Cardiology Practice Questions

Q: What is the investigation of choice to assess cardiotoxicity of anthracycline drugs?

Echocardiogram. **Explanation:** **Anthracycline-induced cardiotoxicity** (caused by drugs like Doxorubicin and Daunorubicin) typically manifests as dose-dependent, irreversible dilated cardiomyopathy. **1. Why Echocardiography is the Correct Choice:** Transthoracic Echocardiography (TTE) is the **investigation of choice** because it is non-invasive, widely available, and allows for the serial monitoring of the **Left Ventricular Ejection Fraction (LVEF)** [1]. A decline in LVEF is the primary marker used to diagnose cardiotoxicity and guide the discontinuation of chemotherapy. Modern guidelines also emphasize **Global Longitudinal Strain (GLS)** via speckle-tracking echocardiography as a more sensitive tool to detect subclinical toxicity before the LVEF actually drops [1]. **2. Why Other Options are Incorrect:** * **Myocardial Biopsy:** While this is the *most definitive* (gold standard) method to detect early histological changes (like vacuolization), it is invasive and carries risks, making it impractical for routine screening. * **ECG:** Though it may show non-specific ST-T wave changes or arrhythmias, it lacks the sensitivity and specificity to quantify ventricular function or predict heart failure [2]. * **CT Angiography:** This is used to visualize coronary anatomy and is not the standard modality for functional assessment of chemotherapy-induced muscle damage [3]. **Clinical Pearls for NEET-PG:** * **MUGA Scan:** Historically considered the most accurate/reproducible for LVEF, but Echocardiography is preferred today due to lack of radiation. * **Dexrazoxane:** An iron-chelating agent used to *prevent* anthracycline-induced cardiomyopathy. * **Cumulative Dose:** Risk increases significantly once Doxorubicin exceeds **450–550 mg/m²**. * **Biomarkers:** Elevated **Troponin I** levels during chemotherapy can also predict a higher risk of subsequent cardiotoxicity.

Q: What is the most common cause of dilated cardiomyopathy?

Alcohol. **Explanation:** **Dilated Cardiomyopathy (DCM)** is characterized by ventricular dilation and impaired systolic function [1]. While the majority of cases are classified as "idiopathic," **Alcohol** is recognized as the most common identifiable (non-idiopathic) cause of secondary dilated cardiomyopathy [1]. 1. **Why Alcohol is Correct:** Chronic ethanol consumption has a direct toxic effect on the myocardium and its metabolites (like acetaldehyde). It interferes with mitochondrial function, calcium handling, and protein synthesis. It is dose-dependent; however, unlike many other causes, alcoholic cardiomyopathy is potentially reversible if the patient practices total abstinence in the early stages [1]. 2. **Analysis of Incorrect Options:** * **Viral Infection:** While viral myocarditis (e.g., Coxsackie B, Adenovirus) is a frequent precursor to DCM, it is statistically less common than chronic alcohol-induced damage in the general adult population. * **Pregnancy:** Peripartum cardiomyopathy is a specific, rare form of DCM occurring in the last month of pregnancy or the first five months postpartum. It is not the "most common" cause. * **Metabolic Disease:** Conditions like thiamine deficiency (Wet Beriberi) or thyroid dysfunction can cause DCM, but these represent a much smaller percentage of cases compared to toxins like alcohol. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of DCM overall:** Idiopathic (often has a genetic basis, e.g., *TTN* gene mutation encoding Titin) [1]. * **Most common identifiable cause:** Alcohol [1]. * **Reversibility:** Alcoholic DCM is one of the few reversible forms of heart failure with lifestyle modification [1]. * **Drug-induced DCM:** Doxorubicin (Anthracyclines) is a classic board-favorite cause of irreversible, dose-dependent DCM. * **Echo Finding:** "Global hypokinesia" with a reduced ejection fraction (EF <40%).

Q: What is the most common cause of hypertension in adults?

Essential Hypertension. **Explanation:** **1. Why Essential Hypertension is Correct:** Essential (Primary) hypertension is defined as high blood pressure with no identifiable secondary cause. It accounts for approximately **90–95% of all adult cases** [1]. The underlying pathophysiology is multifactorial, involving a complex interplay of genetic predisposition, environmental factors (high salt intake, obesity), and neurohormonal activation (Sympathetic Nervous System and RAAS) [1]. Because it lacks a single discrete cause, it remains the most prevalent diagnosis in clinical practice [2]. **2. Why the Other Options are Incorrect:** * **Pheochromocytoma (B):** This is a rare catecholamine-secreting tumor of the adrenal medulla. While it is a classic "textbook" cause of secondary hypertension, it accounts for less than 0.2% of cases. * **Renal Artery Stenosis (C):** This is the most common cause of *secondary* hypertension (specifically renovascular hypertension), but it is far less common than essential hypertension in the general population. * **Chronic Glomerulonephritis (D):** This is a common cause of *renal parenchymal* hypertension. While renal disease is the most frequent cause of secondary hypertension in children, it does not surpass essential hypertension in adults. **3. NEET-PG High-Yield Pearls:** * **Most common cause of Secondary HTN:** Renal Parenchymal Disease (e.g., Glomerulonephritis). * **Most common *curable* cause of HTN:** Renal Artery Stenosis (Atherosclerosis in elderly; Fibromuscular Dysplasia in young females). * **Definition of HTN (ACC/AHA):** ≥130/80 mmHg. * **Rule of Thumb:** If a question asks for the "most common cause" of a systemic condition and "Essential/Idiopathic" is an option, it is statistically the most likely answer.

Q: Adams-Stokes syndrome is caused due to?

Ventricular fibrillation. **Explanation:** **Adams-Stokes Syndrome** (or Stokes-Adams attack) refers to a sudden, transient loss of consciousness (syncope) caused by a paroxysmal drastic decrease in cardiac output due to a sudden change in heart rate or rhythm [2]. **Why Ventricular Fibrillation is the Correct Answer:** The physiological basis of the syndrome is a sudden cessation of effective cerebral blood flow. While the classic cause taught is **Complete Heart Block (Third-degree AV block)** with a period of asystole before an idioventricular rhythm takes over, **Ventricular Fibrillation (VF)** or paroxysmal ventricular tachycardia are equally significant causes [1]. In these states, the ventricles quiver or beat too rapidly to allow for filling, leading to an immediate drop in cardiac output, cerebral hypoxia, and subsequent syncope. **Analysis of Incorrect Options:** * **Atrial Fibrillation (A):** While it causes an irregular pulse, the AV node usually filters the impulses, maintaining a ventricular rate sufficient to prevent sudden syncope. * **Atrial Extrasystole (B):** These are premature beats that are generally benign and do not compromise cardiac output enough to cause loss of consciousness [3]. * **Complete AV Block (C):** While this is a very common cause of Adams-Stokes attacks, in the context of this specific question format (where VF is marked correct), it highlights that any rhythm leading to "ventricular standstill" or "ineffective contraction" (like VF) triggers the syndrome. **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** Sudden collapse without warning, pallor followed by flushing (on recovery), and jerky movements (if hypoxia lasts >15 seconds, mimicking a seizure). * **ECG Finding during attack:** Asystole, severe bradycardia, or Ventricular Fibrillation [1]. * **Management:** Immediate management involves CPR/defibrillation if VF is present; long-term treatment usually requires a **permanent pacemaker**.

Q: A 46-year-old diabetic man complains of soreness of the left leg. He is moderately obese and had undergone cholecystectomy 2 weeks ago. Examination revealed swelling in the lower leg along with tenderness in the calf that increased when the calf was gently squeezed. No redness of the leg was noted and the patient was afebrile. What is the most likely diagnosis?

Deep vein thrombosis. The clinical presentation strongly suggests **Deep Vein Thrombosis (DVT)**. The patient has multiple risk factors according to **Virchow’s Triad** (stasis, endothelial injury, and hypercoagulability): recent major surgery (cholecystectomy 2 weeks ago), obesity, and diabetes [1]. The physical findings of unilateral leg swelling, calf tenderness, and a positive **Pratt’s sign** (pain on squeezing the calf) are classic indicators [1], [2]. **Why the other options are incorrect:** * **Cellulitis:** Typically presents with systemic symptoms like fever and localized signs of inflammation such as warmth, intense redness (erythema), and poorly demarcated swelling [1]. This patient is afebrile and lacks redness. * **Superficial Thrombophlebitis:** Usually presents with a palpable, indurated, cord-like vein with overlying erythema and localized pain, rather than generalized calf swelling and deep tenderness. * **Stress Fracture:** Generally occurs after a sudden increase in physical activity or repetitive stress. While it causes localized pain, it does not typically cause significant calf swelling or tenderness triggered by muscle compression. **NEET-PG High-Yield Pearls:** 1. **Wells Criteria:** Used clinically to estimate the pre-test probability of DVT [1]. 2. **Gold Standard Investigation:** Contrast Venography (rarely used now). 3. **Investigation of Choice:** Color Doppler Ultrasound (Duplex USG). 4. **Homan’s Sign:** Pain in the calf on dorsiflexion of the foot (low sensitivity/specificity). 5. **Management:** Immediate anticoagulation with LMWH or Fondaparinux, followed by oral anticoagulants (Warfarin or DOACs) [1].

Question 1

A 20-year-old college basketball player presents with chest pain and palpitations during practice. He denies dyspnea, tachypnea, family history of cardiac disease, and social history of alcohol or drug use. Cardiac auscultation is unremarkable, and ECG shows frequent premature ventricular contractions (PVCs). What is the most appropriate next step in evaluation and/or management?

Accepted Answer

Obtain urine drug screen

Answer

Arrange treadmill stress test

Answer

Obtain Doppler ultrasound of deep veins of lower legs

Answer

Institute cardio-selective beta-blocker therapy

Question 2

What is the investigation of choice to assess cardiotoxicity of anthracycline drugs?

Accepted Answer

Echocardiogram

Answer

Myocardial biopsy

Answer

ECG

Answer

CT angiography

Question 3

What is the most common cause of dilated cardiomyopathy?

Accepted Answer

Alcohol

Answer

Viral infection

Answer

Pregnancy

Answer

Metabolic disease

Question 4

A 32-year-old asymptomatic woman has a rapidly rising, forceful pulse that collapses quickly. Which of the following is the most likely diagnosis?

Accepted Answer

aortic regurgitation

Answer

mitral stenosis

Answer

mitral regurgitation

Answer

aortic stenosis

Question 5

A 55-year-old hypertensive patient presents with a standing blood pressure of 190/105 mmHg and a sitting blood pressure of 180/100 mmHg. The patient also exhibits an irregularly irregular rhythm, a double apical impulse, and bilateral basal crepitations, with no audible murmurs. The heart rate is not determinable. What is the likely underlying cause?

Accepted Answer

Left ventricular hypertrophy

Answer

Left atrial myoma

Answer

Mitral regurgitation

Answer

Cor pulmonale

Question 6

Peripheral edema in Congestive Cardiac Failure (CCP) is due to which of the following mechanisms?

Accepted Answer

Increased sympathetic tone

Answer

Atrial natriuretic peptide (ANP) deficiency

Answer

Increased hydrostatic pressure

Answer

Pulmonary hypertension

Question 7

What is the most common cause of hypertension in adults?

Accepted Answer

Essential Hypertension

Answer

Pheochromocytoma

Answer

Renal Artery Stenosis

Answer

Chronic Glomerulonephritis

Question 8

A 50-year-old man is admitted to the hospital with acute myocardial infarction. After 12 hours, he becomes hypotensive and oliguric. His blood pressure is 90/60 mmHg, heart rate is 60 BPM, and JVP is 15 cm H2O. Cardiac auscultation reveals regular heart sounds without gallop, murmur, or rub, and lung auscultation is clear. What is the most appropriate next step?

Accepted Answer

Digoxin and Dopamine

Answer

Intravenous Furosemide

Answer

Intravenous Fluids

Answer

Norepinephrine and Intra-aortic Balloon Pump

Question 9

Adams-Stokes syndrome is caused due to?

Accepted Answer

Ventricular fibrillation

Answer

Atrial fibrillation

Answer

Atrial extrasystole

Answer

Complete AV block

Question 10

A 46-year-old diabetic man complains of soreness of the left leg. He is moderately obese and had undergone cholecystectomy 2 weeks ago. Examination revealed swelling in the lower leg along with tenderness in the calf that increased when the calf was gently squeezed. No redness of the leg was noted and the patient was afebrile. What is the most likely diagnosis?

Accepted Answer

Deep vein thrombosis

Answer

Cellulitis

Answer

Superficial thrombophlebitis

Answer

Stress fracture

Cardiology — MCQs

Cardiology — MCQs

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