New Series of Interactive Cardiology MCQs 2
1. What is the most common cause of functional tricuspid regurgitation?
Explanation: Functional TR is usually due to annular dilation from right ventricular enlargement or pulmonary hypertension.
2. Which ECG finding is most specific for acute pericarditis?
Explanation: PR segment depression is highly specific for acute pericarditis and represents atrial injury.
3. What is the primary mechanism of action of Sacubitril?
Explanation: Sacubitril is a prodrug that inhibits neprilysin, an enzyme that degrades natriuretic peptides.
4. Kussmaul’s sign (paradoxical rise in JVP on inspiration) is classically seen in which condition?
Explanation: It indicates impaired right ventricular filling, classic for constrictive pericarditis, right ventricular infarction, or restrictive cardiomyopathy.
5. What is the most common cyanotic congenital heart disease surviving to adulthood?
Explanation: ToF is the most common cyanotic CHD and with surgical repair, many patients survive well into adulthood.
6. Pulsus bisferiens (bifid pulse) is most characteristically associated with which of the following?
Explanation: It can also be seen in isolated severe AR and mixed AS/AR, but the classic double systolic peak is a hallmark of HOCM.
7. Which valve is most commonly affected in infective endocarditis in intravenous drug users?
Explanation: The tricuspid valve is the first valve encountered by venous blood returning from peripheral injections, making it highly susceptible in IVDUs.
8. The ‘S1Q3T3’ pattern on an ECG is classically associated with which condition?
Explanation: This pattern indicates acute right heart strain, classically taught as a sign of pulmonary embolism, though sinus tachycardia is more common.
9. Which antihypertensive medication class is absolutely contraindicated in bilateral renal artery stenosis?
Explanation: ACE inhibitors remove the angiotensin II-mediated efferent arteriolar vasoconstriction, precipitating acute renal failure in bilateral RAS.
10. Which cardiac biomarker is considered the first-line choice for diagnosing acute myocardial infarction due to its high sensitivity and specificity?
Explanation: Cardiac troponins are the most sensitive and specific markers for myocardial necrosis.
11. An early diastolic, high-pitched, blowing murmur heard best at the left sternal border is characteristic of:
Explanation: This is the classic description of the murmur of aortic regurgitation.
12. What is the fundamental mechanism of action of Aspirin in cardiovascular disease prevention?
Explanation: Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), preventing the formation of Thromboxane A2 and thus inhibiting platelet aggregation.
13. Beck’s triad, consisting of hypotension, jugular venous distension, and muffled heart sounds, is indicative of:
Explanation: Beck’s triad is the classic clinical presentation of acute cardiac tamponade.
14. The typical ECG manifestation of Wolff-Parkinson-White (WPW) syndrome includes a short PR interval and a slurred upstroke of the QRS complex known as a:
Explanation: The delta wave represents early ventricular depolarization via an accessory pathway (Bundle of Kent).
15. Which cardiomyopathy is primarily characterized by a thickened, non-dilated left ventricle in the absence of another systemic or cardiac disease capable of producing the magnitude of hypertrophy?
Explanation: HCM is a genetic disorder of the cardiac sarcomere characterized by unexplained LV hypertrophy.
16. Bisoprolol belongs to which class of medications?
Explanation: Bisoprolol is a highly selective beta-1 adrenergic receptor antagonist.
17. A ‘machine-like’ continuous murmur heard at the left infraclavicular area is classic for:
Explanation: PDA causes a continuous flow of blood from the aorta to the pulmonary artery throughout the cardiac cycle.
18. The most common primary cardiac tumor in adults is:
Explanation: Atrial myxomas are the most common primary cardiac tumors, predominantly occurring in the left atrium.
19. What is the appropriate pharmacological antidote for severe Warfarin toxicity with bleeding?
Explanation: Vitamin K reverses warfarin over time, while PCC provides immediate replacement of vitamin K-dependent clotting factors.
20. A ‘water-hammer’ (Corrigan’s) pulse, characterized by a rapid upstroke and rapid collapse, is seen in:
Explanation: The widened pulse pressure in aortic regurgitation leads to this bounding, rapidly collapsing pulse.
21. In a right-dominant coronary circulation, which artery supplies the AV node?
Explanation: In about 80-85% of people (right-dominant), the posterior descending artery and AV nodal branch arise from the RCA.
22. Janeway lesions and Osler nodes are classical peripheral stigmata of:
Explanation: These are classic, though increasingly rare, signs of infective endocarditis.
23. Which of the following drugs is a mineralocorticoid receptor antagonist used to reduce mortality in heart failure with reduced ejection fraction?
Explanation: Spironolactone and Eplerenone antagonize aldosterone, preventing deleterious cardiac remodeling in HFrEF.
24. What is the normal duration of the PR interval on a standard ECG?
Explanation: A normal PR interval is 120-200 ms (3 to 5 small squares). >200 ms defines first-degree AV block.
25. Epsilon waves, a small positive deflection buried in the end of the QRS complex, are characteristically associated with:
Explanation: Epsilon waves reflect delayed right ventricular activation and are a major diagnostic criterion for ARVD/C.
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About The Author
Johnson Francis
Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal