Cardiology Practice Questions

Q: A 64-year-old gentleman presents with severe central chest pain radiating to the left arm for the last 30 minutes. He is profusely sweating and appears to be in agony. Which of the following conditions is he most likely suffering from?

Acute myocardial infarction. **Explanation:** The clinical presentation of severe, crushing central chest pain radiating to the left arm, accompanied by autonomic symptoms like profuse sweating (diaphoresis), is the classic "textbook" description of an **Acute Myocardial Infarction (AMI)** [1]. 1. **Why Option C is Correct:** AMI occurs due to a sudden occlusion of a coronary artery, leading to myocardial necrosis [2]. The pain is typically intense, lasts longer than 20 minutes, and is not relieved by rest or nitroglycerin. The presence of **diaphoresis** is a high-yield sign indicating sympathetic overactivity, which strongly correlates with myocardial ischemia rather than non-cardiac causes [3]. 2. **Why Other Options are Incorrect:** * **Stable Angina:** Pain is typically brief (3–15 minutes), predictable, and triggered by exertion or stress. It is characteristically relieved by rest or sublingual nitrates, unlike the pain described here. * **Oesophagitis:** This usually presents as retrosternal "heartburn" or burning pain, often related to posture (lying down) or food intake. While it can mimic cardiac pain, it rarely causes profuse sweating or radiation to the left arm. * **Pleurisy:** This is characterized by **pleuritic chest pain**—sharp, stabbing pain that is strictly aggravated by inspiration, coughing, or movement. It is not typically central or associated with the systemic agony seen in AMI [4]. **NEET-PG High-Yield Pearls:** * **Levine’s Sign:** A clenched fist held over the chest to describe ischemic pain [1]. * **Silent MI:** Common in elderly patients and diabetics (due to autonomic neuropathy) [3]. * **Gold Standard Investigation:** Coronary Angiography; however, the most immediate initial tests are an **ECG** and **Cardiac Troponins (I or T)**. * **Time is Muscle:** Reperfusion therapy (PCI or Thrombolysis) should be initiated as early as possible to salvage myocardium.

Q: All of the following are true of atrial fibrillation EXCEPT?

Associated with sinus bradycardia. Explanation: Atrial Fibrillation (AF) is a supraventricular tachyarrhythmia characterized by rapid, uncoordinated atrial activation and an ineffective atrial contraction [1]. Why Option D is the correct answer (The Exception): Atrial fibrillation is fundamentally a tachyarrhythmia. In AF, the atrial rate typically ranges from 350–600 bpm [2]. While the ventricular rate depends on AV node conduction, it is usually rapid (tachycardia) unless the patient is on AV-nodal blocking drugs or has underlying conduction system disease [4]. Sinus bradycardia refers to a slow rhythm originating from the SA node; in AF, the SA node is overwhelmed and suppressed by multiple re-entrant wavelets, making the coexistence of a normal sinus rhythm (bradycardic or otherwise) impossible during the arrhythmia. Analysis of Incorrect Options: * Option A: Rheumatic Mitral Stenosis is a classic cause of AF due to left atrial enlargement and fibrosis, which alters the electrophysiological properties of the atrial tissue. * Option B: The lack of effective atrial contraction leads to blood stasis, particularly in the left atrial appendage, significantly increasing the risk of thrombus formation and systemic thromboembolism (e.g., ischemic stroke) [3]. * Option C: Because the AV node is bombarded by irregular atrial impulses, the ventricular response is "random," resulting in the hallmark clinical finding of an irregularly irregularly pulse and a pulse deficit. Clinical Pearls for NEET-PG: * ECG Findings: Absence of P waves, presence of fibrillatory (f) waves, and irregular RR intervals. * Ashman Phenomenon: A long RR interval followed by a short RR interval resulting in an aberrantly conducted QRS (usually RBBB morphology). * Treatment: Hemodynamically unstable patients require immediate synchronized cardioversion. Stable patients are managed with rate control (Beta-blockers/CCBs) and anticoagulation based on the CHA₂DS₂-VASc score [3].

Q: Which murmur increases in intensity with the Valsalva maneuver?

Hypertrophic obstructive cardiomyopathy (HOCM). ### Explanation The **Valsalva maneuver** (specifically the strain phase) increases intrathoracic pressure, which decreases venous return to the heart. This leads to a reduction in Left Ventricular (LV) end-diastolic volume (preload) [2]. **Why HOCM is the correct answer:** In Hypertrophic Obstructive Cardiomyopathy, the murmur is caused by dynamic left ventricular outflow tract (LVOT) obstruction. When the LV volume decreases (due to reduced preload during Valsalva), the hypertrophied interventricular septum and the anterior mitral leaflet come closer together. This **increases the degree of obstruction**, thereby increasing the intensity of the systolic murmur [1]. **Analysis of Incorrect Options:** * **Aortic Stenosis (AS):** Unlike HOCM, AS is a fixed valvular obstruction. Decreased preload means less blood is ejected across the valve, which **decreases** the murmur intensity [3]. * **Ventricular Septal Defect (VSD):** Decreased venous return reduces the volume of blood shunting from left to right, thus **decreasing** the murmur intensity. * **Mitral Stenosis (MS):** Reduced venous return leads to less flow across the stenotic mitral valve, **decreasing** the intensity of the mid-diastolic rumble. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Two":** Only two murmurs **increase** in intensity with Valsalva and Standing (both decrease preload): **HOCM** and **Mitral Valve Prolapse (MVP)**. All other murmurs generally decrease. * **Handgrip Exercise:** Increases afterload. This **decreases** the HOCM murmur (by distending the LV) but **increases** murmurs of AR, MR, and VSD. * **Squatting:** Increases both preload and afterload, which **decreases** the HOCM murmur.

Q: In terms of the cardiac walls viewed by each lead, which of the following is the odd one out?

Lead aVL. To answer this question, one must understand the relationship between ECG leads and the specific anatomical surfaces of the heart they "view." This is a fundamental concept in identifying the location of myocardial infarction (MI) [2]. ### **Explanation of the Correct Answer** The correct answer is **Lead aVL**. Leads are categorized based on the cardiac wall they represent: * **Inferior Wall:** Leads **II, III, and aVF** look at the heart from the bottom (inferior) perspective [4]. * **Lateral Wall:** Leads **I, aVL, V5, and V6** look at the left lateral side of the heart [1]. Since Leads II, III, and aVF all represent the **Inferior Wall**, they form a logical group. **Lead aVL** is the "odd one out" because it represents the **High Lateral Wall**. ### **Analysis of Incorrect Options** * **Lead II (Option A):** This is an inferior lead. It records electrical activity moving toward the positive electrode on the left leg [3]. * **Lead III (Option B):** This is an inferior lead. It records activity between the left arm and left leg [3]. * **Lead aVF (Option D):** The "F" stands for Foot. It is a unipolar limb lead that views the heart directly from the inferior aspect [4]. ### **Clinical Pearls for NEET-PG** * **Blood Supply Correlation:** * **Inferior Wall (II, III, aVF):** Usually supplied by the **Right Coronary Artery (RCA)**. * **Lateral Wall (I, aVL, V5, V6):** Usually supplied by the **Left Circumflex Artery (LCx)**. * **Reciprocal Changes:** In an acute Inferior Wall MI (ST elevation in II, III, aVF), reciprocal ST depression is most commonly seen in **Lead aVL** [2]. * **Septal Leads:** V1 and V2 [1]. * **Anterior Leads:** V3 and V4 (supplied by the Left Anterior Descending artery) [1].

Q: Which of the following conditions is characterized by the absence of P waves on an electrocardiogram?

Atrial fibrillation. ### Explanation **Correct Answer: A. Atrial Fibrillation** In **Atrial Fibrillation (AF)**, the normal organized electrical activity of the SA node is replaced by rapid, chaotic, and disorganized electrical impulses originating from multiple ectopic foci (often near the pulmonary veins). Because the atria do not contract as a single unit but rather "quiver," there is no coordinated atrial depolarization. Consequently, distinct **P waves are absent** on the ECG and are replaced by fine, irregular oscillations called **fibrillatory (f) waves**. The hallmark of AF is an "irregularly irregular" ventricular rhythm. **Analysis of Incorrect Options:** * **B. Congestive Cardiac Failure (CCF):** This is a clinical syndrome of pump failure. While CCF can lead to AF due to atrial stretch, it does not inherently cause the absence of P waves. The ECG may show signs of chamber hypertrophy or underlying ischemia, but P waves are typically present if the rhythm is sinus. * **C. Atrial Flutter:** This is characterized by a "re-entrant" circuit in the right atrium. Instead of absent P waves, it produces regular, rapid, and identical **"saw-tooth" waves** (F waves), usually at a rate of 250–350 bpm. * **D. PSVT:** This typically presents as a narrow-complex tachycardia. While P waves may be difficult to see because they are buried within or immediately follow the QRS complex (due to retrograde conduction), they are technically present or represented by pseudo-S or pseudo-R' waves. **High-Yield NEET-PG Pearls:** * **Atrial Fibrillation:** Look for the triad of **absent P waves**, **irregularly irregular R-R intervals**, and **variable pulse deficit**. * **Ashman Phenomenon:** A long R-R interval followed by a short R-R interval leading to an aberrantly conducted QRS (often RBBB morphology) in AF. * **Hyperkalemia:** Another critical condition where P waves may be absent (or flattened) along with tall tented T waves and widened QRS complexes.

Question 1

Which sign is characterized by a pansystolic murmur that increases in intensity during deep inspiration?

Accepted Answer

Carvallo's sign

Answer

Muller's sign

Answer

Corrigan's sign

Answer

Duroziez sign

Question 2

A 64-year-old gentleman presents with severe central chest pain radiating to the left arm for the last 30 minutes. He is profusely sweating and appears to be in agony. Which of the following conditions is he most likely suffering from?

Accepted Answer

Acute myocardial infarction

Answer

Stable angina

Answer

Oesophagitis

Answer

Pleurisy

Question 3

All of the following are true of atrial fibrillation EXCEPT?

Accepted Answer

Associated with sinus bradycardia

Answer

Occurs in rheumatic mitral stenosis

Answer

May cause thromboembolic complications

Answer

Pulse is irregularly irregular

Question 4

A 15-year-old boy complains of pain in his legs when he runs more than 300 m. Physical examination shows temperature, 36.8°C; pulse, 76/min; respirations, 22/min; and blood pressure, 165/90 mm Hg. The radial pulses are 4+, and the dorsalis pedis pulses are 1+. Arterial blood gas measurement shows a normal oxygen saturation level. Which of the following congenital cardiovascular anomalies is most likely to be present in this patient?

Accepted Answer

Coarctation of the aorta

Answer

Aortic valve stenosis

Answer

Patent ductus arteriosus

Answer

Transposition of the great arteries

Question 5

A 68-year-old male with a history of hypertension is brought in unconscious. Upon arrival, his blood pressure is recorded as 245/142 mmHg. The physician decides to assess for end-organ damage. Which of the following investigations would be least useful in this assessment?

Accepted Answer

CT pulmonary angiogram

Answer

Serum Creatinine

Answer

12-lead ECG

Answer

Fundoscopy

Question 6

Which murmur increases in intensity with the Valsalva maneuver?

Accepted Answer

Hypertrophic obstructive cardiomyopathy (HOCM)

Answer

Ventricular septal defect (VSD)

Answer

Mitral stenosis (MS)

Answer

Aortic stenosis (AS)

Question 7

In terms of the cardiac walls viewed by each lead, which of the following is the odd one out?

Accepted Answer

Lead aVL

Answer

Lead II

Answer

Lead III

Answer

Lead aVF

Question 8

Which of the following conditions is characterized by the absence of P waves on an electrocardiogram?

Accepted Answer

Atrial fibrillation

Answer

Congestive Cardiac Failure (CCF)

Answer

Atrial flutter

Answer

Paroxysmal Supraventricular Tachycardia (PSVT)

Question 9

A 52-year-old man presents with sudden crushing chest pain and tachycardia. He admits to cigarette smoking, consumption of alcohol, and abuse of illicit drugs. An ECG is consistent with ischemic change in the anteroseptal region of the heart. Laboratory studies show elevated serum levels of CK-MB and troponin I. Serum cholesterol is 240 mg/dL. Which of the following most likely contributed to this patient's condition?

Accepted Answer

Cigarette smoking

Answer

Alcohol consumption

Answer

Heroin addiction

Answer

Inadequate calcium intake

Question 10

All of the following can lead to AV block except?

Accepted Answer

Ankylosing spondylitis

Answer

Hypothyroidism

Answer

Lyme disease

Answer

Lev's disease

Cardiology — MCQs

Cardiology — MCQs

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