Cardiology Practice Questions

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: The normal electrical axis of the heart is best described as being between which of the following ranges?

-30 degrees to +110 degrees. The electrical axis of the heart represents the net direction of ventricular depolarization (the mean QRS vector) in the frontal plane [1]. In a healthy adult, the heart is positioned such that the majority of the electrical activity travels downward and to the left. **1. Why Option A is Correct:** The standard physiological range for a **normal axis is -30° to +90° or +110°** [1]. While some textbooks define it strictly up to +90°, most clinical guidelines (including those followed by NEET-PG) extend the normal range to +110° to account for vertical heart positions often seen in thin individuals. **2. Analysis of Incorrect Options:** * **Option B (+30° to -110°):** This range is anatomically incorrect as it spans through the "no man's land" (extreme axis) and the superior quadrants. * **Option C (-30° to -110°):** This defines **Left Axis Deviation (LAD)** [1]. Common causes include Left Anterior Fascicular Block (LAFB), inferior wall MI, and LVH. * **Option D (+90° to +110°):** This is a very narrow subset of the normal range. Values beyond +110° (e.g., +120°) would constitute **Right Axis Deviation (RAD)** [1], seen in RVH, PE, or Left Posterior Fascicular Block (LPFB). **High-Yield Clinical Pearls for NEET-PG:** * **Quick Look Method:** If QRS is positive in Lead I and Lead II, the axis is normal. * **Left Axis Deviation (-30° to -90°):** Look for "Leaves" (Lead I positive, Lead aVF negative). * **Right Axis Deviation (+110° to +180°):** Look for "Reaching" (Lead I negative, Lead aVF positive). * **Extreme Axis (-90° to -180°):** Also called "Northwest Axis," often seen in Ventricular Tachycardia or severe hyperkalemia.

Question 1

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 2

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 3

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 4

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 5

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 6

Which of the following conditions is most commonly associated with heart failure with preserved ejection fraction?

Accepted Answer

Restrictive cardiomyopathy

Answer

Dilated cardiomyopathy

Answer

Myocardial infarction

Answer

Hypertension

Question 7

The normal electrical axis of the heart is best described as being between which of the following ranges?

Accepted Answer

-30 degrees to +110 degrees

Answer

+30 degrees to -110 degrees

Answer

-30 degrees to -110 degrees

Answer

+90 degrees to +110 degrees

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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