Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 1671: All of the following are true regarding Tetralogy of Fallot except which of the following?

A. Single second heart sound
B. Ejection systolic murmur in second intercostal space
C. Predominantly left to right shunt (Correct Answer)
D. Normal jugular venous pressure

Explanation: ***Predominantly left to right shunt*** - Tetralogy of Fallot is characterized by a **right-to-left shunt** due to subpulmonary stenosis, leading to cyanosis [1]. - A persistent **left-to-right shunt** is inconsistent with the typical presentation of Tetralogy of Fallot [1]. *Ejection systolic murmur in second intercostal space* - The **ejection systolic murmur** in the second intercostal space is due to the **pulmonic stenosis**, which is a key component of Tetralogy of Fallot [1]. - The murmur's intensity is inversely proportional to the severity of the obstruction. *Single second heart sound* - The single second heart sound is a common finding because of the **reduced pulmonary blood flow** and thus the soft or absent pulmonary component of S2. - The **aortic component** is typically heard clearly, but the pulmonary component is diminished. *Normal jugular venous pressure* - **Normal jugular venous pressure** is expected in Tetralogy of Fallot unless there is associated right-sided heart failure, which is not a primary feature of uncomplicated TOF. - The primary hemodynamic derangement involves shunting at the ventricular level, not elevated right atrial pressure.

Question 1672: The treatment of acute myocardial infarction includes which of the following?

A. Oral anticoagulants
B. Aspirin (Correct Answer)
C. Heparin
D. Alteplase

Explanation: ***Aspirin*** - **Aspirin** is a cornerstone of acute myocardial infarction treatment due to its **antiplatelet effects**, which reduce thrombus formation in the coronary arteries [4]. - It works by **irreversibly inhibiting cyclooxygenase-1 (COX-1)**, thereby preventing the synthesis of thromboxane A2, a potent platelet aggregator [4]. *Heparin* - **Heparin** (unfractionated or low molecular weight) is an **anticoagulant** often used adjunctively in acute MI, particularly in patients undergoing percutaneous coronary intervention (PCI) or with concurrent atrial fibrillation [1]. - Its primary role is to **prevent further clot formation** rather than directly dissolving existing clots, making it not the initial, primary treatment for MI itself. *Alteplase* - **Alteplase** is a **fibrinolytic agent** used in acute ST-elevation myocardial infarction (STEMI) to **dissolve existing clots** and restore blood flow [3]. - While effective, it is not universally indicated for *all* acute MI cases and has specific contraindications, making it a secondary rather than primary initial treatment choice in many scenarios when compared to aspirin [2]. *Oral anticoagulants* - **Oral anticoagulants** (e.g., warfarin, direct oral anticoagulants) are primarily used for **long-term prevention** of thromboembolic events, such as in atrial fibrillation or after venous thromboembolism. - They are generally **not used in the immediate acute phase of MI** as the primary treatment due to their slower onset of action and different mechanisms compared to antiplatelet drugs like aspirin.

Question 1673: Buerger's disease affects all except which of the following?

A. Small vessels
B. Nerves
C. Veins
D. Lymphatics (Correct Answer)

Explanation: ***Lymphatics*** - Buerger's disease (Thromboangiitis obliterans) primarily involves the **small and medium-sized arteries and veins**, leading to inflammation and thrombosis [1]. - It does not directly affect the **lymphatic system**; lymphatic involvement is not a characteristic feature of this disease. *Small vessels* - Buerger's disease is an **inflammatory vasculitis** that specifically targets small and medium-sized arteries and veins of the extremities [1]. - This involvement leads to **thrombosis** and occlusion, causing ischemia and tissue damage. *Nerves* - While Buerger's disease primarily affects blood vessels, **peripheral nerve involvement** can occur secondary to vascular insufficiency and ischemia. - **Ischemic neuropathy** is a common complication due to reduced blood flow to the nerves. *Veins* - Buerger's disease frequently involves the superficial and deep veins, causing **superficial phlebitis** and thrombophlebitis. - This venous inflammation contributes to the overall vascular pathology observed in affected limbs.

Question 1674: Pulsus paradoxus is not observed in which of the following conditions?

A. IPPV (Correct Answer)
B. COPD
C. Constrictive pericarditis
D. Cardiac Tamponade

Explanation: ***IPPV*** - **Intermittent positive pressure ventilation (IPPV)** involves positive pressure delivery of air, which tends to increase intrathoracic pressure. This counteracts the inspiratory fall in intrathoracic pressure that normally accentuates pulsus paradoxus [1]. - In patients on mechanical ventilators, the respiratory variation in intrathoracic pressure is altered, often **attenuating or reversing the normal physiological mechanisms** that lead to pulsus paradoxus [1]. *COPD* - Patients with **severe COPD** often exhibit pulsus paradoxus due to the greatly exaggerated negative intrathoracic pressure generated during inspiration. - The increased **airflow resistance** and **hyperinflation** in COPD lead to extreme swings in intrathoracic pressure, which impedes venous return and left ventricular filling during inspiration. *Cardiac Tamponade* - **Cardiac tamponade** is a classic cause of pulsus paradoxus, where fluid in the pericardial sac compresses the heart, severely restricting ventricular filling. - During inspiration, the increased venous return to the right side of the heart causes the interventricular septum to bulge into the left ventricle, further reducing left ventricular filling and causing a **marked drop in systolic blood pressure**. *Constrictive pericarditis* - Patients with **constrictive pericarditis** often show pulsus paradoxus, although it may be less pronounced than in cardiac tamponade. - The **rigid, thickened pericardium** impairs ventricular filling, and the respiratory variations in filling still impact the transpulmonary gradient, leading to a inspiratory drop in systolic pressure.

Question 1675: What is the most common cause of death in amyloidosis?

A. Cardiac failure (Correct Answer)
B. Renal failure
C. Sepsis
D. None of the options

Explanation: The original text provided did not have any references with sufficient relevance (score ≥ 7) to support the claims regarding amyloidosis mortality. All provided references were evaluated and determined to be irrelevant or specific to unrelated conditions. ***Cardiac failure*** - **Cardiac amyloidosis** leads to restrictive cardiomyopathy, impairing the heart's ability to fill with blood and pump effectively. - The progressive accumulation of **amyloid fibrils** in the myocardium results in wall thickening, diastolic dysfunction, and ultimately pump failure, making it the most frequent cause of death. *Renal failure* - While **renal involvement** is common in amyloidosis, particularly AL amyloidosis, leading to proteinuria and nephrotic syndrome, it is not the leading cause of death. - The primary cause of mortality shifts more towards cardiac complications, especially with improved dialysis and kidney transplantation options. *Sepsis* - Patients with amyloidosis may be **immunocompromised** due to chronic illness or treatments, increasing their risk of infections and sepsis. - However, sepsis is typically a complication that can occur in various severe illnesses, rather than the primary and most common terminal event directly attributable to amyloid organ damage itself, as **cardiac amyloidosis** is. *None of the options* - This option is incorrect because **cardiac failure** is a well-established and the most common cause of mortality in patients with systemic amyloidosis.

Question 1676: High-output cardiac failure is seen in:

A. Thyrotoxicosis (Hyperthyroidism) (Correct Answer)
B. Heart failure with preserved ejection fraction (HFpEF)
C. Cor pulmonale (Right heart failure due to pulmonary hypertension)
D. Aortic stenosis (Obstruction to left ventricular outflow)

Explanation: ***Thyrotoxicosis (Hyperthyroidism)*** - High levels of thyroid hormones increase **basal metabolic rate** and cardiac output, leading to a state where the heart struggles to meet the body's excessive demands despite a normal or even elevated cardiac output. - This chronic state of increased cardiac workload can eventually lead to cardiac enlargement and **heart failure** despite good systolic function. *Heart failure with preserved ejection fraction (HFpEF)* - HFpEF is characterized by **diastolic dysfunction**, where the heart's pumping ability is normal but its relaxation and filling are impaired [1]. - While it represents a type of heart failure, it's typically understood as a **low-output state** or normal-output state relative to demand, not a high-output state caused by increased metabolic needs [2]. *Cor pulmonale (Right heart failure due to pulmonary hypertension)* - Cor pulmonale is **right ventricular failure** resulting from pulmonary hypertension, where the right side of the heart struggles to pump against increased resistance in the pulmonary circulation. - This condition is characterized by **elevated pulmonary vascular resistance** and often reduced cardiac output, not an intrinsic high-output state. *Aortic stenosis (Obstruction to left ventricular outflow)* - Aortic stenosis causes an **obstruction to blood flow** from the left ventricle, leading to increased pressure load on the left ventricle and eventual concentric hypertrophy. - This condition typically results in a **reduced or normal cardiac output** because of the outflow obstruction and is not considered a high-output state.

Question 1677: What is the most common cause of sudden cardiac death in adults?

A. Cerebral haemorrhage
B. Arrhythmias (Correct Answer)
C. Ruptured aortic aneurysm
D. Cancer

Explanation: ***Arrhythmias*** - The most common cause of sudden cardiac death in adults is due to **ventricular fibrillation** or **ventricular tachycardia**, which are types of arrhythmias [2]. - These lethal arrhythmias are frequently triggered by underlying **coronary artery disease** [3]. *Cerebral haemorrhage* - While a serious and life-threatening condition, **cerebral haemorrhage** is not the most common cause of sudden cardiac death. - It primarily affects the brain and its immediate consequences are related to neurological function, although secondary cardiac issues can occur. *Ruptured aortic aneurysm* - A **ruptured aortic aneurysm** is a catastrophic event leading to massive internal bleeding and rapid death [1]. - However, its incidence is significantly lower than that of sudden cardiac death due to arrhythmias. *Cancer* - **Cancer** can lead to death but typically not as a sudden event in the way of sudden cardiac death. - Death from cancer is usually a more protracted process, often due to widespread metastatic disease or complications of treatment.

Question 1678: What is the most important prognostic marker of tetralogy of Fallot?

A. Overriding aorta
B. Ventricular septal defect (VSD)
C. Right ventricular hypertrophy
D. Degree of pulmonary stenosis (Correct Answer)

Explanation: **Degree of pulmonary stenosis** - The severity of **pulmonary stenosis** dictates the degree of right ventricular outflow obstruction and thus the amount of **right-to-left shunting** through the VSD, which directly impacts the patient's cyanosis and overall prognosis [1]. - More severe stenosis leads to greater cyanosis, earlier presentation of symptoms, and a higher risk of complications and mortality without intervention. *Ventricular septal defect (VSD)* - A **VSD** is a required component of tetralogy of Fallot, allowing for communication between the ventricles [1]. - While essential for the pathophysiology, its presence alone does not determine the severity of the clinical presentation or prognosis as much as the degree of pulmonary outflow obstruction. *Overriding aorta* - An **overriding aorta** is another structural component of tetralogy of Fallot, meaning the aorta originates over both ventricles [1]. - This anatomical feature is a defining characteristic but does not directly dictate the clinical severity or prognosis as much as the blood flow dynamics determined by pulmonary stenosis. *Right ventricular hypertrophy* - **Right ventricular hypertrophy** is a compensatory response to the increased pressure load from pulmonary stenosis [1]. - It is a consequence of the obstruction, not the primary determinant of prognosis, although severe hypertrophy can lead to complications such as arrhythmias and decreased ventricular function.

Question 1679: What is the commonest site affected by thromboangiitis obliterans?

A. Femoral artery
B. Popliteal artery
C. Iliac artery
D. Digital arteries (Correct Answer)

Explanation: ***Digital arteries*** - Thromboangiitis obliterans, also known as **Buerger's disease**, primarily affects the **small and medium-sized arteries and veins** of the upper and lower extremities. - The **digital arteries** (in fingers and toes) are the most commonly affected sites, leading to **ischemia**, pain, and eventually **gangrene** of the digits. *Femoral artery* - The **femoral artery** is a large artery in the thigh and is typically not the primary site of involvement in thromboangiitis obliterans. - Involvement of large arteries like the femoral artery is more characteristic of conditions such as **atherosclerosis**. *Popliteal artery* - The **popliteal artery** is located behind the knee and is also considered a medium-to-large artery. - While it can be affected in advanced or widespread cases of Buerger's disease, it is not the most common initial or predominant site of involvement. *Iliac artery* - The **iliac arteries** are large arteries supplying blood to the legs and pelvic organs. - These arteries are typically spared in thromboangiitis obliterans, which primarily targets distal, smaller vessels.

Question 1680: The aortic component of the second heart sound is best heard at what location?

A. Infraclavicular region
B. Apex
C. Right second intercostal space near the sternum (Correct Answer)
D. Left second intercostal space near the sternum

Explanation: ***Right second intercostal space near the sternum*** - This location is the **aortic area**, where sounds originating from the **aortic valve** are best heard [1]. - The **aortic component of S2** (A2) is produced by the closure of the aortic valve. *Infraclavicular region* - This region is generally not used for auscultating specific heart valve sounds. - While some radiated sounds might be heard, it's not the primary location for the aortic component of S2. *Apex* - The apex is the best site for listening to sounds originating from the **mitral valve**, known as the **mitral area** [1]. - S1 is typically loudest at the apex, associated with mitral and tricuspid valve closure. *Left second intercostal space near the sternum* - This is the **pulmonic area**, which is where sounds from the **pulmonic valve** are best auscultated [1]. - The **pulmonic component of S2** (P2) is heard here, produced by the closure of the pulmonic valve [1].

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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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Valvular Heart Diseases

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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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Non-invasive Cardiac Diagnostics

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Preventive Cardiology

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Cardiology — MCQs

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