Cardiology Practice Questions

Q: Brugada syndrome is characterized by what ECG finding?

ST elevation. Explanation: Brugada Syndrome is an autosomal dominant genetic disorder caused by a mutation in the SCN5A gene, which encodes the cardiac sodium channel. This leads to a defect in the inward sodium current, primarily affecting the right ventricular outflow tract (RVOT). Why ST elevation is correct: The hallmark ECG finding in Brugada Syndrome is coved-type ST-segment elevation (≥2 mm) followed by a negative T-wave in the right precordial leads (V1–V3). This is known as the Type 1 Brugada pattern. It is often described as having a "shark fin" or "saddle-back" appearance. These changes occur due to an imbalance between inward and outward currents during the early repolarization phase of the action potential. Why other options are incorrect: * Prolonged PR interval: Associated with first-degree AV block or conditions like hyperkalemia and Lyme disease [3], but not the diagnostic hallmark of Brugada. * Prolonged QT interval: Characteristic of Long QT Syndrome (LQTS), which predisposes to Torsades de Pointes [2]. Brugada typically has a normal QT interval. * Tall T waves: Usually seen in hyperkalemia (peaked T waves) [3] or the hyperacute phase of myocardial infarction [1]. High-Yield Clinical Pearls for NEET-PG: * Demographics: Most common in young males of Southeast Asian descent. * Clinical Presentation: Sudden cardiac death (SCD) due to polymorphic ventricular tachycardia or ventricular fibrillation, often occurring during sleep or while at rest. * Triggers: Fever, alcohol, and certain drugs (e.g., sodium channel blockers) can unmask the ECG pattern. * Management: The only proven effective treatment for symptomatic patients or those at high risk is an Implantable Cardioverter Defibrillator (ICD).

Q: Which of the following is NOT a feature of Atrial Septal Defect?

Complications include left atrial hypertrophy.. **Explanation:** **1. Why Option A is the Correct Answer (The "NOT" feature):** In an Atrial Septal Defect (ASD), blood shunts from the left atrium to the right atrium due to the pressure gradient. This leads to **volume overload of the Right Atrium (RA) and Right Ventricle (RV)**, eventually causing right-sided chamber enlargement and hypertrophy. The left atrium (LA) does not undergo hypertrophy because it is effectively "decompressed" by the shunt; blood flows out of the LA into the RA rather than being stored under high pressure. Therefore, **Left Atrial Hypertrophy is not a feature of ASD.** **2. Analysis of Incorrect Options:** * **Option B:** ASD is often asymptomatic in childhood. Complications like pulmonary hypertension, atrial arrhythmias, and heart failure typically manifest in the **3rd or 4th decade of life**, making it a late-onset clinical entity. * **Option C:** Because it remains asymptomatic for years, ASD is the **most common** congenital heart disease (CHD) first diagnosed in **adulthood**. (Note: VSD is the most common CHD overall, but most are diagnosed in infancy). * **Option D:** A **wide, fixed split S2** is the pathognomonic physical finding of ASD. The split is "wide" due to delayed closure of the pulmonary valve (RV volume overload) and "fixed" because respiratory changes in venous return are balanced across the defect, keeping the stroke volume constant. **Clinical Pearls for NEET-PG:** * **Most common type:** Ostium Secundum (75%). * **Murmur:** ASD itself is silent. The heard murmur is a **systolic ejection murmur** at the left upper sternal border due to increased flow across the pulmonary valve (relative pulmonary stenosis). * **ECG Findings:** Right axis deviation and RSR' pattern in V1 (Partial RBBB). * **Contraindication:** ASD closure is contraindicated if Eisenmenger syndrome (irreversible pulmonary hypertension) develops.

Q: Which of the following is a BNP analogue?

Nesiritide. **Explanation:** **Correct Answer: B. Nesiritide** Nesiritide is a **recombinant human B-type Natriuretic Peptide (BNP)**. It works by binding to the particulate guanylate cyclase receptor in vascular smooth muscle and endothelial cells, leading to increased intracellular cyclic GMP (cGMP) [1]. This results in potent **vasodilation** (reducing both preload and afterload) and **natriuresis** (excretion of sodium by the kidneys) [1], [2]. It is primarily used in the management of acutely decompensated heart failure (ADHF) with dyspnea at rest. **Analysis of Incorrect Options:** * **A. Eplerenone:** This is a selective **mineralocorticoid receptor antagonist (MRA)**. It is a potassium-sparing diuretic used to reduce mortality in chronic heart failure (HFrEF), but it is not a BNP analogue. * **C. Levosimendan:** This is a **calcium sensitizer** and an inodilator. It increases cardiac contractility by sensitizing troponin C to calcium and causes vasodilation by opening ATP-sensitive potassium channels. * **D. Coenzyme Q:** This is an antioxidant and a component of the mitochondrial electron transport chain. While sometimes used as a supplement in heart failure, it has no structural or functional relation to BNP. **High-Yield Clinical Pearls for NEET-PG:** * **BNP vs. NT-proBNP:** BNP is the active hormone (shorter half-life), while NT-proBNP is the inactive N-terminal fragment (longer half-life, more stable for diagnostic testing). * **Sacubitril/Valsartan (ARNI):** Sacubitril is a **neprilysin inhibitor** that prevents the breakdown of endogenous BNP. Note that BNP levels will rise during ARNI therapy, so NT-proBNP should be used for monitoring instead. * **Nesiritide Side Effects:** The most common side effect is dose-related **hypotension**. It may also be associated with a transient increase in serum creatinine.

Q: Which of the following can detect the volume of infarcted area in acute myocardial infarction?

Thallium scan. The correct answer is **Thallium scan (Thallium-201)**. Thallium-201 is a potassium analogue that is actively taken up by viable myocardial cells via the Na+/K+ ATPase pump. In the setting of an acute myocardial infarction (AMI), necrotic or infarcted tissue lacks blood flow and viable cell membranes, resulting in a "cold spot" (perfusion defect) on the scan [1]. The size and intensity of this defect are directly proportional to the **volume of the infarcted area**, making it a highly sensitive tool for quantifying the extent of myocardial damage. **Why other options are incorrect:** * **Echocardiogram:** While excellent for detecting regional wall motion abnormalities (RWMA) and estimating the Ejection Fraction (EF), it cannot definitively distinguish between acutely infarcted, stunned, or hibernating myocardium [2]. * **Electrocardiogram (ECG):** An ECG identifies the location (e.g., anterior vs. inferior) and the age of the infarct (ST-elevation vs. Q-waves), but it is a poor indicator of the actual volumetric size of the necrosis [4], [5]. * **CPK-MB Levels:** These enzymes indicate the *presence* and *timing* of myocardial injury. While the peak level roughly correlates with infarct size, it is influenced by reperfusion (washout phenomenon) and is less precise for volume measurement than nuclear imaging. **High-Yield Clinical Pearls for NEET-PG:** * **Thallium-201 vs. Technetium-99m Sestamibi:** Thallium is better for viability (redistribution), while Sestamibi is preferred for anatomical imaging due to better energy resolution. * **"Hot Spot" Imaging:** While Thallium shows "cold spots," **Technetium-99m Pyrophosphate** binds to calcium in necrotic cells, creating a "hot spot" (specifically used for infarct aging) [1]. * **Gold Standard:** Cardiac MRI (Delayed Gadolinium Enhancement) is currently the gold standard for quantifying infarct size [3], but among the given options, Thallium scan is the classic choice.

Q: All of the following murmurs may be heard in patients with aortic regurgitation except?

Pansystolic murmur.. **Explanation:** In Aortic Regurgitation (AR), the primary hemodynamic abnormality is the backflow of blood from the aorta into the left ventricle (LV) during diastole. **1. Why Pansystolic Murmur is the Correct Answer:** A **pansystolic (holosystolic) murmur** is characteristic of regurgitation between chambers with a significant pressure gradient throughout the entire systole, such as **Mitral Regurgitation (MR)** [3], **Tricuspid Regurgitation (TR)**, or **Ventricular Septal Defect (VSD)**. In AR, the pathology occurs during diastole; therefore, a pansystolic murmur is not a feature of isolated aortic regurgitation. **2. Analysis of Other Options:** * **High-pitched decrescendo diastolic murmur (Option A):** This is the **classical murmur of AR** [1]. It is heard best at the left sternal border (3rd/4th intercostal space) with the patient leaning forward in expiration. It represents the high-pressure regurgitant flow from the aorta to the LV [2]. * **Soft, low-pitched mid-diastolic rumbling murmur (Option B):** This is known as the **Austin Flint murmur**. It occurs because the regurgitant jet from the aorta strikes the anterior leaflet of the mitral valve, causing it to partially close and creating "functional" mitral stenosis [1]. * **Mid-systolic ejection flow murmur (Option C):** In chronic AR, the LV stroke volume is significantly increased (due to the added regurgitant volume). This high-volume flow across the aortic valve during systole creates a functional flow murmur [1], even in the absence of true aortic stenosis. **Clinical Pearls for NEET-PG:** * **Duroziez’s sign:** Systolic and diastolic bruits heard over the femoral artery. * **De Musset’s sign:** Head nodding in sync with the heartbeat. * **Corrigan’s Pulse:** "Water-hammer" or collapsing pulse. * **Hill’s Sign:** Popliteal systolic BP > Brachial systolic BP by >20 mmHg (most sensitive clinical sign for severity).

Question 1

Brugada syndrome is characterized by what ECG finding?

Accepted Answer

ST elevation

Answer

Prolonged PR interval

Answer

Prolonged QT interval

Answer

Tall T waves

Question 2

A 70-year-old man with hypertension presents with severe chest pain and diaphoresis. On examination, he has bounding pulses with wide pulse pressure. A diastolic murmur is heard along the right sternal border. Which of the following is the possible etiology?

Accepted Answer

Aortic dissection

Answer

STEMI with papillary muscle dysfunction

Answer

Myocarditis with functional regurgitation

Answer

Flash pulmonary edema

Question 3

A 60-year-old woman with no past medical history has an elevated blood pressure of 165/80 mm Hg on routine evaluation. Repeated measurements over the next month confirm the elevated pressure. Physical examination, routine blood count, and biochemistry are all normal. For a patient with high blood pressure, select the most appropriate initial medication?

Accepted Answer

Thiazide diuretics

Answer

Spironolactone

Answer

Clonidine

Answer

Prazosin

Question 4

Which of the following is NOT a feature of Atrial Septal Defect?

Accepted Answer

Complications include left atrial hypertrophy.

Answer

Complications due to ASD are of late onset.

Answer

Most common congenital heart disease presenting in adult age.

Answer

Wide fixed split in the second heart sound.

Question 5

Which of the following is a BNP analogue?

Accepted Answer

Nesiritide

Answer

Eplerenone

Answer

Levosimendan

Answer

Coenzyme Q

Question 6

A gradient between pulmonary artery wedge pressure and left ventricular end-diastolic pressure is seen in which of the following conditions?

Accepted Answer

Left atrial myxoma

Answer

Aortic regurgitation

Answer

Constrictive pericarditis

Answer

Pulmonary thromboembolism

Question 7

Rescue PCI is indicated for which of the following conditions?

Accepted Answer

Persistent chest pain with ST elevation more than 90 minutes after thrombolysis

Answer

Persistent chest pain with ST elevation more than 60 minutes after thrombolysis

Answer

Persistent chest pain with ST elevation more than 30 minutes after thrombolysis

Answer

Persistent chest pain with ST elevation more than 120 minutes after thrombolysis

Question 8

Which of the following can detect the volume of infarcted area in acute myocardial infarction?

Accepted Answer

Thallium scan

Answer

Echocardiogram

Answer

Electrocardiogram

Answer

Levels of Creatine Phosphokinase-MB (CPK-MB)

Question 9

All of the following murmurs may be heard in patients with aortic regurgitation except?

Accepted Answer

Pansystolic murmur.

Answer

High-pitched decrescendo diastolic murmur.

Answer

Soft, low-pitched mid-diastolic rumbling murmur.

Answer

Mid-systolic ejection flow murmur.

Question 10

Which of the following is NOT a manifestation of acute aortic dissection?

Accepted Answer

Mitral regurgitation

Answer

Pericardial effusion

Answer

Aortic regurgitation

Answer

Acute myocardial infarction

Cardiology — MCQs

Cardiology — MCQs

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