Cardiology Practice Questions

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.

Q: All of the following statements about Brugada syndrome are true, EXCEPT:

Flecainide can be used for treatment.. Brugada Syndrome is an autosomal dominant genetic channelopathy, most commonly involving a mutation in the **SCN5A gene** (sodium channel). It is a leading cause of sudden cardiac death in young individuals with structurally normal hearts. **Why Option D is the Correct Answer (The Exception):** Flecainide is a Class IC antiarrhythmic that blocks sodium channels. In Brugada syndrome, sodium channel blockers **unmask or worsen** the characteristic ECG pattern and can actually **precipitate** fatal arrhythmias. Therefore, Flecainide is used as a *provocative diagnostic test* (the Flecainide challenge) to reveal the Brugada pattern, but it is strictly **contraindicated for treatment**. The only proven effective treatment for preventing sudden death in high-risk patients is an **Implantable Cardioverter Defibrillator (ICD)**. **Analysis of Other Options:** * **Option A:** The hallmark of Brugada is a pseudo-right bundle branch block and **ST-segment elevation in leads V1-V3**. This pattern can be transient and may be triggered by fever or certain drugs. * **Option B:** It is the primary cause of **Sudden Unexpected Nocturnal Death Syndrome (SUNDS)**, particularly prevalent in young Southeast Asian males. * **Option C:** There is a significantly high risk of **polymorphic ventricular tachycardia** and ventricular fibrillation, which often occurs during sleep or rest. **High-Yield Clinical Pearls for NEET-PG:** * **ECG Patterns:** Type 1 (Coved-type ST elevation ≥2mm) is the only diagnostic pattern. * **Inheritance:** Autosomal Dominant; SCN5A gene mutation (loss of function). * **Triggers:** Fever is a major trigger for arrhythmias; aggressive antipyretic therapy is essential. * **Pharmacotherapy:** While ICD is the gold standard, **Quinidine** (Class IA) can be used as an adjunct to reduce arrhythmia frequency because it also blocks Ito channels.

Question 1

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 2

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 3

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 4

All of the following conditions produce restrictive cardiomyopathy except?

Accepted Answer

Hypothyroidism

Answer

Amyloidosis

Answer

Hyper-eosinophilic syndrome

Answer

Tropical endomyocardial fibrosis

Question 5

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 6

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 7

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 8

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

Question 9

What is the most common cause of morbidity and mortality late in the course of mitral stenosis?

Accepted Answer

Recurrent pulmonary emboli

Answer

Infective endocarditis

Answer

Pulmonary edema

Answer

Pulmonary infections

Question 10

All of the following statements about Brugada syndrome are true, EXCEPT:

Accepted Answer

Flecainide can be used for treatment.

Answer

Transient ST segment elevation in leads V1-V3 is seen.

Answer

It is responsible for the sudden and unexpected nocturnal death syndrome.

Answer

The risk of fatal ventricular arrhythmia is high.

Cardiology — MCQs

Cardiology — MCQs

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