Cardiology Practice Questions

Q: Which of the following is NOT included in the modified Jones criteria?

Prolonged QRS interval. The **Modified Jones Criteria** are used for the diagnosis of **Acute Rheumatic Fever (ARF)**, a non-suppurative sequela of Group A Streptococcus infection [1]. ### **Explanation of the Correct Answer** **Option A (Prolonged QRS interval)** is the correct answer because it is **not** part of the Jones criteria. In ARF, the characteristic ECG finding included in the Minor Criteria is a **prolonged PR interval** (first-degree AV block), not a prolonged QRS. A prolonged QRS usually indicates bundle branch blocks or ventricular conduction delays, which are not specific to ARF. ### **Analysis of Incorrect Options** The Jones criteria are divided into Major and Minor categories. Options B, C, and D are all **Major Criteria**: * **Carditis (B):** Clinical or subclinical (detected by Echo) involvement of the endocardium, myocardium, or pericardium (pancarditis) [1]. * **Chorea (C):** Also known as Sydenham’s chorea or "St. Vitus' dance," characterized by rapid, purposeless movements [1]. * **Erythema Marginatum (D):** A classic evanescent, non-pruritic, pink ring-like rash with central clearing. ### **NEET-PG High-Yield Pearls** * **Mnemonic for Major Criteria (JONES):** **J**oints (Migratory Polyarthritis), **O** (Heart - Carditis), **N**odules (Subcutaneous), **E**rythema marginatum, **S**ydenham’s chorea. * **Minor Criteria:** Fever, Arthralgia, Elevated ESR/CRP, and **Prolonged PR interval**. * **Diagnosis Requirement:** 2 Major OR 1 Major + 2 Minor criteria, plus evidence of preceding Streptococcal infection (ASO titer/Throat culture) [1]. * **Exception:** Chorea or indolent carditis can be diagnostic of ARF on their own without meeting other criteria [1]. * **Most common valve affected:** Mitral valve (Mitral Regurgitation in acute phase; Mitral Stenosis in chronic phase).

Q: Which of the following is a major criterion for the diagnosis of Rheumatic fever according to the modified Jones criteria?

Subcutaneous nodules. The diagnosis of Acute Rheumatic Fever (ARF) is based on the **Modified Jones Criteria**, which requires evidence of a preceding Group A Streptococcal (GAS) infection plus either two major criteria or one major and two minor criteria [1]. ### **Explanation of the Correct Option** **D. Subcutaneous nodules:** These are one of the five **Major Criteria** (mnemonic: **J♥NES**). They are small, painless, firm, mobile lumps usually found over bony prominences or extensor tendons. While they are the least common major manifestation (<10%), they are highly specific for ARF and often associated with severe carditis [1]. ### **Analysis of Incorrect Options** * **A. ASO titre:** This is not a criterion itself; rather, it is the **essential evidence of preceding GAS infection** (along with positive throat culture or Rapid Strep Test) required to apply the Jones criteria [1]. * **B. Past history of Rheumatic fever:** While a history of ARF increases clinical suspicion, it was removed as a formal criterion in later revisions to maintain diagnostic specificity [1]. * **C. Fever:** This is a **Minor Criterion** [1]. Other minor criteria include arthralgia, prolonged PR interval on ECG, and elevated inflammatory markers (ESR/CRP). ### **High-Yield Clinical Pearls for NEET-PG** * **Major Criteria (J♥NES):** **J**oints (Migratory Polyarthritis), **♥** (Carditis), **N**odules (Subcutaneous), **E**rythema marginatum, **S**ydenham’s chorea. * **Joints:** Arthritis must be **migratory** and involve large joints to count as a major criterion in low-risk populations. * **Chorea:** Sydenham’s chorea (St. Vitus' dance) can be a standalone diagnostic finding even without evidence of preceding GAS infection due to its long latent period [1]. * **Exceptions:** In **high-risk populations** (e.g., India), monoarthritis or polyarthralgia can be considered major criteria.

Q: What is the most common cause of Superior Vena Cava (SVC) syndrome?

Extrinsic compression. **Explanation:** **Superior Vena Cava (SVC) Syndrome** occurs due to the obstruction of blood flow through the SVC. The underlying mechanism is broadly categorized into **extrinsic compression** (pressure from outside the vessel) or **intrinsic obstruction** (thrombosis or invasion). 1. **Why Extrinsic Compression is Correct:** The SVC is a thin-walled, low-pressure vessel located in the tight confines of the middle mediastinum, making it highly susceptible to compression by adjacent structures. Historically, infections like syphilis were common, but today, **malignancy** is the cause in >60-90% of cases [1]. Specifically, **Lung Cancer** (especially Small Cell Lung Cancer) and **Non-Hodgkin Lymphoma** cause SVC syndrome primarily through extrinsic compression by primary tumors or enlarged mediastinal lymph nodes [2]. 2. **Why Other Options are Incorrect:** * **Thrombosis (A):** While the incidence of thrombosis is rising due to the increased use of indwelling central venous catheters and pacemakers, it remains less common than extrinsic compression from malignancy. * **Mediastinal Lymphoma (C):** This is a *specific cause* of extrinsic compression, but it is not the *most common* cause (Lung cancer is more frequent) [1]. * **Teratoma (D):** This is a rare germ cell tumor of the mediastinum and is an infrequent cause of SVC obstruction. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Cause:** Bronchogenic Carcinoma (Small Cell > Squamous) [1]. * **Most Common Benign Cause:** Fibrosing Mediastinitis (often secondary to Histoplasmosis or TB). * **Clinical Presentation:** Facial puffiness (worse in the morning), "Pemberton’s sign" (facial flushing when arms are raised), and dilated collateral veins on the chest wall [3]. * **Management:** The first step is usually imaging (Contrast-enhanced CT); treatment involves stenting or treating the underlying malignancy (Radiation/Chemo).

Q: A study of risk factors for atherogenesis in adults is performed. Which of the following substances is most likely to reduce serum cholesterol?

Omega-3 fatty acids. **Explanation:** The correct answer is **Omega-3 fatty acids (D)**. **Mechanism:** Omega-3 fatty acids (specifically EPA and DHA found in fish oil) are potent agents in lipid management [2]. They primarily reduce serum triglycerides by inhibiting hepatic synthesis of VLDL and increasing fatty acid oxidation. While their effect on LDL-cholesterol is variable, they are well-documented to increase HDL ("good") cholesterol and improve the overall lipid profile, thereby exerting a cardioprotective effect against atherogenesis [2]. **Analysis of Incorrect Options:** * **A. C-reactive protein (CRP):** This is an acute-phase reactant and a marker of systemic inflammation. High-sensitivity CRP (hs-CRP) is a strong predictor of cardiovascular risk, but it does not lower cholesterol; rather, it indicates an increased risk of plaque rupture. * **B. Homocysteine:** Elevated levels (hyperhomocysteinemia) cause endothelial damage and promote thrombosis. It is a known independent risk factor for atherosclerosis, not a lipid-lowering agent. * **C. Lipoprotein(a):** This is a low-density lipoprotein-like particle. High levels of Lp(a) are genetically determined and are strongly associated with an increased risk of coronary artery disease and aortic stenosis. **High-Yield Clinical Pearls for NEET-PG:** * **Friedewald Formula:** LDL = Total Cholesterol – HDL – (Triglycerides/5). Note: This is invalid if TG >400 mg/dL. * **Hypertriglyceridemia:** Omega-3 fatty acids and Fibrates (PPAR-α agonists) are the first-line treatments for severe hypertriglyceridemia to prevent pancreatitis [1], [3]. * **Atherogenic Triad:** High TG, Low HDL, and small dense LDL particles (common in Diabetes Mellitus). * **Lp(a):** It is structurally similar to plasminogen and can inhibit fibrinolysis, making it both pro-atherogenic and pro-thrombotic. [4]

Q: Pericardial knock is heard in which condition?

Constrictive pericarditis. **Explanation:** **Constrictive Pericarditis (Correct Answer):** The **pericardial knock** is a high-pitched, early diastolic sound heard shortly after $S_2$. It occurs due to the rigid, non-compliant pericardium characteristic of constrictive pericarditis [1]. During early diastole, there is rapid ventricular filling; however, this filling is abruptly halted when the expanding ventricular volume hits the limit set by the stiff, calcified pericardium. This sudden cessation of ventricular expansion produces the "knock." It occurs earlier than an $S_3$ gallop. **Analysis of Incorrect Options:** * **Cardiac Tamponade:** This is characterized by muffled heart sounds (Beck’s Triad) due to fluid accumulation [3]. There is no "knock" because the fluid prevents the sudden tension of the ventricular wall against a rigid shell. * **Restrictive Cardiomyopathy (RCM):** While clinically similar to constriction, RCM is a disease of the myocardium, not the pericardium [2]. It is more commonly associated with an **$S_3$ gallop** rather than a pericardial knock. * **Acute Pericarditis:** The hallmark auscultatory finding here is a **pericardial friction rub** (scratchy, three-component sound), caused by the inflammation of the pericardial layers. Investigations often show specific ECG changes like ST elevation with upward concavity [4]. **High-Yield Clinical Pearls for NEET-PG:** * **Kussmaul’s Sign:** Paradoxical rise in JVP during inspiration (Seen in Constrictive Pericarditis, NOT in Tamponade). * **Square Root Sign:** Seen on pressure tracings (dip-and-plateau pattern) in Constrictive Pericarditis. * **Chest X-ray:** Pericardial calcification is a classic diagnostic clue for constriction [1]. * **Pulsus Paradoxus:** Characteristically seen in Cardiac Tamponade (drop in SBP >10 mmHg during inspiration).

Q: A patient with known valvular heart disease requires dental extraction. Which of the following is the recommended pretreatment prophylaxis regimen?

Amoxicillin 3g orally one hour before.. **Explanation:** The primary goal of antibiotic prophylaxis in patients with valvular heart disease undergoing dental procedures is to prevent **Infective Endocarditis (IE)** [1]. Dental extractions can cause transient bacteremia, most commonly involving *Viridans group streptococci*. **1. Why Amoxicillin 3g is correct:** Amoxicillin is the drug of choice because it is well-absorbed from the gastrointestinal tract and provides high, sustained serum levels. The standard traditional regimen (as per older AHA/BSAC guidelines often tested in exams) is **3g orally one hour before the procedure**. Note: Modern guidelines (AHA 2021) have updated this to 2g, but in the context of standard NEET-PG options, the 3g dose remains the classic "correct" answer for high-dose prophylaxis [2]. **2. Why the other options are incorrect:** * **Option A (Tetracycline):** Tetracyclines are bacteriostatic and are not effective against the common pathogens that cause IE; they have no role in IE prophylaxis. * **Option C (Amoxicillin 1g IM):** The oral route is preferred for its ease and efficacy. 1g is an under-dose for standard prophylaxis. * **Option D (Benzyl penicillin):** While penicillin is effective, it requires parenteral administration and has a shorter half-life than amoxicillin, making it less ideal for outpatient dental prophylaxis. **Clinical Pearls for NEET-PG:** * **High-risk conditions requiring prophylaxis:** Prosthetic heart valves, prior history of IE, unrepaired cyanotic congenital heart disease, and cardiac transplant recipients with valvulopathy [1]. * **Procedures requiring prophylaxis:** Only those involving manipulation of gingival tissue or the periapical region of teeth. * **Penicillin Allergy:** Use **Clindamycin (600mg)**, Azithromycin, or Clarithromycin (500mg).

Question 1

Which of the following is NOT included in the modified Jones criteria?

Accepted Answer

Prolonged QRS interval

Answer

Carditis

Answer

Chorea

Answer

Erythema marginatum

Question 2

Which of the following is a major criterion for the diagnosis of Rheumatic fever according to the modified Jones criteria?

Accepted Answer

Subcutaneous nodules

Answer

ASO titre

Answer

Past history of Rheumatic fever

Answer

Fever

Question 3

What is the most common cause of Superior Vena Cava (SVC) syndrome?

Accepted Answer

Extrinsic compression

Answer

Thrombosis

Answer

Mediastinal lymphoma

Answer

Teratoma

Question 4

In a patient with wide-complex tachycardia, the presence of all of the following in the ECG indicates ventricular tachycardia except?

Accepted Answer

Typical right bundle branch block morphology

Answer

Atrioventricular dissociation

Answer

Fusion beats

Answer

Capture beats

Question 5

A study of risk factors for atherogenesis in adults is performed. Which of the following substances is most likely to reduce serum cholesterol?

Accepted Answer

Omega-3 fatty acids

Answer

C-reactive protein

Answer

Homocysteine

Answer

Lipoprotein(a)

Question 6

Which valvular or septal defect is associated with the least chance of infective endocarditis?

Accepted Answer

Small atrial septal defect

Answer

Mild mitral stenosis

Answer

Mild mitral regurgitation

Answer

Small ventricular septal defect

Question 7

Pericardial knock is heard in which condition?

Accepted Answer

Constrictive pericarditis

Answer

Cardiac tamponade

Answer

Restrictive cardiomyopathy

Answer

Acute pericarditis

Question 8

A 70-year-old man with a history of coronary artery disease presents with substernal chest pressure, diaphoresis, and nausea, along with difficulty catching his breath. An electrocardiogram shows septal T-wave inversion. His troponin I is elevated. He has been given aspirin and sublingual nitroglycerin. Blood pressure is 154/78 and heart rate is 72. What is the best next step in management?

Accepted Answer

Begin intravenous beta-blocker therapy

Answer

Arrange for emergent cardiac catheterization

Answer

Begin intravenous thrombolytic therapy

Answer

Admit the patient to a monitored cardiac bed and repeat cardiac enzymes and ECG in 6 hours

Question 9

S4 gallop is not heard in which of the following conditions?

Accepted Answer

Ventricular aneurysm

Answer

Mitral regurgitation

Answer

Hypertrophic cardiomyopathy

Answer

Hypertension

Question 10

A patient with known valvular heart disease requires dental extraction. Which of the following is the recommended pretreatment prophylaxis regimen?

Accepted Answer

Amoxicillin 3g orally one hour before.

Answer

Tetracycline 1000mg, one hour before surgery.

Answer

Amoxicillin 1g intramuscularly one hour before.

Answer

Benzyl penicillin 12 lakh units one hour before.

Cardiology — MCQs

Cardiology — MCQs

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