Cardiology Practice Questions

Q: Wolff-Parkinson-White disease may be associated with which of the congenital heart defects?

Ebstein's anomaly. **Explanation:** **Ebstein’s Anomaly** is the congenital heart defect most classically associated with **Wolff-Parkinson-White (WPW) syndrome**. In Ebstein’s anomaly, there is a failure of delamination of the tricuspid valve leaflets, leading to their downward displacement into the right ventricle ("atrialization" of the RV). This structural abnormality is frequently accompanied by **accessory pathways** (Bundle of Kent), particularly located around the malformed tricuspid annulus on the right side of the heart. Approximately 10–20% of patients with Ebstein’s anomaly have WPW syndrome, often involving multiple accessory pathways. **Analysis of Incorrect Options:** * **Tetralogy of Fallot (TOF):** While TOF is associated with right bundle branch block (RBBB) and ventricular arrhythmias post-repair, it does not have a specific developmental association with accessory atrioventricular pathways. * **Patent Ductus Arteriosus (PDA):** PDA is an extracardiac shunt. It leads to volume overload of the left heart but is not associated with the conduction system abnormalities seen in WPW. **High-Yield Clinical Pearls for NEET-PG:** * **WPW in Ebstein’s:** Usually involves **Right-sided accessory pathways**. * **ECG Triad of WPW:** Short PR interval (<0.12s), Delta wave (slurred upstroke of QRS), and prolonged QRS complex. * **Drug of Choice:** For acute orthodromic SVT in WPW, Adenosine is used. However, for permanent destruction of the pathway, **Radiofrequency Ablation** is the definitive treatment. * **Avoid:** "ABCD" drugs (Adenosine, Beta-blockers, Calcium channel blockers, Digoxin) in patients with WPW and Atrial Fibrillation, as they can paradoxically increase conduction through the accessory pathway, leading to Ventricular Fibrillation.

Q: In Marfan's syndrome, aortic aneurysm occurs most commonly in which part of the aorta?

Ascending aorta. **Explanation:** **1. Why the Ascending Aorta is Correct:** Marfan’s syndrome is an autosomal dominant connective tissue disorder caused by a mutation in the **FBN1 gene**, which encodes **fibrillin-1** [1]. This deficiency leads to **cystic medial necrosis** (degeneration of the elastic fibers in the tunica media). The ascending aorta, particularly the **aortic root (Sinus of Valsalva)**, is the site of the highest hemodynamic stress and wall tension (Laplace’s Law). Because this segment has the highest concentration of elastic lamellae, it is most susceptible to progressive dilation, leading to aneurysm formation and potentially Type A aortic dissection [2]. **2. Why the Other Options are Incorrect:** * **B & D (Descending Aorta and Aortic Arch):** While these segments can be involved in Marfan’s syndrome, they are significantly less common than the ascending aorta. Dilation here usually occurs secondary to an extension of an ascending dissection or in much later stages of the disease [2]. * **C (Abdominal Aorta):** Abdominal aortic aneurysms (AAA) are typically associated with **atherosclerosis** and smoking, rather than genetic connective tissue disorders [1]. In Marfan’s, the pathology is predominantly thoracic. **3. Clinical Pearls for NEET-PG:** * **Most common cause of death:** Aortic root dilatation leading to rupture or dissection. * **Cardiac Murmur:** Aortic Regurgitation (early diastolic murmur) is common due to annular stretching. * **Echocardiography:** The gold standard for serial monitoring of aortic root diameter. * **Surgery Indication:** Prophylactic replacement is usually recommended when the diameter reaches **≥50 mm** (or ≥45 mm if there are additional risk factors). * **Associated Sign:** Look for **Steinberg sign** (thumb sign) and **Walker-Murdoch sign** (wrist sign) on physical exam.

Q: The echocardiogram of a patient presenting with exertional dyspnea, bilateral pedal edema, and elevated jugular venous pressure is shown. What is the most likely diagnosis?

Tricuspid regurgitation. ***Tricuspid regurgitation*** - **Exertional dyspnea**, **bilateral pedal edema**, and **elevated jugular venous pressure** indicate **right heart failure**, characteristic of tricuspid regurgitation. - Echocardiogram shows **right ventricular dilatation** and **tricuspid valve insufficiency** with a **regurgitant jet** into the right atrium. *Aortic regurgitation* - Typically presents with **wide pulse pressure**, **diastolic murmur**, and **left ventricular volume overload** on echocardiogram. - Clinical features include **water hammer pulse** and **head bobbing**, not right-sided heart failure signs. *Mitral regurgitation* - Causes **left atrial enlargement** and **left ventricular dilatation** with **pulmonary edema** rather than peripheral edema. - Presents with **apical systolic murmur** radiating to the axilla and **left heart failure** symptoms. *Cor-triatriatum* - A rare **congenital anomaly** with **fibromuscular membrane** dividing the left or right atrium. - Usually presents in **childhood** with **pulmonary congestion** and requires surgical correction, not typical adult presentation.

Q: All of the following conditions produce restrictive cardiomyopathy except?

Hypothyroidism. **Explanation:** Restrictive Cardiomyopathy (RCM) is characterized by rigid ventricular walls that resist diastolic filling, leading to elevated filling pressures despite normal or near-normal systolic function. **Why Hypothyroidism is the correct answer:** Hypothyroidism is primarily associated with **Dilated Cardiomyopathy (DCM)** or pericardial effusion [1]. In severe cases (Myxedema heart), there is a reduction in cardiac output, bradycardia, and weakened contractility. It does not typically cause the rigid, non-compliant ventricular physiology seen in restrictive patterns. **Analysis of Incorrect Options:** * **Amyloidosis:** This is the **most common cause** of infiltrative RCM [2]. Extracellular deposition of amyloid fibrils increases ventricular wall thickness and stiffness, leading to a classic "speckled" appearance on echocardiography. * **Hyper-eosinophilic Syndrome (Löffler Endocarditis):** This is an obliterative RCM where eosinophilic infiltration leads to endomyocardial damage, thrombus formation, and eventual fibrosis, "filling in" the ventricular apex [2]. * **Tropical Endomyocardial Fibrosis (EMF):** A common cause of RCM in tropical regions (like parts of India), characterized by fibrous replacement of the endocardium and myocardium, leading to apical obliteration and severe diastolic dysfunction [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Kussmaul’s Sign:** Often positive in RCM (unlike in cardiac tamponade). * **Differentiating RCM from Constrictive Pericarditis:** RCM typically shows higher pulmonary artery pressures (>50 mmHg) and a thicker ventricular wall on Echo/MRI. * **Sarcoidosis:** Another high-yield cause of RCM, often presenting with conduction blocks [2]. * **Hemochromatosis:** Unique because it can present as either RCM (early) or DCM (late) [2].

Q: A 65-year-old man with diabetes, on an oral hypoglycemic, presents to the ER with a spontaneous right shoulder injury. His heart rate was noted to be irregular and the following ECG was obtained. What is the best immediate therapy?

Observation. ***Observation*** - **Wandering atrial pacemaker (WAP)** is a benign arrhythmia characterized by ≥3 different **P-wave morphologies** with varying **PR intervals**, commonly seen in elderly patients and diabetics. - Since WAP is typically **asymptomatic** and **hemodynamically stable**, observation with monitoring of underlying triggers like **hypoglycemia** from oral hypoglycemics is appropriate. *Atropine* - Atropine is used for **symptomatic bradycardia** with hemodynamic compromise, not for **wandering atrial pacemaker**. - WAP typically maintains adequate **heart rate** and **cardiac output**, making atropine unnecessary and potentially harmful. *Pacemaker* - Pacemaker insertion is indicated for **symptomatic bradyarrhythmias** or **complete heart block** with hemodynamic instability. - WAP is a **benign arrhythmia** that doesn't require permanent pacing as it maintains adequate ventricular response. *Electrical cardioversion* - Cardioversion is used for **unstable tachyarrhythmias** like atrial fibrillation or ventricular tachycardia with hemodynamic compromise. - WAP is not a **life-threatening arrhythmia** and doesn't cause hemodynamic instability requiring emergency cardioversion.

Question 1

Which of the following conditions is most likely to occur in a patient with the following hemodynamic data: Pressures: RA = 12 mm Hg, RV = 50/12 mm Hg, PA=50/15 mm Hg, PA wedge pressure = 8 mm Hg, Aorta = 80/60 mm Hg, Cardiac Index = 1.4 L/min/m², SVR= 1800 dynes·sec/cm⁵, PVR=500 dynes·sec/cm⁵?

Accepted Answer

Acute massive pulmonary embolism

Answer

Acute myocardial infarction with left ventricular failure and cardiogenic shock

Answer

Hypovolemic shock following gastroenteritis

Answer

Early septic shock

Question 2

Wolff-Parkinson-White disease may be associated with which of the congenital heart defects?

Accepted Answer

Ebstein's anomaly

Answer

Tetralogy of Fallot

Answer

Patent Ductus Arteriosus (PDA)

Answer

All of the above

Question 3

In Marfan's syndrome, aortic aneurysm occurs most commonly in which part of the aorta?

Accepted Answer

Ascending aorta

Answer

Descending aorta

Answer

Abdominal aorta

Answer

Aortic arch

Question 4

Which of the following is true about symptomatic mitral valve prolapse?

Accepted Answer

Displacement of one or both mitral valve leaflets posteriorly into the left atrium during systole

Answer

Migration of systolic click and systolic murmur towards S1 during squatting

Answer

Prophylactic beta blockers are indicated

Answer

Restriction of vigorous exercise is recommended to mitigate the risk of sudden cardiac death

Question 5

The echocardiogram of a patient presenting with exertional dyspnea, bilateral pedal edema, and elevated jugular venous pressure is shown. What is the most likely diagnosis?

Accepted Answer

Tricuspid regurgitation

Answer

Aortic regurgitation

Answer

Mitral regurgitation

Answer

Cor-triatriatum

Question 6

All of the following conditions produce restrictive cardiomyopathy except?

Accepted Answer

Hypothyroidism

Answer

Amyloidosis

Answer

Hyper-eosinophilic syndrome

Answer

Tropical endomyocardial fibrosis

Question 7

Calcification of the aortic valve is seen in which condition?

Accepted Answer

Syphilis

Answer

Hurler's syndrome

Answer

Marfan's syndrome

Answer

Hunter syndrome

Question 8

A 65-year-old man with diabetes, on an oral hypoglycemic, presents to the ER with a spontaneous right shoulder injury. His heart rate was noted to be irregular and the following ECG was obtained. What is the best immediate therapy?

Accepted Answer

Observation

Answer

Atropine

Answer

Pacemaker

Answer

Electrical cardioversion

Question 9

A 35-year-old lady has Idiopathic pulmonary artery hypertension. Which findings best describe this patient?

Accepted Answer

Elevated JVP, singular loud S2, Systolic murmur

Answer

Elevated JVP, normal SI S2, Diastolic murmur

Answer

Elevated JVP, wide fixed split S2, Systolic murmur

Answer

Elevated JVP, barrel chest, reverse split S2

Question 10

A smoker presents with a four-year history of blanching of the fingers on exposure to cold. What is the most likely diagnosis?

Accepted Answer

Thromboangiitis obliterans

Answer

Marantic endocarditis

Answer

Kawasaki disease

Answer

Brachial artery entrapment syndrome

Cardiology — MCQs

Cardiology — MCQs

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