Learning Cardiology

 Cardiology MCQ Q. Which of the following leads is not an inferior lead in ECG? A. Lead II B. Lead III C. Lead aVF D. Lead aVR Click the button below to view answer Show answer Correct answer is option D. Lead aVR

Cardiology MCQ Q. What is the mechanism of action of drug Bempedoic acid? A. ATP citrate lyase inhibitor B. HMG CoA reductase inhibitor C. Niemann–Pick C1-like 1 protein (NPC1L1) inhibitor D. PCSK9 inhibitor

Q. What is the life expectancy of a person with aortic stenosis presenting with history of syncope? A. 1 year B. 5 years C. 8 years D. 3 years Answer: D. 3 years Explanation:  Life expectancy of a person with symptomatic severe stenosis: (Mnemonic- A. S. D.) A- Angina- 5 years S- Syncope- 3 years D- Dyspnea (Heart failure)- 2 years

Q.  A young man in late his late 20s, case of rheumatic heart disease has a blood  pressure of 160/70 on examination. His mean arterial pressure  is: a. 100 mm Hg b. 110 mm Hg c. 90 mm Hg d. 120 mm Hg e. Can not be determined without knowing the heart rate Answer: Option a  Mean arterial pressure= (Systolic blood pressure + 2 x Diastolic blood pressure)/ 3

Q. All of the following are relative contraindications of mechanical prosthetic valve except? A. Long expected lifetime B. Unreliable anticoagution therapy C. Pregnancy D. Previous thormbosed valve Answer: A. Long expected lifetime Explanation: Long expected lifetime is an indication for mechanical prosthetic valve as bioprosthetic valve gets degenerated in 10-15 years. Mechanical prosthetic valves have a high risk of valve thrombosis and hence require lifelong anticoagulation. Anticoagulation becomes problematic in pregnancy. And, previous history of valve thrombosis increases the risk of recurrent valve thrombosis.

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. El-Sherif sign is? A. rSR complex in lateral chest leads B. Persistent ST elevation in anterior leads in myocardial infarction C. PR prolongation in acute rheumatic fever D. Delta wave in WPW syndrome Answer: A Explanation: A characteristic rsR′ pattern or its variants (rSr′ or rSR′) with normal or prolonged QRS duration in left surface leads including the apex lead and the orthogonal scalar X lead may be seen in patients with coronary heart disease and left ventricular aneurysm. This was first described by El-Sherif in 1970 hence known as El-Sherif sign. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC487350/

Q. Batista procedure is used for? A. Ebstein's anomaly B. DCMP C. HOCM D. Tricuspid atresia Answer: B. DCMP Explanation: Batista procedure is also called as left ventricular reduction surgery . It is used in dilated cardiomyopathy and is supposed to improve geometric remodeling. Initial reports showed promising results. However, this method was found to be of very little benefit. Hence it is no longer considered a recommended treatment for this disease. 

Q. All of the following predict non-operability in acyanotic congenital heart diseases with increased pulmonary artery pressure except? A. Baseline saturation less than 92% B. PVRI/SVRI >0.3 C. PVRI > 6 woods units/m 2 D. Qp/Qs > 2.0 Answer: D. Qp/Qs > 2.0 Explanation: In acyanotic congenital heart diseases (ASD, VSD, PDA, Complete AVSD) with pulmonary artery hypertension, there is a great dilemma for complete repair of the defect. Because if the patient has developed Eisenmenger syndrome, then he will have a poorer prognosis after surgery. Baseline saturation of less than 92% suggests significant reversal of shunt due to increased PA pressure. During cardiac catheterization study, pulmonary vascular resistance index (PVRI) more than 6 W/m2 and PVRI/SVRI more than 0.3 suggest significantly raised pulmonary artery pressure. These patients might not do well after surgical closure of the defect. For further decision regarding surgery in these cases, vasod

Q . Which of the following is true about NSTEMI? A. Normal ECG (electrocardiogram) does not rule out ACS. B. Patients with normal or abnormal ECG have same prognosis C. >0.2 mV ST depression should be present for diagnosis D. All are correct Ans : A. Normal ECG (electrocardiogram) does not rule out ACS. Explanation Normal ECG (electrocardiogram) carries a favorable prognosis but does not rule out ACS. Nearly 50 % of patients presenting with UA (unstable angina)/NSTEMI (non ST-elevation myocardial infarction) have a normal or unchanged ECG. UA/NSTEMI : New T wave inversions >0.2 mV and ≥ 0.05 mV ST depressions are suggestive.

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. Litten's sign is seen in? A. Rheumatic heart disease B. SLE C. Infective endocarditis D. Aortic regurgitation Answer: C. Infective endocarditis Explanation:  In infective endocarditis , white centred hemorrhages (cotton wool spots) can be seen in the retina on the fundoscopic examination of the patients. These are called as roth spots and sign is known as Litten's sign. 

Q. Most common primary cardiac tumor in infants? A. Myxoma B. Lymphoma C. Rhabdomyoma D. Fibroma Answer: Rhabdomyoma Explanation:  Cardiac tumors

Q. Which of the following is incorrect regarding prevention of contrast induced nephropathy? A. Preprocedure hydration with 0.9% NaCl is better than 0.45% NaCl B. Low osmolar contrast media is better than iso-osmolar contrast media C. Preprocedure use of N-acetyl cysteine is not recommended D. Biplane angiography is useful in reducing the dose of contrast Answer: B. Low osmolar contrast media is better than iso-osmolar contrast media Explanation: Contrast induced nephropathy (CIN) Transient increase in creatinine by 0.5 mg/dl or 25% increase from baseline. Occurs in 5% of patients following cardiac angiography. It is non-oliguric, peak within 1 to 2 days and then return to baseline by 7 days but may rarely require chronic dialysis. Risk factors: DM Pre-existing renal dysfunction Multiple myeloma Volume depletion Other nephrotoxic drug therapy The recommended maximum dose of contrast to limit CIN is 3 ml/kg (or 5 ml/kg divided by S. creatin

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. A 60-year-old man with no previous symptoms had a routine ECG. The ECG shows left bundle branch block. The patient is currently taking Aspirin 75 mg od. He has a family history of myocardial infarction. He smokes 20 cigarettes a day. The GP is concerned and refers the patient for further investigation. On examination, BP is 120/70 mmHg and there are no findings during cardiovascular examination.  Which of the following investigations is indicated? A.  Exercise ECG B.  CT of coronary arteries C.  Myocardial perfusion imaging D.  Coronary angiography    Answer: C. Myocardial perfusion imaging Explanation: For a patient with moderate likelihood of CAD (this patient is not symptomatic so is not in the high-risk category) non-invasive testing such as Exercise tolerance tests or myocardial perfusion tests should be performed. An exercise ECG test (TMT) will be difficult to interpret in this case due to the ECG changes of LBBB. Thus its most  appropriate to conduct a myocardial

Q. Which of the following is not true regarding the ISCHEMIA trial ? A. Patients with stable angina were included B. The patients with LM disease were excluded with a CT angiogram C. Early invasive therapy was found to reduce MI and cardiovascular mortality compared to medical therapy in patients with stable angina D. Results are not applicable to patients with severe LV dysfunction Correct answer: C. Early invasive therapy was found to reduce MI and cardiovascular mortality compared to medical therapy in patients with stable angina Explanation: https://www.learningcardiology.com/2020/06/ischemia-trial.html

Q. Calcium sign is seen in? A. Aortic aneurysm B. Aortic dissection C. Rheumatic heart disease D. Constrictive pericarditis Answer: B. Aortic dissection Explanation: The calcium sign is defined as the separation of the intimal calcification from the outer aortic soft tissue border by more than 10 mm . It is a specific chest radiographic finding of aortic dissection. It is more commonly seen in descending aortic dissection than aortic arch dissections.

Q. Which of the following is false about Takayasu arteritis? A. Strong female predominance B. Increased prevalence in western counties as compared to Asians C. Pulmonary artery involvement is seen in approximately 50% of patients D. Tends to affect younger patients Answer: B. Increased prevalence in western counties as compared to Asians Explanation:  Important points about Takayasu- 1) Takayasu arteritis has strong female predominance (F:M=9:1) 2) Increased prevalence in Asian populations 3) Tends to affect younger patients ( less than 50 years of age) 4) Pulmonary artery involvement is seen in 50% of patients 5) Takayasu was an ophthalmologist