Cardiology MCQ Online 1
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Question 1 of 15
1. Question
1 points
The cut off value for septal thickness above which the risk of sudden cardiac death is considered high in hypertrophic cardiomyopathy is:
15 mm
20 mm
30 mm
40 mm
Correct
Generally the risk of sudden cardiac death in hypertrophic cardiomyopathy is considered to be high in those with a septal thickness of 30 mm or more. Implantation of an ICD (Implantable Cardioverter Defibrillator) may be considered in such situations. Those with a family history of premature sudden death also have a high risk and so do those with a history of resuscitated cardiac arrest. Recurrent episodes of non sustained ventricular tachycardia and syncope are also considered as risk factors.
Incorrect
Generally the risk of sudden cardiac death in hypertrophic cardiomyopathy is considered to be high in those with a septal thickness of 30 mm or more. Implantation of an ICD (Implantable Cardioverter Defibrillator) may be considered in such situations. Those with a family history of premature sudden death also have a high risk and so do those with a history of resuscitated cardiac arrest. Recurrent episodes of non sustained ventricular tachycardia and syncope are also considered as risk factors.
Question 2 of 15
2. Question
1 points
The rhythm in this ECG is suggestive of:
Sinus tachycardia
Atrial fibrillation
Supraventricular tachycardia
None of these
Correct
Supraventricular tachycardia is seen here at a rate of around 150 / min (RR interval 10 mm or 400 msec). The QRS is narrow in supraventricular tachycardia without any aberrant conduction as in this case. If there is aberrant conduction, it can be wide and usually showss a right bundle branch block pattern as aberrancy is more common in right bundle. The P waves are not very evident in this case and may be buried within the QRS complex. This can occur in AV nodal re-entrant tachycardia (AVNRT) and junctional tachycardia due to simultaneous activation of the atria and ventricles. When there is simultaneous contraction of the atria and ventricles, clinical examination will reveal cannon waves.
When a supraventricular tachycardia at a rate of 150 per minute is seen, atrial flutter with 2:1 conduction should also be borne in mind as the flutter waves may not be evident in all leads. Carotid sinus massage may alter the AV conduction ratio to make the flutter waves evident, if they are within the QRS or T waves.
The two common forms of supraventricular tachycardia are AVNRT and atrioventricular re-entrant tachycardia (AVRT) of WPW syndrome. The latter often manifest the typical pattern of WPW syndrome (short PR interval and delta wave) after termination of the tachycardia.
Incorrect
Supraventricular tachycardia is seen here at a rate of around 150 / min (RR interval 10 mm or 400 msec). The QRS is narrow in supraventricular tachycardia without any aberrant conduction as in this case. If there is aberrant conduction, it can be wide and usually showss a right bundle branch block pattern as aberrancy is more common in right bundle. The P waves are not very evident in this case and may be buried within the QRS complex. This can occur in AV nodal re-entrant tachycardia (AVNRT) and junctional tachycardia due to simultaneous activation of the atria and ventricles. When there is simultaneous contraction of the atria and ventricles, clinical examination will reveal cannon waves.
When a supraventricular tachycardia at a rate of 150 per minute is seen, atrial flutter with 2:1 conduction should also be borne in mind as the flutter waves may not be evident in all leads. Carotid sinus massage may alter the AV conduction ratio to make the flutter waves evident, if they are within the QRS or T waves.
The two common forms of supraventricular tachycardia are AVNRT and atrioventricular re-entrant tachycardia (AVRT) of WPW syndrome. The latter often manifest the typical pattern of WPW syndrome (short PR interval and delta wave) after termination of the tachycardia.
Question 3 of 15
3. Question
1 points
This X-ray shows a semilunar shadow of intimal calcification in aortic knuckle (yellow arrow). The position of this calcification can be helpful in the diagnosis of:
Aortoarteritis
Aortic aneurysm
Aortic dissection
None of these
Correct
Calcification of the intima of aortic knuckle (arrow) is a common finding in the elderly. Usually it is of no significance. But a separation of the intimal calcification from the edge of the aortic knuckle shadow indicates a separation of the intima from the media as in aortic dissection. This has been called the “calcium sign” in aortic dissection. A separation of more than 1 cm is considered significant.
Incorrect
Calcification of the intima of aortic knuckle (arrow) is a common finding in the elderly. Usually it is of no significance. But a separation of the intimal calcification from the edge of the aortic knuckle shadow indicates a separation of the intima from the media as in aortic dissection. This has been called the “calcium sign” in aortic dissection. A separation of more than 1 cm is considered significant.
Question 4 of 15
4. Question
1 points
ECG is suggestive of:
Acute anterior wall myocardial infarction
Old inferior wall infarction
Hyperacute inferior wall infarction
Posterior wall infarction
Correct
The ECG show ST segment elevation in leads II, III and aVf of about 3mm. ST segment depression is seen in leads I, aVl and V1 to V5. Overall features are suggestive of hyperacute phase of inferior wall myocardial infarction with “reciprocal” ST segment depression in anterior leads. The hyperacute phase is diagnosed when the ST segment is elevated and the T waves are upright in those leads. The segment is upsloping in hyperacute phase as the T waves are upright and sometime a bit tall. ST segment becomes “coved” as the T waves get inverted in the later phase. The “reciprocal” ST depression in anterior leads could be just an electrical phenomenon due to the ST segment elevation in the inferior leads or due to ischemia in the corresponding territory. We will see what exactly was there in this case in the still pictures of left and right coronary angiograms below.
Angiographic pictures can be viewed at: http://cardiophile.org/2008/11/ecg-quiz-22/
Incorrect
The ECG show ST segment elevation in leads II, III and aVf of about 3mm. ST segment depression is seen in leads I, aVl and V1 to V5. Overall features are suggestive of hyperacute phase of inferior wall myocardial infarction with “reciprocal” ST segment depression in anterior leads. The hyperacute phase is diagnosed when the ST segment is elevated and the T waves are upright in those leads. The segment is upsloping in hyperacute phase as the T waves are upright and sometime a bit tall. ST segment becomes “coved” as the T waves get inverted in the later phase. The “reciprocal” ST depression in anterior leads could be just an electrical phenomenon due to the ST segment elevation in the inferior leads or due to ischemia in the corresponding territory. We will see what exactly was there in this case in the still pictures of left and right coronary angiograms below.
Angiographic pictures can be viewed at: http://cardiophile.org/2008/11/ecg-quiz-22/
Question 5 of 15
5. Question
1 points
QT interval is not increased with:
Acidosis
Hyperkalemia
Hypercalcemia
Digoxin
All of these
None of these
Correct
Acidosis is associated with hyperkalemia due to extracellular shift of potassium. Hypercalcemia shortens the ST segment.
Incorrect
Acidosis is associated with hyperkalemia due to extracellular shift of potassium. Hypercalcemia shortens the ST segment.
Question 6 of 15
6. Question
1 points
Poor R wave progression in chest leads is seen with:
AWMI (anterior wall myocardial infarction)
RBBB (right bundle branch block)
RVH (right ventricular hypertrophy)
Right ventricular myocardial infarction
Correct
Prominent R waves are seen in anterior leads with right bundle branch block and right ventricular hypertrophy.
Incorrect
Prominent R waves are seen in anterior leads with right bundle branch block and right ventricular hypertrophy.
Question 7 of 15
7. Question
1 points
Least useful for diagnosis of reinfarction after a recent myocardial infarction:
CPK (creatine phosphokinase)
CPKMB (MB isoenzyme of CPK)
Troponin T
Myoglobin
Correct
Troponin T levels remain elevated for two weeks after a myocardial infarction. Hence it is not useful in diagnosing early re-infarction.
Incorrect
Troponin T levels remain elevated for two weeks after a myocardial infarction. Hence it is not useful in diagnosing early re-infarction.
Question 8 of 15
8. Question
1 points
Atrial rate always equal to ventricular rate in:
AVRT (atrioventricular re-entrant tachycardia)
Atrial tachycardia
Bundle branch re-entry
Atrial flutter with bypass tract
Correct
In AVRT, since the atria and ventricles are involved in the re-entrant circuit, atrial rate is always equal to ventricular rate. The tachycardia will not be sustained if there is a block in either limbs of the circuit (aneterograde or retrograde). Atrial tachycardia and flutter can continue in the presence of a block in conduction to the ventricles, though one to one conduction is also possible. Bundle branch re-entry causes ventricular tachycardia, which can have VA dissociation.
Incorrect
In AVRT, since the atria and ventricles are involved in the re-entrant circuit, atrial rate is always equal to ventricular rate. The tachycardia will not be sustained if there is a block in either limbs of the circuit (aneterograde or retrograde). Atrial tachycardia and flutter can continue in the presence of a block in conduction to the ventricles, though one to one conduction is also possible. Bundle branch re-entry causes ventricular tachycardia, which can have VA dissociation.
Question 9 of 15
9. Question
1 points
Regarding concealed AV (atrioventricular) bypass tract, true statement is:
Retrograde VA conduction does not occur
Does not participate in AVRT (atrioventricular re-entrant tachycardia)
Ventricular fibrillation will not occur if atrial fibrillation develops
All of these
None of these
Correct
In concealed AV bypass tract, it is the anterograde conduction which is absent, making it obscure in sinus rhythm. Retrograde conduction causes AVRT. It is well known that accessory pathway refractory period decreases when the rate increases as in atrial fibrillation and anterograde conduction may occur.
Incorrect
In concealed AV bypass tract, it is the anterograde conduction which is absent, making it obscure in sinus rhythm. Retrograde conduction causes AVRT. It is well known that accessory pathway refractory period decreases when the rate increases as in atrial fibrillation and anterograde conduction may occur.
Question 10 of 15
10. Question
1 points
Event farthest from the onset of QRS is:
Z point of atrial pressure tracing
Onset of rise of aortic pressure
Onset of isovolumetric contraction
Closure of mitral valve
Correct
The z point denotes the beginning of the c wave in the atrial pressure tracing. This corresponds to the end diastolic pressure after atrial contraction estimates preload to the ventricle. At this point the tricuspid valve is open, the right ventricle is full and the ventricle, atrium and vena cavae are all connected.
Incorrect
The z point denotes the beginning of the c wave in the atrial pressure tracing. This corresponds to the end diastolic pressure after atrial contraction estimates preload to the ventricle. At this point the tricuspid valve is open, the right ventricle is full and the ventricle, atrium and vena cavae are all connected.
Question 11 of 15
11. Question
1 points
Step down of pulmonary artery saturation in PDA (patent ductus arteriosus) is seen in:
Eisenmenger PDA
TOF (tetralogy of Fallot) with PDA
TGA (transposition of great arteries) with PDA
TAPVC (total anomalous pulmonary venous connection) with PDA
AP (aortopulmonary) window
Correct
The term step down is used when the given chamber has an oxygen saturation less than that of the proximal chamber. In TGA, aorta is connected to the pulmonary artery and has a lower oxygen saturation. Pulmonary artery is connected to the left ventricle receiving oxygenated blood from the left atrium. Hence when there is a PDA, desaturated blood enters the pulmonary artery from the aorta causing a step down in oxygen saturation compared to left ventricle which is the proximal chamber in this case.
Incorrect
The term step down is used when the given chamber has an oxygen saturation less than that of the proximal chamber. In TGA, aorta is connected to the pulmonary artery and has a lower oxygen saturation. Pulmonary artery is connected to the left ventricle receiving oxygenated blood from the left atrium. Hence when there is a PDA, desaturated blood enters the pulmonary artery from the aorta causing a step down in oxygen saturation compared to left ventricle which is the proximal chamber in this case.
Question 12 of 15
12. Question
1 points
ECG in myocarditis may show all except:
LBBB (left bundle branch block)
Increase in QRS voltage
Ventricular tachycardia (VT)
Ventricular fibrillation (VF)
Correct
Myocarditis, if at all, should produce a decrease in QRS voltage
Incorrect
Myocarditis, if at all, should produce a decrease in QRS voltage
Question 13 of 15
13. Question
1 points
Cardiotoxic effect of hyperkalemia increased by:
Hypernatremia
Hypercalcemia
Hypocalcemia
Alkalosis
Correct
Intravenous calcium is given for the treatment of hyperkalemia.
Incorrect
Intravenous calcium is given for the treatment of hyperkalemia.
Question 14 of 15
14. Question
1 points
Native valve endocarditis (NVE) least amenable to treatment:
Fungi
Aerobic gram negative bacteria
Staphylococcus aureus
Enterococci
Correct
Fungal endocarditis is characterized by large vegetations an is the most difficult to treat among the native valve endocarditis. Prolonged treatment courses and poor results are the rule. Fortunately, it is much rare compared to the other types.
Incorrect
Fungal endocarditis is characterized by large vegetations an is the most difficult to treat among the native valve endocarditis. Prolonged treatment courses and poor results are the rule. Fortunately, it is much rare compared to the other types.
Question 15 of 15
15. Question
1 points
Isolated diastolic dysfunction as compared to isolated systolic dysfunction:
Increased end diastolic volume
Increased end systolic volume
Increased ejection fraction
None of these
Correct
Increased EDV (end diastolic volume) and ESV (end systolic volume) are seen in systolic dysfunction. Ejection fraction (EF) is normal in diastolic dysfunction and decreased in systolic dysfunction. EDP (end diastolic pressure) is elevated in both diastolic and systolic dysfunction. E/A reversal is a feature of diastolic dysfunction, noted on Doppler echocardiography.
Incorrect
Increased EDV (end diastolic volume) and ESV (end systolic volume) are seen in systolic dysfunction. Ejection fraction (EF) is normal in diastolic dysfunction and decreased in systolic dysfunction. EDP (end diastolic pressure) is elevated in both diastolic and systolic dysfunction. E/A reversal is a feature of diastolic dysfunction, noted on Doppler echocardiography.
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