Cardiology Practice Questions

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: All of the following are clinical features of myxoma, except?

Hypertension. **Explanation:** Atrial myxoma is the most common primary cardiac tumor in adults. It typically presents with a classic triad of **obstructive, embolic, and constitutional symptoms.** **Why Hypertension is the Correct Answer:** Hypertension is **not** a clinical feature of atrial myxoma. Myxomas are localized intracardiac masses and do not possess endocrine mechanisms to elevate systemic blood pressure. In fact, if a myxoma causes severe mitral valve obstruction, it may lead to decreased cardiac output and **hypotension** or syncope (the "tumor plop" phenomenon). **Analysis of Other Options:** * **Fever (A):** Myxomas frequently produce **Interleukin-6 (IL-6)**, a pro-inflammatory cytokine. This leads to constitutional symptoms such as fever, weight loss, and malaise, often mimicking systemic vasculitis or endocarditis. * **Clubbing (B):** While less common than fever, digital clubbing can occur in patients with atrial myxoma due to chronic systemic inflammation or right-to-left shunting if the tumor involves the atrial septum. * **Embolic Phenomenon (D):** Myxomas are friable (easily crumbled). Fragments of the tumor or overlying thrombi can break off and enter the systemic circulation, leading to strokes, mesenteric ischemia, or peripheral arterial occlusion. **NEET-PG High-Yield Pearls:** * **Location:** 75–80% occur in the **Left Atrium** (usually attached to the fossa ovalis). * **Auscultation:** Characterized by a **"Tumor Plop"** (a low-pitched sound heard during early or mid-diastole as the tumor drops into the mitral orifice). * **Diagnosis:** Transthoracic Echocardiography (TTE) is the initial investigation of choice. * **Carney Complex:** An autosomal dominant syndrome involving atrial myxomas, spotty skin pigmentation (lentigines), and endocrine overactivity.

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 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 2

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 3

All of the following conditions produce restrictive cardiomyopathy except?

Accepted Answer

Hypothyroidism

Answer

Amyloidosis

Answer

Hyper-eosinophilic syndrome

Answer

Tropical endomyocardial fibrosis

Question 4

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 5

All of the following are clinical features of myxoma, except?

Accepted Answer

Hypertension

Answer

Fever

Answer

Clubbing

Answer

Embolic phenomenon

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

All of the following statements regarding the Valsalva maneuver are true, EXCEPT:

Accepted Answer

The systolic murmur of hypertrophic cardiomyopathy becomes softer.

Answer

It decreases left ventricular volume.

Answer

The systolic murmur of mitral stenosis becomes softer.

Answer

The ejection systolic murmur of aortic stenosis becomes softer.

Question 10

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

Cardiology — MCQs

Cardiology — MCQs

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