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Cardiology MCQ: Fallacies of assessing mitral valve area by planimetry
Fallacies of assessing mitral valve area by planimetry:
a) Inability to get a cut at the tip of the funnel
b) Inability to get a cut parallel to the orifice
c) Inability to get a full circle at the right time of the cardiac cycle
d) All of the above
Correct answer: d) All of the above
Mitral valve are is often measured by planimetry to assess the severity of mitral stenosis. Usual method is to get a good parasternal short axis image of the mitral valve and measure the valve area using the electronic caliper in the echocardiograph. Once you trace the outline of the valve, the valve area is automatically calculated and displ...
Source: Cardiophile MD - November 27, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Echocardiogram Library Source Type: blogs
Cardiology MCQ: Tricuspid stenosis
Minimum gradient required for diagnosis of tricuspid stenosis:
a) 2 mm Hg
b) 4 mm Hg
c) 6 mm Hg
d) 8 mm Hg
Correct answer: a) 2 mm Hg
The minimum transvalvular gradient required for significant tricuspid stenosis is 2 mm Hg. Cardiac catheterization derived pull back gradient may not be superior to Doppler echocardiography derived gradient as cath gradient ideally requires simultaneous right atrial and right ventricular tracing. The right atrial pressures fluctuate widely with respiration. So in order to measure a small difference between right atrial pressure and right ventricular diastolic pressure, simultaneous tracing...
Source: Cardiophile MD - November 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Catheter thrombosis with Fondaparinux
Catheter thrombosis with Fondaparinux is due to:
a) High anti-Factor Xa activity
b) Low anti-Factor IIa activity
c) High factor VIIIa activity
d) Low factor Xa activity
Correct answer: b) Low anti-Factor IIa activity
Though Fondaparinux is a safe and effective in the management of ST elevation myocardial infarction, it was associated with a higher incidence of guide catheter thrombosis in those who underwent percutaneous coronary intervention. The same concern applies to non ST elevation acute coronary syndromes where fondaparinux is ideal in terms of lower bleeding risk, albeit with a potential risk of guide catheter thro...
Source: Cardiophile MD - November 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology MCQ Coronary Interventions DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Epicardial ablation of VT
Epicardial ablation of VT will not be useful for:
a) Fascicular VT
b) Bundle branch re-entrant VT
c) VT originating from the papillary muscle
d) All of the above
Correct answer: d) All of the above
Most ventricular tachycardias (VT) can be approached for ablation endocardially. But there are a few which needs an epicardial approach. VTs originating from the left ventricular outflow tract is likely to be epicardial and perivascular compared to the right ventricular outflow tract VTs. VTs in non ischemic dilated cardiomyopathy and those in Chagasic cardiomyopathy are likely to have epicardial origin. Among the ischemic VTs,...
Source: Cardiophile MD - November 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
Cardiology MCQ: Platypnea-orthodeoxia
Platypnea-orthodeoxia has been described in:
a) Pulmonary arteriovenous malformation
b) Cirrhosis liver
c) Aortic aneurysm
d) All of the above
Correct answer: d) All of the above
Platypnea-orthodeoxia is characterized by dyspnoea and systemic oxygen desaturation on assuming the sitting or standing position. It was originally described by Burchell et al in 1949 [Burchell HB et al. Reflex orthostatic dyspnea associated with pulmonary hypertension. Am J Physiol. 1949; 159: 563–564]. The basic requirement for the condition is an interatrial communication in the form of a patent foramen ovale, atrial septal defect or an atria...
Source: Cardiophile MD - November 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Omapatrilat
Omapatrilat inhibits:
a) Angiotensin converting enzyme
b) Neprilysin
c) Aminopeptidase P
d) All of the above
Correct answer: d) All of the above
Omapatrilat inhibits angiotensin converting enzyme, neprilysin, and aminopeptidase P [McMurray JJ et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 Sep 11;371(11):993-1004]. This would finally cause vasodilation, natriuresis and diuresis. Hence omapatrilat can have potential use in hypertension and heart failure. Since its actions are not confined to the renin-angiotensin system, its antihypertensive effect occurs in both high renin and...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Neurocardiogenic syncope
Asystole is not seen in type … of neurocardiogenic syncope:
a) Type I
b) Type IIa
c) Type IIb
d) None of the above
Correct answer: b) Type IIa
Heart rate and blood pressure response in to head up tilt test (HUTT) in neurocardiogenic syncope (vasovagal syncope or neurally mediated syncope) has been classified by Sutton R et al [Sutton R et al. Proposed classification for tilt induced vasovagal syncope. Eur J Cardiac Pacing Electrophysiol 1992; 2; 180–3].
The most common is the mixed type (type I) in which there is a fall in both heart rate and blood pressure. Fall in blood precedes the fall in heart rate which fall...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
Cardiology MCQ: Giant coronary aneurysms
Giant coronary aneurysms are seen in:
a) Kartagener Syndrome
b) Ellis-van Creveld Syndrome
c) Kawasaki disease
d) None of the above
c) Kawasaki disease
Kawasaki disease is a rare disorder in which coronary aneurysms can occur in young children. Kawasaki disease is also known as mucocutaneous lymph node syndrome. It typically occurs as a febrile illness with involvement of the lips and tongue. There is conjunctival congestion as well as involvement of the lymph nodes, usually in the neck. Redness of palms and feet and peeling of skin may occur as the cutaneous manifestations.
Suda K et al (Circulation. 2011;123:1836-1842) h...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Add on therapy in heart failure
Preferred add on therapy in heart failure,
to ACE inhibitors and beta blockers:
a) Angiotensin receptor blocker
b) Mineralocorticoid antagonist
c) Renin antagonist
d) None of the above
Correct answer: b) Mineralocorticoid antagonist
Mineralocorticoid antagonist like spironolactone or eplerenone is the add on therapy in heart failure to angiotensin converting enzyme inhibitors (ACEI) and beta blockers in the management of heart failure. Spironolactone has been shown to reduce myocardial fibrosis and corrected QT interval (QTc) [Wong KY et al. Myocardial fibrosis and QTc are reduced following treatment with spironolactone or...
Source: Cardiophile MD - November 29, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Beta blocker in heart failure
Which of the following beta blocker in heart failure had no benefit?
a) Carvedilol
b) Metoprolol extended release
c) Nebivolol
d) Bucindolol
Correct answer: d) Bucindolol
Bucindolol is a beta blocker with partial agonist activity, which did not reduce mortality in heart failure trial [Beta-Blocker Evaluation of Survival Trial (BEST) Investigators. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med. 2001;344:1659 –1667].
Earlier on beta blockers were contraindicated in heart failure because of their negative inotropic effects. But later several large scale trials showed th...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Plastic bronchitis
Plastic bronchitis is seen after:
a) ASD repair
b) Arterial switch
c) Fontan repair
d) VSD closure
Correct answer: c) Fontan repair
Plastic bronchitis is characterised by marked obstruction of the large airways due to the formation of bronchial casts with rubber like consistency. Elevated central venous pressure leading to endobronchial lymph leakage is thought to be the mechanism of plastic bronchitis in post Fontan state. Plastic bronchitis can occur in those without heart disease as well. In those due to inflammatory lung disease, the casts are cellular (type I casts) while in those with underlying heart disease, the ca...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
A crazy cardiology tweet and a wish !
I was recently asked to suggest a topic for debate on STEMI in a major Indian cardiology conference. I wished , this is what we should be mulling over, with a set of virtual guest lectures and special invitees from heaven !
Plenary session : State of the Art STEMI care Time : 11.AM , Speaker : Dr Hippocrates
Topic : Aren’t we erring on either side of the Noble profession ?
Moderator: Dr. William Osler
Chairperson : Dr .Harvey Cushings, Dr,Sir Thomas Lewis ,Dr Paul Wood ,
Excerpts :
“While , vast number of our country-men’s culprit artery doesn...
Source: Dr.S.Venkatesan MD - February 27, 2015 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics cardiology tweet ethics in cardiology stemi care Source Type: blogs
Anticoagulation for AF with HCM – Cardiology MCQ
Anticoagulation for atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is recommended when:
a) In all patients
b) When CHADS2 score is two or more
c) When CHA2DS2-VASC score is two or more
d) None of the above
Correct answer: a) In all patients
As per the ESC (European Society of Cardiology) 2014 recommendations, anticoagulation is recommended in all patients with atrial fibrillation in hypertrophic cardiomyopathy as the stroke risk is high (occurs in over one fourth of patients). In those without AF, but large left atrium of 45 millimeters or more, 48 hour Holter monitoring is recommended in 6-12 monthly inter...
Source: Cardiophile MD - May 2, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
Hypertension with angina – Cardiology MCQ
Drug of choice for hypertension in a person with coronary artery disease and angina pectoris:
a) Alpha blocker
b) Beta blocker
c) Calcium channel blocker
d) Angiotensin receptor blocker
Correct answer: b) Beta blocker
Beta blockers decrease myocardial oxygen demand and hence relieves angina pectoris. Both the negative inotropic and negative chronotropic effects of beta blockers contribute to this effect. This has led to the strong recommendation for beta blockers for management of hypertension in those with coronary artery disease and angina pectoris. Cardioselective beta blockers without intrinsic sympathomimetic activity...
Source: Cardiophile MD - May 9, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Drug not to be combined with nitrates – Cardiology MCQ
Drug which should not be taken within 24 hours of nitrate intake and vice versa:
a) Beta blocker
b) Calcium channel blocker
c) Alpha blocker
d) Sildenafil
Correct answer: d) Sildenafil
Administration of nitrates by any route to those who have taken sildenafil during the past 24 hours can result severe hypotension. Any such inadvertent occurrences should be treated with fluid resucitation and alpha adrenergic agonists.
In case of angina in a person who has taken sildenafil during the past 24 hours, antianginal agents other than nitrates have to be considered, to avoid this interaction. Sildenafil is a phosphodiesterase 5 in...
Source: Cardiophile MD - May 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
