Question 1

Which of the following findings is suggestive of pulsus paradoxus?

Accepted Answer

The finding suggestive of pulsus paradoxus is inspiratory drop in SBP > 10 mmHg. Pulsus paradoxus can be found in cardiac tamponade, constrictive pericarditis, airway obstruction, superior vena cava (SVC) obstruction, COPD, and asthma.

Question 2

The nurse is preparing to record the blood pressure of a patient. What should be the correct position of the patient and arm?

Accepted Answer

The correct position of the patient and arm is that blood pressure should be taken in both arms with the patient supine and upright with the arm at the level of heart. Dependency of the arm below heart level leads to an overestimation of systolic and diastolic pressures of about 10 mm Hg and raising the arm above heart level leads to underestimation of blood pressures.

Question 3

Which of the following correctly defines pulse pressure?

Accepted Answer

Pulse pressure (PP) is defined as the difference of systolic blood pressure and diastolic blood pressure (PP = systolic BP (SBP) - diastolic PB (DBP)).

Question 4

Pulsus bisferiens is present in which of the following conditions?

Accepted Answer

Pulsus bisferiens is a double waveform present in both the aortic stenosis + aortic regurgitation conditions combined.
Pulsus bisferiens, a classic cardiovascular sign, has been described in severe aortic regurgitation, hypertrophic cardiomyopathy, subaortic stenosis, and contained rupture of thoracoabdominal aortic aneurysms. 
A pulse is a rhythmic wave produced by ventricular contraction during systole. A double pulse noticed during systole in the peripheral pulse is called pulsus bisferiens. This is derived from the Latin word, which means strike twice (bis=twice, ferio=strike). It is also called a biphasic wave.

Question 5

What is the character of pulsus parvus et tardus?

Accepted Answer

The character of pulsus parvus et tardus is slow uprising of the carotid upstroke due to severe aortic stenosis (AS).

Question 6

Which of the following statements is not true about third heart sound (S3)?

Accepted Answer

The statement not true about third heart sound is "Heard in pressure overloaded ventricle". Third heart sound (S3) can be heard in each of the following:
•volume overloaded ventricle
•occurs during period of rapid ventricular filling
•low frequency - best heard with bell at apex

Question 7

Which of the following terms correctly defines the character of pericardial friction rub?

Accepted Answer

The character of pericardial friction rub is a scratchy sound like Velcro. Rough rumbling sound is produced by stenotic murmurs such as murmur of mitral stenosis. Soft cooing sound may be heard in some cases of aortic regurgitation.

Question 8

In which of the following set of conditions murmur heard is not a flow murmur?

Accepted Answer

In aortic stenosis the murmur heard is not a flow murmur, the murmur of aortic stenosis is stenotic murmur due to turbulent flow of blood through the Stenosed valve. Flow murmurs are heard in following conditions:
•Anemia
•Thyrotoxicosis
•Pregnancy
•Arteriovenous fistula
•Children
•Fever

Question 9

A patient presents with complaints of palpitations and loss of weight. Blood investigations show thyrotoxicosis. Which of the following murmurs are expected to be heard on auscultation?

Accepted Answer

The murmur expected to be heard on auscultation in a patient with thyrotoxicosis is flow murmurs. High output or "flow" murmurs can be heard in conditions such as anemia, thyrotoxicosis, pregnancy, arteriovenous fistula, children and fever.

Question 10

Which of the following waveforms is not a part of jugular venous pulsation?

Accepted Answer

d-wave is not a part of jugular venous pulsation. The normal waveforms in jugular venous pulsations are:
•"a" wave = atrial contraction - precedes carotid pulse
•"x" descent = atrial relaxation
•"c" wave = bulging up of TV during RV systole (may reflect carotid pulse in neck)
•"x prime" descent = descent of base of heart during ventricular systole
•"v" wave = passive atrial filling against closed AV valve
•"y" descent = early rapid atrial emptying following opening of AV valve - occurs after carotid pulse felt

Question 11

A 75-year old male patient is undergoing carotid endocardiectomy. A cardiac nurse is explaining to the patient about the procedure. Which of the following statements correctly represent the method involved and aim of the procedure?

Accepted Answer

The statement "Carotid artery is clamped and plaque is removed to increase the cerebral blood flow" correctly represents the method and aim of carotid endocardiectomy. Carotid endocardiectomy is a common procedure that removes plaque build-up within the carotid artery that serves cerebral blood flow. The procedure involves clamping of the carotid artery and then removal of the plaque build-up to restore blood flow.

Question 12

In which of the following conditions is ST segment elevation seen on an ECG?

Accepted Answer

ST segment elevation is seen on an ECG in cases of myocardial infarction. Other conditions in which ST segment elevation is present: left ventricular hypertrophy, acute pericarditis, left bundle branch block with acute MI, advanced hyperkalemia, hypothermia

Question 13

The bypass pathway known as bundle of Kent is present in Wolf-Parkinson-White syndrome. Which anatomical structures are connected via the bundle of Kent?

Accepted Answer

The bundle of Kent connects the two anatomical structures of heart, the atria and the ventricle. Wolf-Parkinson-White syndrome develops because of the formation of extra electrical circuits within the heart. The condition leads to rapid heart rate and abnormal electrocardiogram. Wolf-Parkinson-White syndrome is a syndrome, and by definition, an identifiable external cause is not known. It is caused by an accessory pathway in the cardiac conduction system that causes arrhythmias in some individuals. The condition is congenital and there are no risk factors.

Question 14

Which of the following is not a cause of long QT?

Accepted Answer

Hypermagnesemia is not a cause of long QT. The causes of long QT syndromes are: hypokalemia, hypomagnesemia, congenital long QT syndromes, drugs like quinidine, phenthiazine, sotalol, erythromycin etc.

Question 15

Presence of delta wave in ECG is characteristic finding of Wolf-Parkinson-White syndrome. How and where is it visible in ECG?

Accepted Answer

Delta waves are visible in ECG as slurred upstroke of QRS complex in Wolf-Parkinson-White syndrome, this is due to the accessory pathway that is characteristic of Wolf-Parkinson-White syndrome.

Question 16

Which of the following statements are not true about sick sinus syndrome?

Accepted Answer

The statement not true about sick sinus syndrome (SSS) is "It may present as complete heart block". Causes of sick sinus syndrome are structural SA node disease, autonomic abnormalities, or both; bradycardia may be punctuated by episodes of SVT, especially atrial fibrillation or atrial flutter (tachy-brady syndrome). Treatment is pacing for bradycardia and medicines for tachycardia.

Question 17

Which of the following is not an indication of cardiac stress testing?

Accepted Answer

Assessment of ventricular function is not an indication of cardiac stress testing. Indications of cardiac stress testing are:
•Assessment of chest pain (detection of coronary artery disease)
•Risk stratification post-MI
•Preoperative screening and risk assessment
•Assessment of response to therapy
•Assessment of myocardial viability

Question 18

Which of the following parameters are not used for assessment of ventricular function?

Accepted Answer

Thickness of interventricular septum is not used as a parameter for assessment of ventricular function. Parameters used for ventricular function assessment are (LVEF, RVEF, ventricular size and volume, wall motion anomalies, etc.)

Question 19

A cardiac nurse records the ECG of a patient presenting with severe chest pain which shows ST-segment elevation and pathological Q-waves in leads II, III and aVF. Which of the following arteries is likely to be involved?

Accepted Answer

Right coronary artery is most likely to be involved if pathological Q-wave and ST-T changes are present in leads II, III and aVF.

Question 20

A patient presents whom is diagnosed to have dyslipidemia. Which of the following is not a part of goal of treatment in this patient?

Accepted Answer

The goal of treatment in a patient of dyslipidemia is to control lipid levels, decreasing low-density lipoprotein level and triglyceride levels and increasing high-density lipoprotein levels, as well as prevent the onset of cardiovascular diseases such as coronary artery disease, peripheral artery disease, heart attack and stroke.
According to the NIH, Dyslipidemia is the imbalance of lipids such as cholesterol, low-density lipoprotein cholesterol, (LDL-C), triglycerides, and high-density lipoprotein (HDL). This condition can result from diet, tobacco exposure, or genetics, and can lead to cardiovascular disease with severe complications.

Quiz 1: Cardiac Medicine