Cardiology Practice Questions

Q: Which of the following procedures is contraindicated in Wolff-Parkinson-White syndrome?

Procainamide. ### Procainamide - While **procainamide** can be used in Wolff-Parkinson-White (WPW) syndrome for certain **pre-excited arrhythmias**, it is generally **contraindicated** if there is an **atrial fibrillation with rapid ventricular response** because it can paradoxically shorten the refractory period of the accessory pathway. - Shortening the refractory period of the accessory pathway can lead to a **faster conduction** of atrial impulses to the ventricles, potentially causing **ventricular fibrillation** and sudden cardiac death. ### Treadmill test - A **treadmill test** is a common diagnostic tool used to evaluate the presence of **ischemic heart disease** or to assess exercise-induced arrhythmias, and is not contraindicated in WPW [2]. - It can help in risk stratification in patients with WPW by assessing the **response of the accessory pathway** to exercise [2]. ### Electrophysiological studies - **Electrophysiological studies (EPS)** are not only safe but also the **gold standard** for diagnosing and risk stratifying Wolff-Parkinson-White syndrome [1]. - EPS pinpoint the location and characteristics of the **accessory pathway**, and are often performed as a precursor to **catheter ablation** [2]. ### Oral beta blocker - Beta-blockers are generally **contraindicated** in patients with **WPW syndrome** who experience **atrial fibrillation with rapid conduction** over the accessory pathway [3]. - Similar to other AV nodal blocking agents, beta-blockers can block the normal conduction pathway, leading to an **increased reliance on the accessory pathway** and potentially dangerous ventricular rates [3].

Q: A 34-year-old man presents with dyspnea and increasing peripheral edema, following a "flu-like" illness with intermittent sharp left-sided chest pain. On examination, his jugular venous pressure is elevated at 8 cm, heart sounds are soft, and the blood pressure is 104/76 mm Hg, with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. Which of the following is the most likely diagnosis?

cardiac tamponade. ***cardiac tamponade*** - The combination of **elevated JVP**, **soft heart sounds**, and **pulsus paradoxus** (20 mmHg decrease in systolic BP during inspiration) constitutes **Beck's triad**, highly suggestive of cardiac tamponade [1]. - The history of a preceding **"flu-like" illness** could indicate a viral pericarditis, which can progress to pericardial effusion and tamponade [1]. *pulmonary hypertension* - While it can cause **dyspnea** and **peripheral edema**, it does not typically present with **pulsus paradoxus** or acutely develop after a flu-like illness with sharp chest pain in this manner. - Heart sounds would generally include a **loud P2** and may have a right-sided S3, not necessarily soft heart sounds. *ventricular septal defect* - A VSD is a **congenital heart defect** usually discovered earlier in life, although smaller defects can present in adulthood. - Its typical presentation involves a **pansystolic murmu**r and, if large, signs of heart failure, but not the acute constellation of symptoms suggesting tamponade. *coarctation of the aorta* - This condition is characterized by **differences in blood pressure** and pulses between the upper and lower extremities. - It would not typically cause **global heart sound softening** or the presence of **pulsus paradoxus**.

Q: Which of the following is a characteristic EKG finding of ventricular premature beats?

Wide QRS complex. Focusing on the characteristics of ventricular premature beats (VPBs), the EKG typically demonstrates broad, bizarre QRS complexes with no preceding P wave [1]. ***Wide QRS complex*** - A **ventricular premature beat (VPB)** originates in the ventricles, bypassing the normal His-Purkinje system [1]. - This abnormal conduction pathway through ventricular muscle causes a **delayed and wide QRS complex** (typically > 0.12 seconds) on EKG [1]. *Narrow QRS complex* - A **narrow QRS complex** (typically < 0.12 seconds) indicates that ventricular depolarization occurred through the normal His-Purkinje system. - This is characteristic of beats originating above the ventricles, such as **supraventricular premature beats** or normal sinus beats. *Fusion beat* - A **fusion beat** occurs when a beat from the sinoatrial node (or another supraventricular source) and a ventricular beat simultaneously activate the ventricles [1]. - This results in a QRS complex that is a **hybrid** of a normal QRS and a wide, aberrant QRS, but it's not the primary characteristic of a VPB itself. *AV dissociation* - **AV dissociation** refers to the atria and ventricles beating independently [1]. - While it can be seen in various arrhythmias, including some ventricular tachycardias, it is **not a characteristic finding of an isolated ventricular premature beat**.

Q: Which of the following statements is false regarding restrictive cardiomyopathy?

Filling pressure is decreased.. Filling pressure is decreased. - In restrictive cardiomyopathy, the ventricles become stiff and noncompliant, impairing filling. - This leads to increased filling pressures (e.g., elevated left and right atrial pressures) as the heart attempts to fill adequately. Left ventricular hypertrophy is present. - Left ventricular hypertrophy is common in restrictive cardiomyopathy, particularly in conditions like amyloidosis and sarcoidosis, where infiltrative processes thicken the ventricular walls. - While the chambers are not dilated, the walls can be abnormally thick due to underlying pathology. In the early phase, systolic function is impaired. - In the early stages of restrictive cardiomyopathy, systolic function is typically preserved. The primary defect is diastolic dysfunction—impaired ventricular filling. - Systolic dysfunction may develop in later stages as the underlying disease progresses or due to severe volume overload. Heart failure is predominantly right-sided. - Right-sided heart failure symptoms (e.g., peripheral edema, ascites, jugular venous distension) are often prominent in restrictive cardiomyopathy. - Due to the rigid and non-compliant ventricles inhibiting filling, both ventricles are affected, but systemic venous congestion often dominates the clinical picture.

Q: What is the characteristic feature of pain experienced in intermittent claudication?

Brought on by walking and relieved by rest.. **Brought on by walking and relieved by rest.** - **Intermittent claudication** is classically described as muscle pain or cramping in the lower extremities that is **triggered by exercise** (e.g., walking) and consistently **relieved by rest** within a few minutes [1]. - This pattern occurs due to an imbalance between the oxygen supply (limited by **atherosclerotic** narrowing of arteries) and the metabolic demand of the exercising muscles [1]. *Can occur after a few steps.* - While the pain can indeed occur after a few steps in severe cases, this statement alone does not fully define the **characteristic pattern** of intermittent claudication, which crucially includes relief with rest. - The distance at which pain occurs (claudication distance) varies with the severity of the **peripheral artery disease** [1]. *Relieved by standing still.* - For intermittent claudication, it is the cessation of muscle activity (rest), not just standing still, that provides relief. For example, a patient may stand still and still experience pain if the muscle demand has not sufficiently decreased. - Pain relief by standing still is more characteristic of **neurogenic claudication**, such as that caused by **spinal stenosis**, where positional changes can alleviate nerve compression.

Q: In the ECG shown below, which drug should be avoided in the management of atrial fibrillation?

Adenosine. ***Adenosine*** - The ECG shows **atrial fibrillation with rapid ventricular response** and **delta waves**, indicating **Wolff-Parkinson-White (WPW) syndrome**. The tracing demonstrates an irregularly irregular rhythm with variable wide QRS complexes and evidence of accessory-pathway conduction (delta waves, slurred QRS upstroke). - **Adenosine** blocks the AV node, which can increase conduction down the accessory pathway in WPW, potentially leading to **ventricular fibrillation**. *Procainamide* - Procainamide is a preferred agent in acute pre-excited atrial fibrillation (WPW with AF). It slows conduction through the accessory pathway and can restore sinus rhythm without the risk of accelerating accessory pathway conduction. *Ibutilide* - Ibutilide is an acceptable option in acute pre-excited atrial fibrillation. It can terminate the arrhythmia by blocking the accessory pathway and is not contraindicated in WPW with AF. *Synchronized cardioversion* - Synchronized cardioversion is the treatment of choice in hemodynamically unstable patients with pre-excited atrial fibrillation. It is safe and effective in this setting. **Note:** Intravenous amiodarone is **not recommended** in acute pre-excited atrial fibrillation because it may accelerate accessory-pathway conduction and precipitate ventricular fibrillation. AV nodal blocking agents (adenosine, diltiazem, beta-blockers, digoxin) are contraindicated in WPW with AF.

Q: Which of the following statements is true about infective endocarditis in IV drug abusers?

Tricuspid valve is most commonly involved. ***Tricuspid valve is most commonly involved*** - In **IV drug abusers**, the **tricuspid valve** is most often affected due to direct inoculation of pathogens through contaminated needles. - This results in **right-sided endocarditis**, commonly associated with **Staphylococcus aureus** infections [2], [3]. *Staphylococcus aureus is the most common organism.* - While **Staphylococcus aureus** is prevalent [3], [4], it is **not the only organism**; other bacteria can also cause infective endocarditis in this population. - The statement is somewhat misleading as it does not emphasize the broader range of organisms involved. *Pulmonary valve is commonly involved* - The **pulmonary valve** is typically not affected in infective endocarditis related to IV drug use; the focus is primarily on the **tricuspid valve**. - Right-sided endocarditis predominantly affects the **tricuspid valve** due to the route of infection, making this statement incorrect. *Candida is a common cause of infective endocarditis.* - **Candida** is a rare cause of infective endocarditis compared to bacterial causes, especially in IV drug users [1]. - This fungal organism is more associated with **compromised immunity** and not common in standard settings of IV drug abuse, though it can occur via contamination of lemon juice [1].

Q: Which of the following statements regarding the left parasternal lift are NOT true?

All of the options. *All of the options* - This question asks for statements that are **NOT true**, and all listed options contain inaccuracies regarding the timing and physiological correlates of a left parasternal lift. [2] - A left parasternal lift, or heave, is typically associated with **right ventricular hypertrophy** or dilation, reflecting right ventricular activity rather than direct left ventricular events. [2], [3] *Synchronous with left ventricular apical impulse.* - A left parasternal lift is a palpable impulse over the **right ventricle**, while the apical impulse primarily represents the **left ventricular apex**. [2] These are distinct and not synchronous in the manner implied. [1] - While both occur during systole, they represent different ventricular actions and locations, making their direct synchronicity in terms of representing the same event incorrect. [1] *Starts in early systole.* - A left parasternal lift reflecting **right ventricular systole** begins with isovolumetric contraction of the right ventricle, which is indeed in early systole. [1] - However, the overall premise of the question is to identify incorrect statements about a left parasternal lift; while this particular point about timing is generally correct for right ventricular contraction, its inclusion here is part of identifying the broader inaccuracies in the other options if they are considered in the context of what a left parasternal lift *is not*. *Corresponds to 'V' wave in LA pressure curve.* - The 'V' wave in the left atrial (LA) pressure curve represents **passive filling** of the left atrium during ventricular systole and subsequent atrial volume overload, not a direct mechanical event like a parasternal lift. - A left parasternal lift is a **palpable chest wall movement** due to right ventricular activity, unrelated to the 'V' wave of left atrial pressure. [2]

Q: Intracavitary electrocardiography is a diagnostic aid in which of the following conditions?

Ebstein's anomaly of the tricuspid valve. ***Ebstein's anomaly of the tricuspid valve*** - Intracavitary electrocardiography (ECG) is particularly useful in distinguishing **Ebstein's anomaly** from other conditions due to its ability to localize the AV conduction tissue relative to the tricuspid valve. - In Ebstein's anomaly, the **atrialized right ventricle** can be identified by the presence of a ventricular electrogram atrialized segment, which helps characterize the extent of tricuspid valve displacement. *Tricuspid valve stenosis* - While tricuspid valve stenosis affects the right heart, its primary diagnosis is made through **echocardiography** to assess flow obstruction and valve morphology. - Intracavitary ECG is not a standard or primary diagnostic tool for characterizing the anatomical features or hemodynamic severity of **tricuspid stenosis**. *Atrial septal defect* - An **atrial septal defect (ASD)** is typically diagnosed by **echocardiography**, which directly visualizes the defect and assesses shunt size and direction. - Intracavitary ECG is not routinely used for localizing or diagnosing an ASD, as its role is more focused on cardiac conduction and chamber electrophysiology. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is primarily diagnosed using **echocardiography**, which offers clear visualization of the defect location, size, and hemodynamic impact. - Although VSDs can affect ventricular electrophysiology, intracavitary ECG is not a primary diagnostic tool for identifying or characterizing a VSD itself.

Question 1

Which of the following procedures is contraindicated in Wolff-Parkinson-White syndrome?

Accepted Answer

Procainamide

Answer

Treadmill test

Answer

Electrophysiological studies

Answer

Oral beta blocker

Question 2

A 34-year-old man presents with dyspnea and increasing peripheral edema, following a "flu-like" illness with intermittent sharp left-sided chest pain. On examination, his jugular venous pressure is elevated at 8 cm, heart sounds are soft, and the blood pressure is 104/76 mm Hg, with a 20 mm Hg decrease in systolic arterial pressure during slow inspiration. Which of the following is the most likely diagnosis?

Accepted Answer

cardiac tamponade

Answer

pulmonary hypertension

Answer

ventricular septal defect

Answer

coarctation of the aorta

Question 3

Which of the following is a characteristic EKG finding of ventricular premature beats?

Accepted Answer

Wide QRS complex

Answer

Narrow QRS complex

Answer

Fusion beat

Answer

AV dissociation

Question 4

In non-rheumatic atrial fibrillation, which of the following statements is true?

Accepted Answer

Paroxysmal atrial fibrillation is associated with a similar risk of stroke as persistent atrial fibrillation

Answer

Excess alcohol intake is an unlikely cause

Answer

Cardioversion may be performed without anticoagulation if a transthoracic echocardiogram is normal

Answer

The risk of stroke is less than in atrial fibrillation due to rheumatic valve disease

Question 5

Which of the following statements is false regarding restrictive cardiomyopathy?

Accepted Answer

Filling pressure is decreased.

Answer

Left ventricular hypertrophy is present.

Answer

In the early phase, systolic function is impaired.

Answer

Heart failure is predominantly right-sided.

Question 6

What is the characteristic feature of pain experienced in intermittent claudication?

Accepted Answer

Brought on by walking and relieved by rest.

Answer

Can occur after a few steps.

Answer

Relieved by standing still.

Answer

None of the options.

Question 7

In the ECG shown below, which drug should be avoided in the management of atrial fibrillation?

Accepted Answer

Adenosine

Answer

Procainamide

Answer

Ibutilide

Answer

Synchronized cardioversion

Question 8

Which of the following statements is true about infective endocarditis in IV drug abusers?

Accepted Answer

Tricuspid valve is most commonly involved

Answer

Candida is a common cause.

Answer

Pulmonary valve is commonly involved

Answer

Staphylococcus aureus is rarely the commonest organism.

Question 9

Which of the following statements regarding the left parasternal lift are NOT true?

Accepted Answer

All of the options

Answer

Synchronous with left ventricular apical impulse.

Answer

Starts in early systole.

Answer

Corresponds to 'V' wave in LA pressure curve.

Question 10

Intracavitary electrocardiography is a diagnostic aid in which of the following conditions?

Accepted Answer

Ebstein's anomaly of the tricuspid valve

Answer

Tricuspid valve stenosis

Answer

Atrial septal defect

Answer

Ventricular septal defect

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?