Cardiology Practice Questions

Q: A 56-year-old female presents with severe chest pain and breathlessness after coming back from cremation grounds due to the death of her husband. ECG shows ST elevation in the precordial leads, most noticeably in V2-V3. Troponin T and BNP are mildly elevated. Invasive coronary angiography shows completely normal coronary arteries. A transthoracic echocardiogram demonstrates apical akinesis and a left ventricular ejection fraction of 40%. What is the most likely diagnosis?

Takotsubo cardiomyopathy. **Explanation:** The clinical presentation is a classic description of **Takotsubo Cardiomyopathy**, also known as "Broken Heart Syndrome" or "Stress-induced Cardiomyopathy." **1. Why Takotsubo Cardiomyopathy is correct:** This condition typically affects postmenopausal women following an intense emotional or physical stressor (e.g., the death of a spouse) [2]. The pathophysiology involves a **catecholamine surge** leading to microvascular dysfunction or direct myocardial toxicity. Key diagnostic features present in this case include: * **ECG changes:** ST-segment elevation (mimicking an anterior MI). * **Biomarkers:** Mild elevation of Troponins and BNP. * **Angiography:** Absence of obstructive coronary artery disease. * **Echocardiography:** Characteristic **apical ballooning** (apical akinesis with basal hyperkinesis), giving the heart the shape of a Japanese octopus trap (*Takotsubo*). **2. Why other options are incorrect:** * **Anxiety:** While the patient is stressed, anxiety alone cannot explain the ST elevation, elevated troponins, or regional wall motion abnormalities [2]. * **Septal Myocardial Infarction:** Although the ECG mimics an MI, the **normal coronary arteries** on angiography rule out obstructive atherosclerotic infarction [1]. * **Coronary Artery Spasm (Prinzmetal Angina):** While it can cause ST elevation and normal coronaries, it typically presents as transient pain at rest and does not characteristically cause the specific apical ballooning pattern seen on echo. **Clinical Pearls for NEET-PG:** * **Demographics:** Most common in postmenopausal females (>90%). * **Diagnosis:** Requires the **Mayo Clinic Diagnostic Criteria**. * **Prognosis:** Generally excellent; LV function usually recovers within 1–4 weeks with supportive care (ACE inhibitors, Beta-blockers). * **Complication:** Left ventricular outflow tract (LVOT) obstruction can occur due to basal hypercontractility.

Q: In Takayasu arteritis, which artery is most commonly involved?

Subclavian artery. **Explanation:** Takayasu arteritis (also known as "Pulseless Disease") is a chronic, large-vessel vasculitis that primarily affects the aorta and its major branches [1]. **Why Subclavian Artery is Correct:** The **left subclavian artery** is the most frequently involved vessel in Takayasu arteritis (occurring in up to 90% of cases). This involvement leads to the classic clinical presentation of diminished or absent peripheral pulses and significant blood pressure discrepancies between the arms. The inflammation causes segmental stenosis, occlusion, or aneurysmal dilation of the vessel. **Analysis of Incorrect Options:** * **Common carotid artery:** This is the second most common vessel involved. While frequently affected (leading to syncope or carotidynia), it is statistically less common than the subclavian artery. * **Renal artery:** Involved in approximately 40-50% of cases. While it is a major cause of secondary hypertension (renovascular hypertension) in young females, it is not the *most* common site. * **Inferior mesenteric artery:** Large vessel vasculitis rarely involves the mesenteric circulation compared to the arch of the aorta. The abdominal aorta is involved in about 50% of cases, but the subclavian remains the primary site. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in young females (<40 years) of Asian descent. * **Clinical Sign:** Bruits (especially subclavian or carotid) are a hallmark finding. * **Diagnosis:** Gold standard is **Conventional Angiography** (showing "string of pearls" or tapered stenosis), though CT/MR Angiography is now preferred. * **Classification:** Ishikawa’s criteria or ACR criteria are used for diagnosis. * **Treatment:** Glucocorticoids are the first-line treatment to reduce inflammation.

Q: Complete AV nodal block results in?

Unequal PP interval and RR interval. ### Explanation **Correct Answer: D. Unequal PP interval and RR interval** **Understanding the Concept:** Complete AV nodal block (3rd-degree Heart Block) is characterized by **AV dissociation**. In this condition, no atrial impulses reach the ventricles [2]. Consequently, the atria are depolarized by the SA node (at their own intrinsic rate), while the ventricles are depolarized by a subsidiary escape pacemaker (either junctional or ventricular) at a much slower rate. Because the SA node and the escape pacemaker function independently: 1. The **PP intervals** are constant (atrial rate). 2. The **RR intervals** are constant (ventricular rate). 3. However, the **PP interval is shorter than the RR interval** (Atrial rate > Ventricular rate). This results in an unequal relationship between the two intervals and P waves that appear to "march through" the QRS complexes. **Analysis of Incorrect Options:** * **Option A:** This describes **Mobitz Type I (Wenckebach) 2nd-degree AV block**, where the PR interval progressively lengthens until a QRS complex is dropped [1]. * **Option B:** This is the hallmark of **Multifocal Atrial Tachycardia (MAT)**, commonly associated with COPD, not a conduction block. * **Option C:** Absent P waves are seen in **Atrial Fibrillation** (replaced by f-waves) or **Sinuatrial arrest**. In 3rd-degree block, P waves are present but unrelated to QRS complexes. **NEET-PG High-Yield Pearls:** * **Clinical Sign:** Look for **"Cannon A waves"** in the JVP, caused by the right atrium contracting against a closed tricuspid valve. * **Heart Sounds:** Characterized by a **variable intensity of S1**. * **ECG Hallmark:** Complete AV dissociation with a regular RR interval (distinguishes it from Mobitz II where RR is irregular). * **Management:** The definitive treatment for symptomatic 3rd-degree heart block is a **Permanent Pacemaker** [2].

Q: Subaortic stenosis is not associated with which of the following conditions?

Aortic regurgitation. **Explanation:** Subaortic stenosis (SAS) is a form of left ventricular outflow tract obstruction caused by a fibrous membrane or muscular band below the aortic valve. The key to this question lies in distinguishing between **associated congenital anomalies** (conditions that occur alongside SAS) and **acquired complications** resulting from SAS. **Why Aortic Regurgitation (B) is the correct answer:** Aortic Regurgitation (AR) is not a condition *associated* with the development of subaortic stenosis; rather, it is a frequent **complication** of it. The high-velocity jet of blood passing through the subaortic narrowing causes chronic mechanical trauma to the aortic valve leaflets, leading to thickening and subsequent regurgitation. In the context of "associated conditions" (congenital malformations present at birth), AR is excluded. **Analysis of Incorrect Options:** * **A, C, and D (VSD, PDA, and Coarctation of Aorta):** These are well-documented **associated congenital heart defects**. Subaortic stenosis rarely occurs in isolation. It is frequently part of a spectrum of left-sided obstructive lesions (Shone’s complex) or occurs in conjunction with shunts like VSD (especially the malalignment type) and PDA. **NEET-PG Clinical Pearls:** * **Shone’s Complex:** A high-yield syndrome consisting of four obstructive lesions: Supramitral ring, parachute mitral valve, subaortic stenosis, and coarctation of the aorta. * **Dynamic Nature:** Unlike valvular stenosis, subaortic stenosis is often progressive. * **Murmur:** It presents as a harsh systolic ejection murmur, similar to aortic stenosis, but often lacks the "systolic ejection click" because the valve leaflets themselves are initially mobile. * **Management:** Surgical resection of the membrane is required if the pressure gradient is significant (>30-50 mmHg) to prevent the progression of Aortic Regurgitation.

Question 1

A 56-year-old female presents with severe chest pain and breathlessness after coming back from cremation grounds due to the death of her husband. ECG shows ST elevation in the precordial leads, most noticeably in V2-V3. Troponin T and BNP are mildly elevated. Invasive coronary angiography shows completely normal coronary arteries. A transthoracic echocardiogram demonstrates apical akinesis and a left ventricular ejection fraction of 40%. What is the most likely diagnosis?

Accepted Answer

Takotsubo cardiomyopathy

Answer

Anxiety

Answer

Septal myocardial infarction

Answer

Coronary artery spasm

Question 2

Which of the following statements about Wolff-Parkinson-White syndrome is FALSE?

Accepted Answer

Presence of delta waves (epsilon waves) on the electrocardiogram.

Answer

Presence of an accessory pathway between the atria and ventricles with decremental conduction properties.

Answer

Shortened PR interval on the electrocardiogram.

Answer

Widened QRS complexes on the electrocardiogram.

Question 3

In Takayasu arteritis, which artery is most commonly involved?

Accepted Answer

Subclavian artery

Answer

Common carotid artery

Answer

Renal artery

Answer

Inferior mesenteric artery

Question 4

Complete AV nodal block results in?

Accepted Answer

Unequal PP interval and RR interval

Answer

Progressive increase of PR interval followed by a dropped beat

Answer

More than 3 different morphologies of P waves

Answer

Absent P waves

Question 5

Subaortic stenosis is not associated with which of the following conditions?

Accepted Answer

Aortic regurgitation

Answer

Ventricular septal defect

Answer

Patent ductus arteriosus

Answer

Coarctation of aorta

Question 6

A 68-year-old man with a history of recent syncopal episodes presents with congestive heart failure. His blood pressure is 160/80 mm Hg, pulse rate is 80 beats/minute, and he has a grade III/VI harsh systolic murmur. Which of the following findings is most suggestive of aortic stenosis?

Accepted Answer

Delayed carotid upstroke.

Answer

Radiation of the murmur to the neck.

Answer

Decrease of the murmur with handgrip.

Answer

Reduced left ventricular ejection fraction.

Question 7

A 72-year-old obese man, 1 hour after undergoing repair of a left indirect inguinal hernia, is admitted to the emergency department with severe retrosternal pain of 1-hour duration. The pain radiates to the medial aspect of the left hand. The ECG shows Q waves and an elevated ST-segment. A diagnosis of acute myocardial infarction is established 1 hour after admission. What is the immediate management?

Accepted Answer

Thrombolytic therapy with tissue plasminogen activator (tPA)

Answer

Vitamin K

Answer

Ampicillin, 2 mg three times daily by mouth

Answer

Hydrochlorothiazide, 50 mg daily

Question 8

In which condition can atrial fibrillation degenerate into ventricular fibrillation?

Accepted Answer

Wolff-Parkinson-White Syndrome

Answer

Hypertrophic Obstructive Cardiomyopathy

Answer

Arrhythmogenic Right Ventricular Dysplasia

Answer

Pulmonary Embolism

Question 9

A 69-year-old woman complains of atypical chest pain. On examination, the JVP is at 8 cm, with a positive Kussmaul sign, and normal heart sounds. The lungs are clear. The ECG is abnormal, and the CXR shows a normal cardiac silhouette. For the patient presenting with shortness of breath and peripheral edema, what is the most likely diagnosis?

Accepted Answer

right ventricle myocardial infarction (RVMI)

Answer

cardiac tamponade

Answer

constrictive pericarditis

Answer

restrictive cardiomyopathy

Question 10

Pulses paradoxus can be seen in which of the following clinical states EXCEPT?

Accepted Answer

Acute myocardial infarction

Answer

Pericardial tamponade

Answer

Acute severe asthma

Answer

Massive pulmonary embolism

Cardiology — MCQs

Cardiology — MCQs

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