Cardiology exam MCQ

Cardiology MCQ

Dr Praveen GuptaJIPMER

PondicherryIndia

24/12/2016

Based on

Harrison's, 18TH Edition, Chapter 229. Noninvasive Cardiac Imaging:

Echocardiography, Nuclear Cardiology, and MRI/CT Imaging

Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and

Coronary Angiography: Introduction

Question 1

A 45 years old female with history of fever, joint pain since 2 month presented with acute onset weakness of left side of the body, so regarding ECHO finding of this patient which is true?

Option

A)Large vegetation attached to anterior mitral leaflet of the mitral valve

B)Benign tumor of the heart

C)Malignant tumor of the heart

D)Calcification on the anterior mitral leaflet in a patient of mitral stenosis

Answer

B)Benign tumor of the heart

Harrison's, 18TH Edition, Chapter 229. Noninvasive Cardiac Imaging:


The image is showing Left atrial myxoma

Question 2

Regarding Fractional flow reserve, which of the following is not true?

A) Measurement of the fractional flow reserve provides a functional assessment of the

stenosis.

B) The fractional flow reserve is the ratio of the pressure in the coronary artery distal to the

stenosis divided by the pressure in the artery proximal to the stenosis at maximal vasodilation.

C) Fractional flow reserve is measured using a coronary pressure–sensor guidewire at rest and

at maximal hyperemia following the injection of adenosine.

D) A fractional flow reserve of >0.75 indicates a hemodynamically significant stenosis that

would benefit from intervention

Answer

D) A fractional flow reserve of >0.75 indicates a hemodynamically

significant stenosis that would benefit from intervention



Question-3

36-year-old woman with no cardiovascular risk factors or other relevant history who consulted

for chest pain of 1 h duration. An electrocardiogram done by an out-of-hospital emergency

service showed ST elevation in I and aVL, a reciprocal decrease in the inferior leads, and

hyperacute T-waves at V4 through V6. After antiplatelet, anticoagulant, and nitrate therapy, the

elevated ST normalized and the patient arrived at the hospital asymptomatic. The left ventricular

ejection fraction (LVEF) was severely depressed (30%) due to extensive anterolateral akinesia.

Scheduled coronary angiography 48 h later showed coronary arteries with no atherosclerosis, and

a slight loss of diameter in the proximal and middle segments of the left anterior descending

artery (LAD). Following which patient underwent a new invasive imaging for diagnosis so which

of the following regarding this new imaging modaility is NOT TRUE?

Conti.-

Conti-

Conti-

A) Provides a more accurate anatomic assessment of the coronary artery and

the degree of coronary atherosclerosis

B) Performed using a small flexible catheter with a 40-mHz transducer at its tip

that is advanced into the coronary artery over a guidewire

C) May be used to image atherosclerotic plaque precisely, determine luminal

cross-sectional area, and measure vessel size

D) Not useul during or following percutaneous coronary intervention to assess

the stenosis and determine the adequacy of stent placement

Answer

D) Not useul during or following percutaneous coronary intervention to

assess the stenosis and determine the adequacy of stent placement

Image is showing intravascular ultrasound



Question-4

4) In a 30 years old male, regarding ECHO finding mark the correct statement?

A)Concentric left ventricular hypertrophy in a patient with systemic hypertension

B)It is an autosomal dominant condition in which the patient is at risk of ventricular

arrthymia, sudden cardiac death, heart failure

C)Benign lipomatous septal hypertrophy of the heart

D)Rhabdomyoma of the heart

Answer

B) It is an autosomal dominant condition in which the patient is at risk of

ventricular arrthymia, sudden cardiac death, heart failure

This is the ECHO image of HOCM patient

Harrison's, Chapter 229. Noninvasive Cardiac Imaging: Echocardiography,

Nuclear Cardiology, and MRI/CT Imaging

Question-5

A 26 years old male with past history of old treated pulmonary tuberculosis

present with history of pedal edema,ascites along with dyspnoea on

exertion for the past one month. On blood investigation he was found to be

HIV ELISA positive. CECT chest of the patient done so which of the

following is NOT true?

Conti..

Conti.

A) Surgery is the treatment of choice for this patient

B) ECHO cardiography is the best modality to diagnose above medical

condition

C) A diastolic dip and plateau or "square root sign," in the ventricular

waveforms during cardiac catheterization

D) Pressure changes in the right and left ventricles with inspiration are

observed

Answer

B) ECHO cardiography is the best modality to diagnose above medical

condition

Image is showing pericardial thickening along with pericardial calcification

which is the characteristics feature of constrictive pericarditis which is best

diagnosed by CECT chest



Question-6

A patient present with history of dyspnoea on exertion, his pressure tracing

during simultaneously recording of cardiac and aortic pressure is given

below so what is your diagnosis?

Option

A) Aortic stenosis

B) Aortic stenosis with

aortic regurgitation

C) HOCM

D) Coarctation of aorta

Answer

A) Aortic stenosis

Pressure tracing is suggestive of pulsus parvus et tardus which is the

characteristic feature found in a patient with aortic stenosis


Coronary Angiography: Introduction, Figure-230/2

Question-7

Brockenbrough-Braunwald sign is present in?

A) Aortic stenosis

B) HOCM

C) Pulmonary stenosis

D) Mitral stenosis

Answer

Answer- B)HOCM


Coronary Angiography: Introduction, Hemodynamics

Question-8

Regarding intracardiac shunt determination during cardiac catheterization, which of

the following is NOT TRUE?

A) Intra cardiac shunt should be suspected when there is unexplained arterial

saturation or desaturation of oxygen saturation of venous blood

B) A "step up" in oxygen content indicates the presence of a right-to-left shunt while a

"step down" indicates a left-to-right shunt

C) The shunt is localized by detecting a difference in oxygen saturation levels of 5–7%

between adjacent cardiac chambers

D) The severity of the shunt is determined by the ratio of systemic blood flow (Qp) to

the pulmonary blood flow

Answer

Answer- B) A "step up" in oxygen content indicates the presence of a right-

to-left shunt while a "step down" indicates a left-to-right shunt.



Question-9

All of the following are true about High-risk SPECT MPI findings except?

A) Severe resting or poststress LV systolic dysfunction

B) Large or multiple stress-induced defects

C) Large fixed defect with LV dilation

D) Decreased 201Tl lung uptake

Answer

D)Decreased 201Tl lung uptake

Harrison's, Chapter 229. Noninvasive Cardiac Imaging:


Question-10

Regarding PET to determine myocardial viability, which of the following is NOT

TRUE ?

A) Regarded as the gold standard technique for the assessment of myocardial viability.

B) The positron-emitting tracer F-18 fluorodeoxyglucose (FDG) assesses myocardial

glucose metabolism and is an indicator of myocardial viability.

C)With reduced myocardial blood flow and ischemia, substrate utilization switches

from fatty acids and lactate toward glucose

D)Decreased FDG uptake in regions of decreased perfusion identifies areas of ischemic

or hibernating myocardium

Answer

D) Decreased FDG uptake in regions of decreased perfusion identifies areas

of ischemic or hibernating myocardium



Question-11

A patient with a known case of bicuspid aortic valve present with acute

onset retrosternal chest pain radiating to back since two hours, on

examination blood pressure in the right arm was 180/110 mmhg and in the

left arm was 110/70 mmhg, so which of the following is the imaging

modality of choice to detect this condition?

A) Transthoracic echocardiography

B)Transesophageal echocardiography

C)CECT Chest

D)Chest X-ray

Answer

C)CECT Chest

The clinical feature is suggestive of acute aortic dissection which is best

diagnosed by CECT Chest



Question-12

Patient at risk of developing nephrogenic systemic fibrosis have impaired?

A) Liver function

B) Renal function

C) Left ventricular function

D) Diffusion lung capacity

Answer

B) Renal function



Question-13

Which of the following statement regarding coronary angiography is not true?

A) Right dominant circulation is found in 85% of individuals

B) Myocardial bridge most commonly involves the left anterior descending

artery

C) Presence of TIMI grade 3 flow suggests presence of significant coronary

artery stenosis

D) Coronary artery anomalies occur in 1–2% of patients

Answer

C) Presence of TIMI grade 3 flow suggests presence of significant

coronary artery stenosis



Question-14

Regarding hemodynamic measurement of heart in various pathological condition

which of the following is NOT TRUE?

A) In cardiac tamponade, there is decreased "y" descent

B) In constrictive pericarditis, there is prominent "y" descent

C) Concordant pressure changes in the right and left ventricles with inspiration is the

most specific hemodynamic phenomenon for constriction

D) Restrictive cardiomyopathy may be distinguished from constrictive pericarditis by a

marked increase in right ventricular and pulmonary artery systolic pressures

(usually >60 mmHg)

Answer

C) Concordant pressure changes in the right and left ventricles with

inspiration is the most specific hemodynamic phenomenon for constriction



Question-15

Normal Values for Hemodynamic Measurements include all of the following

except?

A) Systemic vascular resistance 900–1400 (dyn-s)/cm5

B) Pulmonary vascular resistance 40–120 (dyn-s)/cm5

C) Cardiac index [(L-min)/m2] 2.8–4.2

D) Pulmonary capillary wedge (mean) 4-6 mmhg

Answer

D) Pulmonary capillary wedge (mean) 4-6 mmhg

Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization

and Coronary Angiography: Introduction, Table 230/2

Cardiology exam MCQ

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