Cardiology Practice Questions

Q: A patient with VSD in CCF develops clubbing with no cyanosis. The diagnosis is:

Right to left shunt. ***Right to left shunt*** - The development of **clubbing** in a patient with a VSD suggests **chronic hypoxemia**, which in this context indicates a **right-to-left shunt**. [1] - While cyanosis is often present with significant right-to-left shunts, its absence might mean it is **subtle**, or the patient has adjusted to a **lower oxygen saturation threshold** for perceived cyanosis. [2] *Subacute bacterial Endocarditis* - Although **clubbing** can be a feature of **subacute bacterial endocarditis (SBE)**, this condition is more typically associated with systemic symptoms like fever, fatigue, and new or worsening heart murmurs. - The primary presentation here is clubbing in the context of a VSD and CCF, making SBE a less direct explanation for the immediate pathophysiology of clubbing. *Pulm. edema* - **Pulmonary edema** is characterized by **shortness of breath**, coughing, and crackles on pulmonary auscultation, resulting from fluid accumulation in the lungs. [3] - It does not directly cause **clubbing**, which is a sign of chronic tissue hypoxia. *Left to right shunt* - A **left-to-right shunt** in a VSD leads to **pulmonary hypertension** and congestive heart failure but generally does not cause **hypoxemia** or **clubbing**. - Clubbing is a sign of **cyanotic heart disease**, which requires at least a temporary or persistent **right-to-left shunt**.

Q: Inability to perform any work without discomfort is

NYHA 4. ***NYHA 4*** - **Class IV** of the **New York Heart Association (NYHA) Functional Classification** describes individuals who are unable to carry on any physical activity without symptoms, and may even experience symptoms at rest [1]. - This classification indicates **severe heart failure**, where patients experience extreme limitations in their daily life due to discomfort, shortness of breath, or angina [1], [2]. *NYHA 3* - **Class III** patients experience **marked limitation of physical activity**; they are comfortable at rest but ordinary physical activity causes fatigue, palpitations, dyspnea, or anginal pain [1]. - This is a less severe functional impairment than Class IV, as patients are still comfortable at rest, unlike those in Class IV [1]. *NYHA 1* - **Class I** patients have **no limitation of physical activity**; ordinary physical activity does not cause undue fatigue, palpitations, dyspnea, or anginal pain [1]. - This represents the mildest form of heart failure, where there are no symptoms during normal activities [1]. *NYHA 2* - **Class II** patients have **slight limitation of physical activity**; they are comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain [1]. - While there is some limitation, it is not as profound as Class IV, where any activity results in discomfort, and symptoms can occur even at rest [1].

Q: "Square root sign" is a hemodynamic finding seen in

Constrictive pericarditis. ***Constrictive pericarditis*** - The "square root sign" refers to the characteristic **ventricular pressure tracing** seen on cardiac catheterization in constrictive pericarditis, resembling a rapid early diastolic filling followed by a plateau (shaped like the mathematical square root symbol √). - This hemodynamic pattern is due to the **abrupt cessation of ventricular filling** when the stiff, fibrotic pericardium limits further expansion. - This is a **catheterization/hemodynamic finding**, not a radiological imaging finding. *ASD* - An **atrial septal defect** (ASD) is a congenital heart defect involving a hole in the septum separating the atria. - It does not present with a "square root sign" on pressure tracings; rather, it's associated with a **fixed, wide splitting of S2** and right heart enlargement on imaging. *Pleuro-pericardial cyst* - A **pleuro-pericardial cyst** is a benign, fluid-filled sac located near the heart or lungs. - While it may be identified on imaging, it typically causes no hemodynamic changes and thus no "square root sign" on cardiac pressure measurements. *HOCM* - **Hypertrophic obstructive cardiomyopathy** (HOCM) is characterized by thickening of the ventricular walls, leading to dynamic outflow tract obstruction. - Its pressure tracings show a **spike-and-dome pattern** with dynamic LVOT gradient, distinct from the "square root sign."

Q: Epsilon waves are most specific for

Arrhythmogenic RV Cardiomyopathy. ***Arrhythmogenic RV Cardiomyopathy*** - Epsilon waves are small, positive deflections seen at the end of the **QRS complex**, best observed in precordial leads (V1-V3), and are a characteristic ECG finding in **Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)**. - They represent delayed and fragmented electrical activity due to fibrofatty replacement of the right ventricular myocardium in ARVC. *Hypokalemia* - **Hypokalemia** typically manifests on ECG with **U waves**, which are positive deflections following the T wave, not epsilon waves. - Other ECG changes in hypokalemia include flattened T waves and ST-segment depression. *Hypothermia* - **Hypothermia** is associated with the presence of **Osborn waves** (J waves), which are positive deflections at the junction of the QRS complex and the ST segment. - These waves are distinct from epsilon waves and represent slowed repolarization. *PSVT* - **Paroxysmal Supraventricular Tachycardia (PSVT)** is a type of arrhythmia characterized by a narrow QRS complex tachycardia with a regular rhythm. - It does not involve epsilon waves; its ECG features are related to abnormal conduction pathways in the atria or AV node.

Q: Isolated systolic hypertension is defined as:

SBP>140, DBP 140, DBP 140, DBP 150, DBP 160, DBP 140 mmHg.

Q: Which of the following is a PRIMARY component of Tetralogy of Fallot?

Pulmonary stenosis. ***Pulmonary stenosis*** - **Pulmonary stenosis** is one of the four primary defects that define Tetralogy of Fallot, specifically an **obstruction to right ventricular outflow** [1]. - The severity of this stenosis largely determines the clinical presentation and degree of cyanosis in patients with Tetralogy of Fallot [1]. *ASD* - An **Atrial Septal Defect (ASD)** is not considered a primary component of Tetralogy of Fallot [2], although it can coexist in some patients. - The four classic defects of Tetralogy of Fallot are **pulmonary stenosis**, **ventricular septal defect (VSD)**, **overriding aorta**, and **right ventricular hypertrophy** [1]. *Right ventricular hypertrophy* - **Right ventricular hypertrophy** is a consequence of the increased workload on the right ventricle due to severe pulmonary stenosis and the **ventricular septal defect (VSD)** [1]. - While it is a characteristic finding, it technically develops secondary to the other primary defects, rather than being an initiating structural malformation itself. *None of the options* - This option is incorrect because **pulmonary stenosis** is a definitive and primary component of Tetralogy of Fallot [1]. - The disease is defined by a specific set of four defects, one of which is pulmonary stenosis [1].

Q: All are minor Jones Criteria except ?

Chorea. ***Chorea*** - **Sydenham's chorea** is considered a **major manifestation** in the modified Jones Criteria for acute rheumatic fever [1]. - It involves involuntary, purposeless movements, and is a strong indicator of the disease [1]. *Prolonged PR Interval* - A prolonged **PR interval** on EKG is a **minor manifestation** in the modified Jones Criteria, reflecting carditis [1]. - It indicates delayed conduction through the AV node, a common finding in acute rheumatic fever [1]. *Fever* - **Fever** is a **minor manifestation** as per the modified Jones Criteria [1]. - While common in many infections, in the context of preceding streptococcal infection, it supports a diagnosis of acute rheumatic fever. *Arthralgia* - **Arthralgia** (joint pain) without objective signs of inflammation is a **minor manifestation** in the modified Jones Criteria [1]. - This differentiates it from arthritis (a major criterion) where there is objective evidence of inflammation.

Q: Which of the following is the most appropriate initial antihypertensive treatment for an elderly patient with isolated systolic hypertension?

Amlodipine. Amlodipine - **Calcium channel blockers (CCBs)**, especially dihydropyridines like amlodipine, are recommended as initial therapy for isolated systolic hypertension in the elderly due to their effectiveness in reducing elevated systolic pressure [2]. - They are well-tolerated and can reduce the risk of cardiovascular events in this population. *Lisinopril* - **ACE inhibitors** like lisinopril are effective antihypertensives but are generally not the first-line choice for isolated systolic hypertension, particularly in elderly patients where a decrease in diastolic pressure might be detrimental [1]. - They are associated with side effects such as **cough** and can cause **acute kidney injury**, which can be a concern in older adults [1]. Atenolol - **Beta-blockers** like atenolol are generally not recommended as first-line therapy for isolated systolic hypertension due to their limited efficacy in lowering systolic blood pressure compared to other drug classes. - They may also worsen certain conditions common in the elderly, such as **peripheral vascular disease** and **bronchospastic lung disease**. *Losartan* - **Angiotensin receptor blockers (ARBs)** like losartan are effective for hypertension but are not typically favored over CCBs or thiazide diuretics as initial monotherapy for isolated systolic hypertension in the elderly [1]. - They share similar side effects and contraindications with ACE inhibitors, including the risk of **renal dysfunction** [1].

Q: Wide fixed S2 is seen in __________

ASD. ***ASD*** - A **wide fixed split S2** is a classic auscultatory finding in an **atrial septal defect (ASD)** due to continuous volume overload of the right ventricle, which delays pulmonic valve closure irrespective of respiration. - The constant shunting from left to right atrium maintains a sustained increase in pulmonary blood flow, causing the persistent delay in P2. *VSD* - A **ventricular septal defect (VSD)** typically presents with a **loud holosystolic murmur** at the left lower sternal border, not primarily a wide fixed split S2. - While VSD can cause pulmonary hypertension and affect S2, it doesn't usually result in a fixed split. *PDA* - A **patent ductus arteriosus (PDA)** is characterized by a **continuous, machinery-like murmur** best heard below the left clavicle. - While it can cause pulmonary hypertension, it does not typically produce a wide fixed S2 split, which is more specific to ASD. *All of the options* - This option is incorrect because a wide fixed S2 is a highly specific finding for **atrial septal defect (ASD)**, not common to all listed conditions. - While other conditions can affect S2, they do not produce the characteristic **fixed and wide splitting** seen in ASD.

Question 1

A patient with VSD in CCF develops clubbing with no cyanosis. The diagnosis is:

Accepted Answer

Right to left shunt

Answer

Subacute bacterial Endocarditis

Answer

Pulm. edema

Answer

Left to right shunt

Question 2

A 27-year-old man was assaulted and stabbed on the left side of the chest between the areola and the sternum. He is hemodynamically unstable with jugular venous distention, distant heart sounds, and hypotension. Which of the following findings would be consistent with a diagnosis of hemodynamically significant cardiac tamponade?

Accepted Answer

Equalization of pressures across the 4 chambers on Swan-Ganz monitoring

Answer

Decreased right atrial pressures on Swan-Ganz monitoring

Answer

More than a 10 mm Hg decrease in systolic blood pressure during inspiration (pulsus paradoxus)

Answer

Compression of the left ventricle on echocardiography

Question 3

Inability to perform any work without discomfort is

Accepted Answer

NYHA 4

Answer

NYHA 3

Answer

NYHA 1

Answer

NYHA 2

Question 4

"Square root sign" is a hemodynamic finding seen in

Accepted Answer

Constrictive pericarditis

Answer

ASD

Answer

Pleuro - pericardial cyst

Answer

HOCM

Question 5

Epsilon waves are most specific for

Accepted Answer

Arrhythmogenic RV Cardiomyopathy

Answer

Hypokalemia

Answer

Hypothermia

Answer

PSVT

Question 6

Isolated systolic hypertension is defined as:

Accepted Answer

SBP>140, DBP<90

Answer

SBP>140, DBP<80

Answer

SBP>150, DBP<90

Answer

SBP>160, DBP<90

Question 7

Which of the following is a PRIMARY component of Tetralogy of Fallot?

Accepted Answer

Pulmonary stenosis

Answer

ASD

Answer

Right ventricular hypertrophy

Answer

None of the options

Question 8

All are minor Jones Criteria except ?

Accepted Answer

Chorea

Answer

Prolonged PR Interval

Answer

Fever

Answer

Arthralgia

Question 9

Which of the following is the most appropriate initial antihypertensive treatment for an elderly patient with isolated systolic hypertension?

Accepted Answer

Amlodipine

Answer

Lisinopril

Answer

Atenolol

Answer

Losartan

Question 10

Wide fixed S2 is seen in __________

Accepted Answer

ASD

Answer

VSD

Answer

PDA

Answer

All of the options

Cardiology — MCQs

Cardiology — MCQs

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