Cardiology Practice Questions

Q: Bundle of Kent is seen in which of the following conditions?

Wolff-Parkinson-White syndrome. **Explanation:** The **Bundle of Kent** is an abnormal accessory conduction pathway between the atria and the ventricles [1]. In **Wolff-Parkinson-White (WPW) syndrome**, this bypass tract allows electrical impulses to circumvent the AV node, leading to "pre-excitation" of the ventricles [1], [3]. **Why Option C is Correct:** In WPW syndrome, the Bundle of Kent conducts impulses faster than the AV node [1]. This results in the classic ECG triad: 1. **Short PR interval** (<0.12s) due to rapid bypass of the AV node [1]. 2. **Delta wave** (slurred upstroke of the QRS) representing early ventricular activation [1]. 3. **Widened QRS complex** due to the fusion of the accessory and normal conduction pathways [1]. **Why Other Options are Incorrect:** * **Brugada Syndrome (Option A):** A genetic sodium channelopathy (SCN5A mutation) characterized by RBBB pattern and ST-elevation in V1–V3. It does not involve accessory pathways. * **Romano-Ward Syndrome (Option B):** The most common form of **Congenital Long QT Syndrome (LQTS)**. It is autosomal dominant and involves only cardiac symptoms (no deafness). * **Jervell and Lange-Nielsen Syndrome (Option D):** An autosomal recessive form of **Congenital LQTS** associated with **sensorineural deafness** [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** Radiofrequency ablation of the accessory pathway (Bundle of Kent). * **Acute Management:** Procainamide or Ibutilide are preferred. * **Contraindication:** Avoid **ABCD** drugs (**A**denosine, **B**eta-blockers, **C**alcium channel blockers, **D**igoxin) in WPW with Atrial Fibrillation, as they block the AV node and may force all impulses through the Bundle of Kent, leading to Ventricular Fibrillation [3].

Q: All of the following are signs of pulmonary hypertension, except?

Right parasternal heave. **Explanation:** The clinical signs of Pulmonary Hypertension (PH) are primarily derived from the effects of increased pressure in the pulmonary circuit and the subsequent strain on the right side of the heart [1]. **Why "Right Parasternal Heave" is the correct (except) option:** While a parasternal heave is a classic sign of right ventricular hypertrophy (RVH) associated with PH [1], it is technically a **left parasternal heave** [2]. The right ventricle is an anterior structure; when it hypertrophies, it lifts the left sternal border. A "right" parasternal heave is not a standard clinical finding in PH and is therefore the "except" in this list. **Analysis of other options:** * **Raised JVP:** As PH progresses, it leads to right heart failure. This causes back-pressure into the systemic venous system, manifesting as a raised Jugular Venous Pressure (JVP), often with a prominent 'a' wave due to forceful atrial contraction against a stiff RV [1]. * **Palpable P2:** High pressure in the pulmonary artery causes the pulmonary valve to close forcefully. This is felt as a palpable second heart sound (P2) in the left second intercostal space [2]. * **Low Volume Pulse:** Severe PH leads to reduced right ventricular output, which in turn decreases left-side filling (preload). This results in a low stroke volume and a low-volume peripheral pulse. **High-Yield Clinical Pearls for NEET-PG:** * **Auscultation:** Look for a loud P2 (most common sign), an ejection click, and a Graham Steell murmur (early diastolic murmur of pulmonary regurgitation). * **ECG Findings:** Right axis deviation, 'P pulmonale' (tall peaked P waves), and RVH patterns (R/S ratio >1 in V1) [1]. * **Gold Standard Investigation:** Right heart catheterization (Mean Pulmonary Artery Pressure >20 mmHg at rest).

Q: Renal artery stenosis may occur in all of the following except?

Pelvic inflammatory disease. Renal Artery Stenosis (RAS) is a condition characterized by the narrowing of one or both renal arteries, leading to secondary hypertension (Renovascular Hypertension) and potentially chronic kidney disease. **Why Option D is Correct:** **Pelvic Inflammatory Disease (PID)** is an infection of the female upper reproductive tract (uterus, fallopian tubes, and ovaries), typically caused by *Chlamydia trachomatis* or *Neisseria gonorrhoeae*. It is a localized inflammatory process within the pelvic cavity and has no anatomical or pathological association with the renal arteries. **Why Other Options are Incorrect:** * **A. Atherosclerosis:** This is the **most common cause** of RAS (approx. 90%), typically affecting the ostium or proximal third of the renal artery. It is most common in elderly males with cardiovascular risk factors. * **B. Fibromuscular Dysplasia (FMD):** This is the second most common cause, typically seen in **young females**. It involves non-inflammatory, non-atherosclerotic thickening of the arterial wall, often presenting with a "string of beads" appearance on angiography. * **C. Takayasu’s Arteritis:** Also known as "Pulseless Disease," this is a large-vessel vasculitis that commonly involves the aorta and its primary branches, including the renal arteries, leading to stenosis. **NEET-PG High-Yield Pearls:** * **Clinical Clue:** Suspect RAS if there is a sudden worsening of hypertension or an **unexplained rise in serum creatinine (>30%)** after starting an ACE inhibitor or ARB. [1] * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA). * **Screening Test of Choice:** Duplex Doppler Ultrasound or CT/MR Angiography. [1] * **Auscultation:** A systolic-diastolic epigastric bruit is highly suggestive of RAS.

Q: The Stanford classification is used to represent which of the following?

Aortic dissection. **Explanation:** The **Stanford classification** is the most widely used system for categorizing **Aortic Dissection**, based on the anatomical involvement of the aorta [1]. It is crucial for determining management strategies: * **Stanford Type A:** Involves the **ascending aorta** (regardless of where the original tear started). These are surgical emergencies due to the risk of complications like aortic regurgitation, cardiac tamponade, or coronary artery occlusion [1]. * **Stanford Type B:** Involves only the **descending aorta** (distal to the left subclavian artery). These are typically managed medically with aggressive blood pressure control (e.g., IV Labetalol) unless complications arise [1], [2]. **Analysis of Incorrect Options:** * **Aortic Rupture (A):** This is a catastrophic complication of an aneurysm or trauma where all layers of the aortic wall are breached. It is not classified by the Stanford system [1]. * **Intramural Hematoma (C) & Penetrating Atherosclerotic Ulcer (D):** Along with aortic dissection, these are part of the **Acute Aortic Syndrome** spectrum. While they may be managed similarly to dissections, the Stanford classification specifically describes the longitudinal cleavage of the aortic media (dissection). **High-Yield Clinical Pearls for NEET-PG:** * **DeBakey Classification:** Another system for dissection. **Type I** (Ascending + Descending), **Type II** (Ascending only), and **Type III** (Descending only). * **Gold Standard Investigation:** CT Angiography (CTA) is the investigation of choice [2]. * **Classic Presentation:** Sudden onset "tearing" or "ripping" chest pain radiating to the back [1]. * **Physical Exam:** Look for pulse deficit or blood pressure discrepancy between arms.

Q: All of the following are true about Atrial Septal Defect (ASD) except?

Left atrial hypertrophy. ### Explanation In an **Atrial Septal Defect (ASD)**, the primary pathophysiology involves a **left-to-right shunt** due to the pressure gradient between the atria. Because the right ventricle (RV) is more compliant than the left ventricle (LV), blood flows from the left atrium (LA) into the right atrium (RA) [1]. **Why Left Atrial Hypertrophy is the Correct Answer (The Exception):** In ASD, the left atrium does not undergo hypertrophy or significant enlargement. This is because the LA effectively "decompresses" itself into the RA through the defect. There is no pressure or volume overload localized to the LA; instead, the excess volume is immediately shunted to the right side of the heart. **Analysis of Incorrect Options:** * **Right Atrial Hypertrophy (A):** The RA receives both the normal systemic venous return and the shunted blood from the LA, leading to volume and eventually pressure overload, causing RA enlargement/hypertrophy. * **Right Ventricular Hypertrophy (C):** The RV handles the increased stroke volume (volume overload). Over time, increased pulmonary blood flow leads to structural changes and hypertrophy. * **Pulmonary Hypertension (D):** Chronic high-volume flow into the pulmonary circulation causes remodeling of the pulmonary vasculature, eventually leading to increased pulmonary vascular resistance and pulmonary hypertension (which can lead to Eisenmenger syndrome). **NEET-PG High-Yield Pearls:** * **Most common type:** Ostium Secundum (located in the region of the fossa ovalis) [1]. * **Auscultation:** Characterized by a **fixed, wide splitting of S2** and a mid-systolic flow murmur at the pulmonary area. * **ECG Findings:** RBBB (Right Bundle Branch Block) and Right Axis Deviation (in Secundum) or Left Axis Deviation (in Primum). * **Paradoxical Embolism:** A unique complication where a systemic venous thrombus crosses the ASD to cause a stroke.

Q: A 50-year-old female patient on losartan and spironolactone therapy for hypertension developed hypotension and bradycardia. The ECG taken is as shown. What is the effective treatment for her condition?

IV calcium gluconate followed by IV sodium bicarbonate. ***IV calcium gluconate followed by IV sodium bicarbonate*** - **Calcium gluconate** provides immediate **membrane stabilization** and cardioprotection against hyperkalemic cardiac toxicity, while **sodium bicarbonate** shifts potassium intracellularly. - This combination addresses both the immediate cardiac danger and begins potassium correction in **hyperkalemia** caused by the **losartan-spironolactone** combination. *Temporary pacing via the right femoral vein* - Pacing will not address the underlying **hyperkalemia** and may be ineffective in severe potassium elevation with **wide QRS complexes**. - The bradycardia here is secondary to **hyperkalemic cardiotoxicity**, not a primary conduction defect requiring pacing. *Intravenous noradrenaline or phenylephrine* - These **vasopressors** address hypotension but do not treat the underlying **hyperkalemia** causing the cardiac conduction abnormalities. - May worsen cardiac arrhythmias in the setting of **severe hyperkalemia** without membrane stabilization. *300 J DC shock* - **Defibrillation** is indicated for **ventricular fibrillation** or **pulseless ventricular tachycardia**, not for bradycardia with hyperkalemia. - Electrical cardioversion without addressing **hyperkalemia** first may precipitate **ventricular fibrillation** or **asystole**.

Q: Pulsus alternans is seen in which of the following conditions?

Severe ventricular dysfunction. **Explanation:** **Pulsus alternans** is a clinical sign characterized by a regular rhythm but with alternating strong and weak pulses. This occurs due to an alternation in stroke volume during each cardiac cycle. **1. Why Severe Ventricular Dysfunction is Correct:** The underlying mechanism is a beat-to-beat variation in the left ventricular (LV) end-diastolic volume and contractility [1]. In a failing heart (**Severe LV Dysfunction/Congestive Heart Failure**), a weak contraction leads to a higher residual volume left in the ventricle [2]. This increased "preload" for the next beat, combined with a longer recovery time for the myocytes (Frank-Starling mechanism), results in a stronger subsequent contraction. This cycle repeats, creating the alternating pulse strength. **2. Analysis of Incorrect Options:** * **HOCM (B):** Typically associated with **Pulsus Bisferiens** (a double-peaked systolic pulse). * **Aortic Stenosis (C):** Characterized by **Pulsus Parvus et Tardus** (a small-amplitude, slow-rising pulse). * **Coarctation of the Aorta (D):** Characterized by **Radio-femoral delay** and diminished pulses in the lower extremities compared to the upper extremities. **3. High-Yield Clinical Pearls for NEET-PG:** * **Best way to detect:** Pulsus alternans is best elicited by applying light pressure on the peripheral arteries (e.g., radial or femoral) or by using a sphygmomanometer (noting a 10–20 mmHg difference in systolic pressure between beats). * **Differentiating Factor:** Unlike *Pulsus Bigeminus* (which also has alternating strengths), Pulsus alternans has a **regular rhythm**. * **Clinical Significance:** It is a grave prognostic sign indicating advanced myocardial failure [2]. * **Electrical Alternans:** If seen on an ECG (alternating QRS amplitude), it is a classic sign of **Cardiac Tamponade** [3].

Question 1

Bundle of Kent is seen in which of the following conditions?

Accepted Answer

Wolff-Parkinson-White syndrome

Answer

Brugada syndrome

Answer

Romano-Ward syndrome

Answer

Jervell and Lange-Nielsen syndrome

Question 2

Which type of myocardial infarction is most likely to cause fatal arrhythmias?

Accepted Answer

Inferior

Answer

Posterior

Answer

Anterolateral

Answer

Subendocardial

Question 3

A young man, previously diagnosed with congenital heart disease with a left-to-right shunt, has a very loud pansystolic murmur at the left sternal edge without any hemodynamic disturbance. What is the most likely diagnosis?

Accepted Answer

Large ventricular septal defect

Answer

Atrial septal defect

Answer

Small ventricular septal defect

Answer

Eisenmenger's syndrome

Question 4

All of the following are signs of pulmonary hypertension, except?

Accepted Answer

Right parasternal heave

Answer

Raised JVP

Answer

Palpable P2

Answer

Low volume pulse

Question 5

Renal artery stenosis may occur in all of the following except?

Accepted Answer

Pelvic inflammatory disease

Answer

Atherosclerosis

Answer

Fibromuscular dysplasia

Answer

Takayasu's arteritis

Question 6

The Stanford classification is used to represent which of the following?

Accepted Answer

Aortic dissection

Answer

Aortic rupture

Answer

Intramural hematoma

Answer

Penetrating atherosclerotic ulcer

Question 7

Reperfusion is useful for which of the following types of myocardium?

Accepted Answer

Hibernating myocardium

Answer

Stunted myocardium

Answer

Non-ischemic viable myocardium

Answer

Mixed ischemic myocardium

Question 8

All of the following are true about Atrial Septal Defect (ASD) except?

Accepted Answer

Left atrial hypertrophy

Answer

Right atrial hypertrophy

Answer

Right ventricular hypertrophy

Answer

Pulmonary hypertension

Question 9

A 50-year-old female patient on losartan and spironolactone therapy for hypertension developed hypotension and bradycardia. The ECG taken is as shown. What is the effective treatment for her condition?

Accepted Answer

IV calcium gluconate followed by IV sodium bicarbonate

Answer

Temporary pacing via the right femoral vein

Answer

Intravenous noradrenaline or phenylephrine

Answer

300 J DC shock

Question 10

Pulsus alternans is seen in which of the following conditions?

Accepted Answer

Severe ventricular dysfunction

Answer

Hypertrophic obstructive cardiomyopathy (HOCM)

Answer

Aortic stenosis (AS)

Answer

Coarctation of the aorta (CoA)

Cardiology — MCQs

Cardiology — MCQs

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