Here are multiple choice questions (MCQs) in cardiology with detailed answers:
1. Which of the following is the most common cause of acute myocarditis?
A) Coxsackievirus B) Streptococcus pneumoniae C) Staphylococcus aureus D) Mycobacterium tuberculosis
Answer: A) Coxsackievirus
Explanation: Coxsackievirus is the most common viral cause of acute myocarditis, leading to inflammation of the heart muscle.
2. What is the characteristic ECG finding in patients with Brugada syndrome?
A) Prolonged QT interval B) ST-segment elevation in leads V1-V3 C) Tall peaked T waves D) Presence of Osborn waves
Answer: B) ST-segment elevation in leads V1-V3
Explanation: Brugada syndrome is characterized by ST-segment elevation in leads V1-V3, often resembling a coved-type pattern.
3. Which of the following is NOT a major criterion for the diagnosis of infective endocarditis according to the modified Duke criteria?
A) Positive blood culture B) Vegetations on echocardiography C) New valvular regurgitation D) Elevated C-reactive protein (CRP)
Answer: D) Elevated C-reactive protein (CRP)
Explanation: Elevated CRP is a minor criterion for the diagnosis of infective endocarditis, not a major one.
4. Which medication is contraindicated in patients with hypertrophic cardiomyopathy due to its negative inotropic effects?
A) Digoxin B) Beta-blockers C) Calcium channel blockers D) Amiodarone
Answer: A) Digoxin
Explanation: Digoxin is contraindicated in hypertrophic cardiomyopathy due to its positive inotropic effects, which can worsen left ventricular outflow obstruction.
5. What is the most common cause of pericarditis?
A) Bacterial infection B) Viral infection C) Tuberculosis D) Fungal infection
Answer: B) Viral infection
Explanation: Viral infections, particularly Coxsackievirus and echovirus, are the most common causes of acute pericarditis.
6. A patient presents with chest pain that worsens with inspiration and improves when leaning forward. Which of the following is the most likely diagnosis?
A) Acute myocardial infarction B) Pulmonary embolism C) Aortic dissection D) Pericarditis
Answer: D) Pericarditis
Explanation: Chest pain worsened by inspiration and relieved by leaning forward is characteristic of pericarditis.
7. Which of the following congenital heart defects is associated with a boot-shaped heart on chest X-ray?
A) Tetralogy of Fallot B) Transposition of the great arteries C) Truncus arteriosus D) Total anomalous pulmonary venous connection
Answer: A) Tetralogy of Fallot
Explanation: Tetralogy of Fallot often presents with a boot-shaped heart due to right ventricular hypertrophy.
8. What is the most common cause of secondary hypertension in adults?
A) Primary hyperaldosteronism B) Renal artery stenosis C) Cushing's syndrome D) Pheochromocytoma
Answer: B) Renal artery stenosis
Explanation: Renal artery stenosis is the most common cause of secondary hypertension in adults.
9. Which of the following is a criterion for diagnosing hypertrophic cardiomyopathy?
A) Left ventricular ejection fraction < 40% B) Left ventricular wall thickness > 12 mm C) Presence of apical ballooning D) Increased left ventricular end-diastolic volume
Answer: B) Left ventricular wall thickness > 12 mm
Explanation: A left ventricular wall thickness > 12 mm is a criterion for diagnosing hypertrophic cardiomyopathy.
10. What is the most common valvular abnormality in patients with rheumatic heart disease?
A) Mitral stenosis B) Aortic stenosis C) Mitral regurgitation D) Aortic regurgitation
Answer: A) Mitral stenosis
Explanation: Mitral stenosis is the most common valvular abnormality seen in patients with rheumatic heart disease.
11. Which of the following medications is NOT used for rate control in atrial fibrillation?
A) Digoxin B) Amiodarone C) Verapamil D) Flecainide
Answer: D) Flecainide
Explanation: Flecainide is a rhythm-control medication and is not used for rate control in atrial fibrillation.
12. A patient presents with a widened mediastinum on chest X-ray. Which of the following conditions is the most likely cause?
A) Pulmonary embolism B) Pneumothorax C) Aortic dissection D) Pleural effusion
Answer: C) Aortic dissection
Explanation: A widened mediastinum is a classic finding in aortic dissection.
13. Which of the following cardiac biomarkers has the highest specificity for myocardial injury?
A) Troponin I B) Troponin T C) CK-MB D) Myoglobin
Answer: A) Troponin I
Explanation: Troponin I has the highest specificity for myocardial injury.
14. A patient presents with exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Which of the following physical examination findings is consistent with heart failure with preserved ejection fraction (HFpEF)?
A) Systolic murmur B) S3 gallop C) Pulsus paradoxus D) Pulsatile hepatomegaly
Answer: B) S3 gallop
Explanation: An S3 gallop is a common physical examination finding in heart failure with preserved ejection fraction.
15. Which of the following is the most common cause of sudden cardiac death in young athletes?
A) Atrial fibrillation B) Hypertrophic cardiomyopathy C) Aortic dissection D) Brugada syndrome
Answer: B) Hypertrophic cardiomyopathy
Explanation: Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in young athletes.
16. Which of the following is a criterion for diagnosing Takotsubo cardiomyopathy?
A) Elevated troponin levels B) Normal left ventricular systolic function C) Absence of chest pain D) Presence of ST-segment elevation on ECG
Answer: A) Elevated troponin levels
Explanation: Elevated troponin levels are often seen in Takotsubo cardiomyopathy, despite the absence of obstructive coronary artery disease.
17. Which of the following is the most common complication of acute myocardial infarction?
A) Cardiogenic shock B) Ventricular arrhythmias C) Pericarditis D) Left ventricular aneurysm
Answer: B) Ventricular arrhythmias
Explanation: Ventricular arrhythmias, such as ventricular fibrillation, are the most common cause of death in the acute phase.
18. What is the most common congenital heart defect associated with cyanosis in newborns?
A) Tetralogy of Fallot B) Transposition of the great arteries C) Total anomalous pulmonary venous connection D) Tricuspid atresia
Answer: B) Transposition of the great arteries
Explanation: Transposition of the great arteries is the most common cyanotic congenital heart defect in newborns.
19. Which of the following is NOT a typical finding on echocardiography in a patient with restrictive cardiomyopathy?
A) Biatrial enlargement B) Ventricular hypertrophy C) Normal left ventricular size D) Increased ventricular wall thickness
Answer: D) Increased ventricular wall thickness
Explanation: Ventricular wall thickness is typically not increased in restrictive cardiomyopathy.
20. What is the characteristic murmur heard in a patient with aortic regurgitation?
A) Crescendo-decrescendo murmur at the left sternal border B) Holosystolic murmur at the apex C) Early diastolic murmur at the left lower sternal border D) Mid-systolic ejection murmur at the right upper sternal border
Answer: C) Early diastolic murmur at the left lower sternal border
Explanation: Aortic regurgitation typically presents with an early diastolic murmur heard at the left lower sternal border.
21. Which of the following electrocardiogram (ECG) findings is NOT consistent with hyperkalemia?
A) Peaked T waves B) Prolonged PR interval C) Widened QRS complex D) Shortened QT interval
Answer: D) Shortened QT interval
Explanation: Shortened QT interval is not typically seen in hyperkalemia; instead, it is associated with hypercalcemia.
22. Which of the following imaging modalities is considered the gold standard for diagnosing pulmonary embolism?
A) Chest X-ray B) Ventilation-perfusion (V/Q) scan C) Transthoracic echocardiography D) Pulmonary angiography
Answer: D) Pulmonary angiography
Explanation: Pulmonary angiography is considered the gold standard for diagnosing pulmonary embolism, although it is invasive and rarely used as a first-line investigation.
23. Which medication is the first-line treatment for acute decompensated heart failure with reduced ejection fraction (HFrEF)?
A) Furosemide B) Nitroglycerin C) Metoprolol D) Dobutamine
Answer: A) Furosemide
Explanation: Loop diuretics, such as furosemide, are the first-line treatment for acute decompensated heart failure with reduced ejection fraction.
24. A patient presents with sudden-onset chest pain, dyspnea, and hypotension. Which of the following is the most likely diagnosis?
A) Myocardial infarction B) Aortic dissection C) Pulmonary embolism D) Pericardial tamponade
Answer: B) Aortic dissection
Explanation: Sudden-onset chest pain, dyspnea, and hypotension are classic features of aortic dissection.
25. Which of the following statements regarding the management of stable angina is correct?
A) Aspirin is contraindicated in patients with stable angina. B) Nitroglycerin is used as first-line therapy for prevention of angina attacks. C) Beta-blockers are contraindicated in patients with stable angina. D) Calcium channel blockers are recommended for first-line therapy in all patients with stable angina.
Answer: D) Calcium channel blockers are recommended for first-line therapy in all patients with stable angina.
Explanation: Calcium channel blockers are often recommended as first-line therapy for stable angina, especially in patients with contraindications to beta-blockers.
26. Which of the following statements regarding atrial fibrillation (AF) is true?
A) AF is more common in men than in women. B) AF is typically associated with a regular ventricular response. C) Warfarin is the preferred anticoagulant in patients with AF and mechanical heart valves. D) Electrical cardioversion is contraindicated in patients with recent-onset AF.
Answer: C) Warfarin is the preferred anticoagulant in patients with AF and mechanical heart valves.
Explanation: Warfarin is the preferred anticoagulant in patients with AF and mechanical heart valves due to its efficacy in preventing thromboembolic events.
27. Which of the following is a risk factor for the development of infective endocarditis?
A) Hypertension B) Diabetes mellitus C) Previous cardiac surgery D) Hyperlipidemia
Answer: C) Previous cardiac surgery
Explanation: Previous cardiac surgery is a risk factor for the development of infective endocarditis due to the presence of prosthetic material.
28. What is the most common cause of right-sided heart failure?
A) Chronic obstructive pulmonary disease (COPD) B) Left-sided heart failure C) Pulmonary embolism D) Tricuspid regurgitation
Answer: B) Left-sided heart failure
Explanation: Left-sided heart failure is the most common cause of right-sided heart failure, as it leads to elevated pressures in the pulmonary circulation, causing right ventricular dysfunction.
29. Which of the following is a feature of Dressler syndrome?
A) Transient loss of consciousness B) Elevated cardiac enzymes C) Pleuritic chest pain D) Hypertension
Answer: C) Pleuritic chest pain
Explanation: Dressler syndrome is characterized by pleuritic chest pain, fever, and pericarditis following myocardial infarction or cardiac surgery.
30. What is the most common cause of acute mitral regurgitation?
A) Papillary muscle rupture B) Mitral valve prolapse C) Rheumatic heart disease D) Aortic dissection
Answer: A) Papillary muscle rupture
Explanation: Papillary muscle rupture, often due to myocardial infarction, is the most common cause of acute mitral regurgitation.
Take A DEEP BREATH and continue:
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31. Which of the following statements regarding the cardiac conduction system is correct?
A) The sinoatrial (SA) node is located at the apex of the heart. B) The atrioventricular (AV) node is responsible for initiating atrial contraction. C) The bundle of His divides into the left and right bundle branches in the atria. D) The Purkinje fibers are responsible for transmitting electrical impulses from the ventricles to the atria.
Answer: B) The atrioventricular (AV) node is responsible for initiating atrial contraction.
Explanation: The atrioventricular (AV) node is responsible for transmitting electrical impulses from the atria to the ventricles, initiating ventricular contraction.
32. Which of the following is NOT a feature of acute pericarditis?
A) Pleuritic chest pain relieved by sitting up and leaning forward B) Friction rub on auscultation C) Diffuse ST-segment elevation on ECG D) Elevated troponin levels
Answer: D) Elevated troponin levels
Explanation: Troponin levels are typically normal in acute pericarditis unless there is associated myocardial involvement.
33. What is the most common cause of acute aortic regurgitation?
A) Infective endocarditis B) Aortic dissection C) Bicuspid aortic valve D) Rheumatic heart disease
Answer: A) Infective endocarditis
Explanation: Infective endocarditis is the most common cause of acute aortic regurgitation, usually due to destruction of the aortic valve leaflets.
34. Which of the following maneuvers is used to differentiate innocent murmur from pathological murmur in a child?
A) Valsalva maneuver B) Handgrip maneuver C) Squatting maneuver D) Tilt-table test
Answer: C) Squatting maneuver
Explanation: Squatting increases systemic vascular resistance, which decreases the intensity of innocent murmurs but not pathological murmurs.
35. What is the characteristic feature of Ebstein's anomaly on echocardiography?
A) Dilated left ventricle B) Hypertrophied interventricular septum C) Displacement of the tricuspid valve leaflets into the right ventricle D) Thickened pulmonary valve leaflets
Answer: C) Displacement of the tricuspid valve leaflets into the right ventricle
Explanation: Ebstein's anomaly is characterized by downward displacement of the tricuspid valve leaflets into the right ventricle.
36. Which of the following is a risk factor for the development of a thoracic aortic aneurysm?
A) Smoking B) Hypotension C) Hypercholesterolemia D) Regular exercise
Answer: A) Smoking
Explanation: Smoking is a significant risk factor for the development of thoracic aortic aneurysm.
37. Which of the following statements regarding the pathophysiology of heart failure with reduced ejection fraction (HFrEF) is true?
A) HFrEF is characterized by impaired diastolic filling of the ventricles. B) Neurohormonal activation leads to vasodilation in HFrEF. C) Ventricular remodeling in HFrEF is characterized by eccentric hypertrophy. D) HFrEF is associated with decreased sympathetic nervous system activity.
Answer: C) Ventricular remodeling in HFrEF is characterized by eccentric hypertrophy.
Explanation: Ventricular remodeling in HFrEF typically involves dilatation of the ventricles, leading to eccentric hypertrophy.
38. Which of the following conditions is associated with a widened pulse pressure?
A) Cardiac tamponade B) Aortic stenosis C) Hypovolemic shock D) Pulmonary embolism
Answer: B) Aortic stenosis
Explanation: Aortic stenosis results in increased systolic pressure and decreased diastolic pressure, leading to a widened pulse pressure.
39. What is the first-line treatment for symptomatic bradycardia?
A) Atropine B) Adenosine C) Amiodarone D) Epinephrine
Answer: A) Atropine
Explanation: Atropine is the first-line treatment for symptomatic bradycardia, particularly in the setting of sinus node dysfunction or AV block.
40. Which of the following conditions is characterized by a "machine-like" murmur?
A) Aortic stenosis B) Patent ductus arteriosus C) Mitral regurgitation D) Hypertrophic cardiomyopathy
Answer: B) Patent ductus arteriosus
Explanation: A "machine-like" murmur is characteristic of patent ductus arteriosus due to continuous flow between the aorta and pulmonary artery.
41. Which of the following is a feature of left ventricular hypertrophy on electrocardiography (ECG)?
A) Deep S waves in leads V1-V3 B) Prolonged PR interval C) Q waves in leads II, III, and aVF D) Tall R waves in leads I and aVL
Answer: A) Deep S waves in leads V1-V3
Explanation: Left ventricular hypertrophy often presents with deep S waves in leads V1-V3 on ECG.
42. Which of the following statements regarding the management of stable angina is correct?
A) Percutaneous coronary intervention (PCI) is the preferred revascularization strategy in all patients with stable angina. B) Ranolazine is a first-line agent for the treatment of stable angina. C) Beta-blockers are contraindicated in patients with stable angina. D) Nitroglycerin is contraindicated in patients with stable angina.
Answer: B) Ranolazine is a first-line agent for the treatment of stable angina.
Explanation: Ranolazine is an antianginal medication that can be used as first-line therapy in patients with stable angina, particularly when other agents are contraindicated or ineffective.
43. Which of the following is a potential complication of Kawasaki disease?
A) Acute rheumatic fever B) Myocardial infarction C) Aortic dissection D) Hypoplastic left heart syndrome
Answer: B) Myocardial infarction
Explanation: Myocardial infarction is a rare but serious complication of Kawasaki disease, particularly in children with coronary artery aneurysms.
44. What is the most common location of a ventricular septal defect (VSD)?
A) Membranous septum B) Muscular septum C) Inlet septum D) Outlet septum
Answer: A) Membranous septum
Explanation: The membranous septum is the most common location of a ventricular septal defect.
45. Which of the following is a feature of Takotsubo cardiomyopathy on echocardiography?
A) Apical ballooning B) Diffuse hypokinesis C) Reduced left ventricular ejection fraction D) Increased left ventricular end-diastolic volume
Answer: A) Apical ballooning
Explanation: Takotsubo cardiomyopathy is characterized by apical ballooning.
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46. What is the most common arrhythmia seen in patients with Wolff-Parkinson-White (WPW) syndrome?
A) Atrial fibrillation B) Atrial flutter C) Ventricular tachycardia D) Supraventricular tachycardia
Answer: D) Supraventricular tachycardia
Explanation: Patients with Wolff-Parkinson-White syndrome commonly present with episodes of supraventricular tachycardia (SVT) due to the presence of an accessory pathway.
47. Which of the following is a feature of aortic dissection on computed tomography angiography (CTA)?
A) Filling defect in the left ventricle B) Intimal flap and false lumen C) Eccentric calcification of the aorta D) Pericardial effusion
Answer: B) Intimal flap and false lumen
Explanation: Aortic dissection typically presents with the characteristic findings of an intimal flap and false lumen on computed tomography angiography.
48. Which of the following is a feature of hypertrophic obstructive cardiomyopathy (HOCM) on echocardiography?
A) Increased left ventricular end-diastolic volume B) Reduced septal wall thickness C) Decreased left ventricular outflow tract (LVOT) gradient D) Anterior displacement of the papillary muscles
Answer: D) Anterior displacement of the papillary muscles
Explanation: Hypertrophic obstructive cardiomyopathy is characterized by asymmetric septal hypertrophy and anterior displacement of the papillary muscles, leading to dynamic LVOT obstruction.
49. Which of the following is a risk factor for the development of atrial fibrillation?
A) Hypertension B) Bradycardia C) Right ventricular hypertrophy D) Hyperkalemia
Answer: A) Hypertension
Explanation: Hypertension is a significant risk factor for the development of atrial fibrillation due to structural changes in the atria and atrial fibrosis.
50. What is the most common cause of sudden cardiac death in patients with hypertrophic cardiomyopathy?
A) Ventricular arrhythmias B) Atrial fibrillation C) Atrioventricular block D) Sinus bradycardia
Answer: A) Ventricular arrhythmias
Explanation: Ventricular arrhythmias, such as ventricular fibrillation, are the most common cause of sudden cardiac death in patients with hypertrophic cardiomyopathy, particularly in young individuals.
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