Cardiology Practice Questions

Q: Positive hepatojugular reflux is found in all of the following conditions except -

Decreased afterload. ***Decreased afterload*** - **Hepatojugular reflux** is a sign of **right-sided heart dysfunction** [1] where compressing the liver increases jugular venous pressure due to impaired right ventricular filling [2]. - **Decreased afterload** would typically improve cardiac output and reduce intracardiac pressures, making hepatojugular reflux less likely. *Tricuspid regurgitation* - **Tricuspid regurgitation** leads to increased right atrial pressure [2], which can cause engorgement of the liver and an exaggerated hepatojugular reflux. - This condition directly impacts the ability of the right ventricle to empty effectively, contributing to systemic venous congestion. *Right heart failure* - **Right heart failure** is a common cause of hepatojugular reflux due to elevated right atrial and central venous pressures [1]. - The failing right ventricle is unable to handle increased venous return, leading to reflux. *Increased capillary bed pressure* - **Increased capillary bed pressure** in the systemic circulation, often secondary to **right heart failure** [2] or **volume overload**, contributes to elevated venous pressures. - This increased pressure can be transmitted back to the right atrium, leading to a positive hepatojugular reflux.

Q: Obesity is associated with the MOST SIGNIFICANT increased risk of:

Heart disease. ***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.

Q: Sine wave pattern in an ECG is seen in which of the following conditions?

Hyperkalemia. ***Hyperkalemia*** - As **hyperkalemia** worsens, the ECG may show a loss of P waves, widening of the QRS complex, and tall, peaked T waves that merge with the QRS complex, creating a **sine wave pattern** [1]. - This pattern indicates severe electrical instability, often progressing to **ventricular fibrillation** [2] or **asystole** if not urgently treated. *Hypokalemia* - **Hypokalemia** typically manifests on ECG with U waves, T wave flattening or inversion, and prolongation of the QT interval [3]. - It does not cause a **sine wave pattern**, which is characteristic of severe hyperkalemia. *Hyponatremia* - While severe **hyponatremia** can affect cardiac function, it does not typically produce a specific **sine wave pattern** on the ECG [1]. - ECG changes in hyponatremia are often non-specific and may include bradycardia or arrhythmias due to altered nerve conduction. *Hypernatremia* - **Hypernatremia** can lead to various cardiac effects, but a **sine wave pattern** is not a characteristic ECG finding of this condition. - ECG changes in hypernatremia are often non-specific and are more related to volume status and associated electrolyte imbalances.

Q: What is an electrical storm?

3 episodes of ventricular tachycardia within 24 hours. ***3 episodes of ventricular tachycardia within 24 hours*** - An **electrical storm**, also known as **arrhythmia storm**, is defined by the occurrence of **three or more distinct episodes of ventricular tachycardia (VT)**, ventricular fibrillation (VF), or appropriate implantable cardioverter-defibrillator (ICD) shocks within a 24-hour period [1]. - This condition signifies **severe myocardial electrical instability** and is associated with increased morbidity and mortality [1]. *Electromechanical dissociation* - **Electromechanical dissociation (EMD)**, or pulseless electrical activity (PEA), describes a situation where there is organized electrical activity on an electrocardiogram but **no palpable pulse**. - It is a form of cardiac arrest and is distinct from an arrhythmia storm, which specifically refers to recurrent ventricular arrhythmias. *Electrical alternans* - **Electrical alternans** is an electrocardiographic phenomenon characterized by **beat-to-beat alterations in the QRS complex amplitude or axis**. - It is often associated with **pericardial effusion with cardiac tamponade** and is not indicative of recurrent ventricular tachyarrhythmias. *3 episodes of atrial tachycardia within 24 hours* - While recurrent **atrial tachycardia** indicates electrical instability in the atria, an "electrical storm" specifically refers to **ventricular arrhythmias** [1]. - Atrial arrhythmias, though potentially serious, do not meet the diagnostic criteria for an electrical storm.

Q: What is the immediate treatment modality for a patient presenting with acute anterior wall myocardial infarction and hypotension?

Primary Percutaneous Coronary Intervention (Primary PCI). ***Primary Percutaneous Coronary Intervention (Primary PCI)*** - **Primary PCI**, guided by coronary angiography, is the **gold standard** for treating ST-elevation myocardial infarction (STEMI) because it directly restores blood flow to the *ischemic* myocardium. - In a patient with **acute anterior wall MI and hypotension**, immediate revascularization via Primary PCI is crucial to improve cardiac output and stabilize hemodynamics, as hypotension often implies significant myocardial damage and *cardiogenic shock*. - Guidelines recommend Primary PCI within **90 minutes** of first medical contact (door-to-balloon time) when available. *Thrombolytic therapy* - While thrombolysis can restore blood flow, it is considered a **second-line treatment** if PCI is unavailable or significantly delayed (>120 minutes from first medical contact). - It carries a higher risk of bleeding complications and may not achieve complete reperfusion, especially in patients with **hypotension** or *cardiogenic shock*. *Anticoagulation* - Anticoagulation is an **adjunctive therapy** used to prevent further clot formation and maintain coronary artery patency after reperfusion. - It is **not a definitive revascularization strategy** on its own and does not immediately address the acute coronary occlusion causing the MI and hypotension. *Intra-aortic balloon counterpulsation (IABP)* - **IABP** is a mechanical circulatory support device used to reduce *afterload* and increase *coronary perfusion*, primarily in patients with **cardiogenic shock** awaiting or recovering from revascularization. - While beneficial for hemodynamic support, it is **not the primary reperfusion treatment** and should be used in conjunction with immediate PCI, not as a substitute.

Q: Accelerated idioventricular rhythm (AIVR) is most characteristically seen in?

Myocardial reperfusion. ***Myocardial reperfusion*** - **Accelerated idioventricular rhythm (AIVR)** is a common reperfusion arrhythmia, often seen after successful restoration of blood flow to the ischemic myocardium following a myocardial infarction. - The sudden influx of oxygen and nutrients can trigger **automaticity** in the ventricular myocardium, leading to this rhythm. *Atrioventricular nodal block* - While AV nodal block can lead to escape rhythms from lower pacemakers, **AIVR** is a specific ventricular rhythm typically associated with **reperfusion injury**, not primarily with AV block itself. - AV nodal block often results in a slower **junctional or ventricular escape rhythm**, rather than an *accelerated* ventricular rhythm. *Electrolyte imbalance* - Severe electrolyte imbalances, such as **hyperkalemia** or **hypokalemia**, can cause various arrhythmias, including ventricular tachycardias or bradycardias. - However, **AIVR** has a much stronger and more characteristic association with **myocardial reperfusion** than with general electrolyte derangements. *Digitalis therapy* - **Digitalis toxicity** can cause a wide range of arrhythmias, including ventricular ectopy, bigeminy, and even ventricular tachycardia. - While it can increase ventricular automaticity, **AIVR** is not the *most characteristic* arrhythmia specifically linked to digitalis toxicity; other arrhythmias like **bidirectional ventricular tachycardia** are more classic.

Q: Post-myocardial infarction on the 10th day, which of the following enzyme levels is raised?

Troponin. ***Troponin*** - **Cardiac troponins (cTnI and cTnT)** are highly sensitive and specific biomarkers for myocardial injury. - They typically remain elevated for **10-14 days** after an acute myocardial infarction, making them detectable on day 10 [2], [3]. *LDH* - **Lactate dehydrogenase (LDH)** is a non-specific enzyme and its levels begin to rise later than troponin, peaking around 3-4 days. - While elevated in MI, it usually returns to normal within **7-14 days**, making its elevation less reliable or prominent on day 10 compared to troponin [1]. *CPK* - **Creatine phosphokinase (CPK)**, particularly the MB isoenzyme (CK-MB), rises within 3-12 hours after MI [2]. - However, CK-MB levels typically return to normal within **2-3 days**, making it unlikely to be significantly elevated on day 10. *Myoglobin* - **Myoglobin** is one of the earliest markers to rise, appearing within 1-4 hours after MI. - Due to its rapid clearance, myoglobin levels also normalize quickly, usually within **24 hours**, and would not be elevated on day 10.

Q: Duration of pain in angina is:

2-5 mins. **2-5 mins** - **Stable angina** chest pain typically lasts for a few minutes, usually 2 to 5 minutes, and is precipitated by exertion or stress [1]. - Pain is **relieved by rest** or nitroglycerin within minutes [1]. *5-30 mins* - This duration is longer than typical stable angina and could indicate **unstable angina** or another cardiac event, requiring immediate medical evaluation [1]. - While an myocardial infarction (MI) is a possibility, pain lasting this specific duration is not the hallmark of stable angina [1]. *30-60 mins* - This duration is characteristic of prolonged cardiac ischemia, such as an **acute myocardial infarction (heart attack)**, rather than stable angina [1]. - Such prolonged pain signals serious heart damage and requires urgent medical intervention [2]. *> 1 hour* - Pain lasting over an hour is atypical for angina and strongly suggests an **acute myocardial infarction (MI)** or other non-cardiac causes like pericarditis or aortic dissection. - **Angina pain is generally brief** and resolves quickly [1].

Q: What is the most common site of acute aortic dissection?

Ascending aorta. ***Ascending aorta*** - The **ascending aorta** is the most common site for **acute aortic dissection**, particularly within a few centimeters of the **aortic valve** [1]. - This region is under the highest **hemodynamic stress**, making it more susceptible to intimal tear and dissection. *Arch of aorta* - While dissections can propagate into or originate in the **arch of the aorta**, it is a less common primary site compared to the ascending aorta [1]. - Involvement of the arch often occurs as an extension of a more proximal dissection. *Suprarenal abdominal aorta* - The **abdominal aorta** is less commonly affected by acute dissection compared to the thoracic aorta [1]. - When dissection does occur in the abdominal aorta, it is generally an extension from a thoracic dissection and rarely originates primarily here. *Infrarenal abdominal aorta* - The **infrarenal abdominal aorta** is the most common site for **abdominal aortic aneurysms**, but it is an infrequent primary site for acute aortic dissection [2]. - Dissections originating here are rare, though dissections can extend to this segment.

Question 1

Positive hepatojugular reflux is found in all of the following conditions except -

Accepted Answer

Decreased afterload

Answer

Tricuspid regurgitation

Answer

Increased capillary bed pressure

Answer

Right heart failure

Question 2

Obesity is associated with the MOST SIGNIFICANT increased risk of:

Accepted Answer

Heart disease

Answer

Hyperuricemia

Answer

Osteoporosis

Answer

Hypertension

Question 3

Sine wave pattern in an ECG is seen in which of the following conditions?

Accepted Answer

Hyperkalemia

Answer

Hypokalemia

Answer

Hyponatremia

Answer

Hypernatremia

Question 4

Which of the following statements about atherosclerosis is MOST accurate?

Accepted Answer

Hypercholesterolemia is a significant risk factor for atherosclerosis.

Answer

Atherosclerosis primarily affects veins rather than arteries.

Answer

Thoracic aorta is more commonly involved than abdominal aorta in atherosclerosis.

Answer

Intake of saturated fatty acids is associated with decreased atherosclerosis risk.

Question 5

What is an electrical storm?

Accepted Answer

3 episodes of ventricular tachycardia within 24 hours

Answer

Electromechanical dissociation

Answer

Electrical alternans

Answer

3 episodes of atrial tachycardia within 24 hours

Question 6

What is the immediate treatment modality for a patient presenting with acute anterior wall myocardial infarction and hypotension?

Accepted Answer

Primary Percutaneous Coronary Intervention (Primary PCI)

Answer

Anticoagulation

Answer

Thrombolytic therapy

Answer

Intra-aortic balloon counterpulsation

Question 7

Accelerated idioventricular rhythm (AIVR) is most characteristically seen in?

Accepted Answer

Myocardial reperfusion

Answer

Digitalis therapy

Answer

Atrioventricular nodal block

Answer

Electrolyte imbalance

Question 8

Post-myocardial infarction on the 10th day, which of the following enzyme levels is raised?

Accepted Answer

Troponin

Answer

LDH

Answer

CPK

Answer

Myoglobin

Question 9

Duration of pain in angina is:

Accepted Answer

2-5 mins

Answer

5-30 mins

Answer

30-60 mins

Answer

> 1 hour

Question 10

What is the most common site of acute aortic dissection?

Accepted Answer

Ascending aorta

Answer

Arch of aorta

Answer

Suprarenal abdominal aorta

Answer

Infrarenal abdominal aorta

Cardiology — MCQs

Cardiology — MCQs

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