Cardiology Practice Questions

Q: Which of the following heart sounds are best heard with the bell of stethoscope? I. Opening snap II. Systolic click III. Third heart sound IV. Mid diastolic murmur Select the correct answer using the code given below :

III and IV. ***III and IV*** - The **bell of the stethoscope** is designed to auscultate **low-pitched sounds** due to its larger surface area and lighter application to the skin. - The **third heart sound (S3)** and **mid-diastolic murmurs** (e.g., from mitral stenosis) are classic examples of low-pitched sounds best heard with the bell [2]. *II and III only* - While the **third heart sound (S3)** is correctly identified as being heard with the bell, the **systolic click** is a high-pitched sound [1]. - **Systolic clicks**, often associated with mitral valve prolapse, are best heard with the **diaphragm** of the stethoscope [1]. *I, II and III* - This option incorrectly includes both the **opening snap** and **systolic click** as being best heard with the bell. - The **opening snap** (related to mitral stenosis) and **systolic click** (related to mitral valve prolapse) are typically **high-pitched sounds** and are better heard with the **diaphragm** [1], [3]. *I and IV* - This option incorrectly states that the **opening snap** is best heard with the bell. - Although the **mid-diastolic murmur** is correctly identified as a low-pitched sound [2], the **opening snap** is a high-pitched sound [1], [3], making the entire option incorrect.

Q: Smoking is considered to be a modifiable risk factor for Coronary Heart Disease. Consider the following statements with regard to possible mechanisms on the basis of which it acts as a risk factor : 1. Nicotine stimulation of adrenergic drive raises the blood pressure and myocardial oxygen demand. 2. It increases carbon monoxide and induces atherogenesis. 3. It leads to fall in protective high density lipoproteins. 4. It reduces the apolipoprotein-B plasma levels. Which of the statements given above are correct ?

1, 2 and 3. **1, 2 and 3** - **Nicotine** in cigarette smoke stimulates the adrenergic nervous system, leading to increased heart rate, **vasoconstriction**, and elevated blood pressure, which **increases myocardial oxygen demand**. - **Carbon monoxide** from smoking binds to hemoglobin, reducing oxygen delivery to the myocardium, and also contributes to **endothelial damage** and **atherogenesis**. Smoking also **lowers HDL ("good" cholesterol)**, which normally helps remove cholesterol from arteries. *2, 3 and 4* - This option is incorrect because statement 4 is false; smoking typically **increases** apolipoprotein-B levels, associated with increased LDL cholesterol, not reduces them. - While statements 2 and 3 are correct mechanisms, the inclusion of statement 4 makes this option incorrect. *1 and 3 only* - This option is incomplete as it misses the crucial role of **carbon monoxide** in inducing atherogenesis (statement 2), which is a well-established mechanism of smoking-related CHD. - While statements 1 and 3 are correct mechanisms, the absence of statement 2 makes this option less comprehensive. *1 and 2 only* - This option omits the significant effect of smoking on **high-density lipoproteins (HDL)**; smoking is known to cause a **fall in protective HDL levels**, contributing to increased CHD risk. - While statements 1 and 2 are correct mechanisms, the exclusion of statement 3, which is also correct, makes this option incomplete.

Q: Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Muffled heart sounds. ***Muffled heart sounds*** - Pericardial tamponade involves an accumulation of fluid in the **pericardial sac**, which dampens sound transmission and results in **muffled heart sounds** [1]. - This is a key component of **Beck's triad**, indicating compromised cardiac filling. *Collapsed neck veins* - In pericardial tamponade, there is a significant increase in **intrapericardial pressure**, which impedes venous return to the heart [1]. - This typically leads to **distended neck veins** (elevated jugular venous pressure), not collapsed ones. *Tachycardia* - While **tachycardia** can be present as a compensatory mechanism due to reduced cardiac output in tamponade, it is a non-specific finding. - It is not considered part of the **classical Beck's triad**, which specifically focuses on the triad of muffled heart sounds, hypotension, and elevated jugular venous pressure. ***Decreased arterial pressure*** - The increased intrapericardial pressure in tamponade severely restricts **ventricular filling**, leading to a reduction in stroke volume and subsequently **decreased cardiac output** [1], [2]. - This reduction in cardiac output manifests as systemic **hypotension** (decreased arterial pressure), which is a critical finding in tamponade.

Q: Deep vein thrombosis of calf is best managed by :

anticoagulants. ***Anticoagulants*** - **Anticoagulation** therapy is the cornerstone of DVT management, preventing clot extension and reducing the risk of **pulmonary embolism** [1]. - Medications like **heparin**, **low molecular weight heparin**, or **direct oral anticoagulants (DOACs)** are commonly used [1]. *active physiotherapy* - While physical activity can prevent DVT, it is generally **contraindicated in acute DVT** due to the risk of dislodging the clot. - Mobilization is introduced gradually once anticoagulation is therapeutic and the risk of **embolization** is reduced. *thrombolysis* - **Thrombolysis** (clot dissolution) is usually reserved for **proximal, extensive DVT** [1] or DVT with **limb-threatening ischemia** [2]. - It carries a **higher risk of bleeding** compared to anticoagulation and is not typically necessary for isolated calf DVT [2]. *surgical venous thrombectomy* - **Surgical thrombectomy** is rarely performed for DVT and is generally reserved for **massive iliocaval thrombosis** with severe limb threat. - It is an **invasive procedure** with significant risks and is not indicated for typical calf DVT.

Q: When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...

0.3. ***0.3*** - A value of **less than 0.3** indicates **severe blood flow impairment**, consistent with critical limb ischemia, necessitating urgent intervention [1]. - This extremely low ABPI reflects a profound decrease in perfusion to the lower extremity [1]. *0.7* - An ABPI of **less than 0.7** typically suggests **moderate peripheral artery disease (PAD)**, which could cause claudication but is not usually indicative of critical limb ischemia [1]. - While concerning, it does not represent the severe, limb-threatening ischemia implied by the term "critical." *1.0* - An ABPI of around **1.0 (0.9-1.3)** is considered **normal**, indicating healthy blood flow without significant arterial obstruction. - This value would rule out any significant peripheral artery disease, including critical limb ischemia. *0.9* - An ABPI of **less than 0.9** generally suggests **peripheral artery disease (PAD)**, which can cause symptoms like intermittent claudication [1]. - However, it is not low enough to diagnose critical limb ischemia, which represents a more severe state of arterial insufficiency [1].

Q: The normal ankle brachial pressure index (ABPI) is 1.0. A value of 0.8 suggests

some degree of arterial obstruction. ***some degree of arterial obstruction*** - An **ABPI of 0.8** indicates a reduction in blood flow to the lower extremities compared to the upper limbs [1]. - This value is generally considered to signify **mild to moderate peripheral artery disease (PAD)**, suggesting the presence of arterial narrowing or obstruction [1]. *impending gangrene* - **Impending gangrene** or critical limb ischemia is typically associated with a much lower ABPI, usually **below 0.4** or even 0.3 [1]. - At an ABPI of 0.8, severe tissue damage and gangrene are not imminent, although careful monitoring is still warranted. *presence of collaterals* - While **collateral arteries** can develop in response to chronic arterial obstruction, an ABPI of 0.8 primarily reflects the overall net blood flow, which is still reduced despite collaterals [1]. - The presence of collaterals can actually help to maintain tissue viability and prevent more severe symptoms, but they don't normalize the ABPI in the presence of significant disease [1]. *good flow* - A value of **1.0 to 1.4** is generally considered a normal ABPI, indicating good arterial flow. - An ABPI of **0.8 is significantly below normal** and suggests impaired rather than good blood flow [1].

Q: A patient presents with claudication in both buttocks and has impotence. The clinical examination reveals bruit over lower abdomen. What is the clinical diagnosis?

Aortoiliac occlusion. Aortoiliac occlusion - The triad of **buttock claudication**, **impotence**, and **absent or diminished femoral pulses** (often associated with an abdominal bruit) is classic for **Leriche syndrome**, which is caused by aortoiliac occlusion [2], [3]. - This occlusion impairs blood flow to both lower extremities and the internal iliac arteries, affecting erectile function [1]. Bilateral iliofemoral occlusion - While this would cause bilateral lower limb symptoms, it typically would not explain the **impotence** as clearly as an aortoiliac occlusion which affects the internal iliac arteries that supply the penis [2], [3]. - An iliofemoral occlusion is distal to the aorta, and the symptom complex provided points to a more **proximal lesion**. Bilateral iliac artery occlusion - This would cause similar symptoms to aortoiliac occlusion including **buttock claudication** and **impotence** [2]. - However, the presence of a **bruit over the lower abdomen** often indicates a more proximal lesion involving the aorta, making aortoiliac occlusion a more comprehensive diagnosis for these findings. Bilateral femoropopliteal occlusion - This would primarily cause **calf and thigh claudication**, less commonly buttock claudication, as the occlusion is more distal [1]. - **Impotence** is not a typical symptom of isolated femoropopliteal occlusion, as the internal iliac arteries are usually unaffected.

Q: Patients with phlebographically confirmed deep vein thrombosis of the calf:

are at risk for significant pulmonary embolism. ***are at risk for significant pulmonary embolism*** - While calf DVT is often considered less severe than proximal DVT, it still carries a definite risk of extending proximally [1] and subsequently leading to **pulmonary embolism (PE)**, especially if untreated. - Approximately **10-20% of calf DVTs extend proximally**, increasing the risk of potentially fatal PE. *can expect asymptomatic recovery if treated promptly with anticoagulant* - Even with prompt anticoagulant treatment, a significant percentage of patients with DVT experience **post-thrombotic syndrome (PTS)**, characterized by pain, swelling, and skin changes. - While anticoagulants [2] prevent clot extension and PE, they do not guarantee an **asymptomatic recovery** or fully prevent long-term sequelae. *may be effectively treated with low-dose heparin* - **Low-dose heparin** is typically used for DVT prophylaxis, not for treating acute DVT. - Treatment of acute DVT, including calf DVT, requires **therapeutic anticoagulation** with unfractionated heparin, low molecular weight heparin, or oral anticoagulants [2] to prevent clot propagation and embolism. *may be effectively treated with pneumatic compression stockings* - **Pneumatic compression stockings** are primarily used for DVT prevention in high-risk patients, especially post-surgery. - They are not a primary treatment for an **established acute DVT**, where anticoagulation is the cornerstone of therapy to prevent complications.

Question 1

Which of the following heart sounds are best heard with the bell of stethoscope?
I. Opening snap
II. Systolic click
III. Third heart sound
IV. Mid diastolic murmur

Select the correct answer using the code given below :

Accepted Answer

III and IV

Answer

II and III only

Answer

I, II and III

Answer

I and IV

Question 2

Smoking is considered to be a modifiable risk factor for Coronary Heart Disease. Consider the following statements with regard to possible mechanisms on the basis of which it acts as a risk factor :

1. Nicotine stimulation of adrenergic drive raises the blood pressure and myocardial oxygen demand.
2. It increases carbon monoxide and induces atherogenesis.
3. It leads to fall in protective high density lipoproteins.
4. It reduces the apolipoprotein-B plasma levels. Which of the statements given above are correct ?

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1 and 3 only

Answer

1 and 2 only

Question 3

Which of the following are included in the classical clinical presentation of pericardial tamponade ?

Accepted Answer

Muffled heart sounds

Answer

Collapsed neck veins

Answer

Tachycardia

Question 4

Deep vein thrombosis of calf is best managed by :

Accepted Answer

anticoagulants

Answer

active physiotherapy

Answer

thrombolysis

Answer

surgical venous thrombectomy

Question 5

The "Subclavian steal syndrome" occurs due to

Accepted Answer

Occlusion of the subclavian artery proximal to origin of vertebral artery

Answer

Occlusion/stenosis of the carotid artery

Answer

Occlusion/stenosis of the vertebral artery

Answer

Occlusion of the subclavian artery distal to origin of vertebral artery

Question 6

When a patient suffers from critical limb ischemia, the ankle-brachial pressure index (ABPI) is less than ...

Accepted Answer

0.3

Answer

0.7

Answer

1.0

Answer

0.9

Question 7

Match List-I with List-II and select the correct answer using the code given below the Lists:

**List-I**
A. Atrial fibrillation
B. Ventricular tachycardia
C. Complete heart block
D. Ventricular fibrillation

**List-II**
1. Chaotic rhythm
2. Dissociation of P and QRS waves
3. Wide QRS complexes and regular rapid rate
4. Irregular R-R interval without P waves

Accepted Answer

A→4  B→3  C→2  D→1

Answer

A→4  B→3  C→1  D→2

Answer

A→3  B→2  C→4  D→1

Answer

A→3  B→2  C→1  D→4

Question 8

The normal ankle brachial pressure index (ABPI) is 1.0. A value of 0.8 suggests

Accepted Answer

some degree of arterial obstruction

Answer

impending gangrene

Answer

presence of collaterals

Answer

good flow

Question 9

A patient presents with claudication in both buttocks and has impotence. The clinical examination reveals bruit over lower abdomen. What is the clinical diagnosis?

Accepted Answer

Aortoiliac occlusion

Answer

Bilateral iliofemoral occlusion

Answer

Bilateral iliac artery occlusion

Answer

Bilateral femoropopliteal occlusion

Question 10

Patients with phlebographically confirmed deep vein thrombosis of the calf:

Accepted Answer

are at risk for significant pulmonary embolism

Answer

can expect asymptomatic recovery if treated promptly with anticoagulant

Answer

may be effectively treated with low-dose heparin

Answer

may be effectively treated with pneumatic compression stockings

Cardiology — MCQs

Cardiology — MCQs

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