Cardiology Practice Questions

Q: A 16-year-old boy has a history of recurrent episodes of fainting in school assembly. ECG was done. Which is incorrect about the condition?

Pacemaker is treatment of choice. ***Pacemaker is treatment of choice*** - The ECG shows features of **Wolff-Parkinson-White (WPW) syndrome**, which is a type of **pre-excitation syndrome**. The primary treatment for symptomatic WPW syndrome, especially in a young person with recurrent syncope, is typically **catheter ablation** of the accessory pathway, not a pacemaker. - A pacemaker is generally indicated for bradyarrhythmias or certain types of heart block, neither of which is the primary issue in WPW syndrome. *Pre-excitation syndrome* - The ECG demonstrates characteristic findings of pre-excitation syndrome, specifically Wolff-Parkinson-White syndrome, where an **accessory pathway** bypasses the AV node, leading to early ventricular activation. - This is a **correct statement** about the condition shown in the ECG. *Wide QRS* - The ECG shows a **widened QRS complex** (greater than 0.10 seconds), which is a common feature of WPW syndrome due to the fusion of ventricular activation via the normal conduction system and the accessory pathway. - This broadens the QRS duration as ventricular depolarization starts earlier. This is a **correct statement**. *Delta wave* - A **delta wave**, which is a slurred upstroke of the QRS complex, is evident in the ECG and represents the initial, slow ventricular activation through the accessory pathway. - The delta wave is a hallmark of WPW syndrome. This is a **correct statement**. *Short PR interval* - The ECG demonstrates a **short PR interval** (less than 0.12 seconds), which is a characteristic finding of pre-excitation syndrome. - This occurs because the accessory pathway allows rapid conduction that bypasses the normal AV nodal delay. This is a **correct statement**.

Q: A 70-year-old hypertension patient presents with complaints of palpitations and presyncope. On examination, his heart rate is 72 bpm and BP is 150/100, ECG done shows:

Atrial flutter. ***Atrial flutter*** - The ECG shows **organized sawtooth flutter waves** and a **relatively regular ventricular rate**, consistent with atrial flutter with approximately 4:1 AV conduction. - The organized atrial activity produces a characteristic flutter wave pattern, especially visible in leads II, III, and aVF, and is consistent with the patient's complaints of palpitations and presyncope in the setting of hypertension. *Atrial fibrillation* - Characterized by **irregularly irregular R-R intervals** and the **absence of distinct P waves**, with a chaotic fibrillatory baseline. - The organized sawtooth flutter waves and relatively regular ventricular response seen in this ECG are inconsistent with atrial fibrillation. *Multifocal atrial tachycardia* - Defined by at least **three different P wave morphologies** and an irregular rhythm. - The organized sawtooth flutter waves and relatively regular ventricular rate seen in this ECG rule out multifocal atrial tachycardia, which would require distinct P waves of varying morphology rather than the uniform flutter wave pattern present here. *PSVT* - Paroxysmal supraventricular tachycardia (PSVT) typically presents with a **regular, narrow-complex tachycardia** with an abrupt onset and termination. - The ECG in question exhibits **organized sawtooth flutter waves** with a relatively regular ventricular rhythm, which is inconsistent with the regular P waves or pseudo-R' waves often seen in typical PSVT and is more characteristic of atrial flutter. *Sinus rhythm with premature atrial contractions* - While PACs can cause an irregular rhythm, they occur against a background of **regular sinus rhythm with identifiable P waves**. - In this ECG, the organized sawtooth flutter wave pattern distinguishes atrial flutter from occasional PACs.

Q: A 50-year-old dilated cardiomyopathy patient underwent a procedure shown below. What is it known as?

Cardiac resynchronization therapy. ***Cardiac resynchronization therapy*** - The image shows three leads: one in the **right atrium**, one in the **right ventricle**, and crucially, one in a **coronary vein** overlying the **left ventricle**. - This configuration with **biventricular pacing** (right and left ventricular leads) is characteristic of CRT, designed to improve cardiac synchrony in patients with heart failure and ventricular dyssynchrony. *Cardiac resynchronization therapy with defibrillator* - CRT-D combines biventricular pacing with defibrillation capabilities, featuring leads similar to CRT but with **shock coil electrodes** for high-energy defibrillation. - The leads shown in the image appear to be standard thin pacing leads without the characteristic **large coil electrodes** seen in defibrillator systems. *Implantable cardioverter defibrillator* - While an ICD also involves leads inserted into the heart, it typically includes leads with large **coil electrodes** capable of delivering high-energy shocks for defibrillation. - The depicted leads are thin pacing leads, not characteristic of high-energy defibrillation leads, though some ICDs can also provide pacing. *Direct cardioversion* - Direct cardioversion is an **external procedure** using paddles or patches to deliver an electric shock to the chest wall. - It does not involve surgically implanted leads within the heart chambers. *Transvenous pacemaker* - A standard transvenous pacemaker typically has one or two leads, commonly placed in the **right atrium** and/or **right ventricle**. - It lacks the dedicated **left ventricular lead** (often placed via the coronary sinus) seen in the image, which is essential for resynchronization.

Q: A patient suffers from STEMI. He was taken to cath lab. What is the name of the Catheter shown below?

Judkin's catheter. ***Judkin's catheter*** - The image displays the characteristic pre-formed curved tip of a **Judkin's catheter** designed to selectively engage the **coronary arteries** from the ascending aorta. - Judkin's catheters come in different curves (e.g., JL for left, JR for right) to optimally cannulate the specific coronary ostia for angiography or intervention. *Amplatz catheter* - An **Amplatz catheter** is another type of pre-formed coronary catheter with different curve configurations (e.g., AL for left, AR for right) used for selective coronary engagement. - Amplatz catheters have a wider, more circular primary curve compared to Judkin's catheters and are particularly useful when Judkin's catheters fail to engage or in cases of unusual coronary anatomy. - The catheter shown has the characteristic Judkin's curve rather than the Amplatz configuration. *Aubaniac catheter* - The **Aubaniac catheter** is a recognized historical device used for **subclavian venous catheterization**, named after Robert Aubaniac who described the infraclavicular subclavian vein approach. - Its structure and function are entirely different from the catheter shown, which is used for selective coronary cannulation. *Pig tail catheter* - A **pigtail catheter** has a distinctive curved tip with multiple side holes, resembling a pig's tail, primarily used for **LV ventriculography** or non-selective angiography in large vessels. - Its design is for safe, high-volume contrast injection in a chamber like the left ventricle, not for selective coronary cannulation as depicted. *Malecot catheter* - A **Malecot catheter** is a type of self-retaining catheter with wing-like side flanges near the tip, commonly used for **drainage purposes** in urology or gastroenterology (e.g., nephrostomy, gastrostomy). - Its structure and function are entirely different from the catheter shown, which is used for vascular access and cannulation.

Q: The tracing shows a repeating pattern of three normal sinus beats followed by a premature ventricular contraction. This is diagnostic of:

Ventricular quadrigeminy. ***Ventricular quadrigeminy*** - This rhythm pattern consists of **three normal sinus beats** followed by a single PVC, and this sequence repeats. - The provided ECG tracing clearly shows this repeating pattern, with three narrow QRS complexes (sinus beats) followed by a wide, bizarre QRS complex (PVC). *Ventricular bigeminy* - This rhythm is characterized by a **normal sinus beat** followed by a premature **ventricular contraction (PVC)**, and this pattern then repeats. - The tracing shows a 3:1 ratio of normal beats to PVCs, not a 1:1 ratio characteristic of bigeminy. *Ventricular couplets* - This term refers to **two consecutive PVCs** occurring together, which is not the pattern seen in the tracing. - In a couplet, there would be no intervening normal sinus beat between the PVCs. *Ventricular trigeminy* - This rhythm involves **two normal sinus beats** followed by a single PVC, and this sequence repeats. - The tracing shows a 3:1 ratio of normal beats to PVCs, not a 2:1 ratio characteristic of trigeminy. *Ventricular tachycardia* - This is defined as **three or more consecutive PVCs** occurring at a rapid rate, leading to a sustained rhythm of wide QRS complexes. - The tracing shows isolated PVCs alternating with normal beats, not a sustained run of wide QRS complexes.

Q: A 65-year-old pensioner in ESI dispensary complains of exercise intolerance. On auscultation a systolic murmur grade 3 is heard. What does the ECG show?

Left ventricular hypertrophy. ***Left ventricular hypertrophy*** - The ECG shows significantly **tall R waves** in leads V4-V6 and deep S waves in V1-V2, indicating increased left ventricular mass. - This finding is consistent with **left ventricular hypertrophy (LVH)**, which often develops in patients with aortic stenosis, a condition that can cause a systolic murmur and exercise intolerance. *Normal tracing* - A normal ECG would not exhibit such pronounced voltage criteria for LVH or significant ST-T wave changes. - The elevated R wave amplitude in lateral leads and deep S waves in precordial leads are beyond normal limits. *Atrial fibrillation* - Atrial fibrillation is characterized by an **irregularly irregular rhythm** and absence of distinct P waves, neither of which is present on this ECG. - The rhythm here appears regular with clear P waves preceding each QRS complex. *Left bundle branch block* - Left bundle branch block (LBBB) is characterized by a **widened QRS complex** (>0.12 seconds) and a dominant S wave in V1, with broad, notched R waves in lateral leads (I, aVL, V5, V6). - While there are tall R waves in lateral leads, the QRS duration is not significantly widened, and the characteristic morphology of LBBB is absent. *Right ventricular hypertrophy* - Right ventricular hypertrophy (RVH) typically shows **tall R waves in V1-V2** with deep S waves in V5-V6, which is the opposite pattern of what is seen here. - RVH is associated with conditions like pulmonary stenosis or chronic lung disease, and would present with right axis deviation, not the left-sided voltage criteria seen in this ECG.

Question 1

A 16-year-old boy has a history of recurrent episodes of fainting in school assembly. ECG was done. Which is incorrect about the condition?

Accepted Answer

Pacemaker is treatment of choice

Answer

Pre-excitation syndrome

Answer

Wide QRS

Answer

Delta wave

Answer

Short PR interval

Question 2

A 65-year-old man presents with crushing chest pain for 2 hours. On examination, BP = 80/60 mm Hg and JVP is elevated 4 cm above the sternal angle. All are true about the condition shown except:

Accepted Answer

ST segment depression in lead II, III, aVF

Answer

ST elevation in V4R

Answer

Right ventricular infarction

Answer

Cardiogenic shock

Answer

Proximal right coronary artery occlusion

Question 3

A 40-year-old man who had recently joined a gym collapsed on the treadmill. His resting ECG shows a normal QTc and cardiac imaging shows no structural heart disease. He was rushed to the hospital where an ECG shows presence of:

Accepted Answer

Catecholamine-sensitive ventricular tachycardia

Answer

Long QT syndrome

Answer

Arrhythmogenic right ventricular dysplasia

Answer

Acute extensive anterior wall MI

Answer

Brugada syndrome

Question 4

A 70-year-old hypertension patient presents with complaints of palpitations and presyncope. On examination, his heart rate is 72 bpm and BP is 150/100, ECG done shows:

Accepted Answer

Atrial flutter

Answer

Sinus rhythm with premature atrial contractions

Answer

Multifocal atrial tachycardia

Answer

PSVT

Answer

Atrial fibrillation

Question 5

A 50-year-old dilated cardiomyopathy patient underwent a procedure shown below. What is it known as?

Accepted Answer

Cardiac resynchronization therapy

Answer

Implantable cardioverter defibrillator

Answer

Direct cardioversion

Answer

Transvenous pacemaker

Answer

Cardiac resynchronization therapy with defibrillator

Question 6

This 50-year-old patient developed syncope after having a coffee and is currently unresponsive and hypotensive with sustained polymorphic ventricular tachycardia. ECG was done .Which is the most appropriate therapy for a patient suffering from the condition shown below?

Accepted Answer

DC shock

Answer

Esmolol

Answer

Lignocaine

Answer

Amiodarone

Answer

Magnesium sulfate

Question 7

A patient suffers from STEMI. He was taken to cath lab. What is the name of the Catheter shown below?

Accepted Answer

Judkin's catheter

Answer

Malecot catheter

Answer

Pig tail catheter

Answer

Aubaniac catheter

Answer

Amplatz catheter

Question 8

The tracing shows a repeating pattern of three normal sinus beats followed by a premature ventricular contraction. This is diagnostic of:

Accepted Answer

Ventricular quadrigeminy

Answer

Ventricular bigeminy

Answer

Ventricular trigeminy

Answer

Ventricular tachycardia

Answer

Ventricular couplets

Question 9

A 65-year-old pensioner in ESI dispensary complains of exercise intolerance. On auscultation a systolic murmur grade 3 is heard. What does the ECG show?

Accepted Answer

Left ventricular hypertrophy

Answer

Normal tracing

Answer

Atrial fibrillation

Answer

Left bundle branch block

Answer

Right ventricular hypertrophy

Question 10

An 89-year-old man with hypertension presents for routine follow-up. ECG shows:

Accepted Answer

LBBB

Answer

ST elevation

Answer

Extreme axis deviation

Answer

RBBB

Answer

Left ventricular hypertrophy

Cardiology — MCQs

Cardiology — MCQs

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