Cardiology — MCQs
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Which of the following statements about atrial myxomas is correct?
Murmur heard in aortic stenosis
Duroziez's sign is associated with which of the following conditions?
In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?
What is the most likely cause of fluid overload in a patient presenting with shortness of breath?
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?
Under which condition are steroids administered in rheumatic fever?
Subclavian steal syndrome is
In which of the following conditions is differential cyanosis observed?
Which of the following is associated with WPW syndrome?
Cardiology Indian Medical PG Practice Questions and MCQs
Question 1531: Which of the following statements about atrial myxomas is correct?
- A. More prevalent in males.
- B. Most myxomas are hereditary.
- C. Most commonly found in the Left Atrium. (Correct Answer)
- D. Distant metastasis is commonly observed.
Explanation: ***Most commonly found in the Left Atrium.*** - **Atrial myxomas** are typically found in the **left atrium** (approximately 75-80% of cases), often attached to the **interatrial septum** near the fossa ovalis. - Their presence in the left atrium can lead to **obstruction of the mitral valve**, causing symptoms mimicking mitral stenosis [1]. *More prevalent in males.* - **Atrial myxomas** are more common in **females** than males, with a female-to-male ratio of approximately 2:1. - This higher prevalence in women is a consistent finding in epidemiological studies of cardiac myxomas [2]. *Most myxomas are hereditary.* - The vast majority of **atrial myxomas** are **sporadic** (non-hereditary), accounting for about 90-95% of cases. - A small percentage (5-10%) are part of a familial syndrome known as **Carney complex**, which is an autosomal dominant disorder. *Distant metastasis is commonly observed.* - **Atrial myxomas** are generally **benign tumors** and do not metastasize to distant sites. - While they can embolize fragments, leading to systemic effects, these are not true metastases.
Question 1532: Murmur heard in aortic stenosis
- A. Apex, low pitch murmur associated with mitral valve issues
- B. Pan-systolic murmur, high pitch murmur associated with mitral regurgitation
- C. Left Sternal area, murmur indicating mitral regurgitation
- D. Right 2nd intercostal, high pitch systolic ejection murmur (Correct Answer)
Explanation: ***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].
Question 1533: Duroziez's sign is associated with which of the following conditions?
- A. Aortic Regurgitation (Correct Answer)
- B. Pericardial effusion
- C. Tricuspid Regurgitation
- D. Mitral Stenosis
Explanation: ***Aortic Regurgitation*** - **Duroziez's sign** is a characteristic **systolic and diastolic bruit** heard over the femoral artery, indicative of significant **aortic regurgitation**. [1], [2] - This sign occurs due to the rapid antegrade and retrograde flow of blood during systole and diastole, respectively, caused by the incompetent aortic valve. [2] *Tricuspid Regurgitation* - **Tricuspid regurgitation** is primarily associated with **holosystolic murmur** best heard at the left lower sternal border, often increasing with inspiration (Carvallo's sign). - It does not produce arterial bruits like Duroziez's sign. *Pericardial effusion* - **Pericardial effusion** is characterized by the accumulation of fluid in the pericardial sac, which can lead to distant heart sounds, **pulsus paradoxus**, and electrical alternans on ECG. - It does not involve vascular bruits in peripheral arteries. *Mitral Stenosis* - **Mitral stenosis** classically presents with a **diastolic rumble** and an **opening snap**, typically heard at the apex. - It is a left-sided heart valve condition that does not cause peripheral arterial bruits.
Question 1534: In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?
- A. Mitral stenosis (Correct Answer)
- B. Tricuspid regurgitation
- C. AR
- D. None of the options
Explanation: ***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].
Question 1535: What is the most likely cause of fluid overload in a patient presenting with shortness of breath?
- A. Nephritic syndrome
- B. Cardiac failure (Correct Answer)
- C. TB
- D. Portal hypertension
Explanation: ***Cardiac failure*** - **Cardiac failure** leads to reduced cardiac output, causing blood to back up in the **pulmonary and systemic circulation**, resulting in fluid accumulation in the lungs (pulmonary edema), which manifests as **shortness of breath** [1]. - The heart's inability to pump efficiently results in increased hydrostatic pressure in capillaries, pushing fluid into interstitial spaces and pleural effusions, exacerbating respiratory distress [1]. *Nephritic syndrome* - **Nephritic syndrome** is characterized by inflammation of the glomeruli, leading to **hematuria, proteinuria, and hypertension**. While it can cause fluid retention due to impaired kidney function, it primarily presents with acute renal injury and less direct, rapid onset pulmonary edema compared to cardiac failure. - The fluid accumulation in **nephritic syndrome** is more generalized (edema) rather than acutely focused on pulmonary congestion leading to shortness of breath, as seen in heart failure. *TB* - **Tuberculosis (TB)** primarily affects the lungs, causing **inflammation, granuloma formation, and tissue destruction**, but usually does not directly cause acute fluid overload and pulmonary edema leading to shortness of breath in the manner that heart failure does. - While **TB** can cause pleural effusions, it is not typically associated with widespread fluid overload and acute pulmonary congestion as a primary mechanism of shortness of breath. *Portal hypertension* - **Portal hypertension** is an increase in blood pressure within the **portal venous system**, usually due to liver cirrhosis. This primarily leads to fluid accumulation in the **abdominal cavity (ascites)** and sometimes peripheral edema. - While significant ascites can indirectly limit diaphragmatic movement and cause some breathlessness, it does not directly cause the acute **pulmonary edema** and fluid overload that are hallmarks of cardiac failure presenting with severe shortness of breath.
Question 1536: 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?
- A. Early Revascularization with PCI (Correct Answer)
- B. Continue conservative management and monitoring of cardiac enzymes and ECG
- C. Continue conservative management and plan for outpatient follow-up
- D. Immediate Revascularization with Coronary Angiography
Explanation: ***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 1537: Under which condition are steroids administered in rheumatic fever?
- A. Presence of carditis (Correct Answer)
- B. Presence of subcutaneous nodules
- C. Presence of multiple symptoms
- D. Presence of chorea
Explanation: **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].
Question 1538: Subclavian steal syndrome is
- A. Reversal of blood flow in the ipsilateral vertebral artery (Correct Answer)
- B. Reversal of blood flow in the contralateral carotid artery
- C. Reversal of blood flow in the contralateral vertebral artery
- D. B/L reversal of blood flow in vertebral arteries
Explanation: ***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.
Question 1539: In which of the following conditions is differential cyanosis observed?
- A. VSD with reversal of shunt
- B. PDA with reversal of shunt (Correct Answer)
- C. ASD with reversal of shunt
- D. Tetralogy of Fallot
Explanation: ***PDA with reversal of shunt*** - **Differential cyanosis** is characteristic of a **patent ductus arteriosus (PDA)** with **Eisenmenger syndrome**, where the shunt reverses due to pulmonary hypertension [1]. - Deoxygenated blood from the pulmonary artery shunts into the **descending aorta** distal to the origin of the subclavian arteries, resulting in cyanosis of the lower extremities while the upper extremities remain pink [1]. *VSD with reversal of shunt* - A **ventricular septal defect (VSD)** with reversed shunt typically causes **generalized cyanosis** because deoxygenated blood is shunted from the right ventricle to the left ventricle, affecting both systemic circulations [2]. - It does not produce differential cyanosis unless accompanied by coexisting cardiac anomalies that selectively affect blood flow to different parts of the body. *ASD with reversal of shunt* - An **atrial septal defect (ASD)** with reversed shunt leads to **generalized cyanosis**, as deoxygenated blood from the right atrium enters the left atrium and mixes with oxygenated blood, distributing cyanosis throughout the body [2]. - The mixing of blood occurs at the atrial level, affecting systemic circulation uniformly rather than differentially. *Tetralogy of Fallot* - **Tetralogy of Fallot** causes **generalized cyanosis** due to the right-to-left shunt through a large VSD, forcing deoxygenated blood into the systemic circulation [3]. - The degree of cyanosis depends on the severity of the right ventricular outflow tract obstruction, but it is not typically differential [3].
Question 1540: Which of the following is associated with WPW syndrome?
- A. Ebstein anomaly (Correct Answer)
- B. TOF
- C. VSD
- D. TAPVC
Explanation: ***Ebstein anomaly*** - **Ebstein anomaly** is a congenital heart defect characterized by apical displacement of the septal and posterior leaflets of the tricuspid valve, which is strongly associated with **Wolff-Parkinson-White (WPW) syndrome.** - WPW syndrome, involving an **accessory pathway** that bypasses the AV node [1], is found in 5-25% of patients with Ebstein anomaly, predisposing them to re-entrant tachycardias [3]. *TOF* - **Tetralogy of Fallot (TOF)** is a complex cyanotic congenital heart defect that includes four main features: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [2]. - There is no direct or strong association between TOF and WPW syndrome. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect where there is an opening in the interventricular septum, allowing blood to flow between the ventricles [4]. - While VSDs can occur with other cardiac anomalies, there is no specific or frequent association with WPW syndrome. *TAPVC* - **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a rare congenital heart defect where all four pulmonary veins connect to the systemic venous circulation instead of the left atrium. - This condition does not have a recognized association with WPW syndrome.
Practice by Chapter
Coronary Artery Disease and Angina
Practice Questions
Acute Coronary Syndromes
Practice Questions
Heart Failure
Practice Questions
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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