This document contains a 14 question cardiology MCQ exam based on chapters from Harrison's 18th Edition on noninvasive cardiac imaging modalities and diagnostic cardiac catheterization. Each question is multiple choice with 4 answer options and includes the reference used to write the question. The questions cover topics like echocardiography findings, fractional flow reserve measurement, intravascular ultrasound, stress myocardial perfusion imaging, positron emission tomography, computed tomography of the chest, coronary angiography, and hemodynamic measurements.

1. Cardiology MCQ
Dr Praveen Gupta
JIPMER
Pondicherry
India
24/12/2016

2. Based on
Harrison's, 18TH Edition, Chapter 229. Noninvasive Cardiac Imaging:
Echocardiography, Nuclear Cardiology, and MRI/CT Imaging
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and
Coronary Angiography: Introduction

3. Question 1
A 45 years old female with history of fever, joint pain since 2 month presented with
acute onset weakness of left side of the body, so regarding ECHO finding of this
patient which is true?

4. Option
A)Large vegetation attached to anterior mitral leaflet of the mitral valve
B)Benign tumor of the heart
C)Malignant tumor of the heart
D)Calcification on the anterior mitral leaflet in a patient of mitral stenosis

5. Answer
B)Benign tumor of the heart
Harrison's, 18TH Edition, Chapter 229. Noninvasive Cardiac Imaging:
Echocardiography, Nuclear Cardiology, and MRI/CT Imaging
The image is showing Left atrial myxoma

6. Question 2
Regarding Fractional flow reserve, which of the following is not true?
A) Measurement of the fractional flow reserve provides a functional assessment of the stenosis.
B) The fractional flow reserve is the ratio of the pressure in the coronary artery distal to the stenosis
divided by the pressure in the artery proximal to the stenosis at maximal vasodilation.
C) Fractional flow reserve is measured using a coronary pressure–sensor guidewire at rest and at
maximal hyperemia following the injection of adenosine.
D) A fractional flow reserve of >0.75 indicates a hemodynamically significant stenosis that would
benefit from intervention

7. Answer
D) A fractional flow reserve of >0.75 indicates a hemodynamically
significant stenosis that would benefit from intervention
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and
Coronary Angiography: Introduction

8. Question-3
36-year-old woman with no cardiovascular risk factors or other relevant history who
consulted for chest pain of 1 h duration. An electrocardiogram done by an out-of-hospital
emergency service showed ST elevation in I and aVL, a reciprocal decrease in the inferior
leads, and hyperacute T-waves at V4 through V6. After antiplatelet, anticoagulant, and nitrate
therapy, the elevated ST normalized and the patient arrived at the hospital asymptomatic. The
left ventricular ejection fraction (LVEF) was severely depressed (30%) due to extensive
anterolateral akinesia. Scheduled coronary angiography 48 h later showed coronary arteries
with no atherosclerosis, and a slight loss of diameter in the proximal and middle segments of
the left anterior descending artery (LAD). Following which patient underwent a new invasive
imaging for diagnosis so which of the following regarding this new imaging modaility is NOT
TRUE?
Conti.-

9. Conti-

10. Conti-
A) Provides a more accurate anatomic assessment of the coronary artery and
the degree of coronary atherosclerosis
B) Performed using a small flexible catheter with a 40-mHz transducer at its
tip that is advanced into the coronary artery over a guidewire
C) May be used to image atherosclerotic plaque precisely, determine luminal
cross-sectional area, and measure vessel size
D) Not useul during or following percutaneous coronary intervention to assess
the stenosis and determine the adequacy of stent placement

11. Answer
D) Not useul during or following percutaneous coronary intervention to
assess the stenosis and determine the adequacy of stent placement
Image is showing intravascular ultrasound
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and
Coronary Angiography: Introduction

12. Question-4
4) In a 30 years old male, regarding ECHO finding mark the correct statement?
A)Concentric left ventricular hypertrophy in a patient with systemic hypertension
B)It is an autosomal dominant condition in which the patient is at risk of ventricular
arrthymia, sudden cardiac death, heart failure
C)Benign lipomatous septal hypertrophy of the heart
D)Rhabdomyoma of the heart

13. Answer
B) It is an autosomal dominant condition in which the patient is at risk of
ventricular arrthymia, sudden cardiac death, heart failure
This is the ECHO image of HOCM patient
Harrison's, Chapter 229. Noninvasive Cardiac Imaging: Echocardiography,
Nuclear Cardiology, and MRI/CT Imaging

14. Question-5
A 26 years old male with past history of old treated pulmonary tuberculosis
present with history of pedal edema,ascites along with dyspnoea on
exertion for the past one month. On blood investigation he was found to be
HIV ELISA positive. CECT chest of the patient done so which of the
following is NOT true?

15. Conti..

16. Conti.
A) Surgery is the treatment of choice for this patient
B) ECHO cardiography is the best modality to diagnose above medical
condition
C) A diastolic dip and plateau or "square root sign," in the ventricular
waveforms during cardiac catheterization
D) Pressure changes in the right and left ventricles with inspiration are
observed

17. Answer
B) ECHO cardiography is the best modality to diagnose above medical
condition
Image is showing pericardial thickening along with pericardial calcification
which is the characteristics feature of constrictive pericarditis which is best
diagnosed by CECT chest
Harrison's, Chapter 229. Noninvasive Cardiac Imaging: Echocardiography,
Nuclear Cardiology, and MRI/CT Imaging

18. Question-6
A patient present with history of dyspnoea on exertion, his pressure tracing
during simultaneously recording of cardiac and aortic pressure is given
below so what is your diagnosis?

19. Option
A) Aortic stenosis
B) Aortic stenosis with
aortic regurgitation
C) HOCM
D) Coarctation of aorta

20. Answer
A) Aortic stenosis
Pressure tracing is suggestive of pulsus parvus et tardus which is the
characteristic feature found in a patient with aortic stenosis
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and
Coronary Angiography: Introduction, Figure-230/2

21. Question-7
Brockenbrough-Braunwald sign is present in?
A) Aortic stenosis
B) HOCM
C) Pulmonary stenosis
D) Mitral stenosis

22. Answer
Answer- B)HOCM
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and
Coronary Angiography: Introduction, Hemodynamics

23. Question-8
Regarding intracardiac shunt determination during cardiac catheterization, which
of the following is NOT TRUE?
A) Intra cardiac shunt should be suspected when there is unexplained arterial
saturation or desaturation of oxygen saturation of venous blood
B) A "step up" in oxygen content indicates the presence of a right-to-left shunt
while a "step down" indicates a left-to-right shunt
C) The shunt is localized by detecting a difference in oxygen saturation levels of
5–7% between adjacent cardiac chambers
D) The severity of the shunt is determined by the ratio of systemic blood flow (Qp)
to the pulmonary blood flow

24. Answer
Answer- B) A "step up" in oxygen content indicates the presence of a right-
to-left shunt while a "step down" indicates a left-to-right shunt.
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and
Coronary Angiography: Introduction

25. Question-9
All of the following are true about High-risk SPECT MPI findings except?
A) Severe resting or poststress LV systolic dysfunction
B) Large or multiple stress-induced defects
C) Large fixed defect with LV dilation
D) Decreased 201Tl lung uptake

26. Answer
D)Decreased 201Tl lung uptake
Harrison's, Chapter 229. Noninvasive Cardiac Imaging:
Echocardiography, Nuclear Cardiology, and MRI/CT Imaging

27. Question-10
Regarding PET to determine myocardial viability, which of the following is NOT
TRUE ?
A) Regarded as the gold standard technique for the assessment of myocardial viability.
B) The positron-emitting tracer F-18 fluorodeoxyglucose (FDG) assesses myocardial
glucose metabolism and is an indicator of myocardial viability.
C)With reduced myocardial blood flow and ischemia, substrate utilization switches
from fatty acids and lactate toward glucose
D)Decreased FDG uptake in regions of decreased perfusion identifies areas of ischemic
or hibernating myocardium

28. Answer
D) Decreased FDG uptake in regions of decreased perfusion identifies areas
of ischemic or hibernating myocardium
Harrison's, Chapter 229. Noninvasive Cardiac Imaging: Echocardiography,
Nuclear Cardiology, and MRI/CT Imaging

29. Question-11
A patient with a known case of bicuspid aortic valve present with acute
onset retrosternal chest pain radiating to back since two hours, on
examination blood pressure in the right arm was 180/110 mmhg and in the
left arm was 110/70 mmhg, so which of the following is the imaging
modality of choice to detect this condition?
A) Transthoracic echocardiography
B)Transesophageal echocardiography
C)CECT Chest
D)Chest X-ray

30. Answer
C)CECT Chest
The clinical feature is suggestive of acute aortic dissection which is best
diagnosed by CECT Chest
Harrison's, Chapter 229. Noninvasive Cardiac Imaging: Echocardiography,
Nuclear Cardiology, and MRI/CT Imaging

31. Question-12
Patient at risk of developing nephrogenic systemic fibrosis have impaired?
A) Liver function
B) Renal function
C) Left ventricular function
D) Diffusion lung capacity

32. Answer
B) Renal function
Harrison's, Chapter 229. Noninvasive Cardiac Imaging: Echocardiography,
Nuclear Cardiology, and MRI/CT Imaging

33. Question-13
Which of the following statement regarding coronary angiography is not true?
A) Right dominant circulation is found in 85% of individuals
B) Myocardial bridge most commonly involves the left anterior descending
artery
C) Presence of TIMI grade 3 flow suggests presence of significant coronary
artery stenosis
D) Coronary artery anomalies occur in 1–2% of patients

34. Answer
C) Presence of TIMI grade 3 flow suggests presence of significant coronary
artery stenosis
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and
Coronary Angiography: Introduction

35. Question-14
Regarding hemodynamic measurement of heart in various pathological condition
which of the following is NOT TRUE?
A) In cardiac tamponade, there is decreased "y" descent
B) In constrictive pericarditis, there is prominent "y" descent
C) Concordant pressure changes in the right and left ventricles with inspiration is the
most specific hemodynamic phenomenon for constriction
D) Restrictive cardiomyopathy may be distinguished from constrictive pericarditis by a
marked increase in right ventricular and pulmonary artery systolic pressures
(usually >60 mmHg)

36. Answer
C) Concordant pressure changes in the right and left ventricles with inspiration
is the most specific hemodynamic phenomenon for constriction
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and
Coronary Angiography: Introduction

37. Question-15
Normal Values for Hemodynamic Measurements include all of the following
except?
A) Systemic vascular resistance 900–1400 (dyn-s)/cm5
B) Pulmonary vascular resistance 40–120 (dyn-s)/cm5
C) Cardiac index [(L-min)/m2] 2.8–4.2
D) Pulmonary capillary wedge (mean) 4-6 mmhg

38. Answer
D) Pulmonary capillary wedge (mean) 4-6 mmhg
Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization
and Coronary Angiography: Introduction, Table 230/2