Cardiology Practice Questions

Q: Inoue balloon is used in the treatment of which condition?

Mitral Stenosis. The **Inoue Balloon** is the gold-standard device used for **Percutaneous Transvenous Mitral Commissurotomy (PTMC)**, also known as Balloon Mitral Valvotomy (BMV) [1]. It is specifically designed to treat symptomatic **Mitral Stenosis**, typically of rheumatic origin, provided the valve morphology is favorable (assessed via the Wilkins Score) [1]. **Why it is the correct answer:** The Inoue balloon is a unique, pressure-expandable, multi-stage balloon made of nylon and rubber. It has a "waist" that allows it to be self-centering across the stenotic mitral valve. When inflated, it exerts mechanical force to split the fused commissures, thereby increasing the valve area and relieving the obstruction. **Why other options are incorrect:** * **Atrial Septal Defect (ASD) & Patent Foramen Ovale (PFO):** These are septal defects treated with **occluder devices** (e.g., Amplatzer Septal Occluder) to close the shunt, not balloons to open a valve. * **Mitral Regurgitation:** This is a condition of valvular incompetence [2]. Balloon dilatation would worsen the leak. Treatment usually involves surgical repair/replacement or percutaneous clips (e.g., MitraClip) [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Wilkins Score:** Used to assess suitability for PTMC. It evaluates four parameters: Leaflet mobility, thickening, calcification, and subvalvular thickening. A score **≤ 8** is ideal for the procedure. * **Contraindications for PTMC:** Presence of a left atrial thrombus (risk of stroke) and moderate-to-severe mitral regurgitation [2], [3]. * **Access:** The procedure requires **transseptal puncture** (passing from the right atrium to the left atrium through the fossa ovalis) to reach the mitral valve.

Q: What is the most common complication of infective endocarditis?

Myocardial abscesses. **Explanation:** Infective Endocarditis (IE) is characterized by the formation of vegetations on heart valves [1]. While systemic complications are frequent, **Myocardial Abscesses** (perivalvular extension) are considered the most common intracardiac complication of IE [3]. **1. Why Myocardial Abscesses are Correct:** The infection often spreads beyond the valve leaflets into the adjacent endocardium and myocardium. This leads to the formation of perivalvular abscesses, particularly in cases involving the aortic valve or prosthetic valves [2]. These abscesses can lead to conduction disturbances (like heart block) and are a primary reason for surgical intervention. **2. Analysis of Incorrect Options:** * **A. Thromboembolism:** While a very common and serious *extracardiac* complication (occurring in up to 25-50% of cases), it is generally ranked second to cardiac-specific complications in terms of overall frequency and morbidity in hospitalized patients [2]. * **B. Mycotic Aneurysm:** This is a rare vascular complication resulting from septic emboli weakening the arterial wall (most commonly in the cerebral circulation). It occurs in only about 3-5% of patients. * **C. Fibrinous Pericarditis:** This is an uncommon complication of IE. Pericarditis in IE usually suggests a localized extension of a myocardial abscess or a secondary immune response, but it is not a "most common" finding. **High-Yield NEET-PG Pearls:** * **Most common cause of death in IE:** Congestive Heart Failure (CHF) due to valvular regurgitation. * **Most common valve involved:** Mitral valve (except in IV drug users, where it is the Tricuspid valve). * **Clinical Sign:** If a patient with IE develops a new-onset conduction delay (prolonged PR interval on ECG), suspect an **Aortic Root Abscess** [1]. * **Duke’s Criteria:** Remember that persistent bacteremia and new valvular regurgitation are Major Criteria [1].

Q: Which of the following physical signs is seen in a patient with severe aortic stenosis?

Delayed peak of systolic murmur. **Explanation:** In **Aortic Stenosis (AS)**, the hallmark physical finding is a crescendo-decrescendo systolic ejection murmur [1]. As the stenosis becomes more **severe**, the pressure gradient across the valve takes longer to reach its maximum, causing the murmur to peak later in systole. This **delayed peak of systolic murmur** (late-peaking) is a reliable indicator of severity, often accompanied by a "pulsus parvus et tardus" (weak and delayed carotid upstroke) [1]. **Analysis of Incorrect Options:** * **A. Opening Snap:** This is a high-pitched diastolic sound characteristic of **Mitral Stenosis** [2], caused by the sudden tensing of the chordae tendineae and stenotic valve leaflets. * **B. Diastolic Rumble:** This describes the low-pitched mid-diastolic murmur of **Mitral Stenosis** or the Austin Flint murmur of Aortic Regurgitation [3]. AS produces a systolic, not diastolic, murmur. * **C. Holosystolic Murmur:** This is typical of **Mitral Regurgitation, Tricuspid Regurgitation, or Ventricular Septal Defect (VSD)**, where the pressure gradient remains constant throughout systole. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of Severe AS:** Angina, Syncope, and Dyspnea (SAD). * **Soft/Absent S2:** In severe AS, the aortic component (A2) becomes soft or disappears because the valve leaflets are too calcified to snap shut [1]. * **Paradoxical Splitting of S2:** Occurs in severe AS because the prolonged left ventricular ejection time causes A2 to occur after P2. * **Gallavardin Phenomenon:** The dissociation between the noisy (musical) component of the AS murmur at the apex and the harsh component at the base, often mimicking mitral regurgitation [1].

Q: A midsystolic click is a characteristic feature of which condition?

Mitral Valve Prolapse (MVP). **Explanation:** **1. Correct Answer: Mitral Valve Prolapse (MVP)** The characteristic auscultatory finding in MVP is a **mid-systolic click**, often followed by a late systolic murmur [1]. The click is a non-ejection sound caused by the sudden tensing of the redundant valve leaflets and elongated chordae tendineae as they prolapse into the left atrium during ventricular systole. **2. Analysis of Incorrect Options:** * **Mitral Stenosis (MS):** Characterized by an **Opening Snap** (diastolic sound) occurring shortly after S2, followed by a mid-diastolic rumbling murmur [1], [3]. * **Aortic Regurgitation (AR):** Typically presents with an early diastolic, decrescendo murmur [2]. It does not produce a systolic click. * **Pulmonary Outflow Obstruction (e.g., Pulmonic Stenosis):** Associated with an **early systolic ejection click** (which decreases in intensity with inspiration) and a harsh systolic ejection murmur [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Dynamic Auscultation:** This is a favorite topic for examiners. In MVP, maneuvers that **decrease venous return** (e.g., Standing, Valsalva strain phase) cause the click and murmur to occur **earlier** in systole and become longer/louder. Conversely, Squatting (increased preload) moves the click **later** in systole. * **Barlow’s Syndrome:** Another name for MVP, often associated with connective tissue disorders like Marfan or Ehlers-Danlos syndrome. * **Most Common Cause:** MVP is the most common cause of isolated mitral regurgitation in developed countries.

Q: A 55-year-old female presented to the ER with sudden onset of shortness of breath along with syncope. Chest X-ray was unremarkable. ECG was done. On examination, some skin lesions were observed. What is the most likely diagnosis in this case?

Sarcoidosis. ***Sarcoidosis*** - **Cardiac sarcoidosis** can present with **complete heart block** causing **syncope** and **shortness of breath**, with **unremarkable chest X-ray** in isolated cardiac involvement. - **Skin manifestations** like **lupus pernio** or **erythema nodosum** are characteristic features that support the diagnosis. *Carney syndrome* - A rare **genetic disorder** characterized by **cardiac myxomas**, **skin pigmentation**, and **endocrine tumors**. - Syncope would be due to **myxoma obstruction**, not **conduction abnormalities**, and lacks the typical skin lesions of sarcoidosis. *Hypothyroidism* - Causes **bradycardia** and **fatigue** but rarely leads to **complete heart block** or **acute syncope**. - Associated with **myxedematous skin changes** (dry, coarse skin), not the inflammatory skin lesions described. *SLE* - Can cause **pericarditis** and **Libman-Sacks endocarditis** but rarely presents with **isolated heart block**. - **Malar rash** and **discoid lesions** are typical, but the acute presentation with syncope is less characteristic.

Q: Which ECG feature is characteristic of acute cor pulmonale, such as that caused by pulmonary embolism?

All of the above three. **Explanation:** Acute cor pulmonale, most commonly caused by a massive pulmonary embolism (PE), results from a sudden increase in pulmonary vascular resistance. This leads to acute right ventricular (RV) pressure overload and dilatation. 1. **S1Q3T3 Pattern (McGinn-White Sign):** This is the classic "textbook" sign of acute RV strain [1]. It consists of a prominent **S** wave in lead I, a **Q** wave in lead III, and an inverted **T** wave in lead III. While highly specific for RV strain, it is only present in about 15-20% of cases. 2. **Poor R-wave Progression (V1-V4):** As the right ventricle dilates, it displaces the heart and shifts the transition zone. This, combined with RV ischemia or conduction delays, leads to a loss of the normal R-wave height increase across the precordial leads, often mimicking an anterior myocardial infarction. 3. **Atrial Fibrillation:** Acute stretching of the right atrium due to high pressures can trigger supraventricular arrhythmias. Atrial fibrillation and sinus tachycardia (the most common ECG finding in PE) are frequently observed [1]. **Clinical Pearls for NEET-PG:** * **Most Common Finding:** Sinus tachycardia is the most frequent ECG abnormality in PE [1]. * **Most Specific Finding:** S1Q3T3 is specific but not sensitive. * **T-wave Inversions:** Inversions in leads V1-V3 (Right ventricular strain pattern) are actually more common and more suggestive of PE than the S1Q3T3 pattern [1]. * **Right Axis Deviation:** Often accompanies acute cor pulmonale due to the shift in the heart's electrical vector.

Question 1

Inoue balloon is used in the treatment of which condition?

Accepted Answer

Mitral Stenosis

Answer

Atrial Septal Defect (ASD)

Answer

Mitral Regurgitation

Answer

Patent Foramen Ovale (PFO)

Question 2

Ventricular ectopic beats are represented by which of the following findings?

Accepted Answer

Irregular RR interval

Answer

Incomplete compensatory pause

Answer

A.V. dissociation

Answer

Presence of fusion beat

Question 3

What is the most common complication of infective endocarditis?

Accepted Answer

Myocardial abscesses

Answer

Thromboembolism

Answer

Mycotic aneurysm

Answer

Fibrinous pericarditis

Question 4

In a hospital cardiac care unit, there are three patients with different cardiac conditions: a 52-year-old man with dilated cardiomyopathy, an 18-year-old girl with mitral valve prolapse, and a 30-year-old man with infective endocarditis of the mitral valve. Which of the following features do all these patients most likely share?

Accepted Answer

Risk of systemic thromboembolism

Answer

Decreased compliance

Answer

Depressed myocardial contractility

Answer

Infectious etiology

Question 5

Which of the following physical signs is seen in a patient with severe aortic stenosis?

Accepted Answer

Delayed peak of systolic murmur

Answer

Opening snap

Answer

Diastolic rumble

Answer

Holosystolic murmur

Question 6

Which of the following lesions is not a common cause for vegetation formation in the heart?

Accepted Answer

Atrial Septal Defect (ASD)

Answer

Aortic Stenosis (AS)

Answer

Mitral Stenosis (MS)

Answer

Mitral Regurgitation (MR)

Question 7

A midsystolic click is a characteristic feature of which condition?

Accepted Answer

Mitral Valve Prolapse (MVP)

Answer

Mitral Stenosis (MS)

Answer

Aortic Regurgitation (AR)

Answer

Pulmonary Outflow Obstruction (POA)

Question 8

A 55-year-old female presented to the ER with sudden onset of shortness of breath along with syncope. Chest X-ray was unremarkable. ECG was done. On examination, some skin lesions were observed. What is the most likely diagnosis in this case?

Accepted Answer

Sarcoidosis

Answer

Carney syndrome

Answer

Hypothyroidism

Answer

SLE

Question 9

A 68-year-old man who has had a recent syncopal episode is hospitalized with congestive heart failure. His blood pressure is 160/80 mmHg. His pulse rate is 80 beats per minute, and there is a grade III/IV harsh systolic murmur. An echocardiogram shows a disproportionately thickened ventricular septum and systolic anterior motion of the mitral valve. Which of the following findings would most likely be present in this man?

Accepted Answer

Decrease of the murmur with hand grip.

Answer

Radiation of the murmur to the neck.

Answer

Delayed carotid upstroke.

Answer

Reduced left ventricular ejection fraction.

Question 10

Which ECG feature is characteristic of acute cor pulmonale, such as that caused by pulmonary embolism?

Accepted Answer

All of the above three

Answer

S1Q3T3 pattern

Answer

Slow "r" wave progression in leads V1 to V4

Answer

Atrial fibrillation

Cardiology — MCQs

Cardiology — MCQs

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