Cardiology Practice Questions

Q: Murmur heard in aortic stenosis

Right 2nd intercostal, high pitch systolic ejection murmur. ***Right 2nd intercostal, high pitch systolic ejection murmur*** - The murmur of **aortic stenosis** is classically heard loudest at the **right second intercostal space** (aortic area) due to turbulent flow through the stenosed aortic valve. - It is a **high-pitched, systolic ejection murmur** with a crescendo-decrescendo pattern, often radiating to the carotid arteries [2]. *Apex, low pitch murmur associated with mitral valve issues* - A murmur heard at the **apex** that is low-pitched typically suggests **mitral stenosis**, which is a diastolic rumble, not an aortic stenosis murmur [1]. - This option refers to characteristics associated with **mitral valve disease**, not aortic stenosis. *Pan-systolic murmur, high pitch murmur associated with mitral regurgitation* - A **pan-systolic murmur** is characteristic of conditions like **mitral regurgitation** or tricuspid regurgitation, where blood flows throughout the entire systole [3]. - While it can be high-pitched, its pan-systolic nature and association with mitral regurgitation make it distinct from aortic stenosis. *Left Sternal area, murmur indicating mitral regurgitation* - Murmurs heard primarily at the **left sternal area** can indicate various conditions, but this option specifically points to **mitral regurgitation**. - **Mitral regurgitation** is better heard at the apex and usually radiates to the axilla, and the description does not fit the typical presentation of aortic stenosis [3].

Q: Wide pulse pressure is seen in all except which of the following?

Aortic stenosis. **Aortic stenosis** - In **aortic stenosis**, there is a fixed obstruction to left ventricular outflow, leading to a compensatory increase in systolic pressure to overcome the stenotic valve [2]. - The **reduced stroke volume** and impaired flow through the rigid valve cause a lower pulse pressure, often resulting in a **narrow pulse pressure**. *PDA (Patent Ductus Arteriosus)* - In **PDA**, blood flows from the aorta to the pulmonary artery during systole and diastole, causing a decrease in diastolic pressure. - This creates a **run-off phenomenon**, leading to a **wide pulse pressure** due to high systolic and low diastolic pressures. *Aortic Regurgitation* - **Aortic regurgitation** involves blood flowing back into the left ventricle during diastole, causing a rapid fall in diastolic pressure [1]. - The increased stroke volume from the left ventricle leads to a high systolic pressure, resulting in a **wide pulse pressure** [1]. *A.V. malformation (Arteriovenous Malformation)* - An **AV malformation** creates a shunt where arterial blood flows directly into the venous system, bypassing the capillary bed. - This leads to a **decrease in peripheral resistance** and an increased cardiac output, causing a higher systolic pressure and a lower diastolic pressure, thereby producing a **wide pulse pressure**.

Q: Which one of the following is not an early complication of acute myocardial infarction?

Dressler's syndrome. ***Dressler's syndrome*** - **Dressler's syndrome** (post-myocardial infarction syndrome) is a **late complication** of acute myocardial infarction, typically occurring weeks to months after the event. - It is an **immune-mediated pericarditis**, characterized by chest pain, fever, and pericardial effusion, but is not seen immediately following an MI. *Papillary muscle dysfunction* - **Papillary muscle dysfunction** or rupture can occur as an **early complication** due to ischemia and necrosis of the muscle, leading to **mitral regurgitation** [1]. - This usually manifests within hours to days of the infarct, especially in **inferior MIs** affecting the posterior papillary muscle. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is an **early mechanical complication** resulting from necrosis and rupture of the interventricular septum. - It typically presents within the **first week** after an MI, causing a new **holosystolic murmur** and signs of heart failure. *Pericarditis* - **Early pericarditis** (within a few days of MI) results from inflammation overlying the necrotic myocardial tissue [1]. - It presents with **pleuritic chest pain** that improves with leaning forward and a **pericardial friction rub**, and is distinct from Dressler's syndrome.

Q: In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Mitral stenosis. ***Mitral stenosis*** - **Mitral stenosis** leads to an obstruction of blood flow from the **left atrium to the left ventricle**, causing pressure buildup in the left atrium [1]. - This increased pressure over time results in **left atrial enlargement** as the chamber struggles to push blood through the narrowed valve [1]. *Tricuspid regurgitation* - **Tricuspid regurgitation** involves the backflow of blood from the **right ventricle to the right atrium**. - This condition primarily affects the **right side of the heart**, leading to **right atrial enlargement**, not left. *AR* - **Aortic regurgitation (AR)** is the backflow of blood from the **aorta into the left ventricle**. - While AR can cause **left ventricular enlargement** and eventually lead to left atrial dilation, it is not the most common direct cause of *primary* left atrial enlargement compared to mitral stenosis [2]. *None of the options* - **Mitral stenosis** is a well-established cause of significant left atrial enlargement due to the direct pressure overload it imposes on the left atrium [1].

Q: Under which condition are steroids administered in rheumatic fever?

Presence of carditis. **Presence of carditis** - **Carditis** is the most serious manifestation of **rheumatic fever**, as it can lead to permanent **rheumatic heart disease** [1]. - **Corticosteroids** are administered to reduce the inflammation of the heart in cases of moderate to severe carditis, preventing or minimizing long-term damage [1]. *Presence of subcutaneous nodules* - **Subcutaneous nodules** are a minor manifestation of **rheumatic fever** and do not typically require steroid administration. - They are generally **painless** and resolve spontaneously, and their presence alone does not indicate the need for such aggressive anti-inflammatory treatment. *Presence of multiple symptoms* - The presence of **multiple minor symptoms** or asymptomatic major symptoms (other than **carditis**) does not warrant steroid use. - Steroid administration is reserved for situations with high potential for **morbidity** or **mortality**, such as severe **cardiac inflammation** [1]. *Presence of chorea* - **Sydenham's chorea** is a neurological manifestation of **rheumatic fever** and is usually managed with **antidopaminergic drugs** (e.g., haloperidol) or sedatives. - While it can be distressing, **corticosteroids** are generally not indicated for chorea unless there is co-existing **carditis** [1].

Q: Torsades de pointes is seen in all except

Hyponatremia. ***Hyponatremia*** - **Hyponatremia** (low sodium levels) primarily affects neuronal function and can lead to neurological symptoms like seizures and altered mental status [1]. - It does not directly cause **QT prolongation** or **Torsades de Pointes (TdP)**, which are typically associated with electrolyte imbalances affecting cardiac repolarization. *Hypocalcemia* - **Hypocalcemia** (low calcium levels) can prolong the **QT interval** on an electrocardiogram. - Prolongation of the QT interval increases the risk of developing **Torsades de Pointes**, a life-threatening polymorphic ventricular tachycardia [2]. *Hypomagnesemia* - **Hypomagnesemia** (low magnesium levels) is a common cause and aggravator of **Torsades de Pointes**. - Magnesium plays a crucial role in cardiac ion channel function, and its deficiency can lead to significant **QT prolongation** and ventricular arrhythmias. *Hypokalemia* - **Hypokalemia** (low potassium levels) can prolong the **QT interval** and increase the risk of developing ventricular arrhythmias, including **Torsades de Pointes** [1]. - Potassium channels are essential for cardiac repolarization, and their dysfunction due to low potassium can destabilize myocardial electrical activity [1].

Q: Graham Steell murmur is associated with which of the following conditions?

Pulmonary Regurgitation (PR). ***Pulmonary Regurgitation (PR)*** - The **Graham Steell murmur** is a high-pitched, decrescendo early diastolic murmur heard best at the left sternal border associated with **pulmonary hypertension**. [1] - It results from dilation of the pulmonary artery due to **elevated pulmonary pressures**, leading to functional pulmonary valve regurgitation. [1] *Tricuspid Regurgitation (TR)* - TR typically presents as a **holosystolic murmur** best heard at the left lower sternal border, often increasing with inspiration (Carvallo's sign). - It is caused by improper coaptation of the tricuspid valve leaflets, often due to **right ventricular dilation**. *Tricuspid Stenosis (TS)* - TS is characterized by a **diastolic rumble** heard best at the lower left sternal border, often with an opening snap. [2] - It is relatively rare and often associated with **rheumatic heart disease**. *Pulmonary Stenosis (PS)* - PS typically produces a **systolic ejection murmur** heard at the upper left sternal border, often radiating to the back. - It is caused by **obstruction to blood flow** from the right ventricle to the pulmonary artery.

Q: Subclavian steal syndrome is

Reversal of blood flow in the ipsilateral vertebral artery. ***Reversal of blood flow in the ipsilateral vertebral artery*** - Subclavian steal syndrome occurs due to a **proximal stenosis** or **occlusion of the subclavian artery**. - This causes blood to be "stolen" from the **ipsilateral vertebral artery**, flowing retrograde to supply the arm and thereby reducing blood flow to the brainstem. *Reversal of blood flow in the contralateral carotid artery* - The carotid arteries supply blood to the brain directly and are typically not directly involved in thesteal phenomenon in this specific syndrome. - Reversal of flow in the carotid artery would indicate a much more severe and different pathology, not characteristic of subclavian steal. *Reversal of blood flow in the contralateral vertebral artery* - The steal phenomenon specifically involves the vertebral artery on the **same side (ipsilateral)** as the subclavian artery obstruction. - The contralateral vertebral artery would typically continue to supply blood to the brain without a reversed flow in this syndrome. *B/L reversal of blood flow in vertebral arteries* - Subclavian steal syndrome is generally a **unilateral phenomenon**, affecting the vertebral artery ipsilateral to the subclavian artery stenosis. - Bilateral reversal would imply bilateral subclavian artery obstruction or other severe cerebrovascular disease, which is not the definition of subclavian steal syndrome itself.

Q: Absent P Wave is seen on an ECG in:

Atrial Fibrillation (AF). ***Atrial Fibrillation (AF)*** - In **atrial fibrillation**, the atria beat chaotically and irregularly, leading to the absence of coordinated **atrial depolarization**, thus no distinct P wave is seen [1]. - The ECG characteristically shows an **irregularly irregular rhythm** with narrow QRS complexes and no discernible P waves. *Cor Pulmonale* - Cor pulmonale involves right ventricular hypertrophy and dilation due to lung disease, which can cause peaked **P waves (P pulmonale)** in leads II, III, aVF, indicating right atrial enlargement. - It does not typically lead to the absence of P waves but rather changes in their morphology. *Mitral Stenosis* - **Mitral stenosis** can cause left atrial enlargement, which typically manifests as a broad, notched **P wave (P mitrale)**, especially in lead II, and a prominent negative phase in V1. - P waves are present but altered in appearance due to the increased atrial pressure and volume. *Chronic Obstructive Pulmonary Disease (COPD)* - Patients with **COPD** often show signs of right atrial enlargement, similar to cor pulmonale, resulting in **P pulmonale** on the ECG due to increased pulmonary pressures. - While other ECG changes like low voltage and right axis deviation may be present, the P wave is generally present, though often peaked.

Q: A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?

Early Revascularization with PCI. ***Early Revascularization with PCI*** - The patient presents with **NSTEMI** (ST depression, elevated troponins) and is already on antiplatelet and anticoagulant therapy. **Early revascularization** (ideally within 24 hours for high-risk NSTEMI) is indicated to restore blood flow and prevent further myocardial damage [1]. - Given the patient's history of prior **PCI** and the current NSTEMI presentation, this suggests possible **in-stent restenosis** or progression of coronary artery disease, making revascularization crucial. *Continue conservative management and monitoring of cardiac enzymes and ECG* - While initial conservative management with medications is appropriate, simply continuing monitoring without definitive intervention is insufficient for a **high-risk NSTEMI** patient. - The elevated troponins and ST depression indicate ongoing myocardial injury that requires active management beyond just observation [1]. *Continue conservative management and plan for outpatient follow-up* - This approach is entirely inappropriate for a patient presenting with an **acute coronary syndrome (NSTEMI)**. - Outpatient follow-up is for stable conditions, not for an ongoing cardiac event that requires urgent hospital-based intervention. *Immediate Revascularization with Coronary Angiography* - **Immediate revascularization** (within 90 minutes) is primarily indicated for **STEMI** (ST elevation myocardial infarction). - While coronary angiography will precede PCI, the term "immediate" in this context usually refers to the urgency seen in STEMI; NSTEMI typically warrants "early" rather than "immediate" intervention (within 12-24 hours for high-risk patients like this one) [1].

Question 1

Murmur heard in aortic stenosis

Accepted Answer

Right 2nd intercostal, high pitch systolic ejection murmur

Answer

Apex, low pitch murmur associated with mitral valve issues

Answer

Pan-systolic murmur, high pitch murmur associated with mitral regurgitation

Answer

Left Sternal area, murmur indicating mitral regurgitation

Question 2

Wide pulse pressure is seen in all except which of the following?

Accepted Answer

Aortic stenosis

Answer

Aortic Regurgitation

Answer

PDA

Answer

A.V. malformation

Question 3

Which one of the following is not an early complication of acute myocardial infarction?

Accepted Answer

Dressler's syndrome

Answer

Pericarditis

Answer

Papillary muscle dysfunction

Answer

Ventricular septal defect

Question 4

In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Accepted Answer

Mitral stenosis

Answer

Tricuspid regurgitation

Answer

AR

Answer

None of the options

Question 5

Under which condition are steroids administered in rheumatic fever?

Accepted Answer

Presence of carditis

Answer

Presence of subcutaneous nodules

Answer

Presence of multiple symptoms

Answer

Presence of chorea

Question 6

Torsades de pointes is seen in all except

Accepted Answer

Hyponatremia

Answer

Hypomagnesemia

Answer

Hypokalemia

Answer

Hypocalcemia

Question 7

Graham Steell murmur is associated with which of the following conditions?

Accepted Answer

Pulmonary Regurgitation (PR)

Answer

Tricuspid Regurgitation (TR)

Answer

Tricuspid Stenosis (TS)

Answer

Pulmonary Stenosis (PS)

Question 8

Subclavian steal syndrome is

Accepted Answer

Reversal of blood flow in the ipsilateral vertebral artery

Answer

Reversal of blood flow in the contralateral carotid artery

Answer

Reversal of blood flow in the contralateral vertebral artery

Answer

B/L reversal of blood flow in vertebral arteries

Question 9

Absent P Wave is seen on an ECG in:

Accepted Answer

Atrial Fibrillation (AF)

Answer

Cor Pulmonale

Answer

Mitral Stenosis

Answer

Chronic Obstructive Pulmonary Disease (COPD)

Question 10

A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?

Accepted Answer

Early Revascularization with PCI

Answer

Continue conservative management and monitoring of cardiac enzymes and ECG

Answer

Continue conservative management and plan for outpatient follow-up

Answer

Immediate Revascularization with Coronary Angiography

Cardiology — MCQs

Cardiology — MCQs

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