Cardiology Practice Questions

Q: A 40-year-old man with a history of intravenous drug abuse develops rapidly progressive right-sided heart failure. Which of the following conditions is the most likely cause?

Tricuspid insufficiency. ### Explanation **Correct Answer: D. Tricuspid insufficiency** **Why it is correct:** In the context of **Intravenous Drug Abuse (IVDA)**, the most common cardiac complication is **Infective Endocarditis (IE)**. Unlike the general population, IVDA patients frequently develop right-sided endocarditis because the tricuspid valve is the first "filter" encountered by contaminated needles/syringes injected into the venous system [2]. Acute **Tricuspid Insufficiency (Regurgitation)** leads to sudden volume overload of the right ventricle, manifesting as **rapidly progressive right-sided heart failure** (elevated JVP, hepatomegaly, and peripheral edema) [1]. *Staphylococcus aureus* is the most common causative organism in these cases. **Why the other options are incorrect:** * **A. Aortic insufficiency & B. Mitral regurgitation:** While these can occur in IVDA, they involve the left side of the heart. Left-sided failure typically presents with pulmonary congestion (dyspnea, crackles) rather than isolated right-sided failure [2]. * **C. Ruptured chordae tendineae:** This is a mechanical complication usually associated with the mitral valve (causing acute MR) or secondary to myocardial infarction [3]. While IE can cause chordae rupture, it is less specific to the IVDA/right-heart failure presentation than primary tricuspid valve involvement. **NEET-PG High-Yield Pearls:** * **Most common valve involved in IVDA:** Tricuspid Valve (>50% of cases). * **Most common organism in IVDA IE:** *Staphylococcus aureus*. * **Clinical Sign:** A holosystolic murmur at the left lower sternal border that increases with inspiration (**Carvallo’s sign**) is characteristic of tricuspid regurgitation [1]. * **Radiology:** Look for "septic pulmonary emboli" (multiple wedge-shaped opacities) on a chest X-ray, which are common complications of right-sided IE.

Q: N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are elevated in which of the following conditions?

Left heart failure. **Explanation:** **NT-proBNP** is a pro-hormone released primarily from the ventricular myocardium in response to **increased wall stress** (stretch) caused by pressure or volume overload [1]. 1. **Why Left Heart Failure is the Correct Answer:** In Left Heart Failure (LHF), the left ventricle experiences increased end-diastolic pressure and volume [1]. This mechanical stretch triggers the synthesis of proBNP, which is cleaved into active BNP and the inactive **NT-proBNP**. NT-proBNP is a useful biomarker in the investigation of patients with breathlessness and is elevated in heart failure [1]. 2. **Analysis of Other Options:** While NT-proBNP can be elevated in several cardiac conditions, the question asks for the primary clinical association. * **Atrial Fibrillation (A):** Can cause mild elevations due to atrial stretch [1], but it is not the primary diagnostic use. * **Pulmonary Thromboembolism (C):** Causes right ventricular strain, which can elevate NT-proBNP, but this is a secondary marker of severity rather than the primary diagnostic condition. * **Myocardial Infarction (D):** Levels may rise due to ischemia-induced wall stress [1], but NT-proBNP is not used for the diagnosis of MI (Troponins are the markers of choice). **High-Yield Clinical Pearls for NEET-PG:** * **Cut-off values:** To rule out acute heart failure, use a threshold of ** 450), 50–75 years (>900), and >75 years (>1800 pg/mL). * **The "Obesity Paradox":** NT-proBNP levels are falsely **lower** in obese patients. * **Renal Clearance:** NT-proBNP is cleared by the kidneys; therefore, levels are significantly **elevated in chronic kidney disease (CKD)** regardless of heart failure status.

Q: A 70-year-old woman with known diabetes mellitus presents with dyspnea, nausea, and a feeling of impending doom. What does the ECG show?

Myocardial infarction. ***Myocardial infarction*** - The combination of **dyspnea**, **nausea**, and **feeling of impending doom** represents an **atypical presentation** of MI common in **diabetic** and **elderly women**, who may lack classic chest pain due to **diabetic neuropathy**. - The ECG would show **ST-elevation** or **new Q waves** indicating **myocardial necrosis**, distinguishing it from other acute coronary syndromes. *Unstable angina* - Characterized by **chest pain at rest** or with minimal exertion, but **no ST-elevation** or cardiac enzyme elevation on ECG. - The ECG typically shows **ST-depression** or **T-wave inversions**, not the ST-elevation pattern expected in this clinical scenario. *Prinzmetal angina* - Caused by **coronary artery vasospasm** leading to **transient ST-elevation** that resolves when spasm ends. - Unlike MI, there is **no permanent myocardial damage** and symptoms typically occur at **rest** or during **sleep**, not with the constellation of symptoms described. *Aortic dissection* - Presents with **sudden, tearing chest pain** radiating to the back, often with **pulse differentials** between arms. - ECG findings are **non-specific** and may show **left ventricular hypertrophy** or signs of **aortic regurgitation**, not the acute changes of myocardial infarction.

Q: Lambert-Eaton myasthenic syndrome is associated with which of the following?

Small cell lung carcinoma. **Explanation:** **Lambert-Eaton Myasthenic Syndrome (LEMS)** is a paraneoplastic syndrome caused by autoantibodies directed against **presynaptic P/Q-type voltage-gated calcium channels (VGCC)** at the neuromuscular junction. This leads to impaired release of acetylcholine into the synaptic cleft. 1. **Why Small Cell Lung Carcinoma (SCLC) is correct:** Approximately 50–60% of LEMS cases are associated with an underlying malignancy, and of those, **SCLC** is the most common (found in >90% of paraneoplastic LEMS) [1]. SCLC cells are of neuroendocrine origin and express VGCCs on their surface, which triggers the production of cross-reacting antibodies. [3] 2. **Why other options are incorrect:** * **Thymoma:** Strongly associated with **Myasthenia Gravis (MG)** (found in ~15% of MG patients), but not with LEMS. [4] * **Myasthenia Gravis:** This is a distinct autoimmune disorder caused by antibodies against *postsynaptic* nicotinic acetylcholine receptors. While both cause weakness, their pathophysiology and clinical features differ. [2] * **Adenocarcinoma of lung:** While any malignancy can theoretically trigger paraneoplastic syndromes, SCLC is the classic and most frequent association for LEMS due to its neuroendocrine nature. [1] **NEET-PG High-Yield Pearls:** * **Clinical Triad:** Proximal muscle weakness (starts in lower limbs), autonomic dysfunction (dry mouth, erectile dysfunction), and depressed deep tendon reflexes. * **Lambert’s Sign:** A characteristic finding where muscle strength and reflexes **improve/increase** after repeated muscle contraction or exercise (post-exercise facilitation). This is the opposite of Myasthenia Gravis. * **Diagnosis:** Confirmed by Repetitive Nerve Stimulation (RNS) showing an **incremental response** (increase in CMAP amplitude) at high frequencies. * **Treatment:** 3,4-Diaminopyridine (first-line) and treating the underlying malignancy. [1]

Q: A patient presents with ventricular fibrillation, hypotension, and absent peripheral pulses. What is the initial management?

200 Joule defibrillation. ### Explanation **Correct Answer: D. 200 Joule defibrillation** **Why it is correct:** The patient is in **Ventricular Fibrillation (VF)**, a "shockable" cardiac arrest rhythm characterized by chaotic electrical activity and no mechanical contraction [1]. In any pulseless cardiac arrest with a shockable rhythm (VF or Pulseless Ventricular Tachycardia), the **most critical intervention is immediate defibrillation** [1]. The goal is to depolarize a critical mass of the myocardium simultaneously, allowing the heart's natural pacemaker (SA node) to resume a normal rhythm [3]. According to ACLS guidelines, for a biphasic defibrillator, the initial energy dose is typically **120–200 Joules**. **Why the other options are incorrect:** * **A & B (Lidocaine/Amiodarone):** These are anti-arrhythmic drugs used in the ACLS algorithm for *refractory* VF (VF that persists after at least 2–3 shocks and CPR). They are never the first-line treatment for VF. * **C (Atropine):** Atropine is used for symptomatic bradycardia or asystole (though no longer routine for the latter). It has no role in the management of VF. **High-Yield Clinical Pearls for NEET-PG:** 1. **Shockable Rhythms:** VF and Pulseless VT [1]. 2. **Non-Shockable Rhythms:** PEA (Pulseless Electrical Activity) and Asystole [1]. These require immediate CPR and Epinephrine, NOT defibrillation. 3. **Time is Myocardium:** For every minute that passes without defibrillation in VF, the probability of survival declines by 7–10% [1]. 4. **Sequence:** Shock → Immediate CPR (2 minutes) → Check Rhythm → Shock (if still VF) → CPR + Epinephrine. Amiodarone is typically given after the 3rd shock [2].

Question 1

Which of the following is effective in the management of patients with heart failure with preserved ejection fraction?

Accepted Answer

Angiotensin receptor blocker with neprilysin inhibitor

Answer

Digoxin

Answer

Isosorbide mononitrate

Answer

Phosphodiesterase inhibitor

Question 2

Which of the following valvular heart diseases is most commonly associated with sudden death?

Accepted Answer

Aortic Stenosis

Answer

Mitral Stenosis

Answer

Mitral Regurgitation

Answer

Aortic Regurgitation

Question 3

A 40-year-old man with a history of intravenous drug abuse develops rapidly progressive right-sided heart failure. Which of the following conditions is the most likely cause?

Accepted Answer

Tricuspid insufficiency

Answer

Aortic insufficiency

Answer

Mitral regurgitation

Answer

Ruptured chordae tendineae

Question 4

Asynchronous cardioversion is indicated in which of the following arrhythmias?

Accepted Answer

Ventricular fibrillation

Answer

Atrial fibrillation

Answer

Atrial flutter

Answer

Ventricular tachycardia

Question 5

N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are elevated in which of the following conditions?

Accepted Answer

Left heart failure

Answer

Atrial fibrillation

Answer

Pulmonary thromboembolism

Answer

Myocardial infarction

Question 6

A 36-year-old female presents with recurrent chest pain and palpitations of varying duration and severity, with 6-7 ectopic beats per minute. These symptoms are not related to exertion. Her blood pressure is 86 mm Hg and pulse rate is 86/min. What is the ideal investigation?

Accepted Answer

Electrophysiological studies

Answer

Echocardiography

Answer

Thallium study

Answer

Technetium pyrophosphate scan

Question 7

A 70-year-old woman with known diabetes mellitus presents with dyspnea, nausea, and a feeling of impending doom. What does the ECG show?

Accepted Answer

Myocardial infarction

Answer

Unstable angina

Answer

Prinzmetal angina

Answer

Aortic dissection

Question 8

Lambert-Eaton myasthenic syndrome is associated with which of the following?

Accepted Answer

Small cell lung carcinoma

Answer

Thymoma

Answer

Myasthenia gravis

Answer

Adenocarcinoma of lung

Question 9

A patient presents with ventricular fibrillation, hypotension, and absent peripheral pulses. What is the initial management?

Accepted Answer

200 Joule defibrillation

Answer

Lidocaine push

Answer

Amiodarone push

Answer

Atropine push

Question 10

A 60-year-old man with a history of left ventricular aneurysm post-myocardial infarction in 2017 presents with recurrent episodes of syncope. Following consumption of coffee, he experienced syncope and was brought to the hospital. What is the best management strategy to prevent future episodes?

Accepted Answer

Implantable cardioverter-defibrillator

Answer

Daily oral amiodarone

Answer

Direct current shock at 200 Joules

Answer

Catheter ablation

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?