Cardiology — MCQs
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Straight back syndrome is associated with?
A 38-year-old man presents with pain and shortness of breath. His pulse rate is 85 per minute, blood pressure is 180/80 mmHg, and the cardiac examination reveals an ejection systolic murmur. The ECG shows a LVH pattern and ST depression in the anterior leads. His Troponin T test is positive. Based on these findings, the echocardiogram is likely to reveal which of the following conditions?
What is the best drug for managing atrial flutter with a 4:1 block?
Which drug is considered the first-line treatment for pain relief in myocardial infarction?
Which of the following murmurs will increase with Valsalva?
A patient after myocardial infarction becomes pulseless and blood pressure crashes. Diagnosis is?
Absolute contraindication to thrombolytic therapy is:
Among the following components of cigarette smoke, which is most directly associated with an increased risk of coronary artery disease?
In which of the following conditions is left atrial enlargement least prominent?
A wide and notched P wave is typically seen in:
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: A 38-year-old man presents with pain and shortness of breath. His pulse rate is 85 per minute, blood pressure is 180/80 mmHg, and the cardiac examination reveals an ejection systolic murmur. The ECG shows a LVH pattern and ST depression in the anterior leads. His Troponin T test is positive. Based on these findings, the echocardiogram is likely to reveal which of the following conditions?
- A. Aortic regurgitation
- B. Aortic stenosis (Correct Answer)
- C. Mitral regurgitation
- D. Mitral valve prolapse
Explanation: Aortic stenosis - The presence of an **ejection systolic murmur** [2], **left ventricular hypertrophy** on ECG [1], and a history of **pain and shortness of breath** are classic signs of aortic stenosis. The **wide pulse pressure** (180/80 mmHg) despite a normal pulse rate suggests increased peripheral resistance, common in advanced aortic stenosis. - **Elevated troponin T** suggests myocardial injury, which can occur due to increased myocardial oxygen demand in the context of severe aortic stenosis and LVH. *Aortic regurgitation* - This condition typically presents with a **diastolic murmur**, not an ejection systolic one [3]. - While it can cause LVH, the hallmark symptom of an **ejection systolic murmur** points away from regurgitation. *Mitral regurgitation* - This condition is characterized by a **holosystolic murmur** best heard at the apex and radiating to the axilla, different from the ejection systolic murmur described [1]. - While it can lead to LVH over time, the clinical presentation and specific murmur type are not consistent with mitral regurgitation. *Mitral valve prolapse* - This condition is often associated with a **mid-systolic click** followed by a late systolic murmur, rather than a clear ejection systolic murmur [4]. - Although it can sometimes cause chest pain, it rarely leads to the degrees of LVH and **troponin elevation** described in this scenario without other contributing factors.
Question 1603: What is the best drug for managing atrial flutter with a 4:1 block?
- A. Esmolol
- B. Amiodarone (Correct Answer)
- C. Vernakalant
- D. Lignocaine
Explanation: ***Amiodarone*** - **Amiodarone** is an effective antiarrhythmic drug for managing **atrial flutter** by controlling ventricular rate and potentially restoring sinus rhythm. - Its broad spectrum of action, including effects on potassium, sodium, and calcium channels, makes it suitable for various supraventricular and ventricular arrhythmias. *Esmolol* - **Esmolol** is a **beta-blocker** primarily used for rapid heart rate control in acute settings due to its short half-life. - While it can control ventricular rate in **atrial flutter**, it does not typically convert the rhythm to sinus [1]. *Vernakalant* - **Vernakalant** is an **antiarrhythmic drug** specifically approved for the rapid conversion of recent-onset atrial fibrillation to sinus rhythm. - It is not indicated for **atrial flutter** or for managing chronic arrhythmias. *Lignocaine* - **Lignocaine** (Lidocaine) is a **Class Ib antiarrhythmic drug** primarily used for **ventricular arrhythmias**. - It is generally ineffective for **supraventricular arrhythmias** like atrial flutter.
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: A wide and notched P wave is typically seen in:
- A. COPD
- B. Cor pulmonale
- C. Pulmonary embolism
- D. Mitral stenosis (Correct Answer)
Explanation: ***Mitral stenosis*** - A **wide and notched P wave**, often referred to as **P mitrale**, is characteristic of left atrial enlargement, which is a common sequela of mitral stenosis [1]. - The delayed depolarization of the enlarged left atrium causes the P wave to become prolonged and often develops a bifid or notched appearance. *Cor pulmonale* - Cor pulmonale typically leads to **right atrial enlargement**, which can manifest as a **tall, peaked P wave** (P pulmonale), not a wide and notched one. - This condition is caused by chronic lung disease leading to pulmonary hypertension [2]. *COPD* - While **COPD** can lead to **cor pulmonale** and subsequent right atrial enlargement, the characteristic P wave change is **P pulmonale** (tall, peaked P wave), not a wide and notched P wave. - COPD primarily affects the lungs, leading to increased pulmonary vascular resistance over time. *Pulmonary embolism* - An acute **pulmonary embolism** can cause **acute right heart strain**, which might lead to right atrial enlargement or other changes like **S1Q3T3 pattern** on ECG. - However, it does not typically cause a **wide and notched P wave**; the P wave changes associated with right atrial strain are usually tall and peaked.
Practice by Chapter
Coronary Artery Disease and Angina
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Acute Coronary Syndromes
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Heart Failure
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Cardiac Arrhythmias
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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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Preventive Cardiology
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