Cardiology Practice Questions

Q: Buerger disease triad involves all of the following except?

None of the above. **Explanation:** **Thromboangiitis Obliterans (Buerger’s Disease)** is a non-atherosclerotic, segmental, inflammatory disease that most commonly affects small and medium-sized arteries and veins in the extremities. It is strongly associated with heavy tobacco use. The **classic clinical triad** of Buerger’s disease consists of: 1. **Intermittent Claudication:** Usually involving the arch of the foot or the calf, which may progress to rest pain and ischemic ulcerations. 2. **Raynaud’s Phenomenon:** Digital ischemia triggered by cold or emotion (present in about 40% of cases). 3. **Migratory Superficial Thrombophlebitis:** Inflammation of the superficial veins that appears to "move" from one site to another. Since all three options (A, B, and C) are integral components of the diagnostic triad, the correct answer is **D (None of the above)**. **Analysis of Options:** * **Option A:** Raynaud's phenomenon is a frequent early sign of Buerger’s, reflecting small vessel vasospasm. * **Option B:** Migratory superficial thrombophlebitis is a hallmark feature that distinguishes Buerger’s from other forms of peripheral arterial disease (PAD). * **Option C:** Claudication is the most common presenting symptom, often involving the small vessels of the hands and feet (distal distribution). **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Typically affects young males (<45 years) who are heavy smokers. * **Angiographic Finding:** "Corkscrew collaterals" (Martorell’s sign) due to the occlusion of distal vessels. * **Pathology:** Characterized by a highly cellular, "inflammatory" thrombus with **microabscesses**, but the internal elastic lamina remains intact (unlike vasculitis). * **Treatment:** Absolute smoking cessation is the only definitive way to halt disease progression and prevent amputation.

Q: An ECG shows ST elevation in leads V1 and V2. What is the most likely diagnosis?

Hyperkalemia. **Explanation:** **Hyperkalemia** is a classic "great imitator" on ECGs. While the most famous sign is peaked T-waves, severe hyperkalemia can cause a **"pseudo-infarction" pattern**, characterized by ST-segment elevation, particularly in the right precordial leads (**V1 and V2**) [1]. This occurs due to the alteration of the resting membrane potential and the shortening of the action potential duration, which mimics the current of injury seen in myocardial infarction [1]. In clinical practice, if ST elevation is seen alongside a widened QRS complex or absent P-waves, hyperkalemia should be the first suspicion [1]. **Analysis of Incorrect Options:** * **Hypokalemia:** Typically presents with ST-segment depression, flattened or inverted T-waves, and the appearance of prominent **U-waves**. * **Hyperthermia:** While it can cause sinus tachycardia, it does not typically produce focal ST elevation in V1-V2. (Note: *Hypothermia* causes Osborn/J-waves). * **Hypercalcemia:** Characteristically causes **shortening of the QT interval**. It does not typically cause ST elevation. **NEET-PG High-Yield Pearls:** 1. **Sequence of Hyperkalemia ECG changes:** Peaked T-waves → P-wave flattening/PR prolongation → QRS widening (Sine wave pattern) → Ventricular Fibrillation/Asystole [1]. 2. **Treatment Priority:** Intravenous **Calcium Gluconate** is the first-line treatment to stabilize the cardiac membrane, though it does not lower potassium levels. 3. **Brugada Mimicry:** Hyperkalemia can also induce a "Brugada-like" pattern in V1-V2, which resolves once potassium levels are normalized.

Q: What is the most common cause of renal artery stenosis in young females?

Fibromuscular dysplasia. **Explanation:** **Fibromuscular Dysplasia (FMD)** is the most common cause of renal artery stenosis (RAS) in young females (typically aged 15–50). It is a non-inflammatory, non-atherosclerotic vascular disease characterized by abnormal cell growth in the arterial wall. The most common histological subtype is **medial fibroplasia**, which produces the classic **"string of beads"** appearance on angiography due to alternating areas of stenosis and aneurysmal dilation. **Analysis of Incorrect Options:** * **A. Atherosclerosis:** This is the overall most common cause of RAS (approx. 90%), but it typically affects **older males** with cardiovascular risk factors (smoking, diabetes). It usually involves the ostium or proximal third of the renal artery. * **C. Takayasu Arteritis:** While this "pulseless disease" affects young females and can involve the renal arteries, it primarily targets the **aorta and its major branches**. It is an inflammatory large-vessel vasculitis, whereas FMD is a structural dysplasia. * **D. Polycystic Kidney Disease:** This leads to hypertension via cyst expansion and activation of the RAAS system, but it does not cause primary stenosis of the renal arteries. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** FMD is significantly more common in women (9:1 ratio). * **Location:** FMD typically involves the **distal two-thirds** of the renal artery, whereas atherosclerosis involves the **proximal** portion. * **Clinical Clue:** Suspect FMD in a young woman with sudden-onset or resistant hypertension and an epigastric/flank bruit. * **Treatment:** Percutaneous transluminal angioplasty (PTA) **without stenting** is the treatment of choice for FMD. (Note: Stenting is usually required for atherosclerotic RAS).

Q: Bradycardia occurs in all the following conditions except?

Hyperthyroidism. The correct answer is **Hyperthyroidism** because it is a classic cause of **tachycardia**, not bradycardia. [1] **1. Why Hyperthyroidism is the correct answer:** In hyperthyroidism, excess thyroid hormones ($T_3$ and $T_4$) increase the metabolic rate and enhance the heart's sensitivity to catecholamines. This occurs through the up-regulation of beta-adrenergic receptors in the myocardium. The result is an increased heart rate (tachycardia), increased stroke volume, and often atrial fibrillation. [1] **2. Why the other options are incorrect (Causes of Bradycardia):** * **Increased Intracranial Pressure (ICP):** This triggers the **Cushing Reflex**, a physiological nervous system response to increased ICP that presents as a triad of hypertension, irregular breathing, and **bradycardia**. * **Myxedema (Severe Hypothyroidism):** Low levels of thyroid hormones lead to a generalized slowing of metabolic processes, including a decrease in the firing rate of the SA node and reduced sensitivity to catecholamines, resulting in **bradycardia**. * **Normal Sleep:** During sleep, especially in non-REM stages, there is a physiological increase in vagal (parasympathetic) tone and a decrease in sympathetic activity, which naturally lowers the heart rate. **Clinical Pearls for NEET-PG:** * **Relative Bradycardia:** This is a high-yield concept where the pulse is slower than expected for the degree of fever. Common causes include **Typhoid fever (Faget sign)**, Legionella, Yellow fever, and Brucellosis. * **Drugs causing Bradycardia:** Beta-blockers, Calcium channel blockers (Verapamil, Diltiazem), Digoxin, and Amiodarone. * **Electrolytes:** **Hyperkalemia** is a critical cause of bradycardia and heart blocks.

Q: What is true about pseudohypertension?

All of the above.. **Explanation:** **Pseudohypertension** refers to a clinical situation where the blood pressure (BP) measured by a sphygmomanometer is falsely elevated compared to the actual intra-arterial pressure. 1. **Why Option D is Correct:** * **Elderly Population (Option A):** It is most commonly seen in the elderly due to age-related vascular changes. * **Arteriosclerosis (Option C):** The underlying mechanism is severe **arteriosclerosis** (calcification of the tunica media). The brachial artery becomes so rigid and "pipe-like" that the blood pressure cuff cannot easily compress it [1]. To occlude the artery and stop the pulse, the cuff must be inflated to pressures much higher than the actual systolic pressure. * **High Systolic BP (Option B):** While both readings can be affected, a marked elevation in systolic BP is a hallmark. Because the cuff struggles to collapse the stiff vessel wall, the manometer reflects the pressure needed to overcome arterial stiffness rather than the true intraluminal pressure [1]. 2. **Clinical Pearls for NEET-PG:** * **Osler’s Maneuver:** This is the classic physical exam finding for pseudohypertension. It is considered positive if the **radial or brachial artery remains palpable** (though pulseless) even when the BP cuff is inflated above the systolic pressure. * **When to Suspect:** Suspect pseudohypertension in an elderly patient who has very high BP readings but **no evidence of end-organ damage** (e.g., normal fundi, normal LVH on ECG) or who develops symptoms of hypotension (syncope/dizziness) when started on even low-dose antihypertensive therapy. * **Gold Standard Diagnosis:** The definitive way to rule out pseudohypertension is via **direct intra-arterial pressure measurement**.

Question 1

Buerger disease triad involves all of the following except?

Accepted Answer

None of the above

Answer

Raynaud’s Phenomenon

Answer

Thrombophlebitis of migratory superficial vein

Answer

Intermittent Claudication

Question 2

An ECG shows ST elevation in leads V1 and V2. What is the most likely diagnosis?

Accepted Answer

Hyperkalemia

Answer

Hypokalemia

Answer

Hyperthermia

Answer

Hypercalcemia

Question 3

What is the most common cause of renal artery stenosis in young females?

Accepted Answer

Fibromuscular dysplasia

Answer

Atherosclerosis

Answer

Takayasu arteritis

Answer

Polycystic kidney disease

Question 4

A continuous murmur is found in all of the following conditions, EXCEPT:

Accepted Answer

Mitral stenosis with mitral regurgitation

Answer

Patent ductus arteriosus

Answer

Rupture of sinus of Valsalva

Answer

Systemic arteriovenous fistula

Question 5

In cases of sudden death in a young football player, what is the primary clinical suspicion among the following differentials?

Accepted Answer

Arrhythmogenic right ventricular dysplasia

Answer

Takotsubo cardiomyopathy

Answer

Atrial septal defect

Answer

Eisenmenger complex

Question 6

Bradycardia occurs in all the following conditions except?

Accepted Answer

Hyperthyroidism

Answer

Increased intracranial pressure

Answer

Myxedema

Answer

Normal sleep

Question 7

A female has a diastolic blood pressure (DBP) of 100 mm Hg on two consecutive occasions. What is the best initial management?

Accepted Answer

Antihypertensive drugs

Answer

Rest

Answer

Sedation

Answer

Check for error in BP machine

Question 8

A 56-year-old male presents with the sudden onset of excruciating pain. He describes the pain as beginning in the anterior chest, radiating to the back, and then moving downward into the abdomen. His blood pressure is found to be 160/115. ECG shows no changes. An abdominal x-ray reveals a "double-barrel" aorta. This abnormality most likely results from?

Accepted Answer

Loss of elastic tissue in the media

Answer

A microbial infection

Answer

A congenital defect in the wall of the aorta

Answer

Atherosclerosis of the abdominal aorta

Question 9

What is true about pseudohypertension?

Accepted Answer

All of the above.

Answer

It is seen in the elderly.

Answer

Only systolic blood pressure is high.

Answer

Arteriosclerosis is a feature.

Question 10

All right-sided events tend to increase with inspiration, except:

Accepted Answer

Pulmonary ejection click

Answer

Tricuspid stenosis

Answer

Tricuspid regurgitation

Answer

Pulmonic regurgitation

Cardiology — MCQs

Cardiology — MCQs

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