Cardiology Practice Questions

Q: Which of the following is NOT a high-risk factor for sudden cardiac death in hypertrophic cardiomyopathy?

Left ventricular septal thickness of 2-3 cm. In Hypertrophic Cardiomyopathy (HCM), identifying patients at risk for Sudden Cardiac Death (SCD) is crucial for determining the need for an Implantable Cardioverter Defibrillator (ICD) [1]. **Explanation of the Correct Answer:** **Option C** is the correct answer because the threshold for high risk is a maximal Left Ventricular Wall Thickness (LVWT) of **≥30 mm (3 cm)**. A thickness of 2-3 cm (20-29 mm) is considered moderate hypertrophy but does not meet the major risk criterion on its own. Extreme hypertrophy (≥30 mm) is a potent predictor of SCD, especially in younger patients. **Explanation of Incorrect Options:** * **Option A (Family History):** A history of SCD in one or more first-degree relatives (aged 20 mmHg or a drop in BP during exercise testing indicates hemodynamic instability and an inability to increase cardiac output, marking high risk [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Major Risk Factors for SCD in HCM:** 1. Prior cardiac arrest or sustained VT (Secondary prevention). 2. Family history of SCD. 3. Unexplained syncope (recent). 4. LV wall thickness ≥30 mm. 5. Abnormal exercise BP response. 6. NSVT on monitoring. * **HCM Murmur:** Increases with Valsalva and standing (decreased preload); decreases with squatting and handgrip. * **Management:** Beta-blockers are first-line; ICD is the only proven method to prevent SCD [1].

Q: ST depression and T wave inversion in leads V1 to V6 and aVL indicate which of the following?

Anterolateral wall AMI. **Explanation:** The presence of ST-segment and T-wave changes in leads **V1 to V6** (precordial leads) and **aVL** (lateral lead) signifies pathology involving the **Anterolateral wall** of the left ventricle [2]. 1. **Why Anterolateral AMI is correct:** In the context of an Acute Myocardial Infarction (AMI), leads V1–V4 represent the **Anterior wall**, while leads V5, V6, I, and aVL represent the **Lateral wall** [2]. When changes occur across V1 through V6 plus aVL, it indicates a massive infarction involving both territories, typically due to a proximal occlusion of the **Left Anterior Descending (LAD) artery** or the **Left Main Coronary Artery**. While ST-elevation is the hallmark of STEMI [3], ST-depression and T-wave inversion in these leads signify **NSTEMI** or severe subendocardial ischemia of the anterolateral wall. 2. **Why other options are incorrect:** * **Posterior wall AMI:** Characterized by *reciprocal* ST-depression and tall R waves in V1–V3. It does not typically involve V4–V6 or aVL. * **Inferior AMI:** Involves leads II, III, and aVF (supplied by the Right Coronary Artery) [1]. * **Lateral wall AMI:** Isolated lateral involvement would typically show changes only in I, aVL, V5, and V6, sparing the septal/anterior leads (V1–V4). **High-Yield Clinical Pearls for NEET-PG:** * **LAD Occlusion:** Known as the "Widow Maker." * **Lead Groupings:** * Septal: V1, V2 * Anterior: V3, V4 [2] * Lateral: I, aVL, V5, V6 * Inferior: II, III, aVF [1] * **Wellen’s Syndrome:** Deeply inverted or biphasic T-waves in V2–V3; a critical warning sign of high-grade proximal LAD stenosis.

Q: Anacrotic pulse is seen in which of the following conditions?

Aortic stenosis. **Explanation:** The **Anacrotic pulse** (from the Greek *ana* meaning up and *krotos* meaning beat) is a small-volume, slow-rising pulse characterized by a notch on the ascending limb of the arterial pulse wave. **Why Aortic Stenosis is correct:** In **Aortic Stenosis (AS)**, there is a mechanical obstruction to the left ventricular outflow. This results in a prolonged ejection time as the heart struggles to pump blood through a narrowed valve. This produces the classic **"Pulsus Parvus et Tardus"** (small volume and late/slow-rising pulse). The "anacrotic notch" occurs because the initial ejection is interrupted by the resistance of the stenotic valve, making it a hallmark finding of severe valvular AS [1]. **Why the other options are incorrect:** * **Aortic Regurgitation:** Characterized by a **Water-hammer pulse** (Corrigan’s pulse), which is a large-volume, rapidly collapsing pulse due to increased stroke volume and rapid runoff into the aorta and back into the ventricle [3], [4]. * **Mitral Regurgitation:** Usually presents with a normal or slightly low-volume pulse (if cardiac output is reduced), but never an anacrotic pulse [2]. * **Mitral Stenosis:** Typically presents with a **low-volume pulse** (Pulsus Parvus) due to reduced stroke volume, but the upstroke remains normal. **High-Yield Clinical Pearls for NEET-PG:** * **Pulsus Bisferiens:** Seen in AR + AS or Hypertrophic Obstructive Cardiomyopathy (HOCM). * **Pulsus Alternans:** A sign of severe Left Ventricular Failure (LVF). * **Pulsus Paradoxus:** Characterized by a >10 mmHg drop in systolic BP during inspiration; seen in Cardiac Tamponade, Severe Asthma, and COPD. * **Dicrotic Pulse:** A double-peaked pulse with the second peak in diastole; seen in low cardiac output states like dilated cardiomyopathy or febrile states (Typhoid) [3].

Q: ST elevation and hyperacute T waves in precordial leads V1 to V6 and in lead aVL indicates:

Anterolateral wall MI. ### Explanation **1. Why Anterolateral Wall MI is Correct:** The ECG findings described (ST elevation and hyperacute T waves) represent an acute ST-elevation myocardial infarction (STEMI) [1]. To localize the infarct, we look at the specific leads involved: * **V1–V4:** Represent the **Anterior wall** (supplied by the Left Anterior Descending artery - LAD) [2]. * **V5–V6, I, and aVL:** Represent the **Lateral wall** (supplied by the Left Circumflex artery - LCX or diagonal branches of the LAD) [1], [2]. Since the ST elevation spans from **V1 to V6** (Anterior + Lateral) and includes **aVL** (Lateral), it indicates an **Anterolateral wall MI**. This typically suggests a proximal occlusion of the **Left Main Coronary Artery** or a very proximal **LAD**. **2. Why Other Options are Incorrect:** * **Posterior Wall MI:** Characterized by ST *depression* and tall R waves in V1–V3 (reciprocal changes). Diagnosis is confirmed by ST elevation in posterior leads V7–V9. * **Inferior MI:** Characterized by ST elevation in leads **II, III, and aVF** [1]. It usually involves the Right Coronary Artery (RCA). * **Lateral Wall MI:** Isolated lateral MI involves only leads I, aVL, V5, and V6. Since V1–V4 (anterior leads) are also involved here, "Anterolateral" is the more accurate and comprehensive diagnosis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Septal MI:** Leads V1–V2 [2]. * **Anterior MI:** Leads V3–V4 [1], [2]. * **Extensive Anterior MI:** Leads V1–V6, I, and aVL. * **Reciprocal Changes:** Look for ST depression in II, III, and aVF when viewing an Anterolateral MI; this reinforces the diagnosis of STEMI [1]. * **Hyperacute T waves:** These are the *earliest* ECG sign of MI, appearing even before ST elevation.

Q: Judkins technique is used for which procedure?

Coronary arteriography. **Explanation:** The **Judkins technique** is the most widely used method for **coronary arteriography** (diagnostic cardiac catheterization). It involves a percutaneous approach, typically through the femoral artery (Seldinger technique), using pre-shaped, specialized catheters designed to selectively engage the ostia of the right and left coronary arteries. * **Why Option B is correct:** The Judkins technique utilizes specific catheters—the **Judkins Left (JL)** and **Judkins Right (JR)**—which have secondary curves tailored to the anatomy of the aortic arch and the location of the coronary ostia, allowing for rapid and safe opacification of the coronary arteries. * **Why Options A & D are incorrect:** Central venous line placement and chest tube insertion are bedside procedures that do not require specialized arterial catheters or fluoroscopic guidance for coronary engagement. * **Why Option C is incorrect:** While renal angiography also uses a percutaneous arterial approach, it typically employs different catheter shapes (e.g., Cobra or RDC catheters) specifically designed for the renal artery anatomy. **High-Yield Pearls for NEET-PG:** * **Sones Technique:** An older alternative to Judkins that uses a single catheter via a brachial artery cut-down. * **Radial Approach:** Currently gaining preference over the femoral (Judkins) approach due to lower bleeding complications, often using **Tiger or Jacky catheters** which can cannulate both coronaries with one catheter. * **Gold Standard:** Coronary angiography remains the gold standard for diagnosing Coronary Artery Disease (CAD). * **Contrast Media:** Non-ionic, low-osmolar contrast media (LOCM) are preferred to reduce the risk of nephropathy and arrhythmias.

Question 1

A young man with a history of breathlessness while walking to the gym has an ejection murmur on examination that increases with the Valsalva maneuver. Echocardiogram shows left ventricular hypertrophy (LVH) with deep Q waves in anterior chest leads. What should this patient avoid?

Accepted Answer

Digitalis

Answer

Regular walking in the gym

Answer

Verapamil

Answer

Sublingual nitroglycerine

Question 2

A 25-year-old man presents with headache, dizziness, and bilateral leg claudication. Physical examination reveals hypertension in the upper limbs and hypotension in the lower limbs. Which of the following additional findings is most likely in this patient?

Accepted Answer

Notching of inferior margins of ribs

Answer

Aortic valvular stenosis

Answer

Patent ductus arteriosus

Answer

Vasculitis involving the aortic arch

Question 3

Which of the following is NOT a high-risk factor for sudden cardiac death in hypertrophic cardiomyopathy?

Accepted Answer

Left ventricular septal thickness of 2-3 cm

Answer

Family history of sudden cardiac death

Answer

Non-sustained ventricular tachycardia on cardiac monitoring

Answer

Abnormal drop in systolic blood pressure

Question 4

ST depression and T wave inversion in leads V1 to V6 and aVL indicate which of the following?

Accepted Answer

Anterolateral wall AMI

Answer

Posterior wall AMI

Answer

Inferior AMI

Answer

Lateral wall AMI

Question 5

Anacrotic pulse is seen in which of the following conditions?

Accepted Answer

Aortic stenosis

Answer

Aortic regurgitation

Answer

Mitral regurgitation

Answer

Mitral stenosis

Question 6

Which of the following is NOT a feature of a complete heart block?

Accepted Answer

Heart rate increase during exercise

Answer

Bradycardia

Answer

Cannon waves

Answer

Varying intensity of the first heart sound

Question 7

ST elevation and hyperacute T waves in precordial leads V1 to V6 and in lead aVL indicates:

Accepted Answer

Anterolateral wall MI

Answer

Posterior wall MI

Answer

Inferior MI

Answer

Lateral wall MI

Question 8

Judkins technique is used for which procedure?

Accepted Answer

Coronary arteriography

Answer

Central venous line placement

Answer

Renal angiography

Answer

Chest tube insertion

Question 9

A 46-year-old smoker presents to the emergency department with sharp, left-sided chest pain that is not focal. Physical examination reveals no specific findings. The pain is neither aggravated nor relieved by postural changes or inspiration. An ECG shows anterior ST elevation. What should be the next step in management?

Accepted Answer

Urgent bedside echocardiogram to rule out regional wall motion abnormality

Answer

Activation of the primary angioplasty team

Answer

Await troponin tests and administer analgesia

Answer

Administer non-steroidal anti-inflammatory analgesia

Question 10

Fixed splitting of the second heart sound (S2) may be seen in all of the following conditions except?

Accepted Answer

Left bundle branch block

Answer

Pulmonary embolism

Answer

Pulmonary stenosis

Answer

Atrial septal defect

Cardiology — MCQs

Cardiology — MCQs

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