Cardiology Practice Questions

Q: In Myocardial infarction, what is the most specific marker?

Troponin T. The diagnosis of Myocardial Infarction (MI) relies on the detection of a rise and/or fall of cardiac biomarkers, with **Cardiac Troponins (I and T)** being the preferred markers due to their high **myocardial specificity** and sensitivity [1]. **Why Troponin T is the Correct Answer:** Troponins are structural proteins of the cardiac myofibrils. Unlike other enzymes, Troponin I and T have isoforms that are unique to cardiac myocytes. They are released into the bloodstream following even minute areas of myocardial necrosis [1]. Troponin T begins to rise within 3–6 hours of injury and can remain elevated for up to 10–14 days, providing a wide diagnostic window. **Analysis of Incorrect Options:** * **Pro-BNP:** This is a marker of ventricular wall stretch and is primarily used for the diagnosis and prognosis of **Heart Failure**, not for identifying acute necrosis. * **Myoglobin:** This is the **earliest marker** to rise (within 1–2 hours). However, it lacks specificity because it is also found in skeletal muscle and can be elevated due to trauma or strenuous exercise. * **CPK-MB:** While specific to the heart, it is less specific than Troponins [1]. Its primary utility is in detecting **re-infarction** because it returns to baseline quickly (within 48–72 hours), whereas Troponins stay elevated longer. **NEET-PG High-Yield Pearls:** * **Most Specific Marker:** Troponin I (slightly more specific than T in patients with renal failure). * **Earliest Marker:** Myoglobin. * **Marker for Re-infarction:** CPK-MB. * **Gold Standard for Diagnosis:** Cardiac Troponins [1]. * **Bedside Test:** Troponin T (Rapid immunochromatographic test).

Q: Which of the following is untrue regarding sick sinus syndrome?

Coronary artery disease is a common cause.. Sick Sinus Syndrome (SSS) refers to a spectrum of cardiac arrhythmias caused by generalized dysfunction of the sinoatrial (SA) node. **Why Option B is the correct (untrue) statement:** While it is a common misconception, **Coronary Artery Disease (CAD) is NOT a common cause of SSS.** The most frequent underlying cause is **idiopathic degenerative fibrosis** of the SA node and the surrounding atrial myocardium [2]. Although an acute myocardial infarction (especially inferior wall MI) can cause transient SA node dysfunction, chronic CAD rarely leads to the persistent clinical syndrome of SSS. **Analysis of other options:** * **Option A:** SSS occurs most commonly in the **elderly** (typically 7th–8th decade) due to age-related fibro-degenerative changes [2]. * **Option C:** ECG manifestations are notoriously **intermittent** [1]. Patients may alternate between sinus bradycardia, sinus arrest, SA exit block, and paroxysmal supraventricular tachycardias (Tachy-Brady Syndrome) [2]. This often necessitates prolonged monitoring (Holter or ILR) for diagnosis [1]. * **Option D:** The definitive treatment for **symptomatic** SSS is the implantation of a **permanent pacemaker** (usually dual-chamber/DDDR) [1][2]. As the condition is progressive and often exacerbated by necessary rate-controlling drugs, pacing is required to alleviate symptoms like syncope or presyncope. **High-Yield Clinical Pearls for NEET-PG:** * **Tachy-Brady Syndrome:** The most common clinical presentation where periods of bradycardia are followed by paroxysmal atrial tachyarrhythmias (usually Atrial Fibrillation) [2]. * **Pharmacology:** Drugs like Beta-blockers, CCBs, and Digoxin can worsen SSS symptoms and are often the "trigger" for diagnosis. * **Intrinsic Heart Rate:** A key diagnostic feature is the failure of the heart rate to increase appropriately during exercise (Chronotropic Incompetence).

Q: A 60-year-old smoker presents with breathlessness for 2 weeks. On examination, heart rate is 100/min, BP = 90/60 mm Hg, and neck veins are distended with a palpable liver. CXR is shown. What is the probable diagnosis?

Pericardial effusion. ***Pericardial effusion*** - The triad of **hypotension** (90/60 mmHg), **raised JVP** (distended neck veins), and **tachycardia** (100/min) with hepatomegaly suggests **cardiac tamponade** from pericardial effusion. - CXR likely shows the classic **"water-bottle" heart** appearance with enlarged cardiac silhouette, pathognomonic of significant pericardial effusion. *Cor pulmonale* - Results from **chronic lung disease** causing **pulmonary hypertension** and right heart failure, but would typically show signs of underlying lung pathology on CXR. - Usually presents with **elevated JVP** but **normal or elevated blood pressure**, not hypotension as seen here. *Broken heart syndrome* - **Takotsubo cardiomyopathy** typically occurs after severe **emotional or physical stress** in postmenopausal women, not fitting this demographic. - Characterized by **apical ballooning** on echocardiography and **normal coronary arteries**, with different hemodynamic profile than described. *Brugada syndrome* - A **genetic channelopathy** causing **ventricular arrhythmias** and sudden cardiac death, not heart failure symptoms. - Diagnosed by characteristic **ECG pattern** (coved ST-elevation in V1-V3) and **family history**, unrelated to the presented clinical picture.

Q: Regarding Hypertrophic Obstructive Cardiomyopathy (HOCM), all are true except?

Autosomal recessive inheritance. Hypertrophic Obstructive Cardiomyopathy (HOCM) is a genetic cardiac disorder characterized by asymmetric septal hypertrophy and left ventricular outflow tract (LVOT) obstruction. **Why Option B is the correct answer (The "Except"):** HOCM is primarily an **Autosomal Dominant** condition with variable penetrance [1]. It is most commonly caused by mutations in genes encoding sarcomeric proteins, specifically the **Beta-myosin heavy chain** (most common) and **Myosin-binding protein C** [1]. It is not autosomal recessive. **Analysis of other options:** * **A. Myocyte disarray:** This is the hallmark histopathological feature of HOCM [1]. The normal parallel alignment of cardiac myocytes is replaced by a chaotic, "disarrayed" pattern, which serves as a substrate for ventricular arrhythmias. * **C. Diastolic failure:** In HOCM, the primary functional abnormality is **diastolic dysfunction**. The hypertrophied, stiff ventricle cannot relax properly during diastole, leading to impaired filling and increased end-diastolic pressure, despite a normal or supranormal Ejection Fraction (EF). * **D. Bifid pulse:** Also known as **Bisferiens pulse** or "spike and dome" pulse. In HOCM, there is a rapid initial contraction (spike), followed by a mid-systolic dip due to LVOT obstruction, and a second slower rise (dome). **NEET-PG High-Yield Pearls:** * **Murmur:** Harsh systolic ejection murmur heard best at the left sternal border. * **Dynamic Auscultation:** The murmur **increases** with Valsalva and standing (decreased preload) and **decreases** with squatting or handgrip (increased preload/afterload). * **ECG:** May show "dagger-like" Q waves in lateral/inferior leads. * **Drug of Choice:** Beta-blockers (first-line) or Verapamil to improve diastolic filling. **Avoid Nitrates and Diuretics** as they worsen the obstruction.

Q: What is the critical degree of narrowing of coronary vessels that causes angina?

More than 70%. **Explanation:** The concept of "critical stenosis" in cardiology refers to the degree of narrowing at which the coronary artery can no longer increase blood flow to meet the metabolic demands of the myocardium during exertion [1]. **Why 70% is correct:** Under resting conditions, coronary blood flow can remain normal even with significant narrowing due to compensatory distal vasodilation. However, once the luminal diameter is reduced by **more than 70%** (which corresponds to approximately an 80-90% reduction in cross-sectional area), the coronary flow reserve is exhausted. At this threshold, the vessel cannot provide the 3-to-5-fold increase in flow required during exercise, leading to subendocardial ischemia and the clinical symptom of **stable angina** [2]. **Analysis of Incorrect Options:** * **A & B (50% - 60%):** While a 50% reduction is often used to define "obstructive" coronary artery disease (CAD) on angiography, it is usually hemodynamically insignificant at rest and during moderate exercise. Most patients remain asymptomatic at this level. * **D (80%):** While 80% stenosis certainly causes angina, it is not the *minimum* threshold. The "critical" level is established at 70%. Narrowing >90% is typically required to produce symptoms even at rest (unstable angina or decubitus angina). **High-Yield Clinical Pearls for NEET-PG:** * **Stable Angina:** Occurs at >70% stenosis; pain is predictable and relieved by rest/nitroglycerin [1]. * **Rest Angina:** Usually occurs when stenosis exceeds **90%**. * **Left Main Disease:** Considered critical at **>50%** due to the massive amount of myocardium at risk. * **Fractional Flow Reserve (FFR):** A physiological measure used in the cath lab; an FFR **<0.80** indicates a lesion is hemodynamically significant, regardless of the visual percentage.

Q: Giant 'a' waves in JVP occur in all except?

Tricuspid regurgitation. ### Explanation The **'a' wave** in the Jugular Venous Pulse (JVP) represents **atrial contraction** [1]. Giant 'a' waves occur when the right atrium contracts against increased resistance (a non-compliant ventricle or a closed valve). **Why Tricuspid Regurgitation (TR) is the correct answer:** In TR, the 'a' wave is typically normal. Instead, TR is characterized by **giant 'v' waves** (or 'cv' waves). During ventricular systole, blood regurgitates back into the right atrium, causing a prominent systolic surge in pressure. This leads to the "ventricularization" of the JVP and systolic pulsations of the liver. **Analysis of Incorrect Options:** * **Junctional Rhythm:** The atria and ventricles contract simultaneously. Since the tricuspid valve is closed during ventricular systole, the atrium contracts against a closed valve, producing **Cannon 'a' waves** (a form of giant 'a' wave). * **Pulmonary Hypertension:** Increased pressure in the pulmonary circuit leads to right ventricular hypertrophy. The right atrium must contract harder against a stiff, non-compliant right ventricle, resulting in **giant 'a' waves**. * **Complete Heart Block:** There is total AV dissociation. Occasionally, the atrium contracts while the tricuspid valve is closed by ventricular systole, leading to intermittent, irregular **Cannon 'a' waves** [1]. **NEET-PG High-Yield Pearls:** * **Giant 'a' waves:** Seen in Tricuspid Stenosis, Pulmonary Stenosis, and Right Ventricular Hypertrophy (resistance to filling). * **Cannon 'a' waves:** Seen in AV dissociation (Complete heart block, Ventricular Tachycardia) and Junctional rhythms. * **Absent 'a' waves:** Pathognomonic for **Atrial Fibrillation** (no coordinated atrial contraction). * **Prominent 'y' descent:** Seen in Constrictive Pericarditis and TR; **Absent 'y' descent** is seen in Cardiac Tamponade.

Q: A 49-year-old man has his serum lipids measured. Which pattern suggests the lowest risk for coronary artery disease?

Total cholesterol 202 mg/dL, HDL cholesterol 45 mg/dL. The risk of coronary artery disease (CAD) is not determined by total cholesterol alone but by the balance between atherogenic lipoproteins and protective ones [1]. The most reliable predictor among the given options is the **Total Cholesterol to HDL ratio (TC/HDL ratio)** [3]. A lower ratio indicates a lower cardiovascular risk. **1. Why Option D is Correct:** In Option D, the TC/HDL ratio is **4.48** (202/45). This is the lowest ratio among all choices. Furthermore, an HDL level >40 mg/dL in men is considered protective, whereas levels <40 mg/dL are independent risk factors for CAD [2]. Option D provides the best combination of a near-optimal total cholesterol and the highest HDL level. **2. Analysis of Incorrect Options:** * **Option A:** Ratio = **7.67** (215/28). This represents the highest risk due to high total cholesterol and very low HDL (well below the 40 mg/dL threshold). * **Option B:** Ratio = **5.0** (215/43). While the HDL is acceptable, the total cholesterol is higher than in Option D, leading to a higher overall ratio. * **Option C:** Ratio = **6.20** (180/29). Despite having the lowest total cholesterol, the very low HDL (29 mg/dL) significantly increases the risk, resulting in a worse ratio than Option D. **High-Yield Clinical Pearls for NEET-PG:** * **The "Good" vs. "Bad":** HDL is anti-atherogenic (removes cholesterol from foam cells via reverse cholesterol transport), while LDL is pro-atherogenic [1]. * **Target Ratios:** A TC/HDL ratio ** 5.0** indicates high risk [3]. * **Non-HDL Cholesterol:** Calculated as (Total Cholesterol - HDL). It is often a better predictor of risk than LDL alone, especially in patients with high triglycerides. * **Negative Risk Factor:** An HDL level **≥60 mg/dL** is considered a "negative" risk factor, meaning it removes one risk factor from the total cardiovascular risk profile.

Q: The murmur of hypertrophic cardiomyopathy is decreased in which of the following positions or maneuvers?

Supine position. **Explanation:** The murmur of **Hypertrophic Obstructive Cardiomyopathy (HOCM)** is a dynamic systolic ejection murmur. Its intensity depends on the degree of Left Ventricular Outflow Tract (LVOT) obstruction. The obstruction increases when the left ventricular volume (preload) decreases or contractility increases. **1. Why the Supine Position is Correct:** When a patient moves from a standing to a **supine position**, there is an increase in venous return to the heart (**increased preload**). This increased volume distends the left ventricle, moving the interventricular septum away from the mitral valve, thereby widening the LVOT and reducing the obstruction. Consequently, the intensity of the murmur **decreases** [1]. **2. Analysis of Incorrect Options:** * **Standing Position:** This leads to venous pooling in the lower limbs, decreasing venous return (decreased preload). This results in a smaller LV volume and **increased** murmur intensity. * **Valsalva Maneuver (Strain Phase):** This increases intrathoracic pressure, which significantly decreases venous return. The reduced LV volume worsens the obstruction and **increases** the murmur. * **Amyl Nitrite Inhalation:** This is a potent vasodilator that reduces systemic vascular resistance (decreased afterload). Lower afterload facilitates faster ejection and smaller LV dimensions, which **increases** the murmur [1]. **High-Yield Clinical Pearls for NEET-PG:** * **The Rule of Two:** HOCM and Mitral Valve Prolapse (MVP) are the **only** two murmurs that *increase* in intensity with Valsalva and Standing (maneuvers that decrease preload). * **Squatting vs. Standing:** Squatting increases both preload and afterload, thereby **decreasing** the HOCM murmur (similar to the supine position). * **Handgrip Exercise:** Increases afterload, which helps keep the LVOT open, thereby **decreasing** the HOCM murmur [1].

Question 1

Low renin hypertension is seen in all of the following conditions, except:

Accepted Answer

Renovascular hypertension

Answer

Essential hypertension

Answer

Conn's syndrome

Answer

Liddle's syndrome

Question 2

Acute aortic regurgitation is seen in all the following conditions except?

Accepted Answer

Acute myocardial infarction

Answer

Marfan's syndrome

Answer

Bacterial endocarditis

Answer

Ankylosing spondylitis

Question 3

In Myocardial infarction, what is the most specific marker?

Accepted Answer

Troponin T

Answer

Pro-Brain Natriuretic Peptide

Answer

Myoglobin

Answer

Creatine Phosphokinase MB (CPK MB)

Question 4

Which of the following is untrue regarding sick sinus syndrome?

Accepted Answer

Coronary artery disease is a common cause.

Answer

Occurs most commonly in the elderly.

Answer

ECG manifestations are often intermittent.

Answer

Most symptomatic patients will require permanent pacing.

Question 5

A 60-year-old smoker presents with breathlessness for 2 weeks. On examination, heart rate is 100/min, BP = 90/60 mm Hg, and neck veins are distended with a palpable liver. CXR is shown. What is the probable diagnosis?

Accepted Answer

Pericardial effusion

Answer

Cor pulmonale

Answer

Broken heart syndrome

Answer

Brugada syndrome

Question 6

Regarding Hypertrophic Obstructive Cardiomyopathy (HOCM), all are true except?

Accepted Answer

Autosomal recessive inheritance

Answer

Myocyte disarray

Answer

Diastolic failure

Answer

Bifid pulse

Question 7

What is the critical degree of narrowing of coronary vessels that causes angina?

Accepted Answer

More than 70%

Answer

More than 50%

Answer

More than 60%

Answer

More than 80%

Question 8

Giant 'a' waves in JVP occur in all except?

Accepted Answer

Tricuspid regurgitation

Answer

Junctional rhythm

Answer

Pulmonary hypertension

Answer

Complete heart block

Question 9

A 49-year-old man has his serum lipids measured. Which pattern suggests the lowest risk for coronary artery disease?

Accepted Answer

Total cholesterol 202 mg/dL, HDL cholesterol 45 mg/dL

Answer

Total cholesterol 215 mg/dL, high-density lipoprotein (HDL) cholesterol 28 mg/dL

Answer

Total cholesterol 215 mg/dL, HDL cholesterol 43 mg/dL

Answer

Total cholesterol 180 mg/dL, HDL cholesterol 29 mg/dL

Question 10

The murmur of hypertrophic cardiomyopathy is decreased in which of the following positions or maneuvers?

Accepted Answer

Supine position

Answer

Standing position

Answer

Valsalva maneuver

Answer

Amyl nitrite inhalation

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?