Cardiology Practice Questions

Q: A patient with recurrent episodes of PSVT (Paroxysmal Supraventricular Tachycardia) is being considered for long-term prophylactic therapy to prevent future episodes. Which of the following is the most appropriate preventive treatment?

Oral Verapamil. ***Oral Verapamil*** - This is a non-dihydropyridine **Calcium Channel Blocker** that effectively slows conduction and increases refractoriness in the **AV node**. - It is a standard oral medication used for the **long-term prevention (prophylaxis)** of recurrent PSVT, especially in cases of AVNRT or AVRT. *IV lignocaine* - Lignocaine (Lidocaine) is a **Class IB antiarrhythmic** primarily used to treat and prevent **ventricular arrhythmias** (premature ventricular contractions, VT). - It is generally ineffective for chronic prophylaxis of supraventricular tachycardias like PSVT. *IV Adenosine* - **Adenosine** is the preferred drug for the **acute termination** of PSVT due to its potent, transient block of the AV node (half-life of <10 seconds). - It has an extremely short half-life, making it unsuitable for a chronic, **oral preventive regimen**. *Oral Nifedipine* - Nifedipine is a **dihydropyridine Calcium Channel Blocker** primarily acting as a **peripheral vasodilator**. - It has minimal effects on the **AV nodal conduction** properties required for PSVT prophylaxis and is therefore not used for this purpose.

Q: A patient presents with palpitations and an irregularly irregular pulse. He presents within 2 hours of symptom onset, and has no history of diabetes or other comorbidities. What is the most appropriate initial management?

Cardioversion. ***Cardioversion*** - Since the patient presented within **<12 hours** of symptom onset (paroxysmal AF) and is hemodynamically stable, particularly without comorbidities, urgent rhythm control via **cardioversion (electrical or pharmacological)** is the optimal management to restore sinus rhythm [1]. - The very early presentation (within 2 hours) and the absence of significant comorbidities suggest a good chance for maintenance of sinus rhythm without immediate concern for complex thrombus formation. *TEE for starting anticoagulation* - **Transesophageal echocardiography (TEE)** is performed to rule out left atrial appendage thrombus before cardioversion if the duration of AF is **unknown or >48 hours**, or if anticoagulation has been inadequate (less than 3 weeks). - In this case, since the onset is clearly 48 hours** ago. - For new-onset AF with a short duration, **rhythm control** (cardioversion) is preferred [1]. *Wait and watch* - **Wait and watch** is inappropriate as **atrial fibrillation (AF)** is associated with a high risk of systemic embolization and stroke, necessitating prompt management (either rhythm or rate control). - Immediate intervention is required to prevent complications and potentially restore sinus rhythm, especially given the very early presentation.

Q: A patient with paroxysmal supraventricular tachycardia (PSVT) requires treatment for prophylaxis. Which drug is appropriate?

Oral verapamil. ***Verapamil*** - It is an oral **non-dihydropyridine calcium channel blocker** commonly used for long-term **prophylaxis** of recurrent PSVT (AVNRT/AVRT) by slowing conduction through the AV node [1], [2]. - It is effective for reducing the frequency of episodes and achieving chronic **rate and rhythm control** in stable patients [1]. *IV adenosine* - Adenosine is the drug of choice for the **acute termination** of PSVT due to its rapid onset and extremely short half-life, making it unsuitable for chronic long-term **prophylaxis** [2]. - It works by transiently blocking the **AV node** conduction [2]. *IV esmolol* - Esmolol is an ultra-short-acting **beta-blocker** administered intravenously, primarily used for **acute control** of heart rate or rhythm in emergency settings [3]. - Since the requirement is for prophylaxis, an oral formulation (e.g., oral metoprolol) would be preferred over an **intravenous agent** [3]. *Oral phenytoin* - Phenytoin is mainly an anti-epileptic and is historically reserved for the treatment of **digitalis-induced ventricular arrhythmias**. - It is **not a standard or primary agent** recommended by current guidelines for the long-term prophylactic management of typical non-digitalis-induced PSVT.

Q: The lead of ECG marked as $X$ is called:

Lewis lead. ***Lewis lead*** - This image displays the placement of electrodes for a **Lewis lead** ECG, used to enhance the detection of **atrial activity**, particularly for P waves. - The Lewis lead involves placing the right arm electrode (usually from a standard ECG setup) at the **right sternal border in the second intercostal space**, and the left arm electrode at the **right parasternal border in the fourth intercostal space**. *V4R* - **V4R** is a right-sided precordial lead used to detect **right ventricular infarction** and is placed in the fifth intercostal space at the right midclavicular line. - The electrode placement shown in the image is not consistent with V4R. *aVR* - **aVR** is an augmented unipolar limb lead that records electrical activity from the **right arm** relative to the average of the left arm and left leg electrodes. - It is not a chest lead placement, and therefore does not correspond to the image. *V_{a}* - **V_{a}** is not a standard or recognized ECG lead designation in clinical practice. - The commonly used precordial leads are denoted as V1 through V6.

Q: A 60-year-old hypertension patient presents with palpitations and pre-syncope. ECG was done. All drugs can be used for management of this condition except:

Adenosine. ***Adenosine*** - The ECG shows **atrial fibrillation with rapid ventricular response** and evidence of **pre-excitation** (short PR interval, delta wave), suggesting **Wolff-Parkinson-White (WPW) syndrome** complicated by atrial fibrillation. - Adenosine is **absolutely contraindicated** in AF with WPW syndrome because it causes profound AV nodal blockade, forcing all conduction down the accessory pathway, which can precipitate **life-threatening ventricular fibrillation**. - Among AV nodal blockers, **adenosine poses the greatest risk** due to its rapid, complete AV nodal blockade and is the classic teaching example of drugs to avoid in this condition. *Diltiazem* - **Calcium channel blockers** like diltiazem should generally be avoided in AF with WPW because they block the AV node and can worsen conduction via the accessory pathway, potentially leading to VF. - However, their effect is less abrupt than adenosine, making them somewhat less immediately dangerous. *Esmolol* - **Beta-blockers** like esmolol should also be avoided in AF with WPW syndrome because they block the AV node and can increase conduction through the accessory pathway. - Like calcium channel blockers, the risk is real but less catastrophic than with adenosine. *Amiodarone* - Amiodarone is a **Class III antiarrhythmic** that **can be safely used** for rhythm control in AF with WPW syndrome. - Unlike pure AV nodal blockers, it affects **both the AV node and accessory pathway**, helping to slow conduction through both routes without preferentially shunting impulses down the dangerous accessory pathway. - It is considered appropriate for pharmacological management of this condition.

Q: What is incorrect about the condition shown in the image?

Hydralazine is contraindicated. The image shows an **aortic dissection**, characterized by a tear in the **intima** allowing blood to flow between the layers of the aortic wall, creating a **false lumen** (the white area dissecting the red aortic wall). ***Hydralazine is contraindicated*** - Hydralazine is an **arterial vasodilator** that can cause reflex tachycardia and increased aortic shear stress, exacerbating an aortic dissection. - Using hydralazine in this condition could worsen the dissection and lead to further complications, making it an **incorrect** treatment choice. *Intravenous esmolol* - **Intravenous esmolol** is a **beta-blocker** that is often used in the initial management of aortic dissection to lower heart rate and blood pressure. - Reducing heart rate and contractility decreases **aortic shear stress**, which is crucial in preventing the dissection from extending. *Aortography* - **Aortography** is an imaging technique that can visualize the aorta and its branches, including the presence and extent of an aortic dissection. - While other imaging modalities like CT angiography are more commonly used today, aortography remains a diagnostic option, especially in complex cases or when other modalities are inconclusive. *Hemiplegia* - **Hemiplegia**, or paralysis on one side of the body, can be a serious complication of aortic dissection if the dissection extends to involve the **carotid arteries** or other arteries supplying the brain. - Ischemia or infarction due to compromised blood flow to the brain can result in neurological deficits such as hemiplegia.

Question 1

A 58-year-old male presents to a PHC for a routine check-up. His blood pressure readings on two separate occasions are 148 / 90 mmHg and 152 / 96 mmHg. He is asymptomatic and has no known comorbidities. What is the most appropriate next step in management according to current hypertension guidelines?

Accepted Answer

Start Amlodipine 5 mg once daily and advise follow-up after a month

Answer

Initiate treatment only if BP exceeds 160 / 100 mmHg

Answer

Start the patient on IV anti-hypertensive drugs

Answer

Refer to a higher center for further evaluation

Question 2

A patient with recurrent episodes of PSVT (Paroxysmal Supraventricular Tachycardia) is being considered for long-term prophylactic therapy to prevent future episodes. Which of the following is the most appropriate preventive treatment?

Accepted Answer

Oral Verapamil

Answer

IV Adenosine

Answer

Oral Nifedipine

Answer

IV lignocaine

Question 3

A patient presents with palpitations and an irregularly irregular pulse. He presents within 2 hours of symptom onset, and has no history of diabetes or other comorbidities. What is the most appropriate initial management?

Accepted Answer

Cardioversion

Answer

Control ventricular rate with verapamil

Answer

TEE for starting anticoagulation

Answer

Wait and watch

Question 4

A 30-year-old man with 6 month past history of PND and SOB. On examination, JVP is elevated with irregularly irregular pulse and tender hepatomegaly and MDM. past medical history of ARF. Which of the following is not seen in this patient?

Accepted Answer

Presystolic accentuation of mid-diastolic murmur is hallmark feature

Answer

Right heart failure

Answer

Absent a wave in JVP

Answer

Patient has increased risk of embolic stroke

Question 5

A patient with paroxysmal supraventricular tachycardia (PSVT) requires treatment for prophylaxis. Which drug is appropriate?

Accepted Answer

Oral verapamil

Answer

IV esmolol

Answer

Oral phenytoin

Answer

IV adenosine

Question 6

The lead of ECG marked as $X$ is called:

Accepted Answer

Lewis lead

Answer

V4R

Answer

aVR

Answer

V_{a}

Question 7

A 45-year-old patient of hypertension presents with chest pain radiating to inter-scapular area. ECG shows ST segment elevation and elevated cardiac biomarkers. Thrombolysis was initiated but patient did not improve. Cardiac MRI was performed but patient expired thereafter. All are true about the condition shown and its treatment except:

Accepted Answer

The condition progressed to produce coronary artery dissection

Answer

Thrombolysis should not have been started in the patient

Answer

Esmolol would have reduced the propagation of condition

Answer

Sodium nitroprusside would have controlled resultant hypertension

Question 8

A 60-year-old hypertension patient presents with palpitations and pre-syncope. ECG was done. All drugs can be used for management of this condition except:

Accepted Answer

Adenosine

Answer

Diltiazem

Answer

Esmolol

Answer

Amiodarone

Question 9

The image shows the dorsum of distal phalanges of the fingers of both hands approximated, leading to formation of a diamond-shaped gap — this is called Schamroth's window. Hamman crunch sign is heard in pneumomediastinum. Pemberton sign is seen in retrosternal goiter. Oliver sign is called tracheal tug and is seen in aortic aneurysm.

Which of the following statements is TRUE?

Accepted Answer

In mitral stenosis murmur, the presystolic accentuation disappears with atrial fibrillation.

Answer

Malar flush is seen with mitral stenosis. The CXR in the image shows presence of straightening of left heart border.

Answer

Candle flame jet is an apically directed transmitral jet seen on Doppler in mitral stenosis.

Answer

Pulmonary apoplexy occurs due to rupture of thin-walled dilated bronchopulmonary veins as a consequence of sudden rise of left atrial pressure.

Question 10

What is incorrect about the condition shown in the image?

Accepted Answer

Hydralazine is contraindicated

Answer

Intravenous esmolol

Answer

Aortography

Answer

Hemiplegia

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?