Cardiology Practice Questions

Q: What ECG finding is shown?

Hyperacute T wave. ***Hyperacute T wave*** - **Tall, broad-based, peaked T waves** are the earliest ECG sign of **myocardial infarction**, appearing within minutes to hours of coronary occlusion. - These waves indicate **acute myocardial ischemia** and typically progress to **ST elevation** if the vessel remains occluded. *T wave Alternans* - Characterized by **alternating T wave morphology** (beat-to-beat variation) rather than consistently tall, peaked waves. - Associated with **electrical instability** and increased risk of **ventricular arrhythmias**, not acute coronary syndrome. *T wave inversion* - Shows **downward deflection** of T waves, indicating **myocardial ischemia** or **old infarction**. - Typically occurs **hours to days** after the hyperacute phase or represents **chronic changes** from previous cardiac events. *Artifact* - Would show **irregular, non-physiologic** waveforms that don't follow cardiac electrical patterns. - Often caused by **patient movement**, **loose electrodes**, or **electrical interference**, not consistent with systematic T wave changes.

Q: Aortic dissection is associated with which of the following?

Systemic hypertension. **Explanation:** **Aortic Dissection** occurs when a tear in the inner layer of the aorta (tunica intima) allows blood to surge into the media, creating a false lumen [1]. **Why Systemic Hypertension is the Correct Answer:** Systemic hypertension is the **most common predisposing factor** for aortic dissection, present in 70–80% of cases [1]. Chronic high blood pressure leads to mechanical stress and degenerative changes in the aortic wall (cystic medial necrosis), weakening the vessel and making it susceptible to intimal tearing [3]. **Analysis of Incorrect Options:** * **B. Coarctation of Aorta:** While associated with dissection, it is a much less common cause than hypertension [1]. It typically predisposes to dissection in younger patients or those with an associated bicuspid aortic valve. * **C. First Trimester of Pregnancy:** Pregnancy is a risk factor, but it is specifically associated with the **third trimester** and the peripartum period due to hypervolemia and hormonal changes (estrogen/progesterone) that alter the aortic wall collagen [1]. * **D. Takayasu’s Arteritis:** This is a large-vessel vasculitis that primarily causes **stenosis, occlusion, or aneurysm** formation. While it weakens the wall, it is not a classic or common cause of acute aortic dissection compared to hypertension. **High-Yield Clinical Pearls for NEET-PG:** * **Most common risk factor:** Hypertension (older patients); Marfan Syndrome (younger patients) [1]. * **Clinical Presentation:** Sudden onset, "tearing" or "ripping" chest pain radiating to the back [1]. * **Physical Exam:** Pulse deficit (asymmetric pulses) and a new murmur of aortic regurgitation [2]. * **Gold Standard Investigation:** CT Angiography (stable patients) or Transesophageal Echo (unstable patients) [2]. * **Classification:** Stanford Type A (involves ascending aorta; surgical emergency) vs. Type B (descending aorta; medical management) [1].

Q: Which valvular lesion is being repaired in a 20-year-old man presenting with a malar flush?

Mitral stenosis. **Explanation:** The correct answer is **Mitral Stenosis (MS)**. **Why Mitral Stenosis is correct:** The "malar flush" (also known as *facies mitralis*) is a classic clinical sign of chronic, severe mitral stenosis [1]. It is characterized by plum-colored or violaceous patches over the cheeks. The underlying pathophysiology involves a chronic decrease in cardiac output leading to systemic vasoconstriction and pulmonary hypertension [1]. This results in secondary right-sided heart failure and venous stasis, causing the capillaries in the malar region to become engorged and cyanotic [1]. **Why the other options are incorrect:** * **Mitral Regurgitation (MR):** While MR also affects the mitral valve, it typically presents with symptoms of left heart failure (dyspnea, fatigue) and a pansystolic murmur, but it does not classically produce the malar flush [2]. * **Aortic Stenosis (AS):** AS is characterized by the triad of Angina, Syncope, and Dyspnea (SAD). Patients often appear pale due to low cardiac output, rather than flushed. * **Aortic Regurgitation (AR):** AR presents with "peripheral signs" of hyperdynamic circulation (e.g., Corrigan’s pulse, de Musset’s sign, Quincke’s pulse) and a wide pulse pressure, but not a malar flush [3]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of MS:** Rheumatic Heart Disease (99% of cases). * **Auscultation:** Loud S1, Opening Snap (OS), and a mid-diastolic rumbling murmur heard best at the apex in the left lateral position [1]. * **ECG Findings:** "P-mitrale" (broad, notched P-waves in Lead II) indicating left atrial enlargement. * **Complications:** Atrial fibrillation (due to LA enlargement) and systemic thromboembolism are common [1].

Q: A 38-year-old man develops severe retrosternal chest pain radiating to the back, aggravated by breathing and movement. He has no significant past medical history but had a mild upper respiratory tract infection 1 week ago. His electrocardiogram is shown in Figure. Which of the following is the most likely cause for his condition?

A viral infection. ***A viral infection*** - The **pleuritic chest pain** that worsens with breathing and movement, following a recent **upper respiratory tract infection**, is highly suggestive of **viral pericarditis**. - The **ECG pattern** would typically show **diffuse concave ST elevation** and **PR depression** without reciprocal changes, characteristic of **pericarditis** rather than myocardial infarction. *Occlusion of the left anterior descending artery* - Would cause **STEMI** with **convex ST elevation** in leads V1-V6, I, and aVL, not the diffuse pattern seen in pericarditis. - Pain would be **crushing substernal** and not typically **pleuritic** or positional in nature. *Occlusion of the circumflex artery* - Would present with **posterior STEMI** showing **ST depression** in V1-V3 and **ST elevation** in posterior leads (V7-V9). - The **pleuritic nature** of pain and **positional aggravation** are not typical features of myocardial infarction. *Dissection of the aortic artery* - Typically presents with **sudden, tearing chest pain** radiating to the back, but pain is **not pleuritic** or positional. - Would show **widened mediastinum** on chest X-ray and **pulse deficits** or **blood pressure differences** between arms, not ECG changes of pericarditis.

Q: A 57-year-old man presents with sudden onset of severe and central chest pain radiating to the back. ECG shows ST segment elevation in leads V1-V6, I, aVL. The chest X-ray shows a widened mediastinum. What is the most likely diagnosis?

Aortic dissection. ### Explanation **Correct Option: A. Aortic dissection** The clinical presentation of sudden-onset "tearing" chest pain radiating to the back, combined with a **widened mediastinum** on chest X-ray, is a classic triad for aortic dissection [1]. While the ECG shows ST-elevation (STEMI), this occurs in approximately 1–5% of cases when the dissection flap extends proximally to involve the **ostium of the coronary arteries** (most commonly the right coronary artery, leading to inferior MI, but can involve the left main coronary artery as seen here). In NEET-PG, the combination of "mediastinal widening" plus "MI patterns" should immediately raise suspicion for a Type A dissection. **Incorrect Options:** * **B. Acute cor pulmonale:** Usually presents with sudden dyspnea, pleuritic chest pain, and ECG signs of right heart strain (S1Q3T3, RBBB), not a widened mediastinum or global anterior STEMI. * **C. Acute myocardial infarction:** While the ECG strongly suggests this, a simple MI does not cause a widened mediastinum. Administering thrombolytics or anticoagulants in this scenario (thinking it is a simple MI) would be fatal if the underlying cause is a dissection [1]. * **D. Acute Pericarditis:** Typically presents with pleuritic pain relieved by leaning forward and diffuse ST-elevation (concave upwards) with PR depression [2]. It does not cause mediastinal widening. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** CT Angiography (stable patients) or Transesophageal Echocardiogram (unstable patients). * **Stanford Classification:** Type A involves the ascending aorta (surgical emergency); Type B involves only the descending aorta (medical management) [1]. * **Risk Factors:** Hypertension (most common), Marfan Syndrome, and Bicuspid Aortic Valve [1]. * **Physical Exam:** Look for pulse deficit or blood pressure discrepancy (>20 mmHg) between arms.

Q: A 65-year-old hypertensive male presented to the ER with sudden onset of severe, tearing pain in the back of the chest, more so in the interscapular region. He also experienced dyspnea, hemiplegia, hemianesthesia, and frequent episodes of syncope in the past 2 days. On examination, the patient was hypotensive with feeble pulses in bilateral radial arteries, a wide pulse pressure, and a diastolic murmur radiating towards the right sternal border. All of the following are true about the condition except:

Inflammation is usually present.. The clinical presentation of sudden, "tearing" interscapular pain, hypertension, pulse deficits, and a new diastolic murmur (Aortic Regurgitation) is classic for **Aortic Dissection** [1]. The neurological deficits (hemiplegia) suggest involvement of the carotid arteries, while syncope and hypotension indicate potential cardiac tamponade. [1] **1. Why "Inflammation is usually present" is FALSE (Correct Answer):** Aortic dissection is primarily a **non-inflammatory** process. Pathologically, it involves a cleavage of the aortic media. Unlike aortitis (seen in Takayasu or Syphilis), the histological hallmark of dissection is **Cystic Medial Degeneration (CMD)**, characterized by the loss of smooth muscle cells and elastic fibers without a significant inflammatory infiltrate. **2. Analysis of Other Options:** * **Option A:** CMD is indeed the most common histological finding, especially in older hypertensive patients and those with Marfan syndrome. * **Option C:** In patients under 40, aortic dissection is highly associated with connective tissue disorders like **Marfan Syndrome** [1] or **Ehlers-Danlos Syndrome** (Type IV) [1]. * **Option D:** **Beta-blockers** (e.g., Labetalol, Esmolol) are the first-line medical management. They reduce the heart rate and the rate of rise of left ventricular pressure (dP/dt), which limits the propagation of the dissecting hematoma. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Transesophageal Echocardiogram (TEE) [2] for unstable patients; CT Angiography [2] for stable patients. * **Stanford Classification:** Type A (involves ascending aorta) requires urgent surgery; Type B (descending only) is usually managed medically [1]. * **Right Sternal Border Murmur:** A diastolic murmur heard better at the right sternal border (rather than the left) strongly suggests aortic root dilatation/dissection.

Question 1

What ECG finding is shown?

Accepted Answer

Hyperacute T wave

Answer

T wave Alternans

Answer

T wave inversion

Answer

Artifact

Question 2

Aortic dissection is associated with which of the following?

Accepted Answer

Systemic hypertension

Answer

Coarctation of aorta

Answer

First trimester of pregnancy

Answer

Takayasu's arteritis

Question 3

An 89-year-old man with hypertension presents for routine follow-up. What does the ECG show?

Accepted Answer

Left bundle branch block (LBBB)

Answer

Right bundle branch block (RBBB)

Answer

ST elevation

Answer

Extreme axis deviation

Question 4

Which valvular lesion is being repaired in a 20-year-old man presenting with a malar flush?

Accepted Answer

Mitral stenosis

Answer

Mitral regurgitation

Answer

Aortic stenosis

Answer

Aortic regurgitation

Question 5

Pulsus paradoxus is seen in all except?

Accepted Answer

Intermittent positive-pressure ventilation (IPPV)

Answer

Chronic obstructive pulmonary disease (COPD)

Answer

Pulmonary embolism

Answer

Constrictive pericarditis

Question 6

A young patient presents with a systolic murmur at the apex. The murmur increases with both handgrip and Valsalva maneuver. Which of the following conditions is most likely?

Accepted Answer

Mitral Valve Prolapse (MVP)

Answer

Atrial Septal Defect (ASD)

Answer

Aortic Stenosis

Answer

Ventricular Septal Defect (VSD)

Question 7

A 38-year-old man develops severe retrosternal chest pain radiating to the back, aggravated by breathing and movement. He has no significant past medical history but had a mild upper respiratory tract infection 1 week ago. His electrocardiogram is shown in Figure. Which of the following is the most likely cause for his condition?

Accepted Answer

A viral infection

Answer

Occlusion of the left anterior descending artery

Answer

Occlusion of the circumflex artery

Answer

Dissection of the aortic artery

Question 8

Pulsus paradoxus is characteristically seen in cardiac tamponade. Absence of pulsus paradoxus is seen when cardiac tamponade is associated with all except one of the following?

Accepted Answer

Mitral regurgitation (MR)

Answer

Atrial septal defect (ASD)

Answer

Ventricular septal defect (VSD)

Answer

Aortic regurgitation (AR)

Question 9

A 57-year-old man presents with sudden onset of severe and central chest pain radiating to the back. ECG shows ST segment elevation in leads V1-V6, I, aVL. The chest X-ray shows a widened mediastinum. What is the most likely diagnosis?

Accepted Answer

Aortic dissection

Answer

Acute cor pulmonale

Answer

Acute myocardial infarction

Answer

Acute Pericarditis

Question 10

A 65-year-old hypertensive male presented to the ER with sudden onset of severe, tearing pain in the back of the chest, more so in the interscapular region. He also experienced dyspnea, hemiplegia, hemianesthesia, and frequent episodes of syncope in the past 2 days. On examination, the patient was hypotensive with feeble pulses in bilateral radial arteries, a wide pulse pressure, and a diastolic murmur radiating towards the right sternal border. All of the following are true about the condition except:

Accepted Answer

Inflammation is usually present.

Answer

The most frequent pre-existing histologically detectable lesion is cystic medial degeneration.

Answer

A similar condition in a young patient would suggest a diagnosis of a connective tissue disorder.

Answer

Beta-blockers, unless contraindicated, can be given in this condition.

Cardiology — MCQs

Cardiology — MCQs

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