Cardiology Practice Questions

Q: Which of the following physical signs is seen in a patient with severe aortic stenosis?

Delayed peak of systolic murmur. **Explanation:** In **Aortic Stenosis (AS)**, the hallmark physical finding is a crescendo-decrescendo systolic ejection murmur [1]. As the stenosis becomes more **severe**, the pressure gradient across the valve takes longer to reach its maximum, causing the murmur to peak later in systole. This **delayed peak of systolic murmur** (late-peaking) is a reliable indicator of severity, often accompanied by a "pulsus parvus et tardus" (weak and delayed carotid upstroke) [1]. **Analysis of Incorrect Options:** * **A. Opening Snap:** This is a high-pitched diastolic sound characteristic of **Mitral Stenosis** [2], caused by the sudden tensing of the chordae tendineae and stenotic valve leaflets. * **B. Diastolic Rumble:** This describes the low-pitched mid-diastolic murmur of **Mitral Stenosis** or the Austin Flint murmur of Aortic Regurgitation [3]. AS produces a systolic, not diastolic, murmur. * **C. Holosystolic Murmur:** This is typical of **Mitral Regurgitation, Tricuspid Regurgitation, or Ventricular Septal Defect (VSD)**, where the pressure gradient remains constant throughout systole. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of Severe AS:** Angina, Syncope, and Dyspnea (SAD). * **Soft/Absent S2:** In severe AS, the aortic component (A2) becomes soft or disappears because the valve leaflets are too calcified to snap shut [1]. * **Paradoxical Splitting of S2:** Occurs in severe AS because the prolonged left ventricular ejection time causes A2 to occur after P2. * **Gallavardin Phenomenon:** The dissociation between the noisy (musical) component of the AS murmur at the apex and the harsh component at the base, often mimicking mitral regurgitation [1].

Q: A 55-year-old female presented to the ER with sudden onset of shortness of breath along with syncope. Chest X-ray was unremarkable. ECG was done. On examination, some skin lesions were observed. What is the most likely diagnosis in this case?

Sarcoidosis. ***Sarcoidosis*** - **Cardiac sarcoidosis** can present with **complete heart block** causing **syncope** and **shortness of breath**, with **unremarkable chest X-ray** in isolated cardiac involvement. - **Skin manifestations** like **lupus pernio** or **erythema nodosum** are characteristic features that support the diagnosis. *Carney syndrome* - A rare **genetic disorder** characterized by **cardiac myxomas**, **skin pigmentation**, and **endocrine tumors**. - Syncope would be due to **myxoma obstruction**, not **conduction abnormalities**, and lacks the typical skin lesions of sarcoidosis. *Hypothyroidism* - Causes **bradycardia** and **fatigue** but rarely leads to **complete heart block** or **acute syncope**. - Associated with **myxedematous skin changes** (dry, coarse skin), not the inflammatory skin lesions described. *SLE* - Can cause **pericarditis** and **Libman-Sacks endocarditis** but rarely presents with **isolated heart block**. - **Malar rash** and **discoid lesions** are typical, but the acute presentation with syncope is less characteristic.

Q: Carcinoid syndrome produces valvular disease primarily involving which valves?

Tricuspid valves. **Explanation:** Carcinoid heart disease occurs in approximately 50% of patients with systemic carcinoid syndrome. It is characterized by the deposition of **fibrous, plaque-like endocardial thickening** on the valves and endocardial surfaces. **Why Tricuspid Valve is Correct:** The primary mediators of carcinoid syndrome (serotonin, bradykinin, and histamine) are released by neuroendocrine tumors, typically from the GI tract [1]. These substances reach the **right side of the heart** first via the systemic circulation. Serotonin induces fibroblast proliferation, leading to **Tricuspid Regurgitation** (most common) and Pulmonary Stenosis [1]. The valves become thickened, shortened, and rigid. **Why Other Options are Incorrect:** * **Mitral and Aortic Valves (Left-sided):** These are generally **spared** because the lungs contain high concentrations of **Monoamine Oxidase (MAO)**. As blood passes through the pulmonary circulation, MAO inactivates serotonin and other vasoactive substances before they can reach the left atrium and ventricle. * **Pulmonary Valve:** While the pulmonary valve is frequently involved (usually causing stenosis), the **tricuspid valve** is the most commonly and severely affected structure in carcinoid heart disease. **High-Yield Clinical Pearls for NEET-PG:** * **Pathognomonic Feature:** Fibrous white plaques on the endocardium. * **Left-sided involvement occurs ONLY if:** 1. There is a **Right-to-Left shunt** (e.g., Patent Foramen Ovale). 2. The primary tumor is in the **Lungs** (bronchial carcinoid), bypassing pulmonary metabolism. * **Biomarker:** Elevated 24-hour urinary **5-HIAA** (5-Hydroxyindoleacetic acid). * **Management:** Somatostatin analogues (Octreotide) to control symptoms and surgical valve replacement for advanced heart failure.

Q: A 16-year-old male presents for a physical examination before joining a football team. His elder brother died suddenly during football practice. The patient has a loud systolic murmur on chest auscultation. Which of the following findings would NOT be consistent with hypertrophic cardiomyopathy?

Murmur radiating to the neck. **Explanation:** Hypertrophic Cardiomyopathy (HCM) is a common cause of sudden cardiac death in young athletes. The murmur in HCM is caused by dynamic Left Ventricular Outflow Tract (LVOT) obstruction. **Why Option B is the Correct Answer:** Radiation of a systolic murmur to the neck (carotids) is a classic feature of **Valvular Aortic Stenosis (AS)**. In HCM, the obstruction occurs below the valve (sub-valvular); therefore, the murmur typically radiates to the lower left sternal border or the apex, but **not** to the carotids. **Analysis of Incorrect Options:** * **Option A (Crescendo-decrescendo systolic murmur):** This is the characteristic sound of HCM. It is caused by the systolic anterior motion (SAM) of the mitral valve hitting the hypertrophied septum, creating turbulence. * **Option C (Brisk carotid upstroke):** In HCM, the initial ejection of blood is rapid, leading to a brisk or "jerky" pulse (often called a *pulsus bisferiens*). This contrasts with the *pulsus parvus et tardus* (weak and late) seen in valvular AS. * **Option D (Increase with Valsalva/Standing):** These maneuvers decrease venous return (preload). In HCM, a smaller ventricular volume allows the septum and mitral valve to come closer together, worsening the obstruction and **increasing** the murmur intensity. **NEET-PG High-Yield Pearls:** * **Dynamic Murmur:** HCM and MVP are the only two murmurs that **increase** with Valsalva and Standing (decreased preload). * **Handgrip/Squatting:** These increase afterload/preload, which increases LV volume and **decreases** the HCM murmur. * **Inheritance:** Autosomal Dominant, most commonly involving mutations in the **Beta-myosin heavy chain** or Myosin-binding protein C. * **Drug of Choice:** Beta-blockers (to increase diastolic filling time). Avoid Digoxin and Diuretics.

Question 1

Ventricular ectopic beats are represented by which of the following findings?

Accepted Answer

Irregular RR interval

Answer

Incomplete compensatory pause

Answer

A.V. dissociation

Answer

Presence of fusion beat

Question 2

In a hospital cardiac care unit, there are three patients with different cardiac conditions: a 52-year-old man with dilated cardiomyopathy, an 18-year-old girl with mitral valve prolapse, and a 30-year-old man with infective endocarditis of the mitral valve. Which of the following features do all these patients most likely share?

Accepted Answer

Risk of systemic thromboembolism

Answer

Decreased compliance

Answer

Depressed myocardial contractility

Answer

Infectious etiology

Question 3

Which of the following physical signs is seen in a patient with severe aortic stenosis?

Accepted Answer

Delayed peak of systolic murmur

Answer

Opening snap

Answer

Diastolic rumble

Answer

Holosystolic murmur

Question 4

A 55-year-old female presented to the ER with sudden onset of shortness of breath along with syncope. Chest X-ray was unremarkable. ECG was done. On examination, some skin lesions were observed. What is the most likely diagnosis in this case?

Accepted Answer

Sarcoidosis

Answer

Carney syndrome

Answer

Hypothyroidism

Answer

SLE

Question 5

A 68-year-old man who has had a recent syncopal episode is hospitalized with congestive heart failure. His blood pressure is 160/80 mmHg. His pulse rate is 80 beats per minute, and there is a grade III/IV harsh systolic murmur. An echocardiogram shows a disproportionately thickened ventricular septum and systolic anterior motion of the mitral valve. Which of the following findings would most likely be present in this man?

Accepted Answer

Decrease of the murmur with hand grip.

Answer

Radiation of the murmur to the neck.

Answer

Delayed carotid upstroke.

Answer

Reduced left ventricular ejection fraction.

Question 6

A 42-year-old man presents with central, crushing chest pain that radiates to the jaw. The pain occurred while jogging and was alleviated with rest. The ECG is normal. What is the most likely diagnosis?

Accepted Answer

Angina pectoris

Answer

Acute Pericarditis

Answer

STEMI

Answer

NSTEMI

Question 7

A 42-year-old man presents with dizziness on standing, and his systolic blood pressure falls by 50 mm Hg. Which of the following would be most appropriate?

Accepted Answer

Salmeterol

Answer

Gradual stockings and compressions

Answer

Isoproterenol

Answer

Fludrocortisone

Question 8

Carcinoid syndrome produces valvular disease primarily involving which valves?

Accepted Answer

Tricuspid valves

Answer

Pulmonary valves

Answer

Mitral valve

Answer

Aortic valve

Question 9

Which of the following is not an absolute contraindication for thrombolytic therapy in acute ST segment elevation myocardial infarction?

Accepted Answer

Pregnancy

Answer

Significant closed head injury

Answer

Symptoms suggestive of aortic dissection

Answer

Presence of metastatic intracranial malignancy

Question 10

A 16-year-old male presents for a physical examination before joining a football team. His elder brother died suddenly during football practice. The patient has a loud systolic murmur on chest auscultation. Which of the following findings would NOT be consistent with hypertrophic cardiomyopathy?

Accepted Answer

Murmur radiating to the neck

Answer

A crescendo-decrescendo systolic murmur

Answer

Brisk carotid upstroke

Answer

Increase in murmur intensity during Valsalva maneuver or standing

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?