Pulmonary Hypertension — MCQs

10 questions

Drug not used in pulmonary hypertension is:

Which of the following is not associated with pulmonary arterial hypertension?

A 40F with progressive exertional dyspnea and cyanosis. Physical examination reveals digital clubbing and a loud P2 heart sound. Most appropriate next step in diagnosis?

Which of the following is not typically seen on a chest X-ray in pulmonary artery hypertension?

A 55-year-old male, known smoker, complains of calf pain while walking. He experiences calf pain while walking but can continue walking with effort. Which grade of claudication does this patient fall under?

A child presented with a headache, dizziness, intermittent claudication with occasional dyspnoea. The most probable diagnosis is:

A patient presents with cyanosis and pulmonary complications. ECG shows left axis deviation. The most likely diagnosis is:

A child presents with LVH and pulmonary complications. ECG shows left axis deviation. Most likely diagnosis is:

Eisenmenger complex is common in adult in –

Q10

Which of the following drugs can be given in patients of primary pulmonary hypertension?

Pulmonary Hypertension Indian Medical PG Practice Questions and MCQs

Question 1: Drug not used in pulmonary hypertension is:

A. Endothelin receptor antagonist
B. Prostacyclin
C. Alpha blocker (Correct Answer)
D. Calcium channel blocker

Explanation: ***Alpha blocker*** - Alpha-blockers primarily cause **systemic vasodilation** [1] and are not indicated for the specific pulmonary vascular remodeling and vasoconstriction seen in pulmonary hypertension. [2] - Their use could lead to an undesirable drop in **systemic blood pressure** [3] without adequately addressing the pulmonary arterial pressure. *Calcium channel blocker* - **Calcium channel blockers** (namely **dihydropyridines** like nifedipine and amlodipine) are used in a small subset of pulmonary hypertension patients who are **vasoreactive** on acute testing. - They work by relaxing pulmonary arterial smooth muscle, reducing **pulmonary vascular resistance**. *Endothelin receptor antagonist* - **Endothelin receptor antagonists** (e.g., bosentan, ambrisentan) block the effects of **endothelin-1**, a potent vasoconstrictor and smooth muscle proliferator involved in pulmonary hypertension. - They improve hemodynamics, exercise capacity, and clinical outcomes by preventing **vasoconstriction** and **vascular remodeling**. *Prostacyclin* - **Prostacyclin analogs** (e.g., epoprostenol, treprostinil) are potent **vasodilators** and inhibitors of platelet aggregation. - They are highly effective in treating severe pulmonary hypertension by relaxing pulmonary arteries and preventing **thrombosis**.

Question 2: Which of the following is not associated with pulmonary arterial hypertension?

A. Cor - pulmonale
B. Left ventricular hypertrophy (Correct Answer)
C. Mitral Stenosis
D. Interstitial lung disease

Explanation: ***Left ventricular hypertrophy*** - **Left ventricular hypertrophy** is typically caused by conditions that increase the workload on the left ventricle, such as **systemic hypertension** or **aortic stenosis** [1]. - Pulmonary arterial hypertension directly affects the **pulmonary vasculature**, leading to increased pressure in the pulmonary circuit and ultimately right heart strain, not left ventricular hypertrophy. *Cor pulmonale* - **Cor pulmonale** is defined as **right ventricular enlargement** secondary to lung disease or pulmonary vascular disease. - Pulmonary arterial hypertension increases the afterload on the right ventricle, causing it to dilate and hypertrophy, eventually leading to **right heart failure** (cor pulmonale) [2]. *Mitral Stenosis* - **Mitral stenosis** causes an obstruction to blood flow from the left atrium to the left ventricle, leading to increased pressure in the left atrium and pulmonary veins. - This elevated pressure can be transmitted backward into the pulmonary arteries, leading to **pulmonary arterial hypertension** [3]. *Interstitial lung disease* - **Interstitial lung disease** (ILD) can lead to destruction and remodeling of the pulmonary capillaries, increasing pulmonary vascular resistance [2]. - This increased resistance causes the pulmonary arterial pressure to rise, resulting in **pulmonary arterial hypertension**.

Question 3: A 40F with progressive exertional dyspnea and cyanosis. Physical examination reveals digital clubbing and a loud P2 heart sound. Most appropriate next step in diagnosis?

A. Echocardiography (Correct Answer)
B. Pulmonary function test
C. Chest X-ray
D. Electrocardiogram

Explanation: ***Echocardiography*** - The presence of **exertional dyspnea**, **cyanosis**, **digital clubbing**, and a **loud P2 heart sound** strongly suggests pulmonary hypertension [1]. - An **echocardiogram** is crucial for directly visualizing the heart chambers and great vessels, allowing for the estimation of **pulmonary artery pressures** and assessing right ventricular function, which is key in diagnosing and evaluating **pulmonary hypertension** [1]. *Pulmonary function test* - While pulmonary function tests (PFTs) assess lung mechanics and volumes, they primarily help diagnose **obstructive** or **restrictive lung diseases**. - PFTs do not directly measure **pulmonary artery pressures** or assess cardiac structure, which are central to the patient's presentation. *Chest X-ray* - A chest X-ray can show signs of **pulmonary hypertension** such as **enlarged pulmonary arteries** or **cardiomegaly** [1], [2]. - However, it provides limited information regarding cardiac function and **pulmonary artery pressures** and is less specific than an echocardiogram for initial diagnosis [1]. *Electrocardiogram* - An ECG can detect signs of **right ventricular hypertrophy** or **right axis deviation**, which may be present in **pulmonary hypertension** [2]. - However, it offers no direct information on **pulmonary artery pressures** or structural abnormalities of the heart chambers.

Question 4: Which of the following is not typically seen on a chest X-ray in pulmonary artery hypertension?

A. Enlargement of central arteries
B. Peripheral pruning
C. Narrowing of central arteries (Correct Answer)
D. None of the options

Explanation: ***Narrowing of central arteries*** - **Pulmonary artery hypertension** is characterized by the **enlargement of the central pulmonary arteries** due to increased pressure. - **Narrowing of central arteries** would contradict the hemodynamic changes seen in pulmonary hypertension. - This is the finding that is **NOT typically seen**, making this the correct answer. *Enlargement of central arteries* - This is a **hallmark radiographic finding** in pulmonary hypertension, reflecting the **dilatation of the main and proximal pulmonary arteries** due to increased pressure. - The **pulmonary artery segment becomes prominent**, often appearing convex on the left heart border. *Peripheral pruning* - This refers to the **abrupt tapering and loss of peripheral pulmonary vascular markings**, indicating reduced blood flow to the distal lung parenchyma. - It is a **common finding in advanced pulmonary hypertension**, as the distal vessels constrict and become obliterated. *None of the options* - This is incorrect since **narrowing of central arteries** is clearly not a typical finding in pulmonary hypertension.

Question 5: A 55-year-old male, known smoker, complains of calf pain while walking. He experiences calf pain while walking but can continue walking with effort. Which grade of claudication does this patient fall under?

A. Grade I (Mild claudication)
B. Grade II (Moderate claudication) (Correct Answer)
C. Grade III (Severe claudication)
D. Grade IV (Ischemic rest pain)

Explanation: ***Grade II (Moderate claudication)*** - **Grade II claudication** is characterized by **intermittent claudication** where the patient experiences pain while walking but can **continue walking with effort**. - This level of claudication reflects a moderate degree of peripheral arterial disease, where blood flow is sufficiently compromised to cause pain with exertion but not severe enough to force immediate cessation of activity. - The patient in this scenario can continue ambulation despite discomfort, which is the defining feature of this grade. *Grade I (Mild claudication)* - **Grade I claudication** involves discomfort or pain that the patient can **tolerate without significantly altering their gait or pace**. - In this stage, the pain is minimal, and the patient may perceive it as a dull ache or mild fatigue rather than true pain. - Walking can continue without significant effort or limitation. *Grade III (Severe claudication)* - **Grade III claudication** is marked by pain that is **severe enough to stop the patient from walking within a short distance** (typically less than 200 meters). - The pain forces the patient to rest and recover before they can resume walking. - This represents significant functional limitation in daily activities. *Grade IV (Ischemic rest pain)* - **Grade IV**, also known as **critical limb ischemia**, involves **pain even at rest**, especially in the feet or toes, often worsening at night when the limb is elevated. - This stage indicates severe arterial obstruction and is frequently associated with **ulcers, non-healing wounds, or gangrene**. - This represents advanced peripheral arterial disease requiring urgent intervention. **Note:** This grading system is a simplified clinical classification. The standard medical classifications for peripheral arterial disease are the **Fontaine classification** (Stages I-IV) and **Rutherford classification** (Categories 0-6).

Question 6: A child presented with a headache, dizziness, intermittent claudication with occasional dyspnoea. The most probable diagnosis is:

A. TOF
B. PDA
C. Coarctation of aorta (Correct Answer)
D. ASD

Explanation: ***Coarctation of aorta*** - **Headache**, **dizziness**, and **intermittent claudication** in a child are classic symptoms indicating **hypertension in the upper extremities** and **hypoperfusion in the lower extremities**, which are hallmarks of coarctation of the aorta. - **Dyspnea** can occur due to increased left ventricular workload secondary to the aortic obstruction. *TOF (Tetralogy of Fallot)* - While it can cause dyspnea and cyanotic spells, it typically presents with **cyanosis** and **hypoxemia**, not the specific claudication or hypertension-related symptoms described. - The primary defect involves **pulmonary stenosis**, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. *PDA (Patent Ductus Arteriosus)* - Usually presents with a **continuous murmur** and can lead to symptoms of heart failure or pulmonary hypertension if large. - It does not typically cause the specific pattern of headache, dizziness, and intermittent claudication seen with aortic narrowing. *ASD (Atrial Septal Defect)* - Often **asymptomatic** in childhood or presents with exercise intolerance, recurrent respiratory infections, or signs of right heart overload. - It does not cause the **differential blood pressure** or flow abnormalities that lead to headache, dizziness, and claudication.

Question 7: A patient presents with cyanosis and pulmonary complications. ECG shows left axis deviation. The most likely diagnosis is:

A. TOF
B. Tricuspid atresia (Correct Answer)
C. TAPVC
D. VSD

Explanation: ***Correct Answer: Tricuspid atresia*** - Patients with **tricuspid atresia** often present with **cyanosis** due to right-to-left shunting across an atrial septal defect, and **pulmonary complications** can arise depending on pulmonary blood flow. - The ECG finding of **left axis deviation (LAD)** is highly characteristic of tricuspid atresia, as the main blood flow from the right atrium to the left atrium through the atrial septal defect leads to increased volume load on the left ventricle and left ventricular dominance. - LAD in a cyanotic neonate is virtually pathognomonic of tricuspid atresia. *Incorrect: TOF (Tetralogy of Fallot)* - While TOF causes **cyanosis** due to a right-to-left shunt, the ECG typically shows **right axis deviation** and **right ventricular hypertrophy**, not left axis deviation. - Pulmonary complications such as "tet spells" are common, but the distinctive ECG pattern (RAD, not LAD) helps differentiate it. *Incorrect: TAPVC (Total Anomalous Pulmonary Venous Connection)* - **TAPVC** presents with **cyanosis** and pulmonary edema or hypertension depending on the degree of obstruction to pulmonary venous return. - The ECG in TAPVC usually shows **right axis deviation** and **right ventricular hypertrophy** due to increased right-sided pressures, not LAD. *Incorrect: VSD (Ventricular Septal Defect)* - Isolated **VSDs** typically cause a **left-to-right shunt**, leading to pulmonary overcirculation and potentially heart failure, but **cyanosis is not a primary symptom** unless Eisenmenger syndrome develops later. - The ECG in VSD often shows **left ventricular hypertrophy** or biventricular hypertrophy depending on the size and duration of the shunt, but **left axis deviation is not a typical isolated finding** in uncomplicated VSD.

Question 8: A child presents with LVH and pulmonary complications. ECG shows left axis deviation. Most likely diagnosis is:

A. TOF
B. Tricuspid atresia (Correct Answer)
C. TAPVC
D. VSD

Explanation: ***Tricuspid atresia*** - **Left ventricular hypertrophy (LVH)** is common because the entire systemic venous return must pass from the right atrium through an atrial septal defect (ASD) into the left atrium and then to the left ventricle. The left ventricle then pumps blood through both the systemic circulation and, via a VSD, to the pulmonary circulation. - **Left axis deviation** is a classic ECG finding due to the hypoplastic right ventricle and the dominance of the left ventricle in pumping both systemic and pulmonary blood. *TOF* - **Tetralogy of Fallot** typically presents with **right ventricular hypertrophy (RVH)** due to the right ventricular outflow tract obstruction. - ECG usually shows **right axis deviation** and RVH, not LVH or left axis deviation. *TAPVC* - **Total anomalous pulmonary venous connection (TAPVC)** usually leads to **right ventricular volume overload** and **pulmonary hypertension**, resulting in right ventricular hypertrophy. - While it can cause pulmonary complications, **LVH and left axis deviation are not characteristic features**. *VSD* - A large **ventricular septal defect (VSD)** can cause **biventricular hypertrophy** or predominantly **left ventricular hypertrophy** due to increased pulmonary blood flow and left ventricular volume overload. - However, isolated, uncomplicated VSD does not typically present with **left axis deviation**; ECG findings are variable but often show an rsR' pattern in V1 or increased QRS voltages.

Question 9: Eisenmenger complex is common in adult in –

A. Cushion defect
B. ASD
C. PDA
D. VSD (Correct Answer)

Explanation: ***VSD*** - A large, uncorrected **ventricular septal defect (VSD)** is the most common congenital heart defect to progress to **Eisenmenger syndrome** in adults. [1] - The bidirectional or right-to-left shunting through the VSD eventually leads to **pulmonary hypertension** and and systemic cyanosis. [1] *Cushion defect* - While **atrioventricular septal defects (AVSDs)**, or cushion defects, can lead to pulmonary hypertension, they are less common causes of Eisenmenger syndrome than VSDs in adults. [1] - They involve defects in both atrial and ventricular septa, often seen in individuals with **Down syndrome**. [1] *ASD* - **Atrial septal defects (ASDs)** typically involve left-to-right shunting, and while they can cause pulmonary hypertension over many decades, they rarely progress to full Eisenmenger syndrome due to the lower pressure differential between the atria. [1] - The elevated pulmonary pressures with ASD tend to be less severe and slower in onset compared to VSDs or PDAs. [1] *PDA* - A **patent ductus arteriosus (PDA)** can lead to Eisenmenger syndrome, but it is less common in adults than VSDs because PDAs are often recognized and closed earlier in life. [1] - An uncorrected large PDA results in chronic left-to-right shunting, leading to increased pulmonary blood flow and subsequent **pulmonary vascular disease**. [1]

Question 10: Which of the following drugs can be given in patients of primary pulmonary hypertension?

A. Icatibant
B. Bosentan (Correct Answer)
C. Sodium nitroprusside
D. Labetalol

Explanation: ***Bosentan*** - **Bosentan** is an **endothelin receptor antagonist** that blocks the vasoconstrictive and proliferative effects of endothelin-1, a key mediator in the pathogenesis of **pulmonary hypertension**. - It is an FDA-approved medication specifically used for the treatment of **pulmonary arterial hypertension (PAH)**, improving exercise capacity and delaying clinical worsening. *Icatibant* - **Icatibant** is a **bradykinin B2 receptor antagonist** used in the treatment of **hereditary angioedema**. - It has no known role or efficacy in the management of **primary pulmonary hypertension**. *Labetalol* - **Labetalol** is a **beta-blocker** with **alpha-1 adrenergic blocking activity** used primarily for systemic **hypertension** and **hypertensive emergencies**. - Beta-blockers are generally **contraindicated** in pulmonary hypertension as they can worsen right heart function and lead to clinical deterioration. *Sodium nitroprusside* - **Sodium nitroprusside** is a **direct arterial and venous vasodilator** used in hypertensive crises and severe heart failure by reducing both preload and afterload. - While it can lower systemic blood pressure, its use in pulmonary hypertension is **limited** due to the risk of **systemic hypotension** and the lack of selective pulmonary vasodilation compared to other agents.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free