Cardiology Practice Questions

Q: A 70-year-old patient with COPD presents with palpitations. What does the ECG rhythm strip show?

Multifocal atrial tachycardia. ***Multifocal atrial tachycardia*** - **MAT** is the classic arrhythmia in **COPD patients**, caused by increased **sympathetic stimulation** and **hypoxemia** affecting multiple atrial foci. - ECG shows **≥3 distinct P-wave morphologies**, **irregular rhythm**, **variable PR intervals**, and heart rate **100-150 bpm** - pathognomonic for MAT. *Inappropriate sinus tachycardia* - Shows **uniform P-wave morphology** from the sinus node with **regular rhythm** and consistent PR intervals. - **Rate >100 bpm** but lacks the **multiple P-wave morphologies** characteristic of MAT in COPD patients. *Junctional tachycardia* - Characterized by **absent or inverted P-waves** in leads II, III, and aVF due to **AV nodal origin**. - Shows **narrow QRS complexes** with **regular rhythm**, unlike the irregular pattern seen in MAT. *Atrial fibrillation* - Presents with **absent P-waves** and **irregularly irregular rhythm** with **fibrillatory waves**. - Unlike MAT, AF shows **no discernible P-waves** rather than the multiple distinct P-wave morphologies of MAT.

Q: A 25-year-old male who is an IV drug user presents with a 3-week history of worsening lethargy and confusion. On examination, the pulse rate is 130 bpm and blood pressure is 120/80 mmHg. Cardiovascular examination reveals a raised JVP with large v-waves and a loud systolic murmur. A palpable, pulsatile liver is felt when the hepato-jugular reflex is attempted. What type of murmur is most fitting with this patient's presentation?

Tricuspid regurgitation. **Explanation:** The patient is a young IV drug user presenting with signs of right-sided heart failure, which strongly suggests **Infective Endocarditis (IE)**. In IV drug users, the **tricuspid valve** is the most commonly affected site (Staphylococcus aureus being the most frequent organism). **Why Tricuspid Regurgitation (TR) is correct:** The clinical triad of **raised JVP with prominent 'v' waves**, a **pansystolic murmur** (louder on inspiration), and a **pulsatile liver** is pathognomonic for TR [1]. The 'v' wave represents the filling of the right atrium against a closed tricuspid valve; in TR, the backflow of blood during ventricular systole exaggerates this wave [1]. This pressure is transmitted back through the IVC, causing the liver to pulsate synchronously with the heartbeat. **Why the other options are incorrect:** * **Functional murmur:** These are usually soft, mid-systolic, and not associated with structural pathology like a pulsatile liver or large v-waves. * **Tricuspid stenosis:** This would present with a mid-diastolic murmur [2] and a prominent **'a' wave** in the JVP (due to forceful atrial contraction), not a 'v' wave. * **Pulmonary stenosis:** This presents with an ejection systolic murmur and a prominent 'a' wave. It does not typically cause a pulsatile liver unless it leads to secondary TR. **NEET-PG High-Yield Pearls:** * **Carvallo’s Sign:** The murmur of TR increases in intensity during **inspiration** (due to increased venous return to the right heart). This distinguishes it from Mitral Regurgitation. * **IVDU & IE:** The most common valve involved is the Tricuspid valve; however, the most common cause of death in these patients is still left-sided heart failure. * **JVP in TR:** Characterized by a "giant v-wave" and a "steep y-descent" [1].

Q: The following ECG findings are seen in Hypokalemia:

Increased PR interval with ST depression. Hypokalemia (Serum $K^+ < 3.5$ mEq/L) alters the resting membrane potential and prolongs the repolarization phase of the cardiac action potential. This leads to characteristic ECG changes that reflect delayed ventricular repolarization and increased myocardial excitability. [1] **Why Option A is Correct:** In hypokalemia, the ECG typically shows **ST-segment depression**, flattening or inversion of T waves, and the appearance of prominent **U waves**. As the deficiency worsens, the **PR interval increases** due to delayed conduction through the AV node [1]. The apparent prolongation of the QT interval is often actually a "QU interval" caused by the fusion of the T and U waves. **Analysis of Incorrect Options:** * **Option B:** Increased PR interval with **peaked T waves** is the hallmark of **Hyperkalemia**. Peaked "tented" T waves are the earliest sign of high potassium levels [1]. * **Option C:** While T wave inversion occurs in hypokalemia, the "prolonged QT" is usually a pseudo-prolongation (QU interval). True QT prolongation with T wave inversion is more characteristic of **Hypocalcemia** or myocardial ischemia. * **Option D:** **Decreased QT interval** (shortened QT) is a classic finding in **Hypercalcemia**, not hypokalemia. **High-Yield Clinical Pearls for NEET-PG:** * **Sequence of Hypokalemia ECG:** T-wave flattening $\rightarrow$ ST depression $\rightarrow$ Prominent U waves (best seen in V2-V4) $\rightarrow$ Prolonged PR interval. * **The "Rule of T and U":** In hypokalemia, as the T wave goes down, the U wave goes up. * **Severe Hypokalemia:** Can precipitate life-threatening arrhythmias like Torsades de Pointes, especially if the patient is on Digoxin (Hypokalemia increases Digoxin toxicity) [2]. * **Hypomagnesemia:** Often co-exists with hypokalemia and must be corrected to successfully treat the potassium deficit.

Q: Diagnose the cardiac disorder based on the provided ECG findings.

Anterior wall MI. ***Anterior wall MI*** - **ST elevation in leads V1-V4** and the development of **pathological Q waves** are classic ECG findings of anterior wall myocardial infarction. - **Loss of R wave progression** in precordial leads and reciprocal changes in inferior leads further confirm anterior wall involvement. *Right Bundle Branch Block (RBBB)* - RBBB shows **wide QRS complexes (>120ms)** with **RSR' pattern in V1** and **wide S waves in leads I and V6**. - **No ST elevation** or Q waves are typically seen in uncomplicated RBBB, unlike anterior wall MI. *Hyperkalemia* - ECG findings include **tall, peaked T waves**, **prolonged PR interval**, and **widened QRS complexes** in severe cases. - **Absence of ST elevation** and Q waves distinguishes hyperkalemia from anterior wall MI. *Digitalis toxicity* - Characteristic findings include **sagging ST depression** (Salvador Dali sign) and **shortened QT interval**. - **Arrhythmias** like atrial tachycardia with block or ventricular ectopics are common, not the ST elevation pattern of MI.

Q: A 60-year-old male, diabetic and smoker, presents with 3 hours of substernal chest pain. Which of the following statements is true regarding his ECG findings?

ECG shows acute anterior myocardial infarction.. ***ECG shows acute anterior myocardial infarction.*** - A 60-year-old diabetic smoker with **3 hours of substernal chest pain** is at high risk for **acute STEMI**, and anterior MI would show **ST elevation in leads V1-V4/V5**. - **Diabetes** and **smoking** are major risk factors for coronary artery disease, making acute anterior MI the most likely diagnosis with typical chest pain presentation. *Heart rate is 45/min.* - The ECG would more likely show **normal or elevated heart rate** (compensatory tachycardia) during acute MI, not bradycardia. - **Bradycardia at 45/min** would be unusual in acute anterior MI unless there's concomitant **heart block** or **inferior wall involvement**. *The patient should be given IV lidocaine.* - **IV lidocaine** is no longer routinely recommended for acute STEMI as it can worsen outcomes and cause **pro-arrhythmic effects**. - Current treatment focuses on **immediate reperfusion therapy** (PCI or thrombolytics), **dual antiplatelet therapy**, and **anticoagulation**. *ECG is suggestive of hypokalemia.* - **Hypokalemia** typically shows **U waves**, **flattened T waves**, and **prolonged QT interval**, not the acute changes seen in MI. - The clinical presentation of **acute chest pain** in a high-risk patient points toward **ischemic changes** rather than electrolyte abnormalities.

Q: Which of the following is NOT a component of the classical triad of ECG changes in pericardial effusion with cardiac tamponade?

Prolonged ST segment. In cardiac tamponade, the accumulation of fluid in the pericardial space increases intrapericardial pressure, leading to compression of the heart chambers and reduced diastolic filling [1]. This physiological stress manifests as a specific triad of ECG findings. **Why "Prolonged ST segment" is the correct answer:** ST-segment changes in pericardial disease are typically associated with **acute pericarditis** (showing diffuse ST-elevation with PR-depression) [2]. A "prolonged ST segment" is not a feature of tamponade; rather, it is classically seen in **hypocalcemia**. In tamponade, the ECG reflects the physical presence of fluid and the heart's compensatory mechanisms, not a delay in ventricular repolarization. **Explanation of incorrect options:** * **Sinus Tachycardia:** This is the **most common** ECG finding. It is a compensatory mechanism to maintain cardiac output (CO = Stroke Volume × Heart Rate) as stroke volume falls due to compression. * **Low voltage QRS complex:** Defined as QRS amplitude <5mm in limb leads and <10mm in precordial leads. This occurs because the pericardial fluid acts as an "insulator," dampening the electrical signal reaching the surface electrodes [1]. * **Electrical Alternans:** This is a **pathognomonic** (highly specific) finding. It refers to the beat-to-beat variation in QRS amplitude or axis, caused by the heart physically "swinging" back and forth within the large volume of fluid [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Beck’s Triad (Clinical):** Hypotension, Jugular Venous Distension (JVD), and Muffled heart sounds. * **Pulsus Paradoxus:** A drop in systolic BP >10 mmHg during inspiration; a hallmark of tamponade. * **Chest X-ray:** Shows a "Water-bottle" or "Money-bag" heart [1]. * **Treatment:** Immediate **Pericardiocentesis** is the gold standard for management [1].

Question 1

A 70-year-old patient with COPD presents with palpitations. What does the ECG rhythm strip show?

Accepted Answer

Multifocal atrial tachycardia

Answer

Inappropriate sinus tachycardia

Answer

Junctional tachycardia

Answer

Atrial fibrillation

Question 2

Which drug is used to perform stress echocardiography?

Accepted Answer

Dobutamine

Answer

Thallium

Answer

Adrenaline

Answer

Adenosine

Question 3

Widely split S1 is heard in which of the following conditions?

Accepted Answer

Atrial septal defect (ASD)

Answer

Right bundle branch block (RBBB)

Answer

Mitral regurgitation (MR)

Answer

Ventricular septal defect (VSD)

Question 4

A 25-year-old male who is an IV drug user presents with a 3-week history of worsening lethargy and confusion. On examination, the pulse rate is 130 bpm and blood pressure is 120/80 mmHg. Cardiovascular examination reveals a raised JVP with large v-waves and a loud systolic murmur. A palpable, pulsatile liver is felt when the hepato-jugular reflex is attempted. What type of murmur is most fitting with this patient's presentation?

Accepted Answer

Tricuspid regurgitation

Answer

Functional murmur

Answer

Tricuspid stenosis

Answer

Pulmonary stenosis

Question 5

The following ECG findings are seen in Hypokalemia:

Accepted Answer

Increased PR interval with ST depression

Answer

Increased PR interval with peaked T wave

Answer

Prolonged QT interval with T wave inversion

Answer

Decreased QT interval with ST depression

Question 6

Diagnose the cardiac disorder based on the provided ECG findings.

Accepted Answer

Anterior wall MI

Answer

Right Bundle Branch Block (RBBB)

Answer

Hyperkalemia

Answer

Digitalis toxicity

Question 7

What is the typical area of the mitral valve in severe mitral stenosis during pregnancy?

Accepted Answer

1-1.5 cm2

Answer

4-6 cm2

Answer

1.5-2.5 cm2

Answer

0.8-1 cm2

Question 8

A 60-year-old male, diabetic and smoker, presents with 3 hours of substernal chest pain. Which of the following statements is true regarding his ECG findings?

Accepted Answer

ECG shows acute anterior myocardial infarction.

Answer

Heart rate is 45/min.

Answer

The patient should be given IV lidocaine.

Answer

ECG is suggestive of hypokalemia.

Question 9

A 44-year-old woman presents with a 4-year history of increasing dyspnea and fatigue. Physical examination reveals increased JVP and a reduced carotid pulse. Precordial examination reveals a left parasternal lift, loud P2, and right-sided S3 and S4. There are no audible murmurs. Chest X-ray reveals clear lung fields and an ECG shows evidence of right ventricular hypertrophy. Pulmonary function tests show a slight restrictive pattern. A diagnosis of primary pulmonary hypertension (PPH) is made. Which of the following is the most likely cause of death in this condition?

Accepted Answer

Intractable right ventricular failure or sudden death

Answer

Intractable left ventricular failure

Answer

Intractable respiratory failure

Answer

Massive pulmonary embolism

Question 10

Which of the following is NOT a component of the classical triad of ECG changes in pericardial effusion with cardiac tamponade?

Accepted Answer

Prolonged ST segment

Answer

Sinus tachycardia

Answer

Low voltage QRS complex

Answer

Electrical alternans

Cardiology — MCQs

Cardiology — MCQs

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