Cardiology MCQs (Set 1)
This is MCQs set 1 of Cardiology of Medicine. Answers with explanation is given at the end of each MCQ.
Q1. A 40 year old patient had a mitral valve replacement for mitral stenosis 1 month ago. She presents with fevers, lethargy and rigor. Her blood tests reveal Hb 9.5 g/dl, WCC 13 x 109/L, platelets 500 x 109/L, sodium 136 mmol/l, potassium 4.2 mmol/l, ESR 90 mm/hr, CRP 180 mg/l.She also has 2 splinter haemorrhages and 2+ of blood on urine dipstick. 3 sets of blood cultures are taken. Which of the following organisms is most likely to be grown in the blood cultures?
1- E coli
2- Listeria monocytogenes
3-β haemolytic Group A streptococcus
4- Klebsiella
5- Staphylococcus epidermidis
Answer: 5- Staphylococcus epidermidis
In a patient with prosthetic valve, causes can be divided into early (within 60 days of surgery) and late stages.Early prosthetic valve endocarditis is usually the result of perioperative contamination. Causative organisms include Staphylococcus epidermidis is (30%), Staphylococcus aureus (20%), and gram-negative aerobes (20%).
Late prosthetic valve endocarditis is usually the result of bacteremia from dental or genitourinary sources, GI surgery, or intravenous drug abuse. The causative organisms are similar to those causing native valve endocarditis. These include Streptococcus viridans (30%), S epidermidis (30%) and S aureus (12%).surgery) and late stages.Early prosthetic valve endocarditis is usually the result of perioperative contamination. Causative organisms include Staphylococcus epidermis (30%), Staphylococcus aureus (20%), and gram-negative aerobes (20%).Late prosthetic valve endocarditis is usually the result of bacteremia from dental or genitourinary sources, GI surgery, or intravenous drug abuse. The causative organisms are similar to those causing native valve endocarditis. These include Streptococcus viridans (30%), S epidermidis (30%) and S aureus (12%).
Q2- A 55 year old man has progressive shortness of breath and ankle oedema. He has come from Africa originally and gives a history of probably tuberculosis many years ago.On examination, he has a blood pressure of 105/55 mmHg, raised JVP +6 cm with a rapid y descent and significant ankle oedema.
What is the likely diagnosis?
1- Cardiac tamponade
2- Aortic regurgitation
3- Restrictive cardiomyopathy
4- Pericardial constriction
5- Left ventricular impairment causing heart failure
Answer: 4- Pericardial constriction
The signs of pericardial constriction / constrictive pericarditis are rapid y descent, raised JVP and Kussmaul's sign.The y descent is often blunted in cardiac tamponade. A further clue is the history of tuberculosis which predisposes to constrictive pericarditis.
Q3. A 55 year old patient presented with breathlessness and ankle oedema. The blood pressure is 135/80 mmHg. On examination,her JVP rises with inspiration. She has a soft systolic murmur and a third heart sound.Blood tests reveal a Hb 10.5 g/dl, WCC 7.5 x 109/L, Platelets 150 x 109/L, sodium 136 mmol/l, potassium 3.5 mmol/l, creatinine 140 μmol/l, urea 6 μmol/l.ECG shows poor R wave progression. An echocardiogram shows no pericardial effusion, the ventricles are stiff and systolic function is mildly impaired.
Which of the following is the likely diagnosis?
1- Restrictive cardiomyopathy
2- Dilated cardiomyopathy
3- Constrictive pericarditis
4- Ischaemic cardiomyopathy
5- Pulmonary embolus
Answer: 1- Restrictive cardiomyopathy
In this scenario, the symptoms can be caused by any form of cardiomyopathy. The rise in JVP with inspiration suggests either constrictive or restrictive cardiomyopathy.Echocardiography showing no pericardial effusion and stiffness suggests restrictive rather than constrictive cardiomyopathy. The transmitral dopplers on the echo may show E/A wave reversal and high velocities which may suggest restrictive picture.This may be due to infiltration due to haemochromatosis, endomyocardial fibrosis, sarcoidosis, myeloma, lymphoma or connective tissue disease.
Q4. A 50 year old man presents with palpitations. His ECG shows AV dissociation. Which of the following conditions is most likely to cause AV dissociation on an ECG?
1- 1st degree AV block
2- Atrial flutter
3- Mobitz type II block
4- Wenkebach
5- Complete heart block
Answer: 5- Complete heart block
Complete (3rd degree) heart block and ventricular tachycardia are most likely to cause AV dissociation on an ECG.
Q5. A 60 year old man has palpitations. An admission ECG shows QTc prolongation of 0.48 s.
Which of the following conditions might be associated?
1- Digitalis
2- Hyponatraemia
3- Hyperthermia
4- Hypocalcaemia
5- Hyperkalaemia
Answer: 4- Hypocalcaemia
Hypokalaemia, hypocalcaemia , hypomagnesaemia and hypothermia can cause prolonged QT interval on the ECG. Prolonged QT is classified as a QTc interval (corrected) of more than 0.44 seconds.
