Cardiology Practice Questions

Q: Which of the following is a diagnostic criterion for Rheumatic Heart Disease?

Erythema Marginatum. The diagnosis of Acute Rheumatic Fever (ARF), which leads to Rheumatic Heart Disease, is based on the **Revised Jones Criteria** [1]. **Erythema Marginatum** is one of the five **Major Criteria**. It is a classic, non-pruritic, evanescent pink rash with serpiginous (snake-like) borders, typically found on the trunk and proximal extremities, sparing the face. It reflects the systemic inflammatory response triggered by a delayed autoimmune reaction to Group A *Streptococcus* (GAS) pharyngeal infection [1]. **Analysis of Incorrect Options:** * **A. Oral ulcers:** These are common in systemic inflammatory conditions like Systemic Lupus Erythematosus (SLE) or Behçet’s disease, but are not part of the Jones Criteria. * **B. Malar rash:** This is the classic "butterfly rash" pathognomonic for SLE [3]. * **D. Nail telangiectasia:** These are vascular changes typically seen in connective tissue diseases such as Dermatomyositis or Scleroderma [3]. **High-Yield Clinical Pearls for NEET-PG:** * **Jones Criteria Mnemonic (Major):** **J♥NES** (**J**oints-Polyarthritis, **♥**-Carditis, **N**odules-Subcutaneous, **E**rythema Marginatum, **S**ydenham Chorea). * **Minor Criteria:** Fever, Arthralgia, prolonged PR interval on ECG, and elevated ESR/CRP. * **Requirement:** 2 Major OR 1 Major + 2 Minor criteria, plus evidence of preceding GAS infection (ASO titer or Throat culture) [1]. * **Carditis** is the only component of ARF that leads to chronic permanent disability (Rheumatic Heart Disease), most commonly affecting the **Mitral Valve** [2].

Q: Which murmur increases in intensity with the Valsalva maneuver?

Hypertrophic obstructive cardiomyopathy (HOCM). ### Explanation The **Valsalva maneuver** (specifically the strain phase) increases intrathoracic pressure, which decreases venous return to the heart. This leads to a reduction in Left Ventricular (LV) end-diastolic volume (preload) [2]. **Why HOCM is the correct answer:** In Hypertrophic Obstructive Cardiomyopathy, the murmur is caused by dynamic left ventricular outflow tract (LVOT) obstruction. When the LV volume decreases (due to reduced preload during Valsalva), the hypertrophied interventricular septum and the anterior mitral leaflet come closer together. This **increases the degree of obstruction**, thereby increasing the intensity of the systolic murmur [1]. **Analysis of Incorrect Options:** * **Aortic Stenosis (AS):** Unlike HOCM, AS is a fixed valvular obstruction. Decreased preload means less blood is ejected across the valve, which **decreases** the murmur intensity [3]. * **Ventricular Septal Defect (VSD):** Decreased venous return reduces the volume of blood shunting from left to right, thus **decreasing** the murmur intensity. * **Mitral Stenosis (MS):** Reduced venous return leads to less flow across the stenotic mitral valve, **decreasing** the intensity of the mid-diastolic rumble. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Two":** Only two murmurs **increase** in intensity with Valsalva and Standing (both decrease preload): **HOCM** and **Mitral Valve Prolapse (MVP)**. All other murmurs generally decrease. * **Handgrip Exercise:** Increases afterload. This **decreases** the HOCM murmur (by distending the LV) but **increases** murmurs of AR, MR, and VSD. * **Squatting:** Increases both preload and afterload, which **decreases** the HOCM murmur.

Q: In terms of the cardiac walls viewed by each lead, which of the following is the odd one out?

Lead aVL. To answer this question, one must understand the relationship between ECG leads and the specific anatomical surfaces of the heart they "view." This is a fundamental concept in identifying the location of myocardial infarction (MI) [2]. ### **Explanation of the Correct Answer** The correct answer is **Lead aVL**. Leads are categorized based on the cardiac wall they represent: * **Inferior Wall:** Leads **II, III, and aVF** look at the heart from the bottom (inferior) perspective [4]. * **Lateral Wall:** Leads **I, aVL, V5, and V6** look at the left lateral side of the heart [1]. Since Leads II, III, and aVF all represent the **Inferior Wall**, they form a logical group. **Lead aVL** is the "odd one out" because it represents the **High Lateral Wall**. ### **Analysis of Incorrect Options** * **Lead II (Option A):** This is an inferior lead. It records electrical activity moving toward the positive electrode on the left leg [3]. * **Lead III (Option B):** This is an inferior lead. It records activity between the left arm and left leg [3]. * **Lead aVF (Option D):** The "F" stands for Foot. It is a unipolar limb lead that views the heart directly from the inferior aspect [4]. ### **Clinical Pearls for NEET-PG** * **Blood Supply Correlation:** * **Inferior Wall (II, III, aVF):** Usually supplied by the **Right Coronary Artery (RCA)**. * **Lateral Wall (I, aVL, V5, V6):** Usually supplied by the **Left Circumflex Artery (LCx)**. * **Reciprocal Changes:** In an acute Inferior Wall MI (ST elevation in II, III, aVF), reciprocal ST depression is most commonly seen in **Lead aVL** [2]. * **Septal Leads:** V1 and V2 [1]. * **Anterior Leads:** V3 and V4 (supplied by the Left Anterior Descending artery) [1].

Q: What is true about Rheumatic heart disease and Rheumatic fever?

Caused by group A streptococci. Acute Rheumatic Fever (ARF) and its chronic sequela, Rheumatic Heart Disease (RHD), are nonsuppurative inflammatory complications resulting from an autoimmune response to a pharyngeal infection. [1] **1. Why Option A is Correct:** ARF is triggered exclusively by an upper respiratory tract infection (pharyngitis) caused by **Group A Beta-Hemolytic Streptococci (GABHS)**, specifically *Streptococcus pyogenes*. [1] The pathogenesis involves **molecular mimicry**, where antibodies produced against the streptococcal M-protein cross-react with host tissues (heart, joints, brain), leading to the clinical manifestations of the disease. **2. Why Other Options are Incorrect:** * **Option B:** Group B Streptococci (*S. agalactiae*) are primarily associated with neonatal sepsis and meningitis, not rheumatic fever. * **Options C & D:** These options are contradictory and focus on the

Question 1

A 68-year-old male with a history of hypertension is brought in unconscious. Upon arrival, his blood pressure is recorded as 245/142 mmHg. The physician decides to assess for end-organ damage. Which of the following investigations would be least useful in this assessment?

Accepted Answer

CT pulmonary angiogram

Answer

Serum Creatinine

Answer

12-lead ECG

Answer

Fundoscopy

Question 2

Which of the following is a diagnostic criterion for Rheumatic Heart Disease?

Accepted Answer

Erythema Marginatum

Answer

Oral ulcer

Answer

Malar rash

Answer

Nail telangiectasia

Question 3

Which murmur increases in intensity with the Valsalva maneuver?

Accepted Answer

Hypertrophic obstructive cardiomyopathy (HOCM)

Answer

Ventricular septal defect (VSD)

Answer

Mitral stenosis (MS)

Answer

Aortic stenosis (AS)

Question 4

Ventricular hypertrophy is defined as:

Accepted Answer

Diastolic dysfunction

Answer

Systolic dysfunction

Answer

Asystole

Answer

None of the above

Question 5

A 25-year-old basketball player suddenly collapsed during an athletic event and died. Autopsy revealed a hypertrophied septum. What is the most probable diagnosis?

Accepted Answer

Snake bite

Answer

Hypertrophic obstructive cardiomyopathy (HOCM)

Answer

Right ventricular conduction abnormality

Answer

Epilepsy

Question 6

In terms of the cardiac walls viewed by each lead, which of the following is the odd one out?

Accepted Answer

Lead aVL

Answer

Lead II

Answer

Lead III

Answer

Lead aVF

Question 7

What is true about Rheumatic heart disease and Rheumatic fever?

Accepted Answer

Caused by group A streptococci

Answer

Caused by group B streptococci

Answer

Carriers have a high risk of developing Rheumatic fever

Answer

Carriers have a low risk of developing Rheumatic fever

Question 8

A continuous murmur is heard in all of the following conditions except?

Accepted Answer

Rupture of the sinus of Valsalva

Answer

Coarctation of the aorta

Answer

Arteriovenous malformations

Answer

Peripheral pulmonary stenosis

Question 9

A 52-year-old man presents with sudden crushing chest pain and tachycardia. He admits to cigarette smoking, consumption of alcohol, and abuse of illicit drugs. An ECG is consistent with ischemic change in the anteroseptal region of the heart. Laboratory studies show elevated serum levels of CK-MB and troponin I. Serum cholesterol is 240 mg/dL. Which of the following most likely contributed to this patient's condition?

Accepted Answer

Cigarette smoking

Answer

Alcohol consumption

Answer

Heroin addiction

Answer

Inadequate calcium intake

Question 10

All of the following can lead to AV block except?

Accepted Answer

Ankylosing spondylitis

Answer

Hypothyroidism

Answer

Lyme disease

Answer

Lev's disease

Cardiology — MCQs

Cardiology — MCQs

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