Cardiology — MCQs
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A 54-year-old man presents after a syncopal episode with no recollection of the event, and bystanders report that he regained consciousness approximately 45 seconds after falling. He has a history of bipolar disorder managed with quetiapine, and recently experienced prostatitis treated with ciprofloxacin. His other medications include lisinopril and hydrochlorothiazide for hypertension, and cyclobenzaprine and a hydrocodone/acetaminophen combination pill for low back pain. On examination, the patient is alert and oriented, with a nonfocal neurological examination and an unremarkable cardiac examination. Electrocardiogram shows nonspecific ST and T wave changes and a prolonged QT interval (QTc of 540 milliseconds). What is the best initial management approach?
Austin Flint murmur is associated with which condition?
Which of the following ECG findings is most characteristic of acute myocardial infarction?
A 60-year-old woman with a history of diabetes mellitus has had left-sided chest pain radiating to the arm for the past 5 hours. Serial measurements of serum creatine kinase-MB levels show an elevated level 24 hours after the onset of pain. Partial thromboplastin time (PTT) and prothrombin time (PT) are normal. Coronary angiography shows occlusion of the left anterior descending artery. Which of the following mechanisms is the most likely cause of thrombosis in this patient?
A 65-year-old male presents with sudden onset hand pain and coldness in the fingers. What is the most likely cause of his symptoms?
What type of murmur is most likely associated with a patient presenting with elevated JVP, large v-waves, and a loud systolic murmur?
A 68-year-old man presents with a syndrome of alcohol withdrawal. His ECG shows a regular narrow complex tachycardia at 150 bpm with characteristic sawtooth waves. What is the most likely diagnosis?
Manifestations of acute aortic dissection include all of the following, except:
Hockey stick appearance on echo is a feature of.
Obesity is associated with the MOST SIGNIFICANT increased risk of:
Cardiology Indian Medical PG Practice Questions and MCQs
Question 1571: A 54-year-old man presents after a syncopal episode with no recollection of the event, and bystanders report that he regained consciousness approximately 45 seconds after falling. He has a history of bipolar disorder managed with quetiapine, and recently experienced prostatitis treated with ciprofloxacin. His other medications include lisinopril and hydrochlorothiazide for hypertension, and cyclobenzaprine and a hydrocodone/acetaminophen combination pill for low back pain. On examination, the patient is alert and oriented, with a nonfocal neurological examination and an unremarkable cardiac examination. Electrocardiogram shows nonspecific ST and T wave changes and a prolonged QT interval (QTc of 540 milliseconds). What is the best initial management approach?
- A. Admit for permanent implantable cardioverter-defibrillator (ICD)
- B. Admit and begin amiodarone infusion
- C. Refer for genetic counseling
- D. Admit the patient for telemetry and evaluate for reversible causes of QT prolongation (Correct Answer)
Explanation: ***Admit the patient for telemetry and evaluate for reversible causes of QT prolongation*** * The patient experienced a **syncopal episode** with a **prolonged QT interval (QTc of 540 ms)**, which significantly increases the risk of **Torsade de Pointes (TdP)** and sudden cardiac death [1]. * **Telemetry monitoring** is crucial to detect arrhythmias, and identifying and removing **QT-prolonging medications** (quetiapine, ciprofloxacin, hydrocodone) and correcting **electrolyte imbalances** are essential initial steps [1]. *Admit for permanent implantable cardioverter-defibrillator (ICD)* * While an ICD is used for prevention of sudden cardiac death in high-risk patients, it's generally considered after **reversible causes of QT prolongation** have been addressed and the patient remains at high risk or has recurrent **life-threatening arrhythmias**. * Implanting an ICD without first attempting to manage the modifiable risk factors like certain medications or electrolyte imbalances would be premature. *Admit and begin amiodarone infusion* * **Amiodarone** is an **antiarrhythmic drug** that itself can **prolong the QT interval**, which would exacerbate the patient's existing risk for TdP. * This medication would be contraindicated in the presence of an already prolonged QT interval due to the increased risk of potentially fatal arrhythmias. *Refer for genetic counseling* * While **congenital long QT syndrome** can cause profound QT prolongation, **acquired causes** (medications, electrolyte abnormalities) are far more common, especially given the patient's extensive medication list. * Genetic counseling may be considered if reversible causes are ruled out or if there's a strong family history, but it is not the immediate best management for an acute syncopal episode with acquired QT prolongation.
Question 1572: Austin Flint murmur is associated with which condition?
- A. Mitral stenosis
- B. Aortic stenosis
- C. A-V Block
- D. Aortic regurgitation (Correct Answer)
Explanation: ***Aortic regurgitation*** - The **Austin Flint murmur** is a **diastolic rumble** heard at the apex, caused by the regurgitant jet of aortic blood interfering with the normal opening of the mitral valve [1]. - This functional **mitral inflow obstruction** is characteristic of severe aortic regurgitation [1]. *A-V Block* - **A-V block** primarily affects the heart's electrical conduction system, leading to irregular or slow heartbeats, and is not directly associated with a specific murmur. - While it can manifest with various cardiac symptoms, it does not produce the characteristic **diastolic rumbling murmur** of Austin Flint. *Mitral stenosis* - **Mitral stenosis** also produces a diastolic murmur (opening snap followed by a low-pitched rumble), but this is due to **structural narrowing of the mitral valve**, not aortic regurgitation [1], [2]. - The murmur in mitral stenosis is often accompanied by an **opening snap**, which is absent in the Austin Flint murmur [2]. *Aortic stenosis* - **Aortic stenosis** typically presents with a **systolic ejection murmur** that radiates to the carotid arteries, due to obstruction of blood flow from the left ventricle to the aorta [2]. - It does not involve a diastolic rumble at the apex related to mitral valve function, which is the hallmark of an Austin Flint murmur.
Question 1573: Which of the following ECG findings is most characteristic of acute myocardial infarction?
- A. Prolonged QT interval
- B. Prolonged PR interval
- C. Elevation of S wave
- D. ST segment elevation (Correct Answer)
Explanation: ST segment elevation - **ST segment elevation** on an ECG is the hallmark sign of an **acute, transmural myocardial infarction** (STEMI), indicating full-thickness myocardial injury [1]. - This elevation occurs due to the **ischemic tissue** failing to repolarize normally, leading to a current of injury [1]. *Elevation of S wave* - An elevated S wave, or a deep S wave, is not a typical characteristic of acute myocardial infarction and can be seen in various conditions, including **ventricular hypertrophy**. - It primarily reflects **ventricular depolarization** forces and not myocardial injury [2]. *Prolonged QT interval* - A **prolonged QT interval** indicates delayed ventricular repolarization, which can be associated with an increased risk of **ventricular arrhythmias** (like Torsades de Pointes) but is not a direct sign of acute myocardial infarction. - It can be congenital or acquired due to **medications** or **electrolyte imbalances**. *Prolonged PR interval* - A **prolonged PR interval** indicates a delay in conduction from the atria to the ventricles, known as a **first-degree AV block**. - While it can be associated with underlying cardiac disease, it is not a direct or characteristic sign of **acute myocardial infarction**.
Question 1574: A 60-year-old woman with a history of diabetes mellitus has had left-sided chest pain radiating to the arm for the past 5 hours. Serial measurements of serum creatine kinase-MB levels show an elevated level 24 hours after the onset of pain. Partial thromboplastin time (PTT) and prothrombin time (PT) are normal. Coronary angiography shows occlusion of the left anterior descending artery. Which of the following mechanisms is the most likely cause of thrombosis in this patient?
- A. Damage to endothelium (Correct Answer)
- B. Presence of antibody inhibitors to coagulation factors
- C. Reduced levels of antithrombin III
- D. Reduced activity of tissue plasminogen activator (tPA)
Explanation: ***Damage to endothelium*** - Endothelial damage is a critical factor in thrombosis, leading to the exposure of **sub-endothelial collagen** and triggering platelet activation and coagulation cascade [3]. - In the context of **acute coronary syndrome**, such damage often results from **atherosclerosis**, contributing to the formation of thrombosis in coronary arteries [2]. *Decreased antithrombin III level* - While decreased antithrombin III can contribute to thrombosis, it does not directly explain the **acute coronary occlusion** observed in this patient. - This would affect the **inhibition of thrombin** and other coagulation factors, but the mechanism at play here is primarily endothelial damage. *Antibody inhibitor to coagulation* - Antibody inhibitors usually pertain to conditions like **antiphospholipid syndrome**, which is not indicated by the acute presentation and findings in this case. - The normal PT and PTT suggest that there is no significant disruption in coagulation pathways due to antibodies. *Decreased tissue plasminogen activator* - Decreased tissue plasminogen activator (t-PA) would lead to reduced fibrinolysis, but this does not account for the **acute thrombosis** observed in atherosclerosis [1]. - The patient's presentation is more related to the **acute occlusion due to plaque rupture** rather than a deficiency in plasminogen activator [2].
Question 1575: A 65-year-old male presents with sudden onset hand pain and coldness in the fingers. What is the most likely cause of his symptoms?
- A. Ulnar artery occlusion
- B. Wrist fracture
- C. Carpal tunnel syndrome
- D. Acute arterial embolism (Correct Answer)
Explanation: ***Acute arterial embolism*** - **Sudden onset** of pain and **coldness** in the fingers strongly suggests **acute arterial occlusion**, most commonly due to an embolism. - This condition presents with the 6 Ps: **pain**, **pallor**, **pulselessness**, **paresthesia**, **paralysis**, and **poikilothermia** (coldness). *Ulnar artery occlusion* - While this can cause digital ischemia, it typically has a more **gradual onset** or is related to repetitive trauma ("hypothenar hammer syndrome"). - Isolated ulnar artery occlusion would usually affect only the digits supplied by the ulnar artery, not the entire hand's coldness. *Wrist fracture* - A fracture would present with a history of **trauma**, **localized tenderness**, **swelling**, and **deformity**, which are not mentioned. - While a severe fracture could compromise blood flow, the primary symptoms would be related to the bone injury itself. *Carpal tunnel syndrome* - This condition primarily causes **numbness**, **tingling**, and **weakness** in the median nerve distribution (thumb, index, middle, and radial half of ring finger). - It does not typically cause **sudden coldness** [1] or severe ischemic pain in the fingers.
Question 1576: What type of murmur is most likely associated with a patient presenting with elevated JVP, large v-waves, and a loud systolic murmur?
- A. Functional murmur
- B. Tricuspid stenosis
- C. Pulmonary stenosis
- D. Tricuspid regurgitation (Correct Answer)
Explanation: ***Tricuspid regurgitation*** - **Elevated JVP** with prominent **v-waves** and a **loud systolic murmur** are classic findings for tricuspid regurgitation. [1] The large v-waves are due to blood regurgitating into the right atrium during ventricular systole. - The murmur is typically **holosystolic** and may increase with inspiration (Carvallo's sign). *Functional murmur* - Functional murmurs are generally **benign**, not associated with significant hemodynamic compromise, and rarely present with elevated JVP or prominent v-waves. - They are typically **soft**, early or mid-systolic, and often change intensity with position. *Tricuspid stenosis* - Tricuspid stenosis would cause an **elevated JVP**, but the prominent wave would be an **a-wave** (due to increased right atrial pressure during atrial contraction), not a v-wave. - The murmur associated with tricuspid stenosis is a **diastolic rumble**, not a systolic murmur. [3] *Pulmonary stenosis* - Pulmonary stenosis presents with a **systolic ejection murmur** at the upper left sternal border and can cause elevated JVP due to right ventricular hypertrophy and failure. [2] - However, it typically does not cause prominent **v-waves** in the JVP, as the issue is outflow obstruction from the right ventricle, not regurgitation into the right atrium.
Question 1577: A 68-year-old man presents with a syndrome of alcohol withdrawal. His ECG shows a regular narrow complex tachycardia at 150 bpm with characteristic sawtooth waves. What is the most likely diagnosis?
- A. Atrial flutter (Correct Answer)
- B. Atrial fibrillation
- C. PSVT
- D. VT
Explanation: ***Atrial flutter*** - The ECG finding of a **regular narrow complex tachycardia at 150 bpm** with characteristic **sawtooth waves** is pathognomonic for **atrial flutter** [1]. - Alcohol withdrawal can trigger atrial arrhythmias due to increased **sympathetic tone** and electrolyte disturbances. *Atrial fibrillation* - Characterized by an **irregularly irregular rhythm** with no distinct P waves, which contrasts with the regular rhythm and sawtooth waves seen [1]. - While common in alcohol withdrawal, the ECG description does not fit atrial fibrillation. *PSVT* - **Paroxysmal supraventricular tachycardia (PSVT)** is typically a regular narrow complex tachycardia, but it **lacks the sawtooth flutter waves** seen in the ECG [2]. - ECG usually shows sudden onset and termination, often with obscured P waves, but not the distinct flutter waves [3]. *VT* - **Ventricular tachycardia (VT)** is generally characterized by a **wide QRS complex** (>0.12 seconds), which is not consistent with a "narrow complex tachycardia" [4]. - While VT can be regular, it originates from the ventricles and would not show atrial sawtooth waves [4].
Question 1578: Manifestations of acute aortic dissection include all of the following, except:
- A. Pericardial effusion
- B. AR
- C. AMI
- D. Mitral Regurgitation (MR) (Correct Answer)
Explanation: ***Mitral Regurgitation (MR)*** - **Mitral regurgitation** is not a typical direct manifestation of acute aortic dissection. The mitral valve is anatomically separate from the aorta [3]. - While indirect effects on the heart can occur, direct **MR** is highly unlikely as a primary presentation of acute aortic dissection. *Pericardial effusion* - An acute aortic dissection, especially of the ascending aorta, can rupture into the **pericardial space**, leading to **pericardial effusion** and potentially **cardiac tamponade** [2]. - This occurs due to blood leaking from the dissected aorta into the confines of the pericardium. *AR* - **Aortic regurgitation (AR)** is a common and serious complication of acute aortic dissection when the dissection involves the **aortic root** and disrupts the integrity of the aortic valve leaflets or their support structures [1]. - This can lead to new onset or worsening AR, causing acute heart failure. *AMI* - **Acute myocardial infarction (AMI)** can result from an acute aortic dissection if the dissection flap extends into or compromises the ostium of a **coronary artery**, particularly the right coronary artery [1]. - This occlusion of a coronary artery by the dissecting hematoma or flap leads to **myocardial ischemia** and infarction.
Question 1579: Hockey stick appearance on echo is a feature of.
- A. Mitral stenosis (Correct Answer)
- B. Mitral incompetence
- C. Aortic stenosis
- D. Aortic regurgitation
Explanation: ***Mitral stenosis*** - The **"hockey stick" appearance** on echocardiography refers to the characteristic **doming of the anterior mitral leaflet** during diastole, which is a hallmark of mitral stenosis. - This doming is due to the stenotic mitral valve opening incompletely, with the tip of the leaflet bending forward while its base remains tethered [1]. *Mitral incompetence* - **Mitral incompetence (regurgitation)** is characterized by **incomplete closure** of the mitral valve leaflets, leading to backward blood flow into the left atrium during systole. - This condition does not typically present with a "hockey stick" appearance; instead, it is often seen with **leaflet prolapse** or inadequate coaptation [1]. *Aortic stenosis* - **Aortic stenosis** involves the **narrowing of the aortic valve**, impeding blood flow from the left ventricle to the aorta. - Its echocardiographic features include **thickened, calcified aortic valve leaflets** with reduced excursion, not a "hockey stick" appearance. *Aortic regurgitation* - **Aortic regurgitation** is the backward flow of blood from the aorta into the left ventricle during diastole due to **incomplete closure of the aortic valve** [2]. - While it can manifest with various echocardiographic signs like **diastolic flow reversal** in the aorta, the "hockey stick" sign is not associated with this condition [2].
Question 1580: Obesity is associated with the MOST SIGNIFICANT increased risk of:
- A. Hyperuricemia
- B. Osteoporosis
- C. Heart disease (Correct Answer)
- D. Hypertension
Explanation: ***Heart disease*** - **Obesity** is a major independent risk factor for **cardiovascular diseases**, including coronary artery disease, heart failure, and stroke, due to its impact on metabolic and inflammatory pathways. - It contributes to **atherosclerosis** [1], hypertension, dyslipidemia, and insulin resistance, all of which significantly increase the risk of heart disease. *Hypertension* - While **obesity** is a significant risk factor for **hypertension**, hypertension itself is a component of the broader risk of heart disease, not the most significant singular outcome of obesity. - Elevated blood pressure in obese individuals often results from increased sympathetic activity, insulin resistance, and activation of the **renin-angiotensin-aldosterone system**. *Hyperuricemia* - **Obesity** is associated with **hyperuricemia** due to increased purine production and decreased uric acid excretion, which can lead to **gout**. - However, the overall health burden and mortality risk associated with hyperuricemia are generally less significant compared to heart disease linked to obesity. *Osteoporosis* - **Obesity** is generally considered to be protective against **osteoporosis** because increased body weight places mechanical stress on bones, which can increase bone mineral density. - While obesity can lead to other musculoskeletal issues like osteoarthritis, it does not typically increase the risk of osteoporosis.
Practice by Chapter
Coronary Artery Disease and Angina
Practice Questions
Acute Coronary Syndromes
Practice Questions
Heart Failure
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Cardiac Arrhythmias
Practice Questions
Valvular Heart Diseases
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Cardiomyopathies
Practice Questions
Pericardial Diseases
Practice Questions
Congenital Heart Disease in Adults
Practice Questions
Hypertension and Hypertensive Emergencies
Practice Questions
Pulmonary Hypertension
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Non-invasive Cardiac Diagnostics
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Preventive Cardiology
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