventive Cardiology
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