New Series of Interactive Cardiology MCQs 4
Cardiology MCQs: Part 4
Answered: 0 / 25
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1. Which parameter is measured during the wave-free period of diastole without hyperemic agents?
Explanation: Instantaneous wave-free ratio (iFR) is measured during a specific period in diastole where microvascular resistance is constant and minimized, negating the need for vasodilators like adenosine.
2. The genetic mutation most commonly associated with Brugada syndrome involves which ion channel?
Explanation: Mutations in the SCN5A gene, encoding the alpha subunit of the cardiac sodium channel, are the most common identified genetic cause of Brugada syndrome.
3. In a patient with classical low-flow, low-gradient severe AS with reduced LVEF, which test distinguishes true severe from pseudosevere AS?
Explanation: Low-dose dobutamine stress echocardiography is used to assess contractile reserve and differentiate true severe AS from pseudosevere AS.
4. Which drug is a small interfering RNA (siRNA) directed against PCSK9 used for lowering LDL-C?
Explanation: Inclisiran is a double-stranded siRNA that inhibits the translation of PCSK9 in the liver, leading to prolonged reductions in LDL cholesterol.
5. The classic ‘square root sign’ on right ventricular hemodynamic pressure tracing is characteristic of:
Explanation: The dip-and-plateau or ‘square root’ sign represents rapid early diastolic filling followed by an abrupt halt, classically seen in constrictive pericarditis.
6. Which tachycardia is classically described as ‘verapamil-sensitive’?
Explanation: Idiopathic left fascicular VT is famously sensitive to verapamil, typically presenting with RBBB morphology and left axis deviation.
7. ‘Cannon A waves’ in the jugular venous pulse are a hallmark sign of:
Explanation: Cannon A waves occur when the right atrium contracts against a closed tricuspid valve during AV dissociation (e.g., in complete heart block or VT).
8. Primary mechanism of action of sacubitril?
Explanation: Sacubitril is a prodrug that inhibits neprilysin, an enzyme responsible for degrading natriuretic peptides and bradykinin.
9. Which congenital heart defect is most strongly associated with WPW syndrome?
Explanation: Ebstein anomaly, characterized by apical displacement of the tricuspid valve, has a high association with accessory pathways and WPW.
10. LGE on Cardiac MRI showing a global, subendocardial distribution not conforming to a coronary territory is classic for:
Explanation: The classic LGE pattern in cardiac amyloidosis is diffuse, global subendocardial enhancement with abnormal myocardial nulling.
11. Which medication primarily inhibits the late inward sodium current (INa)?
Explanation: Ranolazine selectively inhibits the late phase of the inward sodium current, reducing intracellular calcium overload.
12. Wellens’ syndrome on an ECG is highly specific for critical stenosis of which artery?
Explanation: Wellens’ syndrome (biphasic or deeply inverted T waves in V2-V3) indicates critical proximal stenosis of the LAD.
13. Epsilon waves on an ECG are most commonly associated with:
Explanation: Epsilon waves are a major diagnostic criterion for ARVC, reflecting delayed right ventricular activation.
14. In Marfan syndrome, prophylactic aortic root replacement is recommended when the root diameter reaches:
Explanation: The general threshold for prophylactic surgery in Marfan syndrome is >= 5.0 cm, or smaller if high-risk features exist.
15. A classic side effect uniquely associated with the P2Y12 inhibitor ticagrelor is:
Explanation: Ticagrelor is known to cause dyspnea in a significant percentage of patients, likely related to its effects on adenosine metabolism.
16. A ‘water-bottle’ shaped heart on a chest X-ray is most indicative of:
Explanation: A massive pericardial effusion classically results in an enlarged, globular ‘water-bottle’ shaped cardiac silhouette on CXR.
17. Which targeted therapy acts as an endothelin receptor antagonist for PAH?
Explanation: Bosentan is a dual endothelin receptor antagonist (ERA) used in PAH to prevent endothelin-mediated vasoconstriction.
18. Protein-losing enteropathy (PLE) is a known severe complication of:
Explanation: PLE is a highly morbid complication of the Fontan circulation, characterized by protein loss into the GI tract due to elevated central venous pressures.
19. Which genetic mutation is primarily responsible for Loeys-Dietz syndrome?
Explanation: Loeys-Dietz syndrome is caused by mutations in the transforming growth factor-beta receptor genes, distinguishing it from Marfan syndrome.
20. In HOCM, systolic anterior motion (SAM) typically involves which valve?
Explanation: SAM refers to the abnormal movement of the anterior mitral valve leaflet toward the septum during systole, causing LVOT obstruction.
21. ‘Osborn waves’ (J waves) on an ECG are pathognomonic for:
Explanation: Osborn waves are positive deflections at the J point classically seen in severe hypothermia.
22. Which antiarrhythmic agent requires 3 days of inpatient monitoring during initiation due to Torsades de Pointes risk?
Explanation: Dofetilide carries a high risk of dose-dependent QT prolongation and mandates a minimum of 3 days inpatient telemetry monitoring.
23. Which non-DHP CCB should be avoided in patients with HFrEF?
Explanation: Verapamil has significant negative inotropic effects and is generally contraindicated in HFrEF as it can exacerbate failure.
24. An ‘a’ wave in the venous pulse that is taller than the ‘v’ wave is typical of:
Explanation: In tricuspid stenosis, the right atrium contracts forcefully against a stenotic valve, producing a prominent ‘a’ wave in the JVP.
25. Pulsus paradoxus is defined as:
Explanation: Pulsus paradoxus is a drop in systolic blood pressure of >10 mmHg during inspiration, resulting from enhanced ventricular interdependence in cardiac tamponade.
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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