Cardiology Practice Questions

Q: Which of the following disorders is LEAST likely to cause high output failure?

Addison disease. **Explanation:** High-output heart failure (HOHF) occurs when the heart's cardiac output is elevated but still fails to meet the metabolic demands of the body, or can only do so at the expense of elevated filling pressures. This is typically driven by a decrease in **Systemic Vascular Resistance (SVR)** or an increase in metabolic rate. **Why Addison Disease is the Correct Answer:** Addison disease (primary adrenal insufficiency) is characterized by a deficiency in mineralocorticoids and glucocorticoids. This leads to **hypovolemia** (due to salt wasting), decreased vascular tone, and reduced cardiac contractility. Consequently, patients present with **low cardiac output** and hypotension, making it the "least likely" to cause a high-output state. **Analysis of Incorrect Options:** * **Thiamine Deficiency (Wet Beriberi):** Thiamine is a cofactor for carbohydrate metabolism. Deficiency leads to peripheral vasodilation and increased venous return, causing classic HOHF. * **Hyperthyroidism:** Excess thyroid hormones increase metabolic demand, induce peripheral vasodilation, and have direct positive inotropic/chronotropic effects on the heart, significantly raising cardiac output. * **Paget Disease of Bone:** Extensive remodeling of bone involves the formation of multiple **microscopic arteriovenous (AV) shunts**. These shunts bypass the capillary beds, decreasing SVR and increasing venous return to the heart. **NEET-PG High-Yield Pearls:** * **Common causes of HOHF:** Anemia, Pregnancy, AV Fistulas, Beriberi, Hyperthyroidism, and Paget’s disease. * **Hemodynamic Hallmark:** Decreased SVR + Increased Cardiac Index. * **Clinical Sign:** "Warm failure" (warm extremities and bounding pulses), unlike the "cold failure" seen in typical low-output states.

Q: What is the most common congenital cardiac anomaly diagnosed in adulthood?

Atrial Septal Defect (ASD). ### Explanation **Correct Option: A. Atrial Septal Defect (ASD)** The primary reason **Atrial Septal Defect (ASD)** is the most common congenital heart disease (CHD) diagnosed in adulthood is its **asymptomatic nature** during childhood [1]. Unlike other defects, the pressure gradient between the left and right atria is relatively low, leading to a gradual left-to-right shunt. This volume overload of the right ventricle is well-tolerated for decades. Most patients remain asymptomatic until their 3rd or 4th decade, when they present with exertional dyspnea, fatigue, or palpitations (often due to atrial fibrillation). Among ASDs, the **Secundum type** is the most common variety [1]. **Why other options are incorrect:** * **Ventricular Septal Defect (VSD):** While VSD is the most common CHD at **birth**, most small VSDs close spontaneously in childhood, and large ones cause early heart failure, leading to diagnosis and surgical repair long before adulthood [2]. * **Patent Ductus Arteriosus (PDA):** These are typically detected in infancy due to the characteristic continuous "machinery" murmur and are usually corrected early to prevent pulmonary hypertension [3]. * **Total Anomalous Pulmonary Venous Return (TAPVR):** This is a cyanotic CHD that usually presents with severe respiratory distress or cyanosis in the neonatal period or early infancy; it is incompatible with long-term survival without early surgical intervention. **High-Yield Clinical Pearls for NEET-PG:** * **Most common CHD at birth:** VSD [2]. * **Most common CHD diagnosed in adults:** ASD [1]. * **Auscultation finding in ASD:** Fixed wide splitting of the second heart sound (S2) and a mid-systolic flow murmur at the pulmonary area. * **ECG in Secundum ASD:** Right axis deviation and RSR' pattern in V1 (Partial RBBB). * **Paradoxical Embolism:** ASD is a significant risk factor for systemic emboli (e.g., stroke) originating from deep vein thrombosis.

Q: A 67-year-old male smoker presents with cough and was treated for acute bronchitis. A chest X-ray prompted a referral to the chest clinic. The patient has a past history of myocardial infarction but is currently asymptomatic. Blood pressure is 128/80, and cardiopulmonary examination is unremarkable. A purified protein derivative (PPD) test result is 7 mm. The chest X-ray is shown. What is the likely diagnosis?

Left ventricular aneurysm. ***Left ventricular aneurysm*** - In a patient with **previous myocardial infarction**, a localized bulge at the **left cardiac border** on chest X-ray is characteristic of a **left ventricular aneurysm** formation. - The **asymptomatic presentation** with normal cardiopulmonary examination is typical, as many LV aneurysms remain clinically silent until complications develop. *Hypertensive cardiomyopathy* - Would present with **generalized cardiomegaly** rather than a localized cardiac border bulge seen on the chest X-ray. - The patient's **normal blood pressure** (128/80) makes active hypertensive heart disease unlikely. *Tuberculous pericarditis* - A **PPD test of 7 mm** is considered **negative** in immunocompetent individuals, making active tuberculosis unlikely. - Would typically present with **pericardial effusion** causing a globular heart shadow, not a localized bulge. *Epicardial fat pad* - Appears as a **smooth, well-defined opacity** at the **cardiophrenic angles**, not as a bulge at the left cardiac border. - More commonly seen in **obese patients** and would not be related to the patient's **history of myocardial infarction**.

Q: What is the treatment of choice for hypertension in patients with diabetes mellitus?

ACE Inhibitors. **Explanation:** **ACE Inhibitors (ACEIs)** are the treatment of choice for hypertension in patients with Diabetes Mellitus (DM) primarily due to their **renoprotective effects**. In diabetic patients, ACEIs (and ARBs) dilate the efferent arteriole more than the afferent arteriole. This reduces intraglomerular capillary pressure, thereby decreasing proteinuria and slowing the progression of diabetic nephropathy. **Why other options are incorrect:** * **Beta-blockers:** Generally avoided as first-line therapy in DM because they can mask the autonomic warning signs of hypoglycemia (like tachycardia and tremors) and may impair glucose tolerance by inhibiting insulin secretion. * **Thiazides:** While effective antihypertensives, they can cause hyperglycemia and worsen insulin resistance by inducing hypokalemia (which inhibits insulin release from the pancreas). * **Calcium Channel Blockers (CCBs):** These are metabolically neutral and effective, but they do not offer the same level of superior renal protection as ACEIs/ARBs in the presence of albuminuria. **High-Yield Clinical Pearls for NEET-PG:** * **First-line choice:** If a patient has DM with albuminuria or chronic kidney disease (CKD), ACEIs or ARBs are mandatory. * **Combination Therapy:** If blood pressure is not controlled with ACEIs alone, CCBs or Thiazides are typically added. * **Contraindication:** ACEIs are strictly contraindicated in pregnancy (teratogenic) and bilateral renal artery stenosis. * **Side Effect:** The most common side effect of ACEIs is a dry cough (due to bradykinin accumulation); in such cases, switch the patient to an **ARB (e.g., Losartan)**.

Q: All of the following statements about pulse deficit in Atrial Fibrillation are true, except?

Radial pulse rate may be more than ventricular pulse rate. **Explanation:** The **Pulse Deficit** is defined as the difference between the apical heart rate (measured by auscultation) and the peripheral radial pulse rate. It is a hallmark clinical feature of **Atrial Fibrillation (AF)** [1]. **1. Why Option D is the Correct Answer (The False Statement):** By definition, the radial pulse rate can **never** be higher than the ventricular (apical) rate. A pulse deficit occurs because some ventricular contractions occur so prematurely (during the compensatory pause or short diastole) that the left ventricle has insufficient filling time. This results in a stroke volume too small to open the aortic valve or generate a palpable peripheral pressure wave. Therefore, the radial rate will always be equal to or less than the apical rate. **2. Analysis of Other Options:** * **Option A:** In untreated AF, the pulse deficit is typically significant, often **more than 10 beats per minute**. * **Option B:** As the ventricular rate increases, the diastolic filling time decreases further. This leads to more "ineffectual" contractions that do not reach the periphery, thereby **increasing the deficit**. * **Option C:** Digitalis (Digoxin) slows the ventricular rate by increasing AV nodal refractoriness [2]. As the heart rate slows and becomes more regular, diastolic filling improves, and the **pulse deficit may disappear**. **Clinical Pearls for NEET-PG:** * **Measurement:** To accurately measure pulse deficit, two examiners should ideally count the apical and radial pulses simultaneously for one full minute. * **Other Causes:** Besides AF, pulse deficit can be seen in **Premature Ventricular Contractions (PVCs)**. * **Significance:** A narrowing pulse deficit in an AF patient often indicates successful rate control therapy [3].

Question 1

Positive hepatojugular reflux is found in which of the following conditions?

Accepted Answer

Tricuspid regurgitation

Answer

Left heart failure

Answer

Decreased afterload

Answer

Decreased capillary bed pressure

Question 2

Which of the following disorders is LEAST likely to cause high output failure?

Accepted Answer

Addison disease

Answer

Thiamine deficiency

Answer

Hyperthyroidism

Answer

Paget disease of bone

Question 3

All statements are true regarding non-ST elevation acute coronary syndromes (NSTE-ACS) and ST elevation myocardial infarctions (STEMI) except?

Accepted Answer

Infarction of >=60% of the left ventricle usually results in cardiogenic shock.

Answer

The relative incidence of NSTEMI is rising due to the increasing burden of diabetes and chronic kidney disease in an aging population.

Answer

Pump failure is now the primary cause of in-hospital death from STEMI.

Answer

Percutaneous coronary intervention (PCI) is the treatment of choice for patients with acute coronary syndromes.

Question 4

A 27-year-old woman presents with cough, shortness of breath, and palpitations. Her childhood history includes recurrent "pneumonia." She denies sputum production. On examination, she appears anxious, with distended neck veins, a widened split second heart sound with minimal respiratory variation, and a systolic ejection murmur in the pulmonic area. Lung examination reveals bilateral crackles, mild ascites, and pedal edema. EKG shows right axis deviation. What is the next diagnostic step?

Accepted Answer

Echocardiogram

Answer

CT scan of the chest

Answer

Immunoglobulin levels

Answer

PPD testing

Question 5

What is the most common congenital cardiac anomaly diagnosed in adulthood?

Accepted Answer

Atrial Septal Defect (ASD)

Answer

Ventricular Septal Defect (VSD)

Answer

Patent Ductus Arteriosus (PDA)

Answer

Total Anomalous Pulmonary Venous Return (TAPVR)

Question 6

Spurious hypertension (false elevation of blood pressure readings) is most commonly associated with which of the following findings?

Accepted Answer

Auscultatory gap

Answer

Thick, calcified arteries

Answer

Use of a small blood pressure cuff

Answer

Obesity

Question 7

A 67-year-old male smoker presents with cough and was treated for acute bronchitis. A chest X-ray prompted a referral to the chest clinic. The patient has a past history of myocardial infarction but is currently asymptomatic. Blood pressure is 128/80, and cardiopulmonary examination is unremarkable. A purified protein derivative (PPD) test result is 7 mm. The chest X-ray is shown. What is the likely diagnosis?

Accepted Answer

Left ventricular aneurysm

Answer

Hypertensive cardiomyopathy

Answer

Tuberculous pericarditis

Answer

Epicardial fat pad

Question 8

What is the treatment of choice for hypertension in patients with diabetes mellitus?

Accepted Answer

ACE Inhibitors

Answer

Beta blockers

Answer

Thiazides

Answer

Calcium channel blockers

Question 9

A 57-year-old man comes to see you for follow-up 4 weeks after being discharged from hospital for unstable angina. His coronary angiogram showed moderate nonstenotic disease in two vessels. The cardiologist asks you to follow up on his fasting lipid profile since it was not checked in the hospital. His T-chol is 240 mg/dL, LDL 120 mg/dL, HDL 50 mg/dL, and triglycerides 130 mg/dL. For the above patient with dyslipidemia, select the most appropriate treatment?

Accepted Answer

Hepatic hydroxymethylglutaryl coenzyme A (HMG-Co) reductase inhibitors (lovastatin, simvastatin, pravastatin)

Answer

Fibric acid derivatives (clofibrate, gemfibrozil)

Answer

Nicotinic acid

Answer

Bile acid-binding resins (cholestyramine, colestipol)

Question 10

All of the following statements about pulse deficit in Atrial Fibrillation are true, except?

Accepted Answer

Radial pulse rate may be more than ventricular pulse rate

Answer

Usually more than 10/minute

Answer

Increases with faster ventricular rates

Answer

May be absent in digitalis intoxication

Cardiology — MCQs

Cardiology — MCQs

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