MCQs in Cardiology for MD and DM Students Akash Jain, Prashuka Jain
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History and Physical ExaminationCHAPTER 1

QUESTIONS
1. Single S2 in Eisenmenger is seen in:
  1. VSD
  2. ASD
  3. PDA
  4. AVSD
2. Bendopnea is associated with all, except:
  1. Increased PCWP
  2. Decreased cardiac output
  3. Increased abdominal girth
  4. Increased JVP
3. Pulsus alternans is seen in all, except:
  1. HTN
  2. Loculated pericardial effusion
  3. Hypovolemia
  4. AR
4. Pansystolic murmur is found in all, except:
  1. Traumatic TR
  2. MVP
  3. PPH
  4. Septal rupture in MI
5. Electrical alternans is found in:
  1. Cardiac tamponade
  2. Constrictive pericarditis
  3. Severe AR
  4. Hypertension
6. Effects of long-standing zero gravity are all, except:
  1. Facial puffiness
  2. Fluid shift to upper body
  3. Fluid retention
  4. Postural hypotension on return
7. All of the following changes are seen during exercise except:
  1. CVP raised >10
  2. Systolic BP raised
  3. EF raised
  4. Heart rate increases
8. Split S2 is heard in all, except:
  1. Corrected ASD
  2. C-TGA
  3. Patient with PPI
  4. MS with PAH
9. All are true about pulse, except:
  1. Dicrotic pulse may be seen in cardiac tamponade
  2. Anacrotic notch exaggerated in AS
  3. 2:1 AV block causes pulsus bigeminus
  4. Pulsus alternans in PA in case of RV dysfunction
10. Wide split S2 is heard in all, except:
  1. Failing RV
  2. Coronary sinus ASD
  3. Valvular PS
  4. Patient with PPI
11. Hepatojugular reflex is positive in all, except:
  1. Increase PCWP
  2. TR
  3. Right heart failure
  4. Decrease afterload
12. Regular canon wave is seen in all, except:
  1. CHB
  2. VT
  3. AVRT
  4. AVNRT2
13. Paradoxical split S2 is seen in all, except:
  1. PDA
  2. PPI
  3. Repaired TOF
  4. Angina pectoris
14. Which is the wrong statement?
  1. Pulsus alternans better felt in brachial > carotid
  2. Pulsus-et-tardus is best felt in carotid
  3. Early pulsus paradoxus is detected by sphygmomanometer
  4. Percussion wave is prominent in dicrotic pulse
15. What is seen in diastasis in JVP?
  1. H wave
  2. X descent
  3. Y descent
  4. D wave
16. All are true about cyanotic spell, except:
  1. More in summer
  2. Causes CVA
  3. Blood transfusion causes spell
  4. VSD with pulmonary atresia also causes it
17. Continuous murmur is found in all, except:
  1. RSOV in LV
  2. Coronary AV fistula
  3. AP collateral
  4. Peripheral pulmonary artery stenosis
18. Which is diagnosed better by palpating carotid than peripheral artery?
  1. Parvus et tardus
  2. Bigeminy
  3. Alternans
  4. Paradoxus
19. All are true, except:
  1. Intra-arterial BP correlates best with Korotkoff IV
  2. Cuff width 40% of arm circumference
  3. Narrow cuff also increase DBP
  4. Mönckeberg sclerosis causes pseudohypertension
20. Regarding S4, all are true, except:
  1. Normal in children
  2. Usually present in acute AR
  3. Increase in isometric exercise
  4. CCP
21. Single S2 is found in:
  1. LV pairing
  2. PDA with Eisenmenger
  3. C-TGA
  4. TAPVC
22. Correct statement regarding pulse oximetry:
  1. Based on Doppler
  2. >90 SaO2 sensitivity
  3. Measures PaO2
  4. Unreliable in methHb
23. Premature closure of S1 is seen in:
  1. Severe AR
  2. AS
  3. MS
  4. TS
24. Bisferiens pulse is best felt in:
  1. Carotid
  2. Femoral
  3. Radial
  4. Brachial
25. Pulsus Paradoxus is seen in all, except:
  1. Acute severe bronchial asthma
  2. Cardiac tamponade
  3. Pulmonary embolism
  4. AR exacerbates pulsus paradoxus
26. High risk of adverse cardiovascular events during noncardiac surgery is associated with all, except:
  1. Prior transient ischemic attack
  2. Whipple surgery
  3. Serum creatinine > 2.1 mg/dL
  4. History of syncope
27. All are true about linked angina except:
  1. Precipitated by food
  2. Increases on forward bending
  3. Coronary arteries are normal on angiography
  4. Mimicked by esophageal acid stimulation
28. Pulsus alternans is seen with all, except:
  1. Hypertension
  2. Localized tamponade
  3. Severe AR
  4. Hypovolemia3
29. Continuous murmur is seen in all, except:
  1. TOF with absent PV
  2. Rheumatic MS with ASD
  3. Obstructive TAPVC
  4. Peripheral pulmonary artery stenosis
30. All are true, except:
  1. VSD with Eisenmenger—narrow split S2
  2. MVP with MR decrease with pregnancy
  3. Reverse differential cyanosis in TGA with PAH
  4. In ASD with right to left shunt, there will be no pulmonary flow murmur
31. Perioperative MI is commonly seen in:
  1. Within 48 hours
  2. Within 7 days
  3. Surgery within 12 hours
  4. 12–24 hours
32. All of the following cause continuous murmur, except:
  1. Mammary souffle
  2. Peripheral PS
  3. VSD with aortic regurgitation
  4. Coronary cameral fistula in right atrium
33. Which of the following is a mismatch:
  1. Adenoma sebaceum—rhabdomyoma
  2. NF—RAS
  3. Tuberoeruptive xanthoma—type 2 hyperlipidemia
  4. Marfan—abdominal aortic aneurysm
34. Absent y descent is seen in:
  1. RA myxoma
  2. Tamponade
  3. Effusive-constrictive pericarditis
  4. TS
35. Continuous murmur is not heard in:
  1. Ruptured RSOC
  2. Coarctation of aorta
  3. Peripheral PS
  4. Intercostal AV fistula
36. JVP is 10 cm above sternal angle. What is the RAP?
  1. 10 mm Hg
  2. 12 mm Hg
  3. 14 mm Hg
  4. 16 mm Hg
37. Pansystolic murmur is not heard in:
  1. Traumatic TR
  2. Ischemic MR (if chronic)
  3. TR with PAH
  4. All of the above
38. Wide S2 is not seen in:
  1. HLHS
  2. MR
  3. Pulmonary embolism
  4. Severe AS
39. Pulsus paradoxus is most commonly found in:
  1. Constrictive pericarditis
  2. Tamponade
  3. HOCM
  4. DCM
40. Which of the following questionnaire is incorrectly matched?
  1. Angina—Rose score
  2. Pediatric CHF—ROSS score
  3. HCM—ESC score
  4. PTE—World Health Federation Functional classification
41. Pulsatile liver is not seen in:
  1. Tricuspid atresia
  2. MR with ASD
  3. PPHN
  4. TR
42. Texidor twinge (precordial catch syndrome) is:
  1. Sudden onset chest pain
  2. Sudden onset palpitations
  3. Sudden onset syncope
  4. Sudden onset fatigue
43. Continuous murmur is found in all, except:
  1. RSOV to LV
  2. Lutembacher
  3. Peripheral pulmonary stenosis
  4. BT shunt
44. Continuous murmur is found in all, except:
  1. Arteriovenous fistula
  2. Peripheral PS
  3. Aortic stenosis with aortic regurgitation
  4. Coronary cameral fistula in RA4
ANSWERS
  1. Ans: a
    [Perloff's Clinical Recognition of Congenital Heart Disease, 7th ed, pg 262]
    Cardiac defect
    Character of S2
    ASD
    Wide and fixed
    VSD
    Single loud P2
    PDA
    Close split with normal inspiratory split
    VSD of AV canal type
    Wide and fixed
    TAPVC
    Wide and fixed
    TGA
    Single second sound
  2. Ans: c
    [https://www.ahajournals.org/doi/10.1161/circ.126.suppl_21.A16619]
  3. Ans: b
    [Braunwald 12th ed pg 129-30]
  4. Ans: a
    [Braunwald 12th ed pg 132 Table 13.6]
  5. Ans: a
    [Braunwald 12th ed pg 172]
  6. Ans: c
    [https://www.nasa.gov/mission_pages/station/research/station-science-101/cardiovascular-health-in-microgravity/#:~:text=In%20microgravity%20the%20heart%20changes,c]
  7. Ans: a
    [Braunwald 12th ed pg 579]
  8. Ans: b
    [Braunwald 12th ed pg 131]
  9. Ans: c
    [Braunwald 12th ed pg 129]
  10. Ans: d
    [Braunwald 12th ed pg 131]
  11. Ans: d
    [Braunwald 12th ed pg 128]
  12. Ans: a
    [CSI Handbook for Postgraduates]
  13. Ans: c
    [Braunwald 12th ed pg 131]
  14. Ans: d
    [Braunwald 12th ed pg 129]
  15. Ans: d
    [CSI Textbook for Postgraduates]
  16. Ans: c
    [Park's Pediatric Cardiology]
  17. Ans: a
    [Braunwald 12th ed pg 132 Table 13.6]
  18. Ans: a
    [Braunwald 12th ed pg 129]
  19. Ans: a
    [Braunwald 12th ed pg 128]
  20. Ans: a
    [Braunwald 12th ed pg 135]
  21. Ans: c
    [Braunwald 12th ed pg 131]
  22. Ans: d
    [Harrison 21st ed pg 2222]
  23. Ans: a
    [Braunwald 12th ed pg 131]
  24. Ans: d
    [Braunwald 12th ed pg 129]
  25. Ans: d
    [Braunwald 12th ed pg 129]
  26. Ans: b
    [Braunwald 12th ed pg 415]
  27. Ans: c
    [http://www.onlinejacc.org/content/27/7/1621]
  28. Ans: b
    [Braunwald 12th ed pg 129]
    Causes of pulsus alternans:
    • HF (severe)
    • HTN
    • Hypovolemia
    • AR (severe)
      Pulsus paradoxus is seen in:
    • CCP 1/3 cases
    • Pulmonary embolism (massive)
    • Tamponade
    • Hemorrhagic shock
    • Tension pneumothorax
    • COPD, asthma
    • Pregnancy
    • Obesity5
      Reversed pulsus paradoxus is seen in:
    • Hypertrophic obstructive cardiomyopathy
    • Isorhythmic ventricular rhythm
    • LV systolic dysfunction receiving positive pressure ventilation
  29. Ans: a
    [Braunwald 12th ed pg 132]
  30. Ans: a
    [Perloff's Clinical Recognition of Congenital Heart Disease 7th ed pg 262]
    Causes of reverse differential cyanosis:
    • TGA with PDA and elevated PVR
    • TGA with PDA and preductal aortic interruption or coarctation
    • Supracardiac TAPVC + PDA
    • Anomalous right subclavian artery connected to hypertensive ductus through RPA
      Second heart sound in various defect
    Small VSD
    • Normal
    • P2 normal
    • Normal PA pressures
    • Normal handout interval
    Moderate VSD
    • Normal or wide split
    • P2 moderate intensity
    Moderate PAH
    Large VSD
    • Close split or single S2
    • P2 severe in intensity
    PA pressures near systemic range
    Eisenmenger VSD
    Single S2 as loud P2
    Equalization of handout interval in both
    VSD as a part of a complex defect like TOF, TGA, or DORV
    Single loud A2
    Equalization of hangout interval
    VSD with coarctation of aorta, unruptured or ruptured sinus of Valsalva, bicuspid aortic valve
    Loud A2
    • Systemic hypertension
    • Dilated aortic sinus
    • Thickened but mobile valve
  31. Ans: a
    [Braunwald 12th ed pg 1787]
  32. Ans: c
    [Braunwald 12th ed pg 132]
  33. Ans: c
    [Braunwald 12th ed pg 510]
    • Type 1—eruptive xanthoma
    • Type 2—tendon xanthoma
    • Type 3—palmar xanthoma, tuberous xanthoma
  34. Ans: b
    [Braunwald 12th ed pg 1621]
  35. Ans: b
    [Braunwald 12th ed pg 132]
  36. Ans: b
    [Braunwald 12th ed pg 126]
    JVP—10 + 5 = 15 cm water. Now for conversion to mm Hg, divided by 1.36.
  37. Ans: a
    [Braunwald 12th ed pg 132]
    Types of Eisenmenger
    ASD
    VSD
    PDA
    Usual age of ES
    20–40
    <2
    <2
    Differential cyanosis
    –
    –
    Yes (50%)
    Cardiomegaly
    Yes
    –
    –
    P2
    Wide and fixed
    Single
    Narrow/Normal
    PR murmur
    –
    –
    Yes
    TR murmur
    Yes
    –
    –
    Parasternal heave
    Yes
    –
    –
  38. Ans: a
    [Park's Pediatric Cardiology]
  39. Ans: b
    [Braunwald 12th ed pg 1621]
  40. Ans: d
    [Braunwald 12th ed pg 1670.e1]
    • World Heart Federation Classification for RHD
    • WHO class for PAH
    • ROSE angina questionnaire
    • ESC score for HCM
    • ROSS score for pediatric HF
  41. Ans: a
    [Braunwald 12th ed pg 1578]
  42. Ans: a
    [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1627421/?page=1]
  43. Ans: a
    [Braunwald 12th ed pg 132 Table 13.6]
  44. Ans: c
    [Braunwald 12th ed pg 132 Table 13.6]