[MCQ] Ischemic Heart Disease- Part 1

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Ischemic Heart Disease- Part 1

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Question 1

Which of the following is a determinant of myocardial oxygen demand (MVO2) ?

A	Heart rate
B	Myocardial contractility
C	Myocardial wall tension (stress)
D	All of the above

Question 1 Explanation:

The major determinants of myocardial oxygen demand (MVO2) are heart rate, myocardial contractility, and myocardial wall tension (stress).

Question 2

Majority of blood flow through coronary arteries is during ?

A	Systole
B	Systole
C	Presystole
D	Prediastole

Question 2 Explanation:

Blood flows through coronary arteries in a phasic fashion, with majority occurring during diastole

Question 3

Major determinant of total coronary resistance is found in ?

A	Large epicardial arteries (R1)
B	Prearteriolar vessels (R2)
C	Arteriolar and intramyocardial capillary vessels (R3)
D	R2 + R3

Question 3 Explanation:

About 75% of the total coronary resistance to flow occurs across three sets of arteries: (1) large epicardial arteries (Resistance 1 = R1), (2) prearteriolar vessels (R2), and (3) arteriolar and intramyocardial capillary vessels (R3). In the absence of significant flow-limiting atherosclerotic obstructions, R1 is trivial; the major determinant of coronary resistance is found in R2 and R3.

Question 4

Which of the following statements is false ?

A	Large epicardial coronary arteries are conductance vessels
B	Intramyocardial arterioles are resistance vessels
C	Abnormal constriction of conductance vessels can cause Prinzmetal’s angina
D	Abnormal constriction of resistance vessels can cause Prinzmetal’s angina

Question 4 Explanation:

Although the large epicardial coronary arteries are capable of constriction and relaxation, in healthy persons they serve as conduits and are referred to as conductance vessels, while the intramyocardial arterioles normally exhibit changes in tone and are therefore referred to as resistance vessels. Abnormal constriction of the conductance vessels can cause severe ischemia in Prinzmetal’s angina. Abnormal constriction or failure of normal dilation of coronary resistance vessels causes ischemia termed as microvascular angina.

Question 5

Which of the following sites has the most predilection for atherosclerotic plaques to develop ?

A	Origin of epicardial arteries
B	Branch points in epicardial arteries
C	Terminal regions of epicardial arteries
D	Any of the above

Question 5 Explanation:

Atherosclerotic plaques have a predilection to develop at sites of increased turbulence in coronary flow like branch points in the epicardial arteries.

Question 6

Normal myocardium metabolizes which of the following ?

A	Fatty acids
B	Amino acids
C	Lactate
D	All of the above

Question 6 Explanation:

Normal myocardium metabolizes fatty acids and glucose to carbon dioxide and water

Question 7

During myocardial ischemia, impairment of cell membrane function leads to ?

A	Leakage of potassium from myocytes
B	Uptake of sodium by myocytes
C	Increase in cytosolic calcium
D	All of the above

Question 7 Explanation:

Impaired myocyte cell membrane function due to ischemia leads to leakage of potassium and uptake of sodium by myocytes as well as an increase in cytosolic calcium

Question 8

Minimum duration of total occlusion of epicardial vessel in absence of collaterals for development of myocardial necrosis is ?

A	> 20 minutes
B	> 25 minutes
C	> 30 minutes
D	> 35 minutes

Question 8 Explanation:

Severity & duration of imbalance between myocardial oxygen supply & demand determine whether damage is reversible (<=20 minutes for total occlusion in the absence of collaterals) or whether it is permanent, with subsequent myocardial necrosis (>20 minutes).

Question 9

In ECG, transient ST-segment depression reflects ?

A	Subendocardial ischemia
B	Transmural ischemia
C	Epicardial ischemia
D	All of the above

Question 10

In ECG, transient ST-segment elevation reflects ?

A	Subendocardial ischemia
B	Transmural ischemia
C	Epicardial ischemia
D	All of the above

Question 10 Explanation:

Ischemia also causes characteristic changes in ECG such as repolarization abnormalities in the form of inversion of T waves and, when more severe, by displacement of ST segments. Transient ST-segment depression reflects patchy subendocardial ischemia, while ST-segment elevation is caused by more severe transmural ischemia

Question 11

Coronary atherosclerosis begins to develop at what age ?

A	< 20 years
B	20 - 30 years
C	30 - 40 years
D	> 40 years

Question 11 Explanation:

Postmortem studies have shown that coronary atherosclerosis often begins to develop prior to age 20 and is widespread even among adults who were asymptomatic during life.

Question 12

Squeezing, central, substernal discomfort in angina pectoris is termed ?

A	Landolfi’s sign
B	Levine’s sign
C	Lhermitte’s sign
D	Carvolo’s sign

Question 12 Explanation:

Squeezing, central, substernal discomfort indicative of angina pectoris is termed as Levine’s sign.

Question 13

Which of the following statements about angina is false ?

A	Angina is usually crescendo-decrescendo in nature
B	Typically lasts for 10 to 15 minutes
C	Pain can radiate to both arms
D	Rarely localized below umbilicus or above mandible

Question 13 Explanation:

Angina is usually crescendo-decrescendo in nature, typically lasts 2 to 5 minutes, and can radiate to left shoulder and to both arms, especially to the ulnar surfaces of forearm and hand. It can also arise in or radiate to the back, interscapular region, root of the neck, jaw, teeth, and epigastrium. Angina is rarely localized below the umbilicus or above the mandible

Question 14

Radiation of chest pain towards which of the following is more typical of pericarditis ?

A	Interscapular region
B	Jaw
C	Epigastrium
D	Trapezius muscles

Question 14 Explanation:

Chest discomfort due to myocardial ischemia does not radiate to the trapezius muscles; such a radiation pattern is more typical of pericarditis.

Question 15

“Angina decubitus” refers to anginal pain occuring when the patient is in which of the following positions ?

A	Squatting
B	Sitting with legs hanging
C	Recumbent
D	Any of the above

Question 15 Explanation:

Episodes of angina that occur at night while the patient is recumbent is termed as angina decubitus

Question 16

Atypical presentations of angina pectoris are more frequent in ?

A	Older patients
B	Diabetics
C	Women
D	All of the above

Question 17

Anginal “equivalents” are all except ?

A	Dyspnea
B	Fatigue
C	Palpitation
D	Faintness

Question 18

Anginal “equivalents” are more common in ?

A	Women
B	Smoker
C	Hypertension
D	Diabetes mellitus

Question 18 Explanation:

Anginal “equivalents” are symptoms of myocardial ischemia other than angina. These include dyspnea, fatigue and faintness and are more common in the elderly and in diabetic patients

Question 19

Disorders that may cause angina in absence of coronary atherosclerosis are all except ?

A	Hypertrophic cardiomyopathy
B	Aortic regurgitation
C	Pulmonary hypertension
D	Systemic hypertension

Question 19 Explanation:

Aortic stenosis, aortic regurgitation, pulmonary hypertension and hypertrophic cardiomyopathy may cause angina in the absence of coronary atherosclerosis.

Question 20

All of the following are indications of discontinuing exercise stress testing except ?

A	Chest discomfort
B	Severe shortness of breath
C	Dizziness
D	Rise in systolic blood pressure > 40 mmHg

Question 21

All of the following are indications of discontinuing exercise stress testing except ?

A	ST-segment depression > 0.2 mV (2 mm)
B	Fall in systolic blood pressure > 10 mmHg
C	Development of supraventricular tachyarrhythmia
D	Development of ventricular tachyarrhythmia

Question 21 Explanation:

Treadmill exercise stress test is discontinued upon evidence of chest discomfort, severe shortness of breath, dizziness, severe fatigue, ST-segment depression > 0.2 mV (2 mm), a fall in systolic blood pressure >10 mmHg, or the development of a ventricular tachyarrhythmia

Question 22

False-negative stress test is usual in obstructive disease limited to which coronary artery ?

A	Left anterior descending coronary artery
B	Left circumflex coronary artery
C	Right coronary artery
D	Posterior descending artery

Question 22 Explanation:

Obstructive disease limited to circumflex coronary artery results in a false-negative stress test since lateral portion of heart which it supplies is not well represented on the surface 12-lead ECG.

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See all quizzes of Ischemic Heart Disease at here:

Ischemic Heart Disease- Part 1| Ischemic Heart Disease- Part 2

1.Which of the following is a determinant of myocardial oxygen demand (MVO2) ?
A. Heart rate
B. Myocardial contractility
C. Myocardial wall tension (stress)
D. All of the above

2. Majority of blood flow through coronary arteries is during ?
A. Systole
B. Diastole
C. Presystole
D. Prediastole

3. Major determinant of total coronary resistance is found in ?
A. Large epicardial arteries (R1)
B. Prearteriolar vessels (R2)
C. Arteriolar and intramyocardial capillary vessels (R3)
D. R2 + R3

4. Which of the following statements is false ?
A. Large epicardial coronary arteries are conductance vessels
B. Intramyocardial arterioles are resistance vessels
C. Abnormal constriction of conductance vessels can cause Prinzmetal’s angina
D. Abnormal constriction of resistance vessels can cause Prinzmetal’s angina

5. Which of the following sites has the most predilection for atherosclerotic plaques to develop ?
A. Origin of epicardial arteries
B. Branch points in epicardial arteries
C. Terminal regions of epicardial arteries
D. Any of the above

6. Normal myocardium metabolizes which of the following ?
A. Fatty acids
B. Amino acids
C. Lactate
D. All of the above

7. During myocardial ischemia, impairment of cell membrane function leads to ?
A. Leakage of potassium from myocytes
B. Uptake of sodium by myocytes
C. Increase in cytosolic calcium
D. All of the above

8. Minimum duration of total occlusion of epicardial vessel in absence of collaterals for development of myocardial necrosis is ?
A. > 20 minutes
B. > 25 minutes
C. > 30 minutes
D. > 35 minutes

9.In ECG, transient ST-segment depression reflects ?
A. Subendocardial ischemia
B. Transmural ischemia
C. Epicardial ischemia
D. All of the above
10. In ECG, transient ST-segment elevation reflects ?
A. Subendocardial ischemia
B. Transmural ischemia

C. Epicardial ischemia
D. All of the above

11. Coronary atherosclerosis begins to develop at what age ?
A. < 20 years
B. 20 – 30 years
C. 30 – 40 years
D. > 40 years

12. Squeezing, central, substernal discomfort in angina pectoris is termed ?
A. Landolfi’s sign
B. Levine’s sign
C. Lhermitte’s sign
D. Carvolo’s sign

13. Which of the following statements about angina is false ?
A. Angina is usually crescendo-decrescendo in nature
B. Typically lasts for 10 to 15 minutes
C. Pain can radiate to both arms
D. Rarely localized below umbilicus or above mandible

14.Radiation of chest pain towards which of the following is more typical of pericarditis ?
A. Interscapular region
B. Jaw
C. Epigastrium
D. Trapezius muscles

15. “Angina decubitus” refers to anginal pain occuring when the patient is in which of the following positions ?
A. Squatting
B. Sitting with legs hanging
C. Recumbent
D. Any of the above

16. Atypical presentations of angina pectoris are more frequent in ?

A. Older patients
B. Diabetics
C. Women
D. All of the above
17. Anginal “equivalents” are all except ?
A. Dyspnea
B. Fatigue
C. Palpitation
D. Faintness
18.Anginal “equivalents” are more common in ?
A. Women
B. Smoker
C. Hypertension
D. Diabetes mellitus

19. Disorders that may cause angina in absence of coronary atherosclerosis are all except ?
A. Hypertrophic cardiomyopathy
B. Aortic regurgitation
C. Pulmonary hypertension
D. Systemic hypertension

20. All of the following are indications of discontinuing exercise stress testing except ?
A. Chest discomfort
B. Severe shortness of breath
C. Dizziness
D. Rise in systolic blood pressure > 40 mmHg
21. All of the following are indications of discontinuing exercise stress testing except ?
A. ST-segment depression > 0.2 mV (2 mm)
B. Fall in systolic blood pressure > 10 mmHg
C. Development of supraventricular tachyarrhythmia
D. Development of ventricular tachyarrhythmia

22. False-negative stress test is usual in obstructive disease limited to which coronary artery ?
A. Left anterior descending coronary artery
B. Left circumflex coronary artery
C. Right coronary artery

D. Posterior descending artery

Ischemic Heart Disease

[MCQ] Ischemic Heart Disease- Part 1

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Ischemic Heart Disease- Part 1

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