Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 1601: Straight back syndrome is associated with?

A. Osteopetrosis
B. Mitral valve prolapse (Correct Answer)
C. Cor-triatriatum
D. Ankylosing spondylitis

Explanation: ***Mitral valve prolapse*** - **Straight back syndrome** refers to a reduction in the normal thoracic kyphosis, which can decrease the **anteroposterior diameter** of the chest. - This flattened chest can compress the heart, particularly the **mitral valve**, leading to auscultatory findings suggestive of prolapse, even in the absence of true valvular dysfunction. *Ankylosing spondylitis* - This is a chronic inflammatory disease primarily affecting the **axial skeleton**, leading to spinal fusion and stiffness, which is distinct from a flattened thoracic spine. - While it affects the spine, it causes an abnormal **kyphosis or lordosis** rather than a simply straightened back that predisposes to cardiac compression. *Osteopetrosis* - This is a rare genetic disorder characterized by abnormally dense bones due to a defect in **osteoclast function**. - Its musculoskeletal manifestations involve increased bone fragility and hematological issues, not a specific spinal curvature anomaly like straight back syndrome. *Cor-triatriatum* - This is a rare congenital heart defect where the **left atrium (cor triatriatum sinistrum)** or, less commonly, the **right atrium (cor triatriatum dextrum)** is divided by a fibromuscular membrane. - It is a primary cardiac structural anomaly and has no association with musculoskeletal conditions such as straight back syndrome.

Question 1602: Which of the following is a characteristic feature of Takayasu arteritis?

A. Intimal fibrosis is a common finding. (Correct Answer)
B. Renal hypertension is a complication.
C. Coronary aneurysm can occur.
D. All of the options are features.

Explanation: ***Intimal fibrosis is a common finding.*** - **Intimal fibrosis** and thickening, along with **medial degeneration**, are characteristic pathological features seen in the affected arteries in Takayasu arteritis. - This fibrosis leads to **stenosis** and **occlusion** of large and medium-sized arteries, particularly the aorta and its main branches [1]. *Renal hypertension is a complication.* - While **renal hypertension** can occur in Takayasu arteritis due to **renal artery stenosis**, it is a *complication* of the disease process rather than a defining *characteristic pathological feature* of the vessel itself. - The fundamental characteristic is the inflammatory and fibrotic change in the arterial wall that *leads* to such complications [1]. *Coronary aneurysm can occur.* - **Coronary artery involvement**, including both **stenosis** and **aneurysm formation**, can occur in Takayasu arteritis. - However, similar to renal hypertension, a coronary aneurysm is a *potential manifestation* or complication, rather than the primary microscopic or macroscopic characteristic feature of the affected arterial pathology. *All of the options are features.* - While all listed options can be associated with Takayasu arteritis, only **intimal fibrosis** describes the characteristic *pathological change* within the arterial wall. - The other options describe complications or clinical manifestations that arise *from* this underlying pathological process.

Question 1603: What does Harvey's sign indicate?

A. Transmitted pressure wave on coughing in an artery
B. Indicates venous filling after emptying a vein (Correct Answer)
C. Loss of hair from eyebrows
D. None of the options

Explanation: ***Indicates venous filling after emptying a vein*** - **Harvey's sign**, also known as the **Trendelenburg test (modified)** or **Brodie-Trendelenburg test**, assesses the competence of venous valves in the legs [1]. - It involves emptying the superficial veins by elevating the leg and then observing for rapid venous filling after the patient stands, indicating **venous reflux** due to incompetent valves [1]. *Transmitted pressure wave on coughing in an artery* - This description typically relates to signs of a **patent ductus arteriosus** (a thrill or murmur) or **aneurysms**, where a cough can transmit a palpable impulse. - It is not associated with Harvey's sign or the assessment of venous valve competency [1]. *Loss of hair from eyebrows* - **Madarosis**, specifically loss of hair from the outer third of the eyebrows, is a classic sign of **hypothyroidism** (also known as Hertoghe's sign). - This symptom is entirely unrelated to Harvey's sign, which is a clinical maneuver for evaluating venous function. *None of the options* - This option is incorrect because the second option accurately describes Harvey's sign (or a related clinical maneuver for assessing venous competence).

Question 1604: Which drug is considered the first-line treatment for pain relief in myocardial infarction?

A. Morphine sulfate (Correct Answer)
B. Pentazocine
C. Midazolam
D. Aspirin

Explanation: **Morphine sulfate** - **Morphine sulfate** is considered the first-line opioid analgesic for pain relief in acute myocardial infarction (MI) due to its potent analgesic and anxiolytic effects [1]. - It helps reduce **myocardial oxygen demand** by causing vasodilation, thereby decreasing preload and afterload. *Pentazocine* - **Pentazocine** is an opioid agonist-antagonist that can increase **heart rate** and **blood pressure**, which is undesirable in an MI setting. - It should be avoided in acute MI due to its potential to worsen myocardial ischemia and increase oxygen demand. *Midazolam* - **Midazolam** is a benzodiazepine used for sedation and anxiolysis, but it is not a primary analgesic for acute pain. - While it can help with anxiety associated with MI, it does not directly relieve the **ischemic chest pain**. *Aspirin* - **Aspirin** is crucial in MI management for its **antiplatelet effects**, preventing thrombus formation and reducing mortality. - However, it provides minimal to no direct pain relief for the severe chest pain experienced during an MI, making it an adjunctive treatment, not a primary analgesic.

Question 1605: Which of the following murmurs will increase with Valsalva?

A. HOCM (Correct Answer)
B. Ventricular Septal Defect (VSD)
C. Aortic Stenosis (AS)
D. Mitral Regurgitation (MR)

Explanation: ***HOCM*** - The Valsalva maneuver decreases **preload** and **left ventricular volume**, which exacerbates the **left ventricular outflow tract obstruction** in hypertrophic obstructive cardiomyopathy (HOCM) [1], thereby **increasing the intensity of the murmur**. - Reduced ventricular volume causes the **interventricular septum** and **mitral valve leaflet** to come closer, increasing the obstruction. *Ventricular Septal Defect (VSD)* - The murmur of a VSD is typically **louder with increased systemic vascular resistance**, which Valsalva would tend to *reduce* initially. - A decrease in venous return and ventricular filling during Valsalva would generally **decrease the intensity** of a VSD murmur, as less blood flows through the defect. *Aortic Stenosis (AS)* - Valsalva decreases **preload** and **stroke volume**, leading to a **reduction in blood flow** across the stenotic aortic valve [3]. - This reduction in blood flow results in a **decreased intensity** of the aortic stenosis murmur. *Mitral Regurgitation (MR)* - The murmur of mitral regurgitation is primarily dependent on the pressure gradient between the left ventricle and left atrium, and the size of the regurgitant orifice [2]. - While Valsalva can transiently decrease preload and cardiac output, its effect on MR is typically **attenuation or no significant change**, not an increase, as it would generally *reduce* forward flow.

Question 1606: A patient after myocardial infarction becomes pulseless and blood pressure crashes. Diagnosis is?

A. Bidirectional tachycardia
B. Polymorphic ventricular tachycardia
C. Monomorphic ventricular tachycardia
D. Ventricular fibrillation (Correct Answer)

Explanation: ***Ventricular fibrillation*** - **Ventricular fibrillation (VF)** is a chaotic, disorganized electrical activity in the ventricles resulting in no effective cardiac output, leading to pulselessness and a rapid drop in blood pressure [1, 3]. - It is a common cause of sudden cardiac arrest in post-myocardial infarction patients due to myocardial ischemia and electrical instability [3]. *Monomorphic ventricular tachycardia* - **Monomorphic ventricular tachycardia (VT)** involves rapid, regular ventricular contractions, which may or may not cause hemodynamic instability, but it typically presents with discernable QRS complexes [4]. - While it can lead to hemodynamic collapse, the description of "pulseless" and "blood pressure crashing" suggests a more chaotic rhythm, often preceding or degenerating into VF [1]. *Bidirectional tachycardia* - **Bidirectional tachycardia** is a rare form of ventricular tachycardia characterized by a 180-degree alternating QRS axis from beat to beat, often seen in **digitalis toxicity**. - While it can be unstable, the presentation of pulselessness and blood pressure crash points more strongly towards the chaotic nature of ventricular fibrillation after an MI. *Polymorphic ventricular tachycardia* - **Polymorphic ventricular tachycardia (PVT)** is characterized by continuously changing QRS morphology, indicating multiple ventricular foci or variations in conduction pathways. - While PVT can cause severe hemodynamic compromise and lead to pulselessness (e.g., Torsades de Pointes), the immediate post-MI setting with pulselessness often rapidly deteriorates to ventricular fibrillation [2].

Question 1607: Absolute contraindication to thrombolytic therapy is:

A. Patients on nitrates
B. Hypertension
C. Pregnancy
D. History of hemorrhagic stroke in past one year (Correct Answer)

Explanation: **History of hemorrhagic stroke in past one year** - A **history of hemorrhagic stroke** is an **absolute contraindication** to thrombolytic therapy due to the significantly increased risk of recurrent and fatal intracranial hemorrhage. [1] - Thrombolytic agents dissolve clots, and in a vessel weakened by prior hemorrhage, this can lead to catastrophic re-bleeding. [1] *Pregnancy* - Pregnancy is generally considered a **relative contraindication** but not an absolute one, as the risk-benefit decision depends on the specific clinical scenario and urgent need for thrombolysis. - The primary concern is fetal exposure to radiation and the potential for maternal and fetal bleeding complications. *Patients on nitrates* - Being on nitrates has **no direct contraindication** to thrombolytic therapy. [2] - Nitrates are commonly used in cardiac patients for vasodilation and symptom relief, and their use does not increase the risk of hemorrhage from thrombolysis. [2] *Hypertension* - **Uncontrolled severe hypertension** (e.g., systolic BP >185 mmHg or diastolic BP >110 mmHg) is a relative contraindication to thrombolysis, as it increases the risk of intracranial hemorrhage. - However, isolated hypertension without other risk factors, or hypertension that can be controlled, is not an absolute contraindication.

Question 1608: Among the following components of cigarette smoke, which is most directly associated with an increased risk of coronary artery disease?

A. Tar
B. Polycyclic aromatic hydrocarbons
C. Carbon monoxide (Correct Answer)
D. Nicotine

Explanation: ***Carbon monoxide*** - **Carbon monoxide (CO)** is the cigarette smoke component most directly associated with coronary artery disease through formation of **carboxyhemoglobin (COHb)** [1]. - CO has **200-250 times higher affinity** for hemoglobin than oxygen, significantly reducing **oxygen delivery** to the myocardium and causing **tissue hypoxia** [1], [3]. *Nicotine* - While nicotine has important cardiovascular effects including **vasoconstriction** and **increased heart rate**, its association with coronary artery disease is less direct than CO's immediate impact on oxygen delivery. [2] - Nicotine promotes **platelet aggregation** and **endothelial dysfunction**, but these effects are secondary to CO's direct impact on **myocardial oxygenation**. *Tar* - **Tar** contains numerous **carcinogens** and irritants primarily linked to **lung cancer** and **COPD**, with more indirect cardiovascular effects through systemic inflammation. - While it contributes to **oxidative stress**, its association with coronary artery disease is significantly less direct than CO's immediate hemodynamic effects. *Polycyclic aromatic hydrocarbons* - **PAHs** are potent **carcinogens** with indirect cardiovascular impact through **oxidative stress** and **inflammation**, but not directly affecting coronary circulation like CO. - Their primary toxicity involves **DNA damage** and **cellular mutagenesis**, making their coronary disease association largely indirect and chronic.

Question 1609: In which of the following conditions is left atrial enlargement least prominent?

A. Ventricular septal defect
B. Atrial septal defect (Correct Answer)
C. Patent ductus arteriosus
D. Aortopulmonary window

Explanation: ***Atrial septal defect*** - In an **atrial septal defect (ASD)**, blood shunts from the left atrium (LA) to the right atrium (RA). [1] This flow **reduces the volume load on the LA**, meaning the left atrium does not directly experience a significant increase in pressure or volume. - While increased flow goes to the **right ventricle and pulmonary arteries**, the left atrium itself is spared from the overload that typically causes enlargement. [1] *Ventricular septal defect* - A **ventricular septal defect (VSD)** causes a left-to-right shunt at the ventricular level, increasing blood flow to the **pulmonary circulation** and subsequently back to the left atrium. - This **volume overload returning to the left atrium** leads to prominent left atrial enlargement. *Aortopulmonary window* - An **aortopulmonary window (APW)** results in a large left-to-right shunt from the aorta to the pulmonary artery, significantly increasing **pulmonary blood flow**. - This increased pulmonary flow returns to the left atrium, causing substantial **volume overload and prominent left atrial enlargement**. *Patent ductus arteriosus* - A **patent ductus arteriosus (PDA)** allows blood to shunt from the aorta to the pulmonary artery, leading to increased **pulmonary blood flow**. - This increased flow returns to the left atrium, leading to significant **volume overload and prominent left atrial enlargement**.

Question 1610: In the context of jugular venous pressure (JVP), a giant 'a' wave is typically observed in which of the following conditions?

A. Junctional rhythm
B. Tricuspid regurgitation
C. Complete heart block
D. Tricuspid stenosis (Correct Answer)

Explanation: ***Tricuspid stenosis*** - A **giant 'a' wave** in JVP is caused by increased resistance to right atrial emptying during **atrial systole**, leading to elevated pressure in the right atrium and superior vena cava. - **Tricuspid stenosis** is the most direct cause of this increased resistance, as the narrowed tricuspid valve obstructs blood flow from the right atrium to the right ventricle [1]. *Junctional rhythm* - This rhythm can lead to **cannon 'a' waves**, which are intermittent and result from simultaneous atrial and ventricular contraction against a closed tricuspid valve, not a persistent giant 'a' wave. - The 'a' wave in junctional rhythm is not consistently giant because the atria and ventricles do not always contract simultaneously. *Tricuspid regurgitation* - **Tricuspid regurgitation** is characterized by a prominent **'v' wave** or **CV fusion wave** due to blood flowing back into the right atrium during ventricular systole. - It does not typically cause a giant 'a' wave, as there is no increased resistance to right atrial emptying. *Complete heart block* - In **complete heart block**, there is AV dissociation, leading to random, intermittent **cannon 'a' waves** when the atria contract against a closed tricuspid valve. - This is distinct from a consistently giant 'a' wave seen with conditions like tricuspid stenosis, which reflects a fixed obstruction.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?