Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 1511: A 30-year-old man presents with cramping gluteal pain after walking 500m. Which vascular condition is most likely involved?

A. Aortoiliac arterial disease (Correct Answer)
B. Superficial femoral artery disease
C. Popliteal artery disease
D. No vascular involvement

Explanation: ***Aortoiliac arterial disease*** - **Cramping gluteal pain** (claudication) is characteristic of **aortoiliac disease** due to insufficient blood flow to the gluteal muscles [1]. - The disease typically involves the **aorta** and/or the **iliac arteries**, which supply blood to the pelvis and lower limbs [1]. *Superficial femoral artery disease* - This condition primarily causes claudication in the **calf muscles**, not typically the gluteal region [1]. - The pain would be felt lower down the leg, corresponding to the muscle groups supplied by the **superficial femoral artery** [1]. *Popliteal artery disease* - **Popliteal artery disease** causes claudication in the **calf and foot** due to reduced blood flow to these distal areas [1]. - It would not typically present with gluteal pain, as the popliteal artery is located behind the knee. *No vascular involvement* - The presence of **cramping pain after exertion**, specifically claudication, strongly indicates significant vascular compromise [1]. - This symptom pattern is classic for **peripheral arterial disease**, ruling out no vascular involvement [1].

Question 1512: A patient presents to you with an irregularly irregular pulse of 120/minutes and a pulse deficit of 20. Which of the following would be the jugular venous pressure (JVP) finding?

A. Normal JVP
B. Absent a wave (Correct Answer)
C. Cannon a wave
D. Raised JVP with normal waveform

Explanation: ***Absent a wave*** - An **irregularly irregular pulse** with a **pulse deficit** strongly suggests **atrial fibrillation (AF)**. - In AF, the atria quiver chaotically instead of contracting effectively, leading to the **absence of a coordinated atrial contraction** and thus an **absent 'a' wave** in the JVP. *Normal JVP* - A normal JVP would show a regular **'a' wave** corresponding to normal atrial contraction. - This is inconsistent with the **irregularly irregular pulse** and **pulse deficit** seen in the patient, which points to a significant atrial arrhythmia. *Cannon a wave* - A **cannon 'a' wave** results from the right atrium contracting against a closed tricuspid valve, leading to a large, prominent wave in the JVP. - This is typically seen in conditions like **complete heart block** or **ventricular tachycardia with AV dissociation**, not atrial fibrillation. *Raised JVP with normal waveform* - A raised JVP with a normal waveform indicates increased right atrial pressure but preserves the normal sequence of atrial contraction and relaxation. - This could be due to conditions like **right heart failure** or **volume overload**, but would still show the presence of an 'a' wave, which is absent in atrial fibrillation.

Question 1513: Which of the following statements is true about the Bundle of Kent?

A. It is an abnormal pathway connecting the atria to the ventricles in WPW syndrome.
B. It is an accessory pathway connecting the atria to the ventricles in WPW syndrome. (Correct Answer)
C. It is slower than the AV nodal pathway.
D. None of the options.

Explanation: ***It is an accessory pathway connecting the atria to the ventricles in WPW syndrome.*** - The **Bundle of Kent** is an **accessory electrical pathway** that directly connects the atria and the ventricles, bypassing the **AV node** [1]. - This pathway is characteristic of **Wolff-Parkinson-White (WPW) syndrome** and allows for premature ventricular activation, leading to a **delta wave** on ECG and potential reentrant arrhythmias [1], [2]. *It is an abnormal pathway connecting the atria to the ventricles in WPW syndrome.* - While it is indeed an **abnormal pathway**, the more precise and commonly used term in electrophysiology is **accessory pathway** [2]. - The term "abnormal" is a general description and does not fully capture the specific nature of this congenital electrical connection. *It is slower than the AV nodal pathway.* - The **Bundle of Kent** typically conducts impulses **faster** than the **AV nodal pathway**, particularly during rapid rates [1]. - Unlike the AV node, the Bundle of Kent often has no significant physiological delay, which can lead to **pre-excitation** of the ventricles [1]. *None of the options.* - This statement is incorrect because one of the provided options accurately describes the Bundle of Kent.

Question 1514: In which of the following conditions is the implantation of an Automatic Implantable Cardioverter Defibrillator (AICD) indicated?

A. None of the options
B. Ventricular tachycardia with structural heart disease (Correct Answer)
C. Syncope due to arrhythmias
D. Brugada syndrome

Explanation: ***Ventricular tachycardia with structural heart disease*** - An **AICD** is strongly indicated for patients with **sustained ventricular tachycardia (VT)** in the presence of **structural heart disease** due to the high risk of sudden cardiac death [1]. - In these cases, the AICD can deliver **therapy (antitachycardia pacing or defibrillation)** to terminate life-threatening arrhythmias [1]. *Syncope due to arrhythmias* - While syncope due to arrhythmias can be serious, an **AICD** is not always the first or only treatment and its indication depends on the specific arrhythmia and underlying cause. - Other treatments like **ablation**, **antiarrhythmic medications**, or a **pacemaker** might be more appropriate depending on the type of arrhythmia (e.g., bradycardia). *None of the options* - This option is incorrect because **ventricular tachycardia with structural heart disease** is a clear and well-established indication for AICD implantation [1]. - AICDs are a cornerstone in the secondary prevention of sudden cardiac death in high-risk patients. *Brugada syndrome* - While **Brugada syndrome** carries a risk of sudden cardiac death, AICD implantation is typically reserved for patients who have experienced **symptomatic arrhythmias** (e.g., syncope, aborted sudden cardiac death) or have certain high-risk features, not for all asymptomatic cases. - Risk stratification in Brugada syndrome is complex, and an AICD is not universally indicated for every diagnosed individual.

Question 1515: In which condition does the Ankle-Brachial Pressure Index (ABPI) increase artificially?

A. Arteriosclerosis calcified arteries (Correct Answer)
B. Ischemic ulcers
C. Intermittent claudication
D. DVT

Explanation: ***Arteriosclerosis calcified arteries*** - **Arterial calcification** makes the vessels rigid and **non-compressible**, leading to falsely elevated blood pressure readings in the ankle. - This results in an **artificially high ABPI** (>1.3), masking the true extent of peripheral artery disease or even suggesting absence of disease [2]. *Ischemic ulcers* - **Ischemic ulcers** are a consequence of severe peripheral artery disease, which typically causes a **decreased ABPI** (<0.9) [2]. - The reduced blood flow cannot artificially increase the ABPI; rather, it indicates severe circulatory compromise. *Intermittent claudication* - **Intermittent claudication** is a symptom of peripheral artery disease, where the ABPI is usually **reduced during exercise** or **at rest** (<0.9) [1]. - This condition is characterized by arterial narrowing, not by stiffening that artificially inflates pressure readings. *DVT* - **Deep vein thrombosis (DVT)** primarily affects the venous system and **does not directly influence arterial pressure** measurements used for ABPI [2]. - While DVT can cause leg pain and swelling, it does not cause an artificial increase in arterial pressure readings in the ankle.

Question 1516: What are the potential causes of cardiogenic shock excluding myocardial infarction?

A. All of the options
B. acute mitral regurgitation (Correct Answer)
C. ventricular septal rupture
D. right heart failure

Explanation: ***acute mitral regurgitation*** - Severe acute mitral regurgitation can lead to **cardiogenic shock** by causing a sudden increase in left atrial pressure and pulmonary edema, reducing effective forward flow [1]. - This condition can result from **papillary muscle rupture** or dysfunction, often due to ischemia even in the absence of a large MI, or from infective endocarditis [1]. *ventricular septal rupture* - A ventricular septal rupture (VSR) is a mechanical complication of **myocardial infarction (MI)**, which is explicitly excluded in the question. - VSR creates a **left-to-right shunt**, leading to pulmonary overload and reduced systemic cardiac output, but it's fundamentally post-MI. *right heart failure* - While right heart failure can cause circulatory collapse, it is typically a component of **biventricular failure** or isolated in cases like severe pulmonary embolism [2]. - The question asks for causes of cardiogenic shock excluding MI, and pure **right heart failure** as a sole cause of global cardiogenic shock (affecting systemic perfusion) is less common without significant left heart involvement or severe pulmonary vascular disease. *All of the options* - This option is incorrect because **ventricular septal rupture** is almost exclusively a complication of myocardial infarction, which the question explicitly excludes. - Therefore, not all listed conditions are potential causes of cardiogenic shock *excluding MI*.

Question 1517: What does the CEAP score classify?

A. Atrial disorders
B. Chronic venous disorder (Correct Answer)
C. Neurological disorders
D. Traumatic disorders

Explanation: ***Chronic venous disorder*** - The **CEAP classification** is a standardized system for classifying **chronic venous disorders** [1]. - It stands for **Clinical, Etiological, Anatomical, and Pathophysiological**, providing a comprehensive description of the disease. *Atrial disorders* - **Atrial disorders** refer to conditions affecting the atria of the heart, such as atrial fibrillation, and are classified using different systems. - The CEAP score has **no relevance** to cardiac conditions. *Neurological disorders* - **Neurological disorders** pertain to conditions of the nervous system and are classified by systems tailored to their specific characteristics. - The CEAP score is **not applicable** to neurological diagnoses. *Traumatic disorders* - **Traumatic disorders** result from physical injury and are classified based on the nature and severity of the injury. - The CEAP score is **irrelevant** for assessing or classifying traumatic injuries.

Question 1518: Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

A. Atropine
B. Adenosine
C. High dose vasopressin
D. Amiodarone infusion (Correct Answer)

Explanation: ***Amiodarone infusion*** - **Amiodarone** is a **Class III antiarrhythmic** drug commonly used in advanced cardiac life support (ACLS) protocols for refractory **ventricular fibrillation (VF)** or **pulseless ventricular tachycardia (VT)** that persists despite defibrillation and epinephrine [1]. - It works by blocking potassium channels, prolonging repolarization and the refractory period, which helps to stabilize the electrical activity of the heart. *Atropine* - **Atropine** is an anticholinergic drug primarily used to treat **symptomatic bradycardia** by increasing heart rate. - It is not indicated for the treatment of **ventricular fibrillation** or **ventricular tachycardia** during cardiac arrest. *High dose vasopressin* - **Vasopressin** was previously included in some ACLS algorithms as an alternative to epinephrine for **vasoconstrictive effects**, but recent guidelines do not support its routine use in cardiac arrest. - While it can cause **vasoconstriction**, there is no evidence that high-dose vasopressin improves outcomes in refractory VF/VT over epinephrine. *Adenosine* - **Adenosine** is an antiarrhythmic drug used to treat **supraventricular tachycardias (SVTs)** by transiently blocking the AV node. - It is not effective for **ventricular fibrillation** or **ventricular tachycardia** and can even be harmful in these rhythms.

Question 1519: Roth spots are associated with which of the following conditions?

A. Acute leukaemia (Correct Answer)
B. Bacterial endocarditis
C. Severe Hypertension
D. None of the options

Explanation: **Acute leukaemia** - **Roth spots** are commonly observed in patients with **leukaemia**, characterized by **retinal hemorrhages** with pale centers due to leukemic cell infiltrates [1]. - The presence of these lesions is often an indicator of severe systemic disease [1]. *Bacterial endocarditis* - While **bacterial endocarditis** can cause various **ophthalmologic manifestations** like splinter hemorrhages and Janeway lesions, **Roth spots** are distinctly identified as hemorrhages with pale centers, which, though they can occur, are less characteristically associated than with leukaemia. - These hemorrhages in endocarditis are usually attributed to **immune complex deposition** or **septic emboli**. *Severe Hypertension* - **Severe hypertension** can lead to **hypertensive retinopathy**, presenting as **retinal hemorrhages**, cotton wool spots, and papilledema. - However, the classic description of **Roth spots** with their pale centers is not a direct or prominent feature of hypertensive retinopathy. *None of the options* - This option is incorrect because **Acute leukaemia** is clearly associated with **Roth spots**.

Question 1520: What electrolyte imbalance is most commonly associated with prominent U waves on ECG?

A. Hypokalemia (Correct Answer)
B. Hyponatremia
C. Hypocalcemia
D. Hypercalcemia

Explanation: ***Hypokalemia*** - **Prominent U waves** on an ECG are a classic sign of **hypokalemia**, indicating delayed repolarization of ventricular myocardial cells. - Other ECG changes associated with hypokalemia include **ST-segment depression**, **flattened T waves**, and a prolonged QT interval. *Hyponatremia* - **Hyponatremia** primarily affects neurological function and can lead to symptoms like confusion and seizures [1]. - It does not typically cause specific characteristic ECG changes such as **prominent U waves**. *Hypocalcemia* - **Hypocalcemia** is often associated with a **prolonged QT interval** on an ECG, which reflects delayed ventricular repolarization [2]. - However, it is not primarily linked to the appearance of prominent U waves. *Hypercalcemia* - **Hypercalcemia** is known to cause a **shortened QT interval** on the ECG due to accelerated repolarization. - It does not typically manifest with prominent U waves.

Practice by Chapter

Coronary Artery Disease and Angina

Practice Questions

Acute Coronary Syndromes

Practice Questions

Heart Failure

Practice Questions

Cardiac Arrhythmias

Practice Questions

Valvular Heart Diseases

Practice Questions

Cardiomyopathies

Practice Questions

Pericardial Diseases

Practice Questions

Congenital Heart Disease in Adults

Practice Questions

Hypertension and Hypertensive Emergencies

Practice Questions

Pulmonary Hypertension

Practice Questions

Non-invasive Cardiac Diagnostics

Practice Questions

Preventive Cardiology

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?