Learning Cardiology

Q. Which of the following is not an absolute contraindication of Sacubitril/valsartan combination? A. History of hypersensitivity to valsartan B. History of hyperkalemia with valsartan C. 1st trimester of pregnancy D. History of angioedema with ACE inhibitors Answer:  B. History of hyperkalemia with valsartan Absolute contraindications of sacubitril include 1. History of hypersensitivity to any of component of sacubitril 2. H/o angioedema due to ACE inhibitors or ARBs 3. Pregnancy Past history of hyperkalemia with valsartan is not a contraindication for the use of sacubitril as such potassium should be normal while starting it. However, potassium level should be monitored more carefully in these patients. Hence, sacubitril can be given to patients who have past history of hyperkalemia due to any cause.

Q. A 46 years old patient presented to you with history of chest pain for 3 hours duration. Initial ECG done at primary centre showed ST elevation in inferior leads which have completely resolved now. Patient is pain free at present. His vitals and clinical examination are completely normal. What should be the next appropriate strategy? A. Discharge the patient since clinical examination is normal and patient does not have any chest pain B. Observe him for at least 24 hours for recurrence of chest pain and then ask to follow in cardiology clinic C. Arrange early coronary angiography preferably within 24 hours D. Get the cardiac biomarkers done and if normal, discharge the patient to follow up in cardiology OPD Answer:  C. Arrange early coronary angiography preferably within 24 hours

Q. Contraindications of IABP? A. Aortic dissection B. Abdominal aortic aneurysm C. Significant aortic regurgitation D. Severe peripheral vascular disease E. All of the above Answer: E. All of the above

Q.  In heterotaxy, peripheral blood smear is most likely to show?  A.  Lymphoblasts B.  Spherocytes C.  Howell – Jolly bodies D.  Sickle cells Answer: C. Howell - Jolly bodies Explanation: Right atrial isomerism is associated with asplenia. And, asplenia causes formation of Howell Jolly bodies in the blood. 

Q. Which of the following is not an absolute contraindication for PTMC? A. Moderate MR B. LA clot C. Severe bicommissural calcification D. Wilkins score of 10 Answer: D. Wilkins score of 10 Explanation:  Absolute contraindications of PTMC include- 1. Moderate to severe MR 2. LA clot 3. Severe bicommissural calcification NB: Mild MR and LAA clot are not absolute contraindications for PTMC.

Q. Morrow's procedure is used for? A. Ebstein's anomaly B. DCMP C. HOCM D. DORV with VSD Answer: C. HOCM Explanation:  Morrow's procedure is septal myectomy done to relieve the left ventricular outflow tract (LVOT) obstruction and in turn decreases the gradient through LVOT. 

Q. Most common cause of pulmonary hypertension? A. Idiopathic pulmonary artery hypertension B. Left heart disease C. COPD D. CTEPH Answer: B. Left heart disease

Q. Which of the following is the most common major manifestation out of Jones criteria for the diagnosis of acute rheumatic fever? A. Arthritis B. Carditis C. Chorea D. Subcutaneous nodules E. Erythema marginatum Answer: B. Carditis

Q. All of the following have shown mortality benefit in heart failure except? A. Eplerenone B. Enalapril C. Digoxin D. Metoprolol Answer: C. Digoxin Explanation: Drugs which have shown mortality benefit in patients with heart failure with reduced ejection fraction (HFrEF) are- 1. Beta blockers 2. ACE inhibitors 3. Angiotensin receptor blockers 4. Aldosterone antagonist Digoxin did not show any survival advantage in these patients. None of drugs till date have shown mortality benefit in patients with heart failure with preserved ejection fraction (HFpEF).

Q. Which of the following denotes the power of a statistical method? A. Alpha error B. Beta error C. 1- Alpha D. 1- Beta Answer: D. 1-Beta

Q. Which of the following is not a feature of Trilogy of Fallot? A. Pulmonic stenosis B. VSD C. ASD D. Right ventricular hypertrophy Answer: B. VSD Explanation:  Trilogy of Fallot - 1. Pulmonic stenosis 2. RVH 3. ASD VSD is not part of Trilogy of Fallot. Tetralogy of Fallot - 1. Pulmonic stenosis 2. RVH 3. Overriding of Aorta 4. VSD Pentalogy of Fallot -  1. Pulmonic stenosis 2. RVH 3. Overriding of Aorta 4. VSD 5. ASD

Q. Bovine arch refers to? A. Common origin of brachiocephalic artery and left common carotid artery B. Common origin of left and right common carotid artery C. Separate origin of right subclavian and common carotid artery D. Anomalous origin of left subclavian artery from pulmonary artery Answer:  A.   Common   origin of brachiocephalic artery and left common carotid artery Explanation:  Bovine arch refers to common origin of brachiocephalic artery and left common carotid artery from the aortic arch. It is most common variation of aortic arch seen in human beings.  Bovine arch (BA) term is a  misnomer because it does not actually re fl ect the arch branching pattern found in cattle (a single common brachiocephalic trunk that gives rise to all head and upper extremity vessels is seen in cattles.) Reference: https://www.researchgate.net/publication/322451190_Prevalence_of_Bovine_Aortic_Arch_Variant_in_Patients_with_Aortic_Dissection_and_its_Implications_in_the_Outcome

Q. Most common type of VSD is? A. Muscular B. Perimembranous C. Inlet D. Outlet Answer: B. Perimembranous Explanation: Perimembranous VSD is most common (70%), followed by muscular VSD (24%), doubly committed subarterial VSD (6.4%) and the least common is inlet type of VSD (5.4%).  Reference: https://www.researchgate.net/publication/312590503_Frequency_of_Types_of_Ventricular_Septal_Defect_in_Cardiology  

Q. Acute pericarditis can be differentiated from early repolarization by? A. Progressive changes in ECG over days B. PR segment depression C. ST segment/T wave height ratio> 0.25 D. All of the above Answer: D. All of the above