Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 1611: 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.

Question 1612: Eisenmenger syndrome is characterized by all except:

A. Pulmonary veins not distended
B. Pruning of peripheral pulmonary arteries
C. Return of left ventricle & right ventricle to normal size (Correct Answer)
D. Dilatation of central pulmonary arteries

Explanation: Return of left ventricle & right ventricle to normal size - In Eisenmenger syndrome, the structural heart changes are generally irreversible; the left and right ventricles do not return to normal size due to persistent pulmonary hypertension and shunting [1]. - The syndrome represents an advanced stage of congenital heart disease where the shunt reverses from left-to-right to right-to-left, causing progressive ventricular remodeling. *Pulmonary veins not distended* - This is a characteristic feature of Eisenmenger syndrome. The pulmonary veins are not distended because the reduced pulmonary blood flow, caused by increased pulmonary vascular resistance, leads to decreased venous return to the left atrium. - The altered hemodynamics, specifically the right-to-left shunt, bypasses significant portions of the pulmonary circulation, thus preventing engorgement of the pulmonary veins. *Pruning of peripheral pulmonary arteries* - This is a hallmark of pulmonary hypertension and Eisenmenger syndrome, representing the obliteration and narrowing of smaller pulmonary arterial branches [1]. - The progressive loss of these vessels contributes to the elevated pulmonary vascular resistance and contributes to the irreversible nature of the condition. *Dilatation of central pulmonary arteries* - This is typically seen in Eisenmenger syndrome due to the high pressure and flow through the main pulmonary artery and its larger branches. - While peripheral vessels constrict and "prune," the central arteries often undergo compensatory dilatation in response to the chronic high pressure [2].

Question 1613: Which of the following is a clinical manifestation of inferior vena cava (IVC) obstruction?

A. Thoraco-epigastric dilatation (Correct Answer)
B. Hemorrhoids
C. Esophageal varices
D. Para-umbilical dilatation

Explanation: ***Thoraco-epigastric dilatation*** - **Inferior vena cava (IVC) obstruction** impedes blood flow from the lower body to the heart, leading to increased pressure in the collateral venous systems. - This increased pressure causes the veins of the **thoraco-epigastric system** to dilate and become visible, forming collateral pathways to bypass the obstruction and return blood to the superior vena cava. *Hemorrhoids* - **Hemorrhoids** typically result from increased pressure in the **portal venous system** or local factors like straining, not directly from IVC obstruction. - While IVC obstruction can indirectly increase abdominal pressure, it primarily affects systemic venous return rather than the specific etiology of hemorrhoids. *Esophageal varices* - **Esophageal varices** are a hallmark sign of **portal hypertension**, where blood flow through the liver is obstructed, often due to cirrhosis [1]. - They represent portosystemic collateral veins that bypass the liver via the esophageal plexus, which is a different circulatory system than that affected by IVC obstruction [1]. *Para-umbilical dilatation* - **Para-umbilical dilatation**, often seen as a **caput medusae**, is a classic sign of **portal hypertension**, indicating collateral flow from the portal system to abdominal wall veins [1]. - This condition is specifically linked to an obstruction within the **portal venous system**, not the inferior vena cava.

Question 1614: Which of the following is NOT a cause of restrictive cardiomyopathy (RCM)?

A. Fatty infiltration of myocardium (Correct Answer)
B. Carcinoid syndrome
C. Sarcoidosis
D. Amyloidosis

Explanation: ***Fatty infiltration of myocardium*** - While fatty infiltration can occur in the heart, it is typically associated with **arrhythmogenic right ventricular cardiomyopathy (ARVC)**, a dilated cardiomyopathy [1], rather than restrictive cardiomyopathy. - **Restrictive cardiomyopathy** is characterized by stiff, non-compliant ventricular walls that impair diastolic filling, which is not the primary mechanism of fatty infiltration. *Amyloidosis* - **Amyloidosis** is a common cause of restrictive cardiomyopathy due to the deposition of **insoluble amyloid fibrils** in the myocardial interstitium [2]. - This deposition leads to **increased myocardial stiffness** and impaired diastolic function. *Sarcoidosis* - **Cardiac sarcoidosis** can cause restrictive cardiomyopathy by the infiltration of **non-caseating granulomas** into the myocardium [2]. - These granulomas lead to **fibrosis and thickening** of the ventricular walls, restricting ventricular filling. *Carcinoid syndrome* - **Carcinoid heart disease**, occurring in patients with carcinoid syndrome, can manifest as restrictive cardiomyopathy due to the deposition of **fibrous plaques** on the endocardium, particularly on the right side of the heart. - This fibrosis primarily affects the **valves and endocardial surface**, hindering ventricular filling and function.

Question 1615: What is the recommended management approach for uncomplicated essential hypertension?

A. Lifestyle changes alone are sufficient
B. Medication alone
C. Combination of lifestyle changes and medication
D. Lifestyle changes with medication as needed (Correct Answer)

Explanation: Lifestyle changes with medication as needed - For uncomplicated essential hypertension, initial management often involves lifestyle modification [1], [3], with the addition of pharmacotherapy if blood pressure targets are not met [1]. - This approach balances the benefits of self-management with the efficacy of medication in preventing cardiovascular complications [1], [2]. Lifestyle changes alone are sufficient - While lifestyle changes are crucial, they are usually not sufficient for many patients to achieve and maintain target blood pressure levels, especially as hypertension progresses. - Relying solely on lifestyle changes might lead to uncontrolled hypertension, increasing the risk of organ damage and cardiovascular events [2]. Combination of lifestyle changes and medication - This approach is typically recommended for patients with higher blood pressure readings or those with additional cardiovascular risk factors [2], where immediate and more aggressive blood pressure control is needed. - For uncomplicated hypertension, starting with medication immediately might be considered too aggressive for all patients, as some can achieve control with lifestyle changes first. Medication alone - Managing hypertension with medication alone overlooks the significant benefits of lifestyle modifications such as diet, exercise, and stress reduction [3]. - This approach may require higher doses or multiple medications, potentially increasing side effects and reducing patient adherence without addressing underlying lifestyle contributors.

Question 1616: Which of the following is not a symptom of carotid atherosclerosis?

A. Contralateral body TIA
B. Ipsilateral retinal infarction
C. Ipsilateral amaurosis fugax
D. Contralateral retinal infarction (Correct Answer)

Explanation: ***Contralateral retinal infarction*** - Retinal infarction, or **ocular stroke**, specifically affects the **ipsilateral eye** (the eye on the same side as the affected carotid artery), as the ophthalmic artery branches off the internal carotid artery. - A contralateral retinal infarction would imply the blockage is in the opposite carotid artery or a different circulatory issue. *Ipsilateral retinal infarction* - This is a direct consequence of **carotid stenosis**, as emboli from the carotid artery can travel up the **ophthalmic artery** to cause infarction in the retina of the same-sided eye. - Presents as sudden, painless **loss of vision** in one eye, often in a specific field. *Contralateral body TIA* - **Transient ischemic attacks (TIAs)** resulting from carotid atherosclerosis typically cause neurological deficits on the **contralateral side of the body** due to the decussation of motor and sensory pathways in the brain. - Symptoms like temporary weakness, numbness, or speech difficulties on the opposite side of the body are characteristic. *Ipsilateral amaurosis fugax* - **Amaurosis fugax** is a classic symptom of carotid atherosclerosis, characterized by a **transient monocular vision loss** (often described as a curtain coming down) in the eye on the *same side* as the affected carotid artery. - This occurs due to **retinal emboli** originating from the carotid plaque.

Question 1617: Orthostatic hypotension is said to be present if the systolic blood pressure falls by how much while assuming a standing posture from a sitting posture.

A. >10 mm Hg
B. >20 mm Hg (Correct Answer)
C. >30 mm Hg
D. >40 mm Hg

Explanation: ***>20 mm Hg*** - Orthostatic hypotension is clinically defined as a drop of **at least 20 mmHg** in **systolic blood pressure**, or at least 10 mmHg in diastolic blood pressure, within three minutes of standing [1]. - This drop signifies a failure of the **baroreflex mechanism** to adequately compensate for the gravitational pooling of blood. *>10 mm Hg* - A systolic blood pressure drop of **10 mmHg or less** when standing is typically considered within normal physiological response limits. - A 10 mmHg drop in systolic pressure, while notable, is more specifically the threshold for **diastolic blood pressure** when diagnosing orthostatic hypotension [1]. *>30 mm Hg* - While a drop of **30 mmHg or more** in systolic blood pressure would certainly indicate orthostatic hypotension, it is beyond the established minimum diagnostic criteria. - Such a significant drop often points to more severe cardiovascular dysregulation or autonomic dysfunction. *>40 mm Hg* - A drop of **40 mmHg or more** in systolic blood pressure is an extreme manifestation of orthostatic hypotension and would usually be associated with profound symptoms. - This degree of blood pressure change is well past the diagnostic threshold and indicative of severe compromise in **orthostatic regulation**.

Question 1618: A systolic thrill in the left 2nd or 3rd intercostal space is heard in which of the following conditions?

A. Pulmonary stenosis (Correct Answer)
B. Tetralogy of Fallot (TOF)
C. Ebstein's anomaly (EA)
D. Subpulmonic ventricular septal defect (VSD)

Explanation: ***Pulmonary stenosis*** - A **systolic thrill** in the **left 2nd or 3rd intercostal space** is characteristic of significant **pulmonary stenosis**, where turbulent blood flow occurs across the narrowed pulmonary valve [1]. - The thrill is palpable over the **pulmonic area**, indicating high-velocity flow and pressure gradients [2]. *Tetralogy of Fallot (TOF)* - While TOF includes **pulmonary stenosis**, the primary thrill felt is typically due to the **right ventricular outflow tract obstruction** and is often accompanied by other findings like cyanosis [3]. - The thrill in TOF can be in the pulmonic area but is part of a more complex clinical picture, including a **ventricular septal defect** [3]. *Ebstein's anomaly (EA)* - **Ebstein's anomaly** involves the **tricuspid valve**, leading to tricuspid regurgitation and right atrial enlargement. - A thrill is not a typical finding; instead, auscultation might reveal a **holosystolic murmur of tricuspid regurgitation** at the lower left sternal border. *Subpulmonic ventricular septal defect (VSD)* - A **subpulmonic VSD** typically produces a **holosystolic murmur** best heard at the left sternal border, often accompanied by a thrill directly over the VSD [4]. - The thrill location for a VSD is generally more medial and lower than the pulmonic area [4].

Question 1619: Abdominojugular reflex appears after compressing the abdomen for how long?

A. 30 sec
B. 10 sec (Correct Answer)
C. 5 sec
D. 15 sec

Explanation: ***10 sec*** - The **abdominojugular reflex (AJR)** is observed by compressing the abdomen for at least **10 seconds** to assess for a sustained rise in **jugular venous pressure (JVP)**. - A positive AJR indicates a **right ventricular (RV)** dysfunction or conditions causing elevated right heart pressures, like **tricuspid regurgitation**. *5 sec* - Compressing the abdomen for only 5 seconds may not be a sufficient duration to elicit a **sustained rise** in **JVP** for the abdominojugular reflex. - This shorter duration might lead to a **false negative result** as the venous return may not be significantly altered and sustained to cause a measurable change. *15 sec* - While compressing the abdomen for 15 seconds would likely elicit the reflex if present, it is longer than the **standard recommended duration** of 10 seconds. - Prolonged compression beyond the standard 10 seconds does not add significant diagnostic value and may lead to patient discomfort without enhancing sensitivity. *30 sec* - Compressing the abdomen for 30 seconds is unnecessarily long and does not adhere to the **standardized procedure** for eliciting the abdominojugular reflex. - Such an extended compression time can cause **significant patient discomfort** and is not required for an accurate assessment of the reflex.

Question 1620: Which of the following statements about physiological murmurs is false?

A. Midsystolic murmurs are common in children.
B. Physiological murmurs can be present in children with anemia.
C. Physiological murmurs are always audible without a stethoscope. (Correct Answer)
D. Only diastolic murmurs are present in adults with heart disease.

Explanation: ***Physiological murmurs are always audible without a stethoscope.*** - This statement is **false** because physiological murmurs are typically **soft** and require a **stethoscope** for auscultation [2]. - They are not loud enough to be heard without amplification from a stethoscope [2]. *Midsystolic murmurs are common in children.* - This statement is **true** as physiological or **innocent murmurs** are frequently heard in children, often described as a **Still's murmur**, which is a **midsystolic** ejection murmur. - These murmurs are usually benign and reflect **high flow states** or normal variations in cardiac anatomy [3]. *Physiological murmurs can be present in children with anemia.* - This statement is **true** because **anemia** causes a **hyperdynamic circulation**, leading to increased blood flow velocity [3]. - This increased flow can exaggerate normal heart sounds into an audible murmur, often referred to as a **flow murmur** [3]. *Only diastolic murmurs are present in adults with heart disease.* - This statement is **true** in the context of physiological murmurs, as **diastolic murmurs** in adults are almost always indicative of **pathological heart disease** (e.g., mitral stenosis, aortic regurgitation) and are never physiological [1]. - Conversely, physiological murmurs, when they occur in adults, are typically **systolic**.

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Cardiology — MCQs

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