Cardiology Practice Questions

Q: A 20-year-old girl presented with low-grade fever, malaise, night sweats, weight loss, arthralgia, and fatigue for 1 month. On examination, peripheral pulses were weak in the upper extremities and a bruit was present over the carotid and subclavian arteries. Investigations revealed dilatation of the proximal aorta. What is the most likely diagnosis?

Takayasu's arteritis. The clinical presentation is classic for **Takayasu’s Arteritis (TA)**, also known as "Pulseless Disease." It is a chronic, large-vessel vasculitis that primarily involves the **aorta and its major branches** [1]. 1. **Why it is correct:** The patient is a young female (typical demographic) presenting with systemic symptoms (fever, weight loss) followed by features of vascular inflammation. The **weak upper extremity pulses** and **bruit** over the carotids/subclavian arteries indicate arterial stenosis. The **dilatation of the proximal aorta** (aortitis) is a hallmark finding. According to ACR criteria, age <40, claudication, and decreased brachial artery pulses are key diagnostic features. 2. **Why the other options are wrong:** * **Polyarteritis nodosa (PAN):** A medium-vessel vasculitis that typically involves the renal and visceral arteries (sparing the lungs). It presents with hypertension, skin nodules, and mononeuritis multiplex, not absent pulses in the upper limbs. * **Temporal arteritis (Giant Cell Arteritis):** Also a large-vessel vasculitis, but it almost exclusively affects patients **over the age of 50**. It typically presents with headache, jaw claudication, and visual loss. * **Kawasaki's disease:** Primarily affects **children (<5 years)** [1]. It involves medium-sized vessels, most notably the **coronary arteries** (aneurysms), and presents with "strawberry tongue," conjunctivitis, and rash [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Demographic:** Most common in Asian females 10 mmHg) between the two arms.

Q: Ventricular Tachycardia is represented by all, except:

Typical RBBB QRS complex. **Explanation:** Ventricular Tachycardia (VT) originates from an ectopic focus within the ventricles, bypassing the normal His-Purkinje conduction system. This leads to slow, cell-to-cell depolarization, resulting in a **Wide QRS complex (>0.12s)** (Option A) [1]. **Why Option D is the correct answer:** In VT, the QRS morphology is usually **atypical** or "bizarre" [1]. A **Typical RBBB or LBBB pattern** (Option D) suggests that the impulse is traveling through the normal conduction system, which is characteristic of **Supraventricular Tachycardia (SVT) with aberrancy**, not VT. In VT, the QRS morphology often shows "concordance" (all complexes in precordial leads are either positive or negative) or specific criteria like a Brugada sign. **Analysis of other options:** * **AV Dissociation (Option B):** This is a hallmark of VT. The atria and ventricles beat independently because the rapid ventricular rate prevents retrograde conduction to the atria [1]. * **Capture Beats (Option C):** These occur when a normal sinus impulse occasionally "captures" the ventricle amidst the tachycardia, resulting in a normal-looking, narrow QRS complex. Along with **Fusion beats**, these are pathognomonic for VT [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Brugada Criteria:** Used to differentiate VT from SVT with aberrancy. * **Northwest Axis:** An "extreme axis deviation" (between -90° and 180°) strongly suggests VT. * **Hemodynamic Stability:** Never use stability to rule out VT; stable VT is common and should be treated with Amiodarone or Procainamide, while unstable VT requires immediate DC cardioversion [2].

Q: Which of the following is seen in rheumatic fever?

Sydenham's chorea. **Explanation:** **Sydenham’s Chorea** (also known as St. Vitus' Dance) is a major criterion in the **Jones Criteria** for the diagnosis of Acute Rheumatic Fever (ARF) [1]. It is a delayed manifestation, often appearing months after the initial Group A Streptococcal (GAS) pharyngeal infection [1]. The underlying mechanism is **molecular mimicry**, where antibodies against streptococcal antigens cross-react with the **basal ganglia** (specifically the caudate and putamen), leading to involuntary, purposeless, non-repetitive movements [2]. **Why other options are incorrect:** * **Huntington’s Chorea:** This is an autosomal dominant neurodegenerative disorder caused by CAG repeat expansions in the HTT gene. It presents in mid-adulthood with chorea and progressive dementia, unrelated to streptococcal infections [2]. * **Athetosis:** This refers to slow, writhing, involuntary movements (often seen in cerebral palsy or basal ganglia lesions) [2]. While it involves the same brain region, it is clinically distinct from the rapid, jerky movements of chorea seen in ARF [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Jones Criteria (Revised):** Remember the mnemonic **J♥NES** (Joints-polyarthritis, ♥-Carditis, Nodules-subcutaneous, Erythema marginatum, Sydenham’s chorea). * **Clinical Signs:** Sydenham’s chorea is associated with **"Milkmaid’s grip"** (irregular contractions of hand muscles) and **"Darting tongue"** (inability to protrude the tongue steadily). * **Prognosis:** It is the only major manifestation of ARF that can occur in isolation and typically has a benign, self-limiting course, though it may require symptomatic treatment with valproate or carbamazepine.

Q: All of the following statements about pulse deficit in Atrial Fibrillation are true, except?

Radial pulse rate may be more than ventricular pulse rate. **Explanation:** The **Pulse Deficit** is defined as the difference between the apical heart rate (measured by auscultation) and the peripheral radial pulse rate. It is a hallmark clinical feature of **Atrial Fibrillation (AF)** [1]. **1. Why Option D is the Correct Answer (The False Statement):** By definition, the radial pulse rate can **never** be higher than the ventricular (apical) rate. A pulse deficit occurs because some ventricular contractions occur so prematurely (during the compensatory pause or short diastole) that the left ventricle has insufficient filling time. This results in a stroke volume too small to open the aortic valve or generate a palpable peripheral pressure wave. Therefore, the radial rate will always be equal to or less than the apical rate. **2. Analysis of Other Options:** * **Option A:** In untreated AF, the pulse deficit is typically significant, often **more than 10 beats per minute**. * **Option B:** As the ventricular rate increases, the diastolic filling time decreases further. This leads to more "ineffectual" contractions that do not reach the periphery, thereby **increasing the deficit**. * **Option C:** Digitalis (Digoxin) slows the ventricular rate by increasing AV nodal refractoriness [2]. As the heart rate slows and becomes more regular, diastolic filling improves, and the **pulse deficit may disappear**. **Clinical Pearls for NEET-PG:** * **Measurement:** To accurately measure pulse deficit, two examiners should ideally count the apical and radial pulses simultaneously for one full minute. * **Other Causes:** Besides AF, pulse deficit can be seen in **Premature Ventricular Contractions (PVCs)**. * **Significance:** A narrowing pulse deficit in an AF patient often indicates successful rate control therapy [3].

Q: CCF is associated with an increase in all of the following except?

Serum sodium. In Congestive Cardiac Failure (CCF), the primary pathophysiology involves a decrease in cardiac output leading to systemic venous congestion and compensatory neurohormonal activation [1]. **Why Serum Sodium is the Correct Answer:** In CCF, patients typically develop **Hyponatremia** (decreased serum sodium), not hypernatremia. This occurs due to: 1. **Non-osmotic ADH release:** Low effective arterial blood volume triggers the release of Antidiuretic Hormone (ADH), which causes excessive water reabsorption in the kidneys. 2. **Dilutional effect:** The retention of water is disproportionately greater than the retention of sodium, leading to "dilutional hyponatremia." This is a poor prognostic marker in heart failure. **Explanation of Incorrect Options:** * **Right Atrial (RA) Mean Pressure:** In CCF (especially right-sided failure), blood backs up into the venous system, leading to increased RA pressure, elevated JVP, and peripheral edema [1]. * **Serum Urea:** Decreased renal perfusion in CCF leads to "Prerenal Azotemia." The kidneys increase urea reabsorption to maintain osmotic pressure, resulting in elevated BUN/Urea levels [1]. * **Serum Norepinephrine:** Low cardiac output triggers the **Sympathetic Nervous System**. This leads to a compensatory increase in circulating norepinephrine to increase heart rate and contractility [1]. **High-Yield Clinical Pearls for NEET-PG:** * **BNP (B-type Natriuretic Peptide):** The gold standard biomarker to rule out CCF in acute dyspnea [1]. * **RAAS Activation:** CCF leads to increased Renin, Angiotensin II, and Aldosterone, contributing to fluid overload. * **Cardinal Sign:** The most specific sign of CCF is an elevated **Jugular Venous Pressure (JVP)** [1]. * **Electrolyte Triad in CCF:** Hyponatremia, Hypokalemia (often due to diuretics), and Hyperuricemia.

Q: JVP wave with absent y descent and prominent x wave is seen in which condition?

Cardiac tamponade. **Explanation:** In **Cardiac Tamponade**, the heart is compressed by fluid within the rigid pericardial sac. This high intrapericardial pressure prevents the ventricles from expanding during early diastole. [1] * **Why the 'y' descent is absent:** The 'y' descent represents the rapid emptying of the atria into the ventricles after the tricuspid valve opens. In tamponade, the diastolic pressure in the ventricles is already extremely high (equilibrated with the pericardial pressure), which prevents rapid inflow. Thus, the **'y' descent is blunted or absent.** * **Why the 'x' wave is prominent:** The 'x' descent represents atrial relaxation and the downward pulling of the tricuspid annulus during ventricular systole. Since the heart is compressed, this is the only phase where the intrapericardial pressure momentarily drops, allowing for atrial filling. **Analysis of Incorrect Options:** * **Constrictive Pericarditis:** Characterized by a **prominent/steep 'y' descent** (Friedreich’s sign) due to rapid early diastolic filling followed by a sudden halt. * **Restrictive Cardiomyopathy:** Similar to constriction, it typically shows a **prominent 'y' descent** due to high venous pressure and rapid early filling. * **Right Ventricular Failure:** Usually presents with a prominent 'a' wave (due to decreased RV compliance) and a prominent 'v' wave if tricuspid regurgitation is present, but not an absent 'y' descent. **High-Yield Clinical Pearls for NEET-PG:** * **Kussmaul’s Sign** (paradoxical rise in JVP on inspiration): Seen in Constrictive Pericarditis and RCM, but **absent** in Cardiac Tamponade. * **Pulsus Paradoxus:** A hallmark of Cardiac Tamponade. [1] * **Beck’s Triad (Tamponade):** Hypotension, Muffled heart sounds, and Raised JVP. [1] * **Mnemonic:** Tamponade = **"x"** is present (e**x**tra fluid), **"y"** is absent (**y**ields to pressure).

Question 1

All of the following regarding the Universal Definition of Myocardial Infarction are true EXCEPT?

Accepted Answer

Three times increase in troponin levels are required for coronary artery bypass grafting

Answer

Sudden unexpected cardiac death with symptoms of ischemia

Answer

New regional wall motion abnormality with raised cardiac biomarkers

Answer

Reinfarction can be diagnosed if increased troponin levels by 5-7% in serial samples

Question 2

A 20-year-old girl presented with low-grade fever, malaise, night sweats, weight loss, arthralgia, and fatigue for 1 month. On examination, peripheral pulses were weak in the upper extremities and a bruit was present over the carotid and subclavian arteries. Investigations revealed dilatation of the proximal aorta. What is the most likely diagnosis?

Accepted Answer

Takayasu's arteritis

Answer

Polyarteritis nodosa

Answer

Temporal arteritis

Answer

Kawasaki's disease

Question 3

Ventricular Tachycardia is represented by all, except:

Accepted Answer

Typical RBBB QRS complex

Answer

Wide QRS complex

Answer

AV dissociation

Answer

Capture Beats

Question 4

A 57-year-old man comes to see you for follow-up 4 weeks after being discharged from hospital for unstable angina. His coronary angiogram showed moderate nonstenotic disease in two vessels. The cardiologist asks you to follow up on his fasting lipid profile since it was not checked in the hospital. His T-chol is 240 mg/dL, LDL 120 mg/dL, HDL 50 mg/dL, and triglycerides 130 mg/dL. For the above patient with dyslipidemia, select the most appropriate treatment?

Accepted Answer

Hepatic hydroxymethylglutaryl coenzyme A (HMG-Co) reductase inhibitors (lovastatin, simvastatin, pravastatin)

Answer

Fibric acid derivatives (clofibrate, gemfibrozil)

Answer

Nicotinic acid

Answer

Bile acid-binding resins (cholestyramine, colestipol)

Question 5

Which of the following is seen in rheumatic fever?

Accepted Answer

Sydenham's chorea

Answer

Huntington's chorea

Answer

Athetosis

Answer

All

Question 6

All of the following statements about pulse deficit in Atrial Fibrillation are true, except?

Accepted Answer

Radial pulse rate may be more than ventricular pulse rate

Answer

Usually more than 10/minute

Answer

Increases with faster ventricular rates

Answer

May be absent in digitalis intoxication

Question 7

CCF is associated with an increase in all of the following except?

Accepted Answer

Serum sodium

Answer

Right atrial mean pressure

Answer

Serum urea

Answer

Serum norepinephrine

Question 8

A 40-year-old female G4P4L3A1, who delivered her third child 1 month ago, presented with recent onset of cough and palpitations associated with paroxysmal nocturnal dyspnea, orthopnea, and exertional intolerance. The patient also complained of a few episodes of hemoptysis 2 days prior. She had a history of pre-eclampsia in her last pregnancy. On examination, Jugular Venous Pressure was increased, with crepitations in bilateral basal lung fields and a shift of the apical impulse. Echocardiogram studies showed a left ventricular ejection fraction < 45%. Despite treatment, the patient did not survive. Histopathological examination was performed on the autopsied heart. Which finding would be most likely present on histopathological examination?

Accepted Answer

Lymphocytic myocarditis

Answer

Eosinophilic myocarditis

Answer

Basophilic myocarditis

Answer

Neutrophilic myocarditis

Question 9

A young lady complains of sudden onset of palpitations, extreme weakness, and sweating. On examination, she was found to have a blood pressure of 90/70 mmHg with a regular pulse rate of 180/minute. Her symptoms disappeared after vomiting but she complained of polyuria. What is the most likely diagnosis?

Accepted Answer

Paroxysmal atrial tachycardia

Answer

Primary thyrotoxicosis

Answer

Acute anxiety state

Answer

Paroxysmal atrial flutter

Question 10

JVP wave with absent y descent and prominent x wave is seen in which condition?

Accepted Answer

Cardiac tamponade

Answer

Restrictive cardiomyopathy

Answer

Constrictive pericarditis

Answer

Right ventricular failure

Cardiology — MCQs

Cardiology — MCQs

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