MCQs in Cardiology

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heartMCQs in Cardiology 

1. Following is the largest protein molecule.

a. titin  b. actin  c. myosin  d. troponin  e. tropomyosin

ans…a.titin

titin (connectin)—— myofibrillar protein

longest gene is for cardiac  dystrophin.

2.The following finding differentiates acute LVF from a/c respiratory dyspnoea.

a .accentuated p2  b.bilateral rhonchi  c.sinus tachycardia d.pulsus alternans

e.tachypnea

ans  …..d…Pulsus alternans ….occurs in severe LVT.

Exaggerated in presence of AR, HTN and by reducing venous return.

Better felt in peripheral arteries—brachial/femoral.

Anacrotic,dicrotic and bisferiens better felt over the carotids.

Slow rising pulse—AS

Collapsing pulse-AR,PDA

Bisferens pulse—AS+AR

pulsus paradoxus—Pericardial tamponade,Constrictive pericarditis,RCM,pulmonary embolism,pregnancy,hypovolemia,COPD

corrigan’s pulse—AR

Pistal shot pulse—AR

Quinke’s pulse—-AR

Pulsus bigeminus—AV Block,digitalis toxicity.

3.Cannon  a waves is seen in  which of the following

a.TS  b.PS  c.TR   d.Ebsttein anomaly  e.Complete heart  block.

Ans……..e…..complete heart block

Large a waves –TS, Ebstein anomaly, PS, Pulmonary hypertension, c/c Corpulmonale, Cardiomyopathy

Cannon waves—Complete AV dissociation,eg. Complete heart block,Venticular tachycardia.

Absent a waves— Atrial flutter,Fibrillation

Large v wave—TR,ASD

Large x descent—c/c Constrictive pericarditis(normally x is more prominent)

Large y descent—Constrictive pericarditis(Frederich’s sign)

In cardiac tamponade x is sharper,y is unimpressive

Cardiac filling in cardiac tamponade is unimodal;(normal is bimodal filling)

Shallow y descent—TS

Absent hepatojugular reflux—IVC obstruction,Budd Chiari syndrome

4.. Figure of 8 appearance in x-ray is seen in

a. TAPVC b.TGV c.DORV d.Pulmonary atresia

e.Tricuspid atresia

ans…….a.TAPVC

TGV— egg on side appearance

pericardial effusion—stenciled appearance

Ebstein’s anomaly –Box shaped heart—–lithium?

Ebstein anomaly  is associated with WPW Syndrome type B

5.Following features helps to distinguish a/c Aortic dissection  from a/c MI.

a. the pain is severe b. radiation of pain to neck c. h/o hypertension d. hypotension

e. pain is maximum at the onset itself

ans……..e.pain is maximum at the onset itself

Aortic dissection more in hypertensives

cause of a/c ar

X-ray –calcium sign

best investigation –MRI

6.Cyanosis at birth is seen in the following conditions except

a.tetrology of fallot b.transposition of great arteries c.truncus arteriosus

d.pulmonary atresia e.tricuspid atresia.

.Ans…a…TOF

Commonest CHD  presenting with cyanosis is TGV

TOF—cyanosis usually begins after 6 months

Spells between 2 months and 2 years (cyanotic spells, tet spells)

Commonest cyanotic CHD

X-ray findings—normal sized boot shaped heart, oligemic lung fields

Central cyanosis, squatting position,

PS+VSD+ Over riding of aorta+ RVH

7.Following is true about normal JVP except

a.Normal pressure is 3-8 mmof Hg b.A wave is more prominent than V

c.Y descent is more prominent than X d.H wave is seen before A

e.Y descend occurs after the opening of tricuspid valve

Ans……..c… (normally x is more prominent)

8.Exertional  syncope   can occur in all the following, except

a.AS b.HCM c.primary pulmonary hypertension d.complet heart block e.AR.

Ans……e…

9.Non ejection click is heard in

a.AS b.PS c.TOF d.MVP e.Idiopathic dialatation of aorta

Ans…….d……MVP

10.Following condition causes reverse split

a. RBBB b. LBBB  c .Left anterior hemiblock d. Left posterior hemiblock  e. None

Ans…b…..LBBB

Reverse split..

delayed electrical activation of LV—LBBB, RV pacing, WPW®

obstruction to LV ejection—AS, HOCM

large LV output with low resistance—AR, PDA

LV dysfunction

Systolic hyperfunction

Wide split

RBBB, LV pacing, WPW(l)

PSs

ASD, PR

RV failure

Pulmonary embolism

Wide fixed split

ASD, TAPVC,  Single atrium, Pulmonary embolism, Constructive pericarditis

11.A late diastolic sound can occur in all the following ,except

a.hypertension b.coronary artery disease c.as d.ms e.hcm

ans.d…

early diastolic sounds  –os,s3,pericardial knock,tumor plop in myxoma

12. Continous murmur is heard in the following conditions except

a. ruptured aneurysm of sinus of Valsalva b. PDA c. AP window d. following BT shunt

e. AS+AR

PDA—Gibson murmur

13.Normal PR interval (milliseconds)  in ECG is

a.100-200 b.100—220  c.120-200 d.120—220 e.120—240

Ans…..c…

short PR interval—WPW syndrome, junctional rhythm, low atrial,  rhythm, infants

14.  25yr old female presents with episodes of muscle weakness. O/E BP –220/120,ECG showed LVH, prominent U waves. The likely diagnosis is

a. pheochromocytoma b. renal artery stenosis c. nephritis  d. coarctation of aorta

e. conn’s syndrome

prominent u waves – bradycardia, hypokalemia, hypomagnesaemia, raised intracranial pressure, hypothyroidism, digoxin

15. The most posterior structure of heart is 

a. left atrium b .right atrium c. left ventricle d. right ventricle e. right atrial appendage

ans….a

16. A 5 yr old child is brought with fever and skin rash. O/E cervical lymphadenopathy, splenomegaly. Echocardiogram revealed the following finding

a. MVP b. Aortic dilatation c. Pulmonary artery dilatation d. coronary dilatation

e. coronary atresia

ans…….b.

17.  Ejection fraction is calculated as

a.. SV/EDV b.. SV/ESV c.  ESV/EDV d.  EDV-ESV e.  none of  the above 

18.During phase 0 of action potential

a.sodium enters the cell b. sodium goes out of the cell c. potassium enters the cell

d. potassium goes out of the cell e. calcium leaves the cell

Ans……a…

.phase 1..chloride shift.

.phase 2 .calcium entry

phase  3.potassium exit

19.Commonest cause of sec-HTN is

a.renal parenchymal disease b.rena artery stenosis c.pheochromocytoma

d.primary aldosteronism e.aortoarteritis

Ans  ………..a

20.The apoprotein in LDL is 

a.B100 b.B48 c.A1 d.A11 e.C11

Ans……..a

Apo B48 is for chylomicrons

Apo A1 is –HDL

Cholestrol  <200, LDL<100, HDL >45 in males  >55 in females, TG<150

21.Cardiac lesion seen in Noonan’s syndrome is

a.COA b.Dyplstic pulmonary valve c.PS d.supra valvular AS e.PDA

Ans……b

Holt Oram sy-osteum secundum ASD

TAR-ASD

Ellis Van Creveld-primumASD

Turner’s-COA

Tuberoussclerosis-rhabdomyoma

LEOPARD –PS

William’s –supravalvularAS

Kaetageners-dextrocardia

Marfan’s-AR,MVP

Down’s-VSD-endocardial cushion defect

Rubella-PDA,PS

Lithium-Ebstein anomaly

AR- Murfans,osteogenesis imperfecta,pseudoxanthoma elasticum,Morquio’s

22.Commonest organism producing myocarditis is

a. coxackie virus b. adeno virus c. SARS virus d. mumps virus e. leptospira

ans—a…….

23.Following are true about HCM,except

a.famlial b.risk of sudden death c.fixed LV outflow obstruction d.deep t inversion in ECG

e.echo shows asymmetric septal hypertrophy

ans…c……

LVOT obstruction is dynamic in HOCM

Increases with exercise, ionotropic agents, increase in heart rate, reduction in LV size, vasodilators

Lutembacker syndrome –ASD+RHD(MS)

Brugada syndrome—ST elevation in V1-V3, mainly Thaiwan, familial

Long QT syndrome—familial 5-types ;sudden cardiac death-LQT -3( highest SCD)

24.According to the Starling’s law, the ventricular force of contraction is determined by a. EDV b. ESV c. EDPressure d. ESP e. SV

ans….EDV

25.Width of adult BP cuff is (In inches)

a. 1.5” b. 3” c. 5” d. 7” e. 8”

 Ans ……  c……

26. Widening of QRS  occurs in

a .hypokalemia b. hyperkalemia c. hypomagnesimia d. hypercalcemia e. hypocalcemia

Ans….b

hypokalemia –prominent U waves.ST_Tchanges,QU prolongation

hyperkalemia-tall T waves

27 .Normal right ventricular systolic pressure.

a. 5-10 b.10-15 c.15-30 d.20-40 e.30-45

Ans……c

Early diastolic sounds-OS,pericardial knock[constrictive pericarditis],S3tumor plop[LA myxoma]

LVSP-100-140mmhg

LVEDP-4-12

LA/PAWP-4-14

PA-15-30/5-15[mean-8-18]

RVDEP-3-8

RA-3-8

Prepared by IHMA Trivandrum