Cardiology Practice Questions

Q: Which of the following is NOT a feature of Atrial Septal Defect?

Complications include left atrial hypertrophy.. **Explanation:** **1. Why Option A is the Correct Answer (The "NOT" feature):** In an Atrial Septal Defect (ASD), blood shunts from the left atrium to the right atrium due to the pressure gradient. This leads to **volume overload of the Right Atrium (RA) and Right Ventricle (RV)**, eventually causing right-sided chamber enlargement and hypertrophy. The left atrium (LA) does not undergo hypertrophy because it is effectively "decompressed" by the shunt; blood flows out of the LA into the RA rather than being stored under high pressure. Therefore, **Left Atrial Hypertrophy is not a feature of ASD.** **2. Analysis of Incorrect Options:** * **Option B:** ASD is often asymptomatic in childhood. Complications like pulmonary hypertension, atrial arrhythmias, and heart failure typically manifest in the **3rd or 4th decade of life**, making it a late-onset clinical entity. * **Option C:** Because it remains asymptomatic for years, ASD is the **most common** congenital heart disease (CHD) first diagnosed in **adulthood**. (Note: VSD is the most common CHD overall, but most are diagnosed in infancy). * **Option D:** A **wide, fixed split S2** is the pathognomonic physical finding of ASD. The split is "wide" due to delayed closure of the pulmonary valve (RV volume overload) and "fixed" because respiratory changes in venous return are balanced across the defect, keeping the stroke volume constant. **Clinical Pearls for NEET-PG:** * **Most common type:** Ostium Secundum (75%). * **Murmur:** ASD itself is silent. The heard murmur is a **systolic ejection murmur** at the left upper sternal border due to increased flow across the pulmonary valve (relative pulmonary stenosis). * **ECG Findings:** Right axis deviation and RSR' pattern in V1 (Partial RBBB). * **Contraindication:** ASD closure is contraindicated if Eisenmenger syndrome (irreversible pulmonary hypertension) develops.

Q: Which of the following is a BNP analogue?

Nesiritide. **Explanation:** **Correct Answer: B. Nesiritide** Nesiritide is a **recombinant human B-type Natriuretic Peptide (BNP)**. It works by binding to the particulate guanylate cyclase receptor in vascular smooth muscle and endothelial cells, leading to increased intracellular cyclic GMP (cGMP) [1]. This results in potent **vasodilation** (reducing both preload and afterload) and **natriuresis** (excretion of sodium by the kidneys) [1], [2]. It is primarily used in the management of acutely decompensated heart failure (ADHF) with dyspnea at rest. **Analysis of Incorrect Options:** * **A. Eplerenone:** This is a selective **mineralocorticoid receptor antagonist (MRA)**. It is a potassium-sparing diuretic used to reduce mortality in chronic heart failure (HFrEF), but it is not a BNP analogue. * **C. Levosimendan:** This is a **calcium sensitizer** and an inodilator. It increases cardiac contractility by sensitizing troponin C to calcium and causes vasodilation by opening ATP-sensitive potassium channels. * **D. Coenzyme Q:** This is an antioxidant and a component of the mitochondrial electron transport chain. While sometimes used as a supplement in heart failure, it has no structural or functional relation to BNP. **High-Yield Clinical Pearls for NEET-PG:** * **BNP vs. NT-proBNP:** BNP is the active hormone (shorter half-life), while NT-proBNP is the inactive N-terminal fragment (longer half-life, more stable for diagnostic testing). * **Sacubitril/Valsartan (ARNI):** Sacubitril is a **neprilysin inhibitor** that prevents the breakdown of endogenous BNP. Note that BNP levels will rise during ARNI therapy, so NT-proBNP should be used for monitoring instead. * **Nesiritide Side Effects:** The most common side effect is dose-related **hypotension**. It may also be associated with a transient increase in serum creatinine.

Q: Which of the following can detect the volume of infarcted area in acute myocardial infarction?

Thallium scan. The correct answer is **Thallium scan (Thallium-201)**. Thallium-201 is a potassium analogue that is actively taken up by viable myocardial cells via the Na+/K+ ATPase pump. In the setting of an acute myocardial infarction (AMI), necrotic or infarcted tissue lacks blood flow and viable cell membranes, resulting in a "cold spot" (perfusion defect) on the scan [1]. The size and intensity of this defect are directly proportional to the **volume of the infarcted area**, making it a highly sensitive tool for quantifying the extent of myocardial damage. **Why other options are incorrect:** * **Echocardiogram:** While excellent for detecting regional wall motion abnormalities (RWMA) and estimating the Ejection Fraction (EF), it cannot definitively distinguish between acutely infarcted, stunned, or hibernating myocardium [2]. * **Electrocardiogram (ECG):** An ECG identifies the location (e.g., anterior vs. inferior) and the age of the infarct (ST-elevation vs. Q-waves), but it is a poor indicator of the actual volumetric size of the necrosis [4], [5]. * **CPK-MB Levels:** These enzymes indicate the *presence* and *timing* of myocardial injury. While the peak level roughly correlates with infarct size, it is influenced by reperfusion (washout phenomenon) and is less precise for volume measurement than nuclear imaging. **High-Yield Clinical Pearls for NEET-PG:** * **Thallium-201 vs. Technetium-99m Sestamibi:** Thallium is better for viability (redistribution), while Sestamibi is preferred for anatomical imaging due to better energy resolution. * **"Hot Spot" Imaging:** While Thallium shows "cold spots," **Technetium-99m Pyrophosphate** binds to calcium in necrotic cells, creating a "hot spot" (specifically used for infarct aging) [1]. * **Gold Standard:** Cardiac MRI (Delayed Gadolinium Enhancement) is currently the gold standard for quantifying infarct size [3], but among the given options, Thallium scan is the classic choice.

Q: All of the following murmurs may be heard in patients with aortic regurgitation except?

Pansystolic murmur.. **Explanation:** In Aortic Regurgitation (AR), the primary hemodynamic abnormality is the backflow of blood from the aorta into the left ventricle (LV) during diastole. **1. Why Pansystolic Murmur is the Correct Answer:** A **pansystolic (holosystolic) murmur** is characteristic of regurgitation between chambers with a significant pressure gradient throughout the entire systole, such as **Mitral Regurgitation (MR)** [3], **Tricuspid Regurgitation (TR)**, or **Ventricular Septal Defect (VSD)**. In AR, the pathology occurs during diastole; therefore, a pansystolic murmur is not a feature of isolated aortic regurgitation. **2. Analysis of Other Options:** * **High-pitched decrescendo diastolic murmur (Option A):** This is the **classical murmur of AR** [1]. It is heard best at the left sternal border (3rd/4th intercostal space) with the patient leaning forward in expiration. It represents the high-pressure regurgitant flow from the aorta to the LV [2]. * **Soft, low-pitched mid-diastolic rumbling murmur (Option B):** This is known as the **Austin Flint murmur**. It occurs because the regurgitant jet from the aorta strikes the anterior leaflet of the mitral valve, causing it to partially close and creating "functional" mitral stenosis [1]. * **Mid-systolic ejection flow murmur (Option C):** In chronic AR, the LV stroke volume is significantly increased (due to the added regurgitant volume). This high-volume flow across the aortic valve during systole creates a functional flow murmur [1], even in the absence of true aortic stenosis. **Clinical Pearls for NEET-PG:** * **Duroziez’s sign:** Systolic and diastolic bruits heard over the femoral artery. * **De Musset’s sign:** Head nodding in sync with the heartbeat. * **Corrigan’s Pulse:** "Water-hammer" or collapsing pulse. * **Hill’s Sign:** Popliteal systolic BP > Brachial systolic BP by >20 mmHg (most sensitive clinical sign for severity).

Q: Which of the following statements is FALSE about Takotsubo Cardiomyopathy?

Echocardiographic findings never revert back to normal.. **Takotsubo Cardiomyopathy**, also known as "Broken Heart Syndrome" or "Stress-induced Cardiomyopathy," is a transient cardiac syndrome that mimics an acute coronary syndrome (ACS) [1]. **Why Option D is the Correct (False) Statement:** The hallmark of Takotsubo Cardiomyopathy is its **reversibility**. Unlike a typical myocardial infarction where necrosis leads to permanent scarring, the regional wall motion abnormalities (RWMA) in Takotsubo usually **resolve completely within 1–4 weeks**. Therefore, echocardiographic findings do revert to normal as the myocardium recovers from "stunning." **Analysis of Other Options:** * **Option A (True):** The pathophysiology is driven by a **massive surge in catecholamines** (epinephrine/norepinephrine) triggered by intense emotional or physical stress. This leads to microvascular dysfunction or direct myocyte toxicity [3]. * **Option B (True):** It involves transient **LV contractile dysfunction**, typically manifesting as "apical ballooning" where the apex is akinetic/hypokinetic while the base remains hypercontractile [2]. * **Option C (True):** Patients most commonly present with **acute retrosternal chest pain** and dyspnea, often accompanied by ST-segment elevation on ECG and elevated cardiac biomarkers, making it indistinguishable from an MI at presentation [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in **post-menopausal women** following a stressful trigger. * **Echocardiography:** Classic finding is **Apical Ballooning** (resembling a Japanese octopus trap, or "Takotsubo"). * **Coronary Angiography:** Crucial for diagnosis; it typically shows **absence of obstructive coronary artery disease** or acute plaque rupture. * **Prognosis:** Generally excellent with supportive care, though complications like heart failure or arrhythmias can occur in the acute phase [1].

Q: A female patient complains of chest pain while waking up in the morning. Pain is more in winter months. Which of the following best describes this patient?

Ach-induced coronary vasoconstriction. ***Ach-induced coronary vasoconstriction***- This clinical presentation—chest pain at rest (especially in the morning hours) and exacerbation during winter months (due to cold exposure)—is the hallmark of **Variant (Prinzmetal's) angina**, which is caused by transient **coronary vasospasm**. [1]- The mechanism involves underlying endothelial dysfunction leading to hyperreactivity of coronary smooth muscle, which can be demonstrated via provoked spasm using agents like **Acetylcholine (ACh)** during diagnostic tests. [1]*Fixed plaque obstruction*- This pathology defines **Stable Angina**, where chest pain is typically predictable and primarily brought on by physical **exertion** when myocardial oxygen demand exceeds fixed supply. [1]- Stable angina rarely occurs exclusively at rest upon waking and does not typically exhibit marked seasonal variation associated with **vasospasm** triggers like cold.*Subendocardial ischemia due to increased demand of myocardium*- Demand ischemia results from factors that increase myocardial workload (e.g., high heart rate, exercise), leading to supply-demand mismatch, which is minimized during rest/sleep. [1]- Prinzmetal's angina is a *supply* problem (vasospasm) causing acute, severe **transmural ischemia**, often presenting with transient **ST elevation** on ECG, differentiating it from typical subendocardial demand ischemia.*Increased sympathomimetic drive in morning hours*- While the natural circadian rhythm involves an increase in sympathetic tone upon waking, potentially triggering cardiac events, this does not describe the specific mechanism of the chest pain.- The symptoms described are most diagnostic of **Prinzmetal's angina**, a distinct disorder defined by localized arterial hyperreactivity rather than general sympathetic increase.

Question 1

Which of the following is NOT a feature of Atrial Septal Defect?

Accepted Answer

Complications include left atrial hypertrophy.

Answer

Complications due to ASD are of late onset.

Answer

Most common congenital heart disease presenting in adult age.

Answer

Wide fixed split in the second heart sound.

Question 2

Which of the following is a BNP analogue?

Accepted Answer

Nesiritide

Answer

Eplerenone

Answer

Levosimendan

Answer

Coenzyme Q

Question 3

A gradient between pulmonary artery wedge pressure and left ventricular end-diastolic pressure is seen in which of the following conditions?

Accepted Answer

Left atrial myxoma

Answer

Aortic regurgitation

Answer

Constrictive pericarditis

Answer

Pulmonary thromboembolism

Question 4

Rescue PCI is indicated for which of the following conditions?

Accepted Answer

Persistent chest pain with ST elevation more than 90 minutes after thrombolysis

Answer

Persistent chest pain with ST elevation more than 60 minutes after thrombolysis

Answer

Persistent chest pain with ST elevation more than 30 minutes after thrombolysis

Answer

Persistent chest pain with ST elevation more than 120 minutes after thrombolysis

Question 5

Which of the following can detect the volume of infarcted area in acute myocardial infarction?

Accepted Answer

Thallium scan

Answer

Echocardiogram

Answer

Electrocardiogram

Answer

Levels of Creatine Phosphokinase-MB (CPK-MB)

Question 6

All of the following murmurs may be heard in patients with aortic regurgitation except?

Accepted Answer

Pansystolic murmur.

Answer

High-pitched decrescendo diastolic murmur.

Answer

Soft, low-pitched mid-diastolic rumbling murmur.

Answer

Mid-systolic ejection flow murmur.

Question 7

Which of the following is NOT a manifestation of acute aortic dissection?

Accepted Answer

Mitral regurgitation

Answer

Pericardial effusion

Answer

Aortic regurgitation

Answer

Acute myocardial infarction

Question 8

Which of the following statements is FALSE about Takotsubo Cardiomyopathy?

Accepted Answer

Echocardiographic findings never revert back to normal.

Answer

It is due to major catecholamine discharge.

Answer

It involves left ventricular contractile dysfunction.

Answer

It presents with acute chest pain.

Question 9

A 39-year-old male with symptoms of stress and work-life imbalance is diagnosed with Stage 2 hypertension (blood pressure 150/95 mmHg on three separate occasions) and impaired fasting glucose (120 mg/dL). What is the most appropriate pharmacological management?

Accepted Answer

Start telmisartan

Answer

Start thiazide diuretic

Answer

Advise rest only, no pharmacological treatment

Answer

Start glucocorticoids

Question 10

A female patient complains of chest pain while waking up in the morning. Pain is more in winter months. Which of the following best describes this patient?

Accepted Answer

Ach-induced coronary vasoconstriction

Answer

Fixed plaque obstruction

Answer

Increased sympathomimetic drive in morning hours

Answer

Subendocardial ischemia due to increased demand of myocardium

Cardiology — MCQs

Cardiology — MCQs

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