Cardiology — MCQs
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Torsades de pointes is seen in all except
Under which condition are steroids administered in rheumatic fever?
Absent P Wave is seen on an ECG in:
Treatment of choice for prinzmetal's angina
In the management of a patient with acute myocardial infarction, which of the following is the most critical step in the initial treatment?
Which of the following is a non- modifiable risk factor for CHD -
Creatine kinase is elevated in MI after
Which biomarker is typically elevated in the plasma of patients with chronic heart disease?
Tall T waves on ECG are seen in:
In Marfan's syndrome, Aortic aneurysm occurs most commonly in:
Cardiology Indian Medical PG Practice Questions and MCQs
Question 1541: Torsades de pointes is seen in all except
- A. Hyponatremia (Correct Answer)
- B. Hypomagnesemia
- C. Hypokalemia
- D. Hypocalcemia
Explanation: ***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].
Question 1542: 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 1543: Absent P Wave is seen on an ECG in:
- A. Cor Pulmonale
- B. Mitral Stenosis
- C. Chronic Obstructive Pulmonary Disease (COPD)
- D. Atrial Fibrillation (AF) (Correct Answer)
Explanation: ***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.
Question 1544: Treatment of choice for prinzmetal's angina
- A. Nitroglycerin
- B. Prazosin
- C. Beta-blockers
- D. Calcium Channel Blockers (CCBs) (Correct Answer)
Explanation: ***Calcium Channel Blockers (CCBs)*** - **Dihydropyridine** CCBs like nifedipine or amlodipine, and **non-dihydropyridine** CCBs like diltiazem or verapamil, are the **first-line agents** for Prinzmetal's angina [1]. - They work by **relaxing coronary smooth muscle**, preventing the vasospasm that causes the angina [1]. *Nitroglycerin* - **Nitroglycerin is effective** for acute relief of Prinzmetal's angina symptoms due to its **vasodilatory properties**. - However, it's typically used as **rescue therapy** and not as a long-term preventative treatment. *Beta-blockers* - Beta-blockers are **contraindicated** in Prinzmetal's angina as they can **worsen coronary vasospasm** by blocking beta-2 mediated vasodilation, leaving unopposed alpha-1 vasoconstriction [2]. - They can increase the **frequency and severity of attacks**. *Prazosin* - Prazosin is an **alpha-1 adrenergic blocker** used primarily for **hypertension** and benign prostatic hyperplasia. - While it can cause vasodilation, it is **not the treatment of choice** for Prinzmetal's angina and is less effective than CCBs in preventing coronary spasm.
Question 1545: In the management of a patient with acute myocardial infarction, which of the following is the most critical step in the initial treatment?
- A. Administering beta-blockers
- B. Administering aspirin (Correct Answer)
- C. Performing coronary angiography
- D. Initiating thrombolytic therapy
Explanation: - **Aspirin** is crucial in the immediate management of **acute myocardial infarction (AMI)** due to its **antiplatelet effects**, which prevent further thrombus formation in the coronary arteries [1]. - It rapidly inhibits **cyclooxygenase-1 (COX-1)**, reducing **thromboxane A2** production and thus platelet aggregation, limiting infarct size and improving outcomes. *Performing coronary angiography* - While essential for definitive diagnosis and revascularization (e.g., PCI), **coronary angiography** is typically performed after initial medical stabilization and is not the *first* critical step [2]. - Delay in initial medical therapy to prioritize angiography can worsen myocardial damage. *Initiating thrombolytic therapy* - **Thrombolytic therapy** is a revascularization strategy, similar to PCI, used when immediate catheterization is not available, but it comes with a risk of bleeding [3]. - It is often initiated after **aspirin** and other immediate stabilizing medications, and its use depends on specific criteria and contraindications [3]. *Administering beta-blockers* - **Beta-blockers** are important in AMI management to reduce myocardial oxygen demand, control arrhythmias, and improve long-term outcomes. - However, their administration typically follows **aspirin** and other initial stabilizing measures, and they may be contraindicated in certain conditions like **acute heart failure** or **bradycardia** [2].
Question 1546: Which of the following is a non- modifiable risk factor for CHD -
- A. Diabetes
- B. Smoking
- C. Hypertension
- D. Old age (Correct Answer)
Explanation: Old age - Age is a **non-modifiable risk factor** for Coronary Heart Disease (CHD) because it is an inherent biological process that cannot be changed [3]. - The risk of developing CHD **increases with age** due to cumulative exposure to other risk factors and natural wear and tear on the cardiovascular system [3]. *Diabetes* - Diabetes is a **modifiable risk factor** for CHD because it can be managed and controlled through lifestyle changes, medication, and regular monitoring [2]. - **Poorly controlled diabetes** significantly increases the risk of heart disease by damaging blood vessels and promoting atherosclerosis. *Smoking* - Smoking is a highly **modifiable risk factor** for CHD as it can be completely stopped [1], [2]. - **Cessation of smoking** significantly reduces the risk of heart attack and stroke over time [1]. *Hypertension* - Hypertension is a **modifiable risk factor** for CHD because blood pressure can be lowered through lifestyle interventions, such as diet and exercise, and pharmacotherapy [2]. - **Uncontrolled high blood pressure** places increased stress on the heart and blood vessels, accelerating the development of atherosclerosis [1].
Question 1547: Creatine kinase is elevated in MI after
- A. 4-8 hours
- B. >24 hours
- C. 12-24 hours
- D. 2-4 hours (Correct Answer)
Explanation: ***2-4 hours*** - **Creatine kinase (CK)** levels typically begin to rise within **2-4 hours** after the onset of myocardial infarction. - This early elevation makes CK an effective, though non-specific, marker for **acute MI** in the initial stages [1]. *4-8 hours* - While CK levels may continue to rise during this period, the initial measurable elevation usually occurs earlier, within **2-4 hours**. - A significant elevation at 4-8 hours would indicate that the myocardial event occurred at least several hours prior. *12-24 hours* - Creatine kinase levels typically peak much earlier, between **12-24 hours**, rather than just beginning to elevate at this time. - By this time, other more specific markers like **troponins** would also be significantly elevated and are often preferred for diagnosis [1], [2]. *>24 hours* - Beyond 24 hours, CK levels usually start to decline, making it less useful for the initial detection of an acute MI that began many hours earlier. - For events occurring over 24 hours ago, a positive CK would indicate that the event had happened, but it's not the first time it would be elevated.
Question 1548: Which biomarker is typically elevated in the plasma of patients with chronic heart disease?
- A. Endothelin-1
- B. Troponin T
- C. B-type natriuretic peptide (BNP) (Correct Answer)
- D. Cortisol
Explanation: ***B-type natriuretic peptide (BNP)*** - **BNP** is a hormone secreted by **ventricular cardiomyocytes** in response to increased wall stretch and pressure overload, making it a strong indicator of **myocardial stress** and **chronic heart failure** [1]. - Elevated levels correlate with the **severity of heart failure**, aiding in diagnosis and prognosis [1]. *Endothelin-1* - **Endothelin-1** is a potent **vasoconstrictor** involved in vascular tone regulation and endothelial dysfunction. - While it can be elevated in conditions like **pulmonary hypertension** and **atherosclerosis**, it is not a primary diagnostic biomarker for chronic heart disease in general. *Troponin T* - **Troponin T** is a cardiac-specific protein that is released into the bloodstream following **myocardial injury or necrosis**. - While it is a crucial biomarker for **acute coronary syndromes** (e.g., heart attack), persistently elevated levels are not typical for stable chronic heart disease unless there is ongoing subclinical myocardial damage. *Cortisol* - **Cortisol** is a **stress hormone** produced by the adrenal glands, involved in metabolism, immune response, and blood pressure regulation. - While chronic stress can impact cardiovascular health, cortisol itself is not a specific diagnostic biomarker for chronic heart disease.
Question 1549: Tall T waves on ECG are seen in:
- A. Hyperkalemia (Correct Answer)
- B. Hypokalemia
- C. Hypercalcemia
- D. Hypocalcemia
Explanation: ***Hyperkalemia*** - **Tall, peaked T waves** are a hallmark ECG finding in early to moderate **hyperkalemia**, reflecting altered repolarization due to elevated extracellular potassium [1]. - As potassium levels rise further, other ECG changes may include a **prolonged PR interval**, **widened QRS complex**, and ultimately a **sine wave pattern**, leading to ventricular arrhythmias [1]. *Hypokalemia* - This condition is typically associated with **flattened or inverted T waves**, prominent **U waves**, and a **prolonged QT interval** on the ECG [1]. - The ECG changes in hypokalemia reflect delayed repolarization and increased myocardial instability [1]. *Hypercalcemia* - **Hypercalcemia** is characterized by a **shortened QT interval** on the ECG due to accelerated ventricular repolarization. - T waves, if affected, are usually not tall or peaked but may be wider or slightly less prominent. *Hypocalcemia* - **Hypocalcemia** typically leads to a **prolonged QT interval** on the ECG, primarily due to a lengthened ST segment. - While it can manifest with various T wave morphologies, it does not typically cause the characteristic tall, peaked T waves seen in hyperkalemia.
Question 1550: In Marfan's syndrome, Aortic aneurysm occurs most commonly in:
- A. Ascending aorta (Correct Answer)
- B. Descending aorta
- C. Abdominal aorta
- D. Arch of aorta
Explanation: ***Ascending aorta*** - The **ascending aorta** is the most common site for aortic aneurysm and dissection in Marfan syndrome due to cystic medial degeneration weakening the vessel wall [1]. - This predisposition is linked to defects in the **fibrillin-1 gene (FBN1)**, severely impacting the structural integrity of the arterial media primarily in the ascending aorta [1]. *Descending aorta* - While possible, **descending aortic** involvement is less common than ascending aortic involvement in Marfan syndrome [2]. - Aneurysms here are more frequently associated with atherosclerosis or other connective tissue disorders. *Abdominal aorta* - **Abdominal aortic aneurysms** are relatively rare in Marfan syndrome and are more typically seen in older patients with atherosclerosis [3]. - The disease primarily affects the elastic tissue content, which is most abundant in the proximal aorta. *Arch of aorta* - Aortic arch aneurysms can occur, but they are still less frequent than those in the **ascending aorta** as the primary initial site of dilation and dissection in Marfan syndrome. - Arch involvement often represents an extension of a more proximal ascending aortic pathology.
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
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