Cardiology Practice Questions

Q: Duroziez sign is seen in which of the following conditions?

Aortic regurgitation. **Explanation:** **Duroziez’s sign** is a classic peripheral vascular sign of **Aortic Regurgitation (AR)** [1]. It is characterized by a "double murmur" heard over a large peripheral artery (usually the femoral artery) when it is compressed with a stethoscope. * **Mechanism:** When the stethoscope diaphragm is tilted proximally (towards the heart), a systolic murmur is heard due to rapid forward flow. When tilted distally (away from the heart), a **diastolic murmur** is heard. This diastolic component is the hallmark of AR, caused by the rapid backward flow (retrograde) of blood toward the heart during diastole due to the incompetent aortic valve [1]. **Analysis of Incorrect Options:** * **B. Aortic Stenosis:** Characterized by a narrow pulse pressure and slow-rising pulse (*pulsus parvus et tardus*). There is no retrograde flow in diastole to produce Duroziez’s sign. * **C & D. Mitral Stenosis/Regurgitation:** These are left-sided valvular lesions that do not typically result in the hyperdynamic peripheral circulatory states or significant retrograde arterial flow required to produce this sign. **High-Yield Clinical Pearls for NEET-PG:** * **Hyperdynamic Circulation:** AR is associated with a wide pulse pressure [2]. Other eponymous signs include: * **Corrigan’s Pulse:** "Water-hammer" or collapsing pulse [2]. * **de Musset’s Sign:** Head nodding in sync with the heartbeat [2]. * **Quincke’s Pulse:** Capillary pulsations in the nail bed. * **Traube’s Sign:** "Pistol shot" sounds heard over the femoral artery. * **Hill’s Sign:** Popliteal systolic BP > Brachial systolic BP by >20 mmHg (most sensitive sign for AR severity). * **Auscultation:** AR typically presents with an early diastolic, decrescendo murmur heard best at the left 3rd intercostal space [1].

Q: A patient develops sudden palpitation with HR 150/min, regular. What could be the cause?

PSVT. ### Explanation The clinical presentation of sudden-onset palpitations with a regular heart rate of exactly 150 bpm is a classic description of **Paroxysmal Supraventricular Tachycardia (PSVT)**. **1. Why PSVT is the Correct Answer:** PSVT (most commonly AVNRT) is characterized by a sudden ("paroxysmal") start and finish [3]. It typically presents with a very regular rhythm and a heart rate ranging from 120 to 240 bpm [1]. The "sudden" nature of the palpitations is the key clinical differentiator from sinus tachycardia, which usually has a gradual onset. **2. Analysis of Incorrect Options:** * **Sinus Tachycardia:** This is a physiological response to stress, fever, or exercise. It has a **gradual onset and offset** (warm-up and cool-down effect) rather than a sudden start. * **Ventricular Tachycardia (VT):** While regular, VT usually presents in patients with underlying structural heart disease (e.g., old MI) and is often associated with hemodynamic instability (hypotension/shock) [4]. While possible, PSVT is the more common "textbook" answer for stable, sudden palpitations in a general context. * **Atrial Flutter with Block:** Atrial flutter typically has an atrial rate of 300 bpm. With a common 2:1 conduction block, the ventricular rate is often exactly **150 bpm**. However, the "sudden" onset is more characteristic of the re-entrant mechanism of PSVT [2]. **3. NEET-PG High-Yield Pearls:** * **First-line Management:** Vagal maneuvers (Modified Valsalva). * **Drug of Choice (DOC):** **Adenosine** (6mg → 12mg rapid IV push). It works by slowing conduction through the AV node. * **ECG Finding:** Narrow QRS complex tachycardia with absent or retrograde P-waves [1]. * **Definitve Treatment:** Radiofrequency Ablation (RFA) of the slow pathway. * **Prophylaxis:** Calcium channel blockers (Verapamil/Diltiazem) or Beta-blockers.

Q: What is the most appropriate intervention for acute myocardial infarction?

Early primary coronary intervention. **Explanation:** The management of acute ST-elevation myocardial infarction (STEMI) focuses on the rapid restoration of coronary blood flow to salvage myocardium. **Primary Percutaneous Coronary Intervention (PCI)** is the gold standard and most appropriate intervention when performed within 90–120 minutes of first medical contact [1]. **Why Option C is correct:** Primary PCI (angioplasty with or without stenting) is superior to fibrinolysis (thrombolysis) because it achieves higher rates of "TIMI 3 flow" (complete reperfusion), carries a lower risk of intracranial hemorrhage, and significantly reduces the rates of re-infarction and mortality [1]. **Why other options are incorrect:** * **Options A, B, and D:** These involve **Streptokinase**, a first-generation fibrinolytic agent. While fibrinolysis is an alternative if PCI is unavailable within the recommended timeframe, it is pharmacologically inferior to PCI [1]. Furthermore, Streptokinase is non-fibrin-specific and carries a higher risk of systemic bleeding and allergic reactions compared to newer agents like Tenecteplase. While Aspirin and Heparin are essential *adjuncts* in STEMI management, they do not replace the need for definitive mechanical reperfusion (PCI). **High-Yield Clinical Pearls for NEET-PG:** * **Door-to-Balloon Time:** Should be **<90 minutes** (at a PCI-capable hospital) or **<120 minutes** (if transfer is required). * **Door-to-Needle Time:** If PCI is not possible within 120 minutes, fibrinolysis should be initiated within **30 minutes**. * **Absolute Contraindications to Fibrinolysis:** Prior intracranial hemorrhage, known structural cerebrovascular lesion, ischemic stroke within 3 months, or active internal bleeding. * **Drug of Choice:** Tenecteplase is now preferred over Streptokinase due to its fibrin specificity and bolus administration [1].

Q: What is the abnormality shown in the ECG?

Premature ventricular contractions. ***Premature ventricular contractions*** - Characterized by **wide, bizarre QRS complexes** (>120 ms) with **no preceding P wave**, indicating ventricular origin. - Followed by a **compensatory pause** before the next normal beat, distinguishing them from other arrhythmias. *Sine wave pattern* - Associated with **severe hyperkalemia** (K+ >8-9 mEq/L) showing smooth, undulating waves without distinct P, QRS, or T waves. - Represents a **life-threatening electrolyte abnormality** requiring immediate treatment, not isolated premature beats. *ST segment depression* - Indicates **myocardial ischemia** or **subendocardial injury**, appearing as horizontal or downsloping depression ≥1mm. - Would affect multiple leads consistently in **ischemic patterns**, not present as isolated abnormal beats. *Electrical alternans* - Shows **beat-to-beat variation** in QRS amplitude or axis, typically seen in **pericardial effusion** with cardiac tamponade. - Involves **regular rhythm** with alternating QRS morphology, not premature or ectopic beats.

Q: Pulsus bisferiens is best felt in which artery?

Radial artery. **Explanation:** **Pulsus bisferiens** (or biphasic pulse) is characterized by two strong systolic peaks separated by a mid-systolic dip. It is classically seen in conditions like **Aortic Regurgitation (AR)**, **Combined Aortic Stenosis and Regurgitation (AS+AR)**, and **Hypertrophic Obstructive Cardiomyopathy (HOCM)**. **Why Radial Artery is the Correct Answer:** While central pulses (like the carotid) are better for assessing the *volume* and *character* of most pulses [2], **Pulsus bisferiens is best appreciated in peripheral arteries, specifically the radial or brachial artery.** This is because the double peak is often accentuated as the pressure wave travels peripherally. In clinical practice and standard medical examinations (like NEET-PG), the radial artery is cited as the most accessible and reliable site to palpate these two distinct systolic waves. **Analysis of Incorrect Options:** * **A. Carotid Artery:** Though the carotid is ideal for assessing *Pulsus Parvus et Tardus* (Aortic Stenosis), the rapid, forceful double-peak of bisferiens is often too brisk to distinguish clearly in the neck; it is better felt distally. * **B. Brachial Artery:** While it can be felt here, the radial artery is the conventional textbook answer for the "best" site of palpation for this specific finding. * **D. Femoral Artery:** This is used to check for radio-femoral delay (Coarctation of Aorta) but is not the preferred site for bisferiens [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** The first peak is the 'percussion wave' (rapid ejection), and the second is the 'tidal wave' (reflected wave). * **Differentiating HOCM vs. AR:** In HOCM, the pulse is "Spike and Dome," whereas in AR, both peaks are usually sharp [1]. * **Pulsus Alternans:** Best felt in the **Radial artery** (seen in Left Ventricular Failure). * **Pulsus Paradoxus:** Best assessed using a **Sphygmomanometer** (seen in Cardiac Tamponade).

Q: Which of the following is the best predictor of cardiovascular risk?

C-reactive protein (CRP). **Explanation:** The correct answer is **C-reactive protein (CRP)**, specifically measured via high-sensitivity assays (**hs-CRP**). **1. Why CRP is the best predictor:** Atherosclerosis is now recognized as a chronic inflammatory process rather than just a lipid-storage disease. [1] hs-CRP is an acute-phase reactant produced by the liver in response to Interleukin-6. [2] It serves as a stable, systemic marker of low-grade vascular inflammation. Large-scale clinical trials (e.g., the JUPITER trial) have demonstrated that hs-CRP is a powerful independent predictor of myocardial infarction, stroke, and peripheral arterial disease, often providing more prognostic value than LDL cholesterol levels alone. **2. Analysis of Incorrect Options:** * **Antichlamydial antibody (A):** While *Chlamydia pneumoniae* has been found in atherosclerotic plaques, clinical trials using antibiotics have failed to reduce cardiovascular events. It is not a reliable or standard predictor of risk. * **Lipoprotein (a) (B):** Lp(a) is an independent genetic risk factor for CAD and aortic stenosis. [3] However, it is not as widely used or as strong a dynamic predictor of overall cardiovascular risk in the general population compared to hs-CRP. * **Homocysteine (D):** Elevated homocysteine (hyperhomocysteinemia) is associated with endothelial damage. However, lowering homocysteine levels with B-vitamins has not consistently shown a reduction in cardiovascular events, making it a weaker predictor than inflammatory markers. **High-Yield Clinical Pearls for NEET-PG:** * **hs-CRP Risk Stratification:** * 3 mg/L: High Risk * **Metabolic Syndrome:** hs-CRP is often elevated in patients with obesity and insulin resistance, further compounding their CV risk. * **Statin Therapy:** Statins not only lower LDL but also significantly reduce hs-CRP levels (pleiotropic effect).

Q: A patient with acute inferior wall myocardial infarction has developed shock. Which of the following is the most likely cause of shock?

Right ventricular infarction. **Explanation:** **Right Ventricular Infarction (RVI)** is the most common cause of shock specifically associated with an **acute inferior wall myocardial infarction (MI)**. In RVI, the right ventricle fails as a pump, leading to decreased preload for the left ventricle, resulting in hypotension and cardiogenic shock [1]. This occurs because the Right Coronary Artery (RCA) typically supplies both the inferior wall of the left ventricle and the right ventricle. **Why the other options are incorrect:** * **Cardiac Rupture (Free Wall):** Usually occurs 3–7 days post-MI and leads to rapid cardiac tamponade and sudden death, rather than isolated shock in the acute phase [2]. * **Interventricular Septal Perforation (VSD):** A mechanical complication occurring 3–5 days post-MI. While it causes shock, it is characterized by a new harsh pansystolic murmur and left-to-right shunt, and is less frequent than RVI in the immediate acute setting. * **Papillary Muscle Rupture:** Typically involves the posteromedial papillary muscle (supplied by the RCA). It causes acute, severe mitral regurgitation and pulmonary edema. While it causes shock, the presence of "clear lungs" in the question stem (implied by typical RVI presentations) points away from this. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad of RVI:** Hypotension, Clear Lungs, and Elevated JVP (Kussmaul’s sign may be present). * **Diagnosis:** ST-segment elevation in right-sided leads (especially **V4R**). * **Management:** The mainstay is **aggressive IV fluids** to maintain RV preload. **Avoid nitrates, diuretics, and morphine**, as they reduce preload and can worsen hypotension.

Question 1

Duroziez sign is seen in which of the following conditions?

Accepted Answer

Aortic regurgitation

Answer

Aortic stenosis

Answer

Mitral stenosis

Answer

Mitral regurgitation

Question 2

A patient develops sudden palpitation with HR 150/min, regular. What could be the cause?

Accepted Answer

PSVT

Answer

Sinus tachycardia

Answer

Ventricular tachycardia

Answer

Atrial flutter with block

Question 3

What is the most appropriate intervention for acute myocardial infarction?

Accepted Answer

Early primary coronary intervention

Answer

Streptokinase

Answer

Streptokinase and aspirin

Answer

Streptokinase and heparin

Question 4

What are the absolute contraindications for fibrinolytic therapy?

Accepted Answer

All of the above

Answer

Prior intracranial hemorrhage

Answer

Ischemic stroke within 3 months

Answer

Suspected aortic dissection

Question 5

What is the abnormality shown in the ECG?

Accepted Answer

Premature ventricular contractions

Answer

Sine wave pattern

Answer

ST segment depression

Answer

Electrical alternans

Question 6

Pulsus bisferiens is best felt in which artery?

Accepted Answer

Radial artery

Answer

Carotid artery

Answer

Brachial artery

Answer

Femoral artery

Question 7

Which of the following arrhythmias is most frequent in Holiday Heart Syndrome?

Accepted Answer

Atrial Fibrillation

Answer

Atrial Flutter

Answer

Ventricular Premature Depolarization

Answer

Ventricular Tachycardia

Question 8

Which of the following is the best predictor of cardiovascular risk?

Accepted Answer

C-reactive protein (CRP)

Answer

Antichlamydial antibody

Answer

Lipoprotein (a)

Answer

Homocysteine

Question 9

A 73-year-old man has angina pectoris on exertion, but an angiogram reveals noncritical stenosis of the coronary arteries. This clinical presentation is most frequently associated with which of the following valvular heart diseases?

Accepted Answer

Aortic stenosis

Answer

Mitral stenosis

Answer

Mitral insufficiency

Answer

Pulmonary stenosis

Question 10

A patient with acute inferior wall myocardial infarction has developed shock. Which of the following is the most likely cause of shock?

Accepted Answer

Right ventricular infarction

Answer

Cardiac rupture

Answer

Interventricular septal perforation

Answer

Papillary muscle rupture

Cardiology — MCQs

Cardiology — MCQs

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