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Cardiology MCQ

By AdminPosted On 05-Oct-2016


1. Standing increases which of the following murmur ?

a) Mitral regurgitation (MR)

b) Aortic insufficiency (AI)

c) Tricuspid regurgitation (TR)

d) Hypertrophic cardiomyopathy (HCM)

e) Pulmonary stenosis (PS)


Correct Answer: d) Hypertrophic cardiomyopathy (HCM). Standing decreases venous return and ventricular filling. As a result, standing decreases the intensity of all murmurs except HCM. Murmur due to HCM will increase in intensity with any maneuver that decreases the volume of blood in the left ventricle (such as standing abruptly or the strain phase of a Valsalva maneuver). Administration of amyl nitrite will also accentuate the murmur by decreasing venous return to the heart.


2. Test for Myocardial Dysfunction

The best test for establishing the diagnosis and the degree of myocardial dysfunction is


a) Serial ECGs

b) Creatine phosphokinase (CPK-MB) fractionation

c) Echocardiography

d) Radionuclide angiography

e) Coronary angiography


Correct Answer: d) Radionuclide angiography. Nuclear cardiac-imaging techniques may be useful for detecting MI; assessing infarct size, collateral flow, and jeopardized myocardium; determining the effects of the infarct on ventricular function; and establishing the prognosis of patients with MI. However, the necessity of moving a critically ill patient from the CCU to the nuclear medicine department limits practical application of this study unless a portable gamma camera is available.

For the diagnosis of MI, cardiac radionuclide imaging should be restricted to special, limited situations in which the triad of the patient’s clinical history, ECG findings, and serum marker measurements is unavailable or unreliable.


3. Mitral Stenosis X-ray

In a patient with mitral stenosis will show all of the following findings on x-ray except


a) Raising up of the left bronchus

b) Shadow in shadow appearance

c) Kink in the esophagus in barium swallow studies

d) Obliteration of retrosternal shadow on lateral x ray


Correct Answer: d) Obliteration of retrosternal shadow on lateral x ray.

When left atrium is enlarged, it may compress on the esophagus and cause dysphagia – known as cardio-esophageal syndrome. Obliteration of the retrosternal airspace is seen in any cause of an anterior mediastinal mass.


4. Mitral Stenosis: Cardiology MCQs

All of the following statements are TRUE with regard to mitral stenosis EXCEPT


a) Rheumatic heart disease is the most common cause

b) Symptoms may be precipitated by atrial fibrillation, pregnancy, and anemia

c) Syncope is the most common presenting symptom

d) Hemoptysis is the second most common presenting symptom

e) If the defect is not corrected, atrial fibrillation almost always develops


Correct Answer: c) Syncope is the most common presenting symptom. In patients with structural heart disease, syncope can occur secondary to bradyarrhythmias, tachyarrhythmias, or arrhythmias secondary to medication and electrolyte abnormalities. Cardiac left ventricular outflow obstruction (including aortic stenosis or hypertrophic cardiomyopathy) or right ventricular obstruction (including pulmonary embolus or pulmonary hypertension) can cause syncope. Other cardiac structural abnormalities, such as mitral stenosis, atrial myxoma, or dissecting aortic aneurysm, can also lead to syncope but it is rare.


5. Pulsus bisferiens is seen in all of the following except

a) Aortic stenosis & aortic regurgitation

b) Mitral valve prolapse

c) Severe aortic regurgitation

d) Hypertrophic obstructive cardiomyopathy


Correct Answer: b) Mitral valve prolapse. Pulsus bisferiens, also bisferious pulse or biphasic pulse, is a sign where, on palpation of the pulse, a double peak per cardiac cycle can be appreciated. Bisferious means striking twice. Classically, it is detected when aortic insufficiency exists in association with aortic stenosis, but may also be found in isolated but severe aortic insufficiency, and hypertrophic obstructive cardiomyopathy. It is felt best in the radial artery.


6. Cardiac output : Cardiology MCQs

a) Varies with oxygen consumption

b) Increases with a rise in left ventricular end-diastolic volume

c) Increases with a rise in afterload

d) Increases with a rise in myocardial contractility

e) Can be estimated with echocardiography


Correct Answer: b,d,e. I am not sure about option ‘a’. Maybe somebody can throw light on this issue (Oxygen consumption).


7. Central Venous Pressure: Cardiology MCQ

Reduced central venous pressure may be due to


a) Intermittent positive pressure ventilation

b) Constrictive pericarditis

c) Increased venous capacitance

d) Tricuspid incompetence

e) Reduced myocardial contractility


Correct Answer: c) Increased venous capacitance. Venous dilators reduce venous pressure, which reduces preload on the heart thereby decreasing cardiac output. Sympathetic activation of veins decreases venous compliance, increases venomotor tone, increases central venous pressure and promotes venous return indirectly by augmenting cardiac output through the Frank-Starling mechanism, which increases the total blood flow through the circulatory system.


8. Severe Aortic Stenosis : Cardiology MCQ

Which of the following physical signs is seen in a patient with severe aortic stenosis


a) Holosystolic murmur

b) Diastolic rumble

c) Opening snap

d) Delayed upstroke of carotid


Correct Answer: d) Delayed upstroke of carotid. In severe aortic stenosis, the carotid arterial pulse typically has a delayed and plateaued peak, decreased amplitude, and gradual downslope (pulsus parvus et tardus). It is a sign where, upon palpation, the pulse is weak/small (parvus), and late (tardus) relative to its usually expected character.


9. Coarctation of the aorta (Select True) : Cardiology MCQ

a) is a congenital condition

b) produces upper-limb hypertension

c) may be associated with a displaced apex beat

d) produces a diastolic murmur over the precordium

e) produces skeletal abnormalities on a plain chest x-ray


Correct Answer: a,b,c,e. The murmur associated with coarctation of the aorta may be nonspecific yet is usually a systolic murmur in the left infraclavicular area and under the left scapula.


10. Cardiovascular System : Cardiology MCQ

Which of the following statements is true of the cardiovascular system?


a) Blood pressure = stroke volume X heart rate.

b) Left-to-right shunting across the duct is normal in the fetus.

c) The fetal heart does not start pumping blood until 18–20 weeks, because the placenta performs this function.

d) Contractility of the heart is independent of preload and afterload.

e) The ductus arteriosus can be kept open by the use of ibuprofen or indomethacin, but these have some side effects.


Correct Answer: d) Unlike stroke volume, contractility is independent of preload and afterload and is an innate property of myofibrils. ‘a’ is the formula for cardiac output. The ductus arteriosus carries relatively more oxygenated blood from the pulmonary artery to the aorta in the fetus thereby bypassing the lungs. The fetal heart develops in very early fetal life (18 days) and begins pumping blood by day 21. The placenta does not ‘pump’ blood to the fetus. Ibuprofen or Indomethacin are used to close a patent ductus arteriosus (PDA). Keeping a duct open requires prostaglandin (E1 or E2).


11. Jugular Venous Pressure : Cardiology MCQ

With regard to the jugular venous pressure (JVP) waveform, what can cause an elevated JVP reading with a normal waveform?


a) Atrial fibrillation

b) Left-sided heart failure

c) Right-sided heart failure

d) Tricuspid regurgitation

e) Tricuspid stenosis


Correct Answer: c) Right-sided heart failure. Although tricuspid valve disorders can cause an elevated JVP, there will not be a normal wave form.

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