Cardiology Practice Questions

Q: A 46-year-old diabetic man complains of soreness of the left leg. He is moderately obese and had undergone cholecystectomy 2 weeks ago. Examination revealed swelling in the lower leg along with tenderness in the calf that increased when the calf was gently squeezed. No redness of the leg was noted and the patient was afebrile. What is the most likely diagnosis?

Deep vein thrombosis. The clinical presentation strongly suggests **Deep Vein Thrombosis (DVT)**. The patient has multiple risk factors according to **Virchow’s Triad** (stasis, endothelial injury, and hypercoagulability): recent major surgery (cholecystectomy 2 weeks ago), obesity, and diabetes [1]. The physical findings of unilateral leg swelling, calf tenderness, and a positive **Pratt’s sign** (pain on squeezing the calf) are classic indicators [1], [2]. **Why the other options are incorrect:** * **Cellulitis:** Typically presents with systemic symptoms like fever and localized signs of inflammation such as warmth, intense redness (erythema), and poorly demarcated swelling [1]. This patient is afebrile and lacks redness. * **Superficial Thrombophlebitis:** Usually presents with a palpable, indurated, cord-like vein with overlying erythema and localized pain, rather than generalized calf swelling and deep tenderness. * **Stress Fracture:** Generally occurs after a sudden increase in physical activity or repetitive stress. While it causes localized pain, it does not typically cause significant calf swelling or tenderness triggered by muscle compression. **NEET-PG High-Yield Pearls:** 1. **Wells Criteria:** Used clinically to estimate the pre-test probability of DVT [1]. 2. **Gold Standard Investigation:** Contrast Venography (rarely used now). 3. **Investigation of Choice:** Color Doppler Ultrasound (Duplex USG). 4. **Homan’s Sign:** Pain in the calf on dorsiflexion of the foot (low sensitivity/specificity). 5. **Management:** Immediate anticoagulation with LMWH or Fondaparinux, followed by oral anticoagulants (Warfarin or DOACs) [1].

Q: Which of the following statements regarding torsades de pointes is FALSE?

It is more common in females.. **Explanation** **Torsades de Pointes (TdP)** is a specific form of polymorphic ventricular tachycardia characterized by a "twisting of the points" around the isoelectric line, occurring in the setting of a prolonged QT interval [1]. **Why Option A is the correct (False) statement:** The question asks for the **FALSE** statement. Option A is actually a **true** clinical fact: Torsades de pointes is significantly **more common in females** than in males [1]. This is due to gender-based differences in cardiac repolarization and the fact that women generally have longer baseline QTc intervals [1]. Therefore, stating it is more common in females is a true statement, making it the "correct" answer choice for a "False" question format. **Analysis of other options:** * **Option B (Hypocalcemia):** This is **True**. Electrolyte imbalances that prolong the QT interval, specifically **Hypokalemia, Hypomagnesemia, and Hypocalcemia**, are classic triggers for TdP. * **Option C (IV Magnesium):** This is **True**. Intravenous Magnesium Sulfate is the **first-line treatment** for hemodynamically stable TdP, regardless of the baseline magnesium level, as it stabilizes the cardiac membrane. * **Option D (Beta-blockers):** This is **True**. For congenital Long QT Syndromes (like Romano-Ward), **Beta-blockers** (specifically Propranolol or Nadolol) are the mainstay of therapy to prevent sympathetic surges that trigger arrhythmias [2]. **High-Yield NEET-PG Pearls:** * **Drug-induced TdP:** Common culprits include Class IA and III antiarrhythmics, Macrolides, Fluoroquinolones, and Antipsychotics (e.g., Haloperidol). * **Management:** If IV Magnesium fails, the next steps include **increasing the heart rate** (Overdrive pacing or Isoproterenol) to shorten the QT interval. * **Congenital Syndromes:** Jervell and Lange-Nielsen (Autosomal Recessive + Sensorineural deafness) and Romano-Ward (Autosomal Dominant, no deafness) [2].

Q: Osler's nodes are seen at:

Tip of palm and sole. **Explanation:** **Osler’s nodes** are a classic peripheral stigmata of **Infective Endocarditis (IE)**. They are small, tender, raised, erythematous nodules typically found on the **pulp of the fingers and toes** (tips of the digits) and the **thenar/hypothenar eminences** of the palms and soles. [1] **Pathophysiology:** The underlying mechanism is an **immunological phenomenon** (Type III hypersensitivity). They represent the deposition of immune complexes in the dermal arterioles, leading to localized vasculitis [2]. Unlike Janeway lesions, Osler’s nodes are characteristically **painful/tender**. **Analysis of Options:** * **Option C (Correct):** The distal extremities, specifically the fleshy tips of the fingers and toes (palms and soles), are the primary sites for these immune-mediated lesions. [1] * **Options A, B, and D:** These are incorrect because Osler’s nodes do not occur on the head, large joints (like the knee), or the trunk (abdominal wall). These areas lack the specific small-vessel distribution and clinical presentation associated with IE-related vasculitis. **High-Yield Clinical Pearls for NEET-PG:** * **Osler’s Nodes vs. Janeway Lesions:** * **Osler’s:** Tender, Immunological, found on finger/toe pads. ("**O**sler = **O**uch") * **Janeway:** Non-tender, Embolic (micro-abscesses), found on palms/soles. * **Duke’s Criteria:** Both Osler’s nodes and Roth spots (retinal hemorrhages) are categorized under the **Minor Clinical Criteria** for the diagnosis of Infective Endocarditis. * **Other Peripheral Signs:** Splinter hemorrhages (nails) and Petechiae (conjunctiva/mucosa).

Q: Non-ejection clicks are heard in which of the following conditions?

Mitral valve prolapse. **Explanation:** **Correct Answer: D. Mitral valve prolapse (MVP)** The hallmark auscultatory finding of Mitral Valve Prolapse is a **mid-to-late non-ejection systolic click** [1], often followed by a late systolic murmur. The click is produced by the sudden tensing of the redundant valve leaflets and elongated chordae tendineae as they "prolapse" or balloon into the left atrium during ventricular systole. Unlike ejection clicks, which occur at the start of systole, this click occurs after the mitral valve has already closed [1]. **Analysis of Incorrect Options:** * **A. Aortic Stenosis:** This condition is associated with an **ejection click** (early systolic) [1]. It occurs due to the abrupt opening of a mobile but stenotic aortic valve. * **B. Atrial Myxoma:** This is typically associated with a **"tumor plop,"** a low-pitched sound heard in early or mid-diastole as the pedunculated tumor falls across the mitral orifice. * **C. Mitral Regurgitation:** Chronic MR usually presents with a holosystolic murmur and a soft S1 [2]. It does not typically feature a systolic click unless it is secondary to MVP. **High-Yield Clinical Pearls for NEET-PG:** * **Dynamic Auscultation of MVP:** The timing of the click and murmur is highly sensitive to postural changes. * **Standing/Valsalva (Decreased Preload):** The click occurs **earlier** in systole (closer to S1) and the murmur becomes longer/louder. * **Squatting (Increased Preload):** The click occurs **later** in systole (closer to S2) and the murmur becomes shorter/softer. * **Barlow’s Syndrome:** Another name for MVP [1], often associated with connective tissue disorders like Marfan or Ehlers-Danlos syndrome.

Q: All the following statements are true regarding the given ECG except?

Treated with ibutilide. ***Treated with ibutilide*** - **Ibutilide** is contraindicated in **Torsades de Pointes** as it prolongs the **QT interval** and can worsen the arrhythmia. - The treatment of choice for **TdP** is **intravenous magnesium sulfate**, even in patients with normal magnesium levels. *Seen in hypomagnesemia* - **Hypomagnesemia** is a well-established precipitant of **Torsades de Pointes** by affecting cardiac repolarization. - Low magnesium levels contribute to **QT prolongation** and increased susceptibility to this polymorphic ventricular tachycardia. *Seen in hypokalemia* - **Hypokalemia** is another major electrolyte abnormality that predisposes to **Torsades de Pointes**. - Low potassium levels cause **QT prolongation** and create an unstable electrical environment in the myocardium. *Can convert to ventricular fibrillation* - **Torsades de Pointes** can spontaneously degenerate into **ventricular fibrillation**, which is life-threatening. - This progression requires immediate **defibrillation** and makes TdP a medical emergency requiring prompt recognition and treatment.

Q: A 45-year-old man experiences crushing substernal chest pain after arriving at work one morning. Over the next 4 hours, the pain persists and begins to radiate to his left arm. He becomes diaphoretic and short of breath but waits until the end of his 8-hour shift to go to the hospital. An elevated serum value of which of the following laboratory tests would be most useful for the diagnosis of this patient on admission to the hospital?

CK-MB fraction. The patient is presenting with classic symptoms of an **Acute Myocardial Infarction (AMI)**. The key to this question lies in the **timing of the presentation**. The patient arrives at the hospital approximately **12 hours** after the onset of chest pain (4 hours of initial pain + 8 hours of waiting). [1] **Why CK-MB is the correct answer:** Creatine Kinase-MB (CK-MB) is a cardiac-specific isoenzyme. It begins to rise **3–6 hours** after the onset of myocardial injury, peaks at **12–24 hours**, and returns to baseline within 48–72 hours. Since the patient presented at the 12-hour mark, CK-MB would be significantly elevated, making it a reliable marker for diagnosis in this window. While Troponins (T and I) are the current gold standard due to higher sensitivity, CK-MB remains a high-yield answer in exams, especially for detecting **re-infarction** due to its rapid clearance. [3] **Analysis of Incorrect Options:** * **ALT (Alanine Aminotransferase):** Primarily a marker for hepatocellular injury; it has no diagnostic role in AMI. [2] * **AST (Aspartate Aminotransferase):** Historically used for MI diagnosis, but it is non-specific (found in liver and muscle) and has been replaced by more sensitive cardiac biomarkers. [2] * **C-reactive protein (CRP):** An acute-phase reactant indicating systemic inflammation. While elevated in MI, it is non-specific and cannot be used for a definitive diagnosis. **Clinical Pearls for NEET-PG:** * **Earliest Marker:** Myoglobin (rises in 1–2 hours), but it is non-specific. * **Most Specific/Gold Standard:** Cardiac Troponins (remain elevated for 7–14 days). [3] * **Marker for Re-infarction:** CK-MB (because it returns to normal quickly). * **LDH Flip:** In MI, LDH-1 becomes higher than LDH-2 (peaks at 3–4 days). [2]

Q: Which of the following is NOT true regarding Mitral valve prolapse syndrome?

Mostly symptomatic. Mitral Valve Prolapse (MVP), also known as Barlow’s syndrome, is the most common cause of isolated mitral regurgitation. [1] **Why Option B is the correct answer:** The majority of patients with MVP are **asymptomatic** throughout their lives. When symptoms do occur, they are often non-specific (atypical chest pain, palpitations, or fatigue) and do not necessarily correlate with the severity of the prolapse. Diagnosis is frequently an incidental finding during routine physical examination or echocardiography. **Analysis of other options:** * **Option A (More common in females):** MVP shows a distinct female preponderance (roughly 2:1 ratio), particularly in younger populations, though it can affect both sexes. * **Option C (High incidence of arrhythmia):** Patients with MVP have an increased incidence of both supraventricular and ventricular arrhythmias. Premature ventricular contractions (PVCs) and paroxysmal supraventricular tachycardia are common findings. * **Option D (Transient cerebral ischemia):** MVP is associated with an increased risk of systemic embolization. Fibrin-platelet microemboli can form on the roughened surfaces of the redundant leaflets, leading to Transient Ischemic Attacks (TIAs) or even strokes. **High-Yield Clinical Pearls for NEET-PG:** * **Auscultation:** Characterized by a **Mid-systolic click** followed by a **Late systolic murmur**. * **Dynamic Auscultation:** Squatting (increased preload) delays the click and shortens the murmur; Standing/Valsalva (decreased preload) makes the click occur earlier and lengthens the murmur. * **Association:** Strongly associated with connective tissue disorders like **Marfan Syndrome** and Ehlers-Danlos Syndrome. * **Pathology:** Characterized by **myxomatous degeneration** of the valve leaflets.

Question 1

A 46-year-old diabetic man complains of soreness of the left leg. He is moderately obese and had undergone cholecystectomy 2 weeks ago. Examination revealed swelling in the lower leg along with tenderness in the calf that increased when the calf was gently squeezed. No redness of the leg was noted and the patient was afebrile. What is the most likely diagnosis?

Accepted Answer

Deep vein thrombosis

Answer

Cellulitis

Answer

Superficial thrombophlebitis

Answer

Stress fracture

Question 2

Which of the following statements regarding torsades de pointes is FALSE?

Accepted Answer

It is more common in females.

Answer

Hypocalcemia can be a causative factor.

Answer

IV magnesium is the initial treatment of choice for acquired causes.

Answer

Congenital causes are treated with beta-blockers.

Question 3

Osler's nodes are seen at:

Accepted Answer

Tip of palm and sole

Answer

Head

Answer

Knee joint

Answer

Anterior abdominal wall

Question 4

Non-ejection clicks are heard in which of the following conditions?

Accepted Answer

Mitral valve prolapse

Answer

Aortic stenosis

Answer

Atrial myxoma

Answer

Mitral regurgitation

Question 5

Women with myocardial infarction are more likely to present with which of the following complications than males?

Accepted Answer

Cardiac arrest

Answer

Ventricular tachycardia

Answer

Atrial fibrillation

Answer

Aortic dissection

Question 6

Changing character of a murmur in a patient with joint pain and embolic phenomenon indicates which of the following diagnoses?

Accepted Answer

Subacute bacterial endocarditis

Answer

Mitral stenosis

Answer

Rheumatoid arthritis

Answer

Aortic regurgitation

Question 7

All the following statements are true regarding the given ECG except?

Accepted Answer

Treated with ibutilide

Answer

Seen in hypomagnesemia

Answer

Seen in hypokalemia

Answer

Can convert to ventricular fibrillation

Question 8

A 45-year-old man experiences crushing substernal chest pain after arriving at work one morning. Over the next 4 hours, the pain persists and begins to radiate to his left arm. He becomes diaphoretic and short of breath but waits until the end of his 8-hour shift to go to the hospital. An elevated serum value of which of the following laboratory tests would be most useful for the diagnosis of this patient on admission to the hospital?

Accepted Answer

CK-MB fraction

Answer

ALT

Answer

AST

Answer

C-reactive protein

Question 9

Which of the following is NOT true regarding Mitral valve prolapse syndrome?

Accepted Answer

Mostly symptomatic

Answer

More common in females

Answer

High incidence of arrhythmia

Answer

Transient cerebral ischemia can occur

Question 10

A 64-year-old man with a history of COPD presents with increased shortness of breath, cough, and sputum production, but no fever or chills. On examination, he is in mild respiratory distress with a respiratory rate of 26/min, pulse of 120 beats/min, blood pressure of 145/84 mm Hg, and oxygen saturation of 90%. He has bilateral expiratory wheezes. His ECG reveals multifocal atrial tachycardia (MAT), characterized by discrete P waves with at least three different morphologies. What is the most appropriate treatment for this patient's arrhythmia?

Accepted Answer

Verapamil

Answer

Digoxin

Answer

Diltiazem

Answer

Beta-blockers

Cardiology — MCQs

Cardiology — MCQs

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