Cardiology Practice Questions

Q: The most common accessory pathway leading to Wolff-Parkinson-White syndrome is:

Left free wall. **Explanation:** Wolff-Parkinson-White (WPW) syndrome is caused by the presence of an accessory pathway (the Bundle of Kent) that bypasses the AV node, leading to pre-excitation of the ventricles. **1. Why Left Free Wall is Correct:** Epidemiological studies and electrophysiological mapping consistently show that the **left free wall** is the most common location for these accessory pathways, accounting for approximately **50–60%** of all cases. These pathways are typically located along the mitral valve annulus. **2. Analysis of Incorrect Options:** * **Posteroseptal (Option B):** This is the second most common location, occurring in about **25–30%** of cases. It is located near the coronary sinus ostium. * **Right Free Wall (Option C):** This location is less common, accounting for approximately **10–15%** of cases, usually along the tricuspid annulus. * **Anteroseptal (Option D):** This is the rarest location, seen in roughly **5%** of patients. **3. High-Yield Clinical Pearls for NEET-PG:** * **ECG Triad:** Short PR interval ( 0.12s). * **Localization Tip:** A positive QRS complex (dominant R wave) in lead V1 (Type A WPW) usually suggests a **left-sided** pathway, whereas a negative QRS in V1 (Type B WPW) suggests a **right-sided** pathway. * **Treatment of Choice:** Radiofrequency catheter ablation is the definitive treatment. * **Drug Contraindication:** Avoid AV nodal blockers (ABCD: **A**denosine, **B**eta-blockers, **C**alcium channel blockers, **D**igoxin) in patients with WPW and Atrial Fibrillation, as they can paradoxically increase conduction through the accessory pathway, leading to Ventricular Fibrillation.

Q: A middle-aged lady was diagnosed with an incidentally found ejection systolic murmur at the pulmonary area. A fixed wide split of the second heart sound was also noted. What is the diagnosis?

Atrial septal defect. ### Explanation **Correct Answer: B. Atrial septal defect (ASD)** The clinical presentation of a **fixed wide split of the second heart sound (S2)** combined with an **ejection systolic murmur (ESM)** at the pulmonary area is the classic hallmark of an Atrial Septal Defect [1]. * **Mechanism of S2 Splitting:** In ASD, the persistent communication between the atria leads to a left-to-right shunt [1]. This increases the blood volume in the right ventricle (RV), prolonging RV ejection time and delaying the closure of the pulmonary valve (P2). The split is "fixed" because the respiratory variations in venous return are balanced out by reciprocal changes in the shunt volume across the ASD, keeping the interval between A2 and P2 constant. * **The Murmur:** The ESM is not caused by the flow across the defect itself (which is low-pressure) but by the **increased stroke volume** flowing across the pulmonary valve (relative pulmonary stenosis) [3]. **Why Incorrect Options are Wrong:** * **A. Tetralogy of Fallot:** Characterized by a **single S2** (due to an inconspicuous P2) and a harsh systolic murmur at the left sternal border. * **C. Mitral Stenosis:** Presents with a loud S1, an opening snap [2], and a **mid-diastolic rumbling murmur** at the apex [3]. * **D. Mitral Valve Prolapse:** Typically presents with a **mid-systolic click** followed by a late systolic murmur at the apex [2]. **High-Yield NEET-PG Pearls:** * **Most common type of ASD:** Ostium secundum [1]. * **ECG in ASD:** Right axis deviation and RSR' pattern in V1 (Partial RBBB). * **Chest X-ray:** Enlarged pulmonary artery and increased pulmonary vascular markings (Plethora). * **Lutembacher Syndrome:** Combination of ASD and acquired Mitral Stenosis.

Q: In Left Ventricular Ejection (LVE), which drug can be administered?

Morphine. **Explanation:** The question refers to the management of **Acute Left Ventricular Failure (LVF)**, often presenting as acute pulmonary edema. **Morphine** is a traditional cornerstone in the management of this condition due to its multi-modal beneficial effects: 1. **Venodilation:** It increases venous capacitance (preload reduction), which decreases the volume of blood returning to the failing left ventricle, thereby reducing pulmonary congestion. 2. **Arteriodilation:** It causes mild systemic vasodilation (afterload reduction), making it easier for the heart to pump blood. 3. **Anxiolysis:** By reducing anxiety and the sensation of dyspnea (air hunger), it lowers sympathetic drive, subsequently decreasing heart rate and myocardial oxygen demand. **Analysis of Incorrect Options:** * **Propranolol (Option A):** A non-selective beta-blocker. In acute LVF, beta-blockers are **contraindicated** as they exert negative inotropic effects, further depressing myocardial contractility and worsening heart failure. * **Epinephrine (Option C):** A potent sympathomimetic. While it increases contractility, it significantly increases heart rate and systemic vascular resistance (afterload), which can be detrimental in a failing heart and may trigger arrhythmias or ischemia. * **Amlodipine (Option D):** A Calcium Channel Blocker used for chronic hypertension. It has no role in the acute management of LVF/pulmonary edema and may cause reflex tachycardia. **High-Yield NEET-PG Pearls:** * **Mnemonic for Acute Pulmonary Edema:** **LMNOP** (L-Lasix/Furosemide, M-Morphine, N-Nitroglycerin, O-Oxygen, P-Positioning/CPAP). * **Morphine Side Effect:** Watch for respiratory depression; it should be used cautiously in patients with COPD or hypercapnia. * **Drug of Choice for Preload Reduction:** While Morphine is used, **Nitroglycerin (IV)** is often preferred in modern practice for rapid titration of preload and afterload.

Q: A 16-year-old boy is found to have hypertension on routine evaluation. He has no symptoms of shortness of breath or chest discomfort, but occasionally on exertion notes that his legs get tired easily. On physical examination, the blood pressure in his arms is 140/90 mm Hg bilaterally. Measurement of the blood pressure in his legs is 20 mm Hg lower than in the arms. Which of the following is the most likely diagnosis?

Coarctation of the aorta. ### Explanation **Correct Answer: B. Coarctation of the aorta** The clinical presentation of hypertension in the upper extremities combined with lower blood pressure in the lower extremities is a classic hallmark of **Coarctation of the Aorta (CoA)**. **Underlying Concept:** CoA is a congenital narrowing of the aorta, typically occurring near the insertion of the ductus arteriosus (juxtaductal). This narrowing creates a pressure gradient: high pressure proximal to the obstruction (arms/head) and low pressure distal to it (legs). The "tired legs" on exertion described by the patient is **claudication**, caused by inadequate blood flow to the lower limbs. **Analysis of Incorrect Options:** * **A. Aortic Insufficiency:** Characterized by a wide pulse pressure and "Hill’s sign" (where popliteal systolic pressure is significantly *higher* than brachial pressure), which is the opposite of this case. * **C. Normal Variant:** In a healthy individual, the blood pressure in the legs is typically 10–20 mmHg *higher* than in the arms due to the summation of reflected pressure waves. A lower pressure in the legs is always pathological. * **D. Ventricular Aneurysm:** Usually a complication of myocardial infarction; it presents with heart failure or arrhythmias, not a differential limb blood pressure gradient. **NEET-PG High-Yield Pearls:** * **Physical Exam:** Look for "radio-femoral delay" and a systolic murmur heard best over the left infrascapular area. * **X-ray Findings:** "Rib notching" (due to collateral flow through intercostal arteries) and the "3 sign" on the aortic contour. * **Associations:** Strongly associated with **Turner Syndrome** (30% of cases) and **Bicuspid Aortic Valve** (up to 70% of cases). * **Gold Standard Diagnosis:** CT Angiography or MRI; however, Echocardiography is the initial screening tool.

Q: ST-segment elevation is seen in all the following except?

Right bundle branch block. **Explanation** The correct answer is **Right Bundle Branch Block (RBBB)**. In RBBB, the depolarization of the right ventricle is delayed, leading to secondary repolarization abnormalities. Characteristically, this manifests as **ST-segment depression** and T-wave inversion in the right precordial leads (V1-V3), rather than ST elevation. **Analysis of Options:** * **Tako-tsubo Syndrome (Stress-induced Cardiomyopathy):** This condition mimics an acute coronary syndrome. It typically presents with chest pain and **ST-segment elevation** (most commonly in the precordial leads), despite the absence of obstructive coronary artery disease. * **Acute Pericarditis:** This is a classic cause of **diffuse, concave-upwards ST-segment elevation** across almost all leads (except aVR and V1), often accompanied by PR-segment depression. * **Myocardial Infarction (STEMI):** Transmural ischemia causes a current of injury that manifests as **convex (tombstone) ST-segment elevation** in the leads overlying the infarcted area [1]. **High-Yield Clinical Pearls for NEET-PG:** 1. **LBBB vs. RBBB:** While RBBB causes ST depression, a **New-onset Left Bundle Branch Block (LBBB)** is considered a STEMI equivalent in the clinical context of chest pain. 2. **ST Elevation Differential:** Remember the mnemonic **ELEVATION**: **E**lectrolytes (Hyperkalemia), **L**BBB, **E**arly Repolarization, **V**entricular Aneurysm, **A**bscess (Cardiac), **T**umor, **I**njury (Infarction), **O**ther (Pericarditis/Tako-tsubo), **N**ormal variant. 3. **Spodick’s Sign:** Downsloping TP segment, often seen in viral pericarditis, helps differentiate it from MI. 4. **Brugada Syndrome:** Another high-yield cause of ST elevation in V1-V3 with a pseudo-RBBB pattern.

Q: Vasospasm is the cause of which of the following conditions?

Variant angina. The correct answer is **Variant angina**, also known as **Prinzmetal angina**. **1. Why Variant Angina is Correct:** Variant angina is characterized by a sudden, reversible reduction in coronary blood flow caused by **focal coronary artery vasospasm**, rather than fixed atherosclerotic narrowing. This spasm leads to transmural ischemia, which manifests on an ECG as **transient ST-segment elevation**. Unlike typical angina, it usually occurs at rest, often in the early morning hours, and frequently affects younger patients who may not have traditional cardiovascular risk factors (except smoking). **2. Why Other Options are Incorrect:** * **Stable Angina (Classical Angina):** These are caused by a **fixed atherosclerotic obstruction** (usually >70% stenosis) [1]. The pain is predictable and occurs when myocardial oxygen demand exceeds supply (e.g., during exertion) [2]. * **Unstable Angina:** This is part of the Acute Coronary Syndrome (ACS) spectrum. It is primarily caused by **plaque rupture** with non-occlusive thrombus formation, leading to increased frequency or severity of chest pain at rest [3]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Triggers:** Can be induced by cold weather, emotional stress, or drugs like cocaine and ergotamines. * **ECG Finding:** Transient ST-elevation during the episode which returns to baseline once the pain subsides. * **Drug of Choice:** **Calcium Channel Blockers (CCBs)** are the mainstay of treatment as they promote vasodilation. Nitrates are also effective for acute episodes. * **Contraindication:** **Non-selective Beta-blockers** (e.g., Propranolol) are strictly contraindicated as they can lead to unopposed alpha-adrenergic stimulation, worsening the vasospasm. * **Gold Standard Diagnosis:** Coronary angiography with provocative testing (e.g., using Ergonovine or Acetylcholine).

Question 1

The most common accessory pathway leading to Wolff-Parkinson-White syndrome is:

Accepted Answer

Left free wall

Answer

Posteroseptal

Answer

Right free wall

Answer

Anteroseptal

Question 2

Which of the following is used for the management of a 65-year-old patient presenting with respiratory distress, given that bedside echocardiography shows an ejection fraction of 45%?

Accepted Answer

Lasix, Nitrates, and Morphine

Answer

Lasix, Nitrates, and Sacubitril-Valsartan

Answer

Lasix, Norepinephrine, and Sacubitril-Valsartan

Answer

Lasix, ACE inhibitor, and Digoxin

Question 3

A middle-aged lady was diagnosed with an incidentally found ejection systolic murmur at the pulmonary area. A fixed wide split of the second heart sound was also noted. What is the diagnosis?

Accepted Answer

Atrial septal defect

Answer

Tetralogy of Fallot

Answer

Mitral stenosis

Answer

Mitral valve prolapse

Question 4

A 70-year-old man presented with worsening cough and difficulty in breathing, especially at night. On physical examination, raised JVP, bipedal edema, and hepatomegaly were noted. USG revealed hepatomegaly measuring 16.8 cm. Despite resuscitation attempts, the patient could not be saved. Based on the clinical presentation and investigations, what is the most common etiology for the patient's clinical condition?

Accepted Answer

Right heart failure

Answer

Hepatitis A

Answer

Riedel lobe of liver

Answer

Metabolic disease of liver

Question 5

In Left Ventricular Ejection (LVE), which drug can be administered?

Accepted Answer

Morphine

Answer

Propranolol

Answer

Epinephrine

Answer

Amlodipine

Question 6

A 16-year-old boy is found to have hypertension on routine evaluation. He has no symptoms of shortness of breath or chest discomfort, but occasionally on exertion notes that his legs get tired easily. On physical examination, the blood pressure in his arms is 140/90 mm Hg bilaterally. Measurement of the blood pressure in his legs is 20 mm Hg lower than in the arms. Which of the following is the most likely diagnosis?

Accepted Answer

Coarctation of the aorta

Answer

Aortic insufficiency

Answer

Normal variant

Answer

Ventricular aneurysm

Question 7

ST-segment elevation is seen in all the following except?

Accepted Answer

Right bundle branch block

Answer

Tako-tsubo syndrome

Answer

Acute pericarditis

Answer

Myocardial infarction

Question 8

Kussmaul's sign is a feature of pericarditis with which of the following?

Accepted Answer

Constrictive pericarditis

Answer

Cardiac tamponade

Answer

Restrictive cardiomyopathy

Answer

Pericardial effusion

Question 9

Vasospasm is the cause of which of the following conditions?

Accepted Answer

Variant angina

Answer

Stable angina

Answer

Unstable angina

Answer

Classical angina

Question 10

A 55-year-old patient presents with a history of recent myocardial infarction and a 5-day hospital stay for mild congestive heart failure. The patient is now asymptomatic with a normal physical exam. Which of the following medications should be recommended?

Accepted Answer

An ACE inhibitor

Answer

Digoxin

Answer

Furosemide

Answer

Hydralazine plus nitrates

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?