NEET-PG 2017 Previous Year Questions Practice Questions

Q: Which of the following finding is shown in the chest leads?

Digoxin. ***Digoxin*** - The ECG shows a characteristic **downward sloping ST segment depression** with a "sagging" or "scooped" appearance, often referred to as a **"Salvador Dali mustache"** appearance, which is typical of digoxin effect on the ECG. - This pattern is due to the drug's effect on **myocardial repolarization**, specifically shortening the QT interval and inducing these ST changes, even in the absence of toxicity. *Myocardial ischemia* - Myocardial ischemia typically manifests as **ST segment depression** that is **horizontal** or **downsloping** but usually not with the characteristic "scooped" appearance seen with digoxin. - T-wave inversions may also be present, which are not the primary finding here. *Myocardial injury* - Acute myocardial injury is characterized by **ST segment elevation** (in acute myocardial infarction) or **significant ST depression with T-wave inversions** (in NSTEMI) which differs from the morphology seen in this ECG. - The morphology of the ST segment in myocardial injury is usually more abrupt and not "scooped" like a digoxin effect. *Digoxin toxicity* - While this ECG shows a digoxin effect, **digoxin toxicity** usually presents with **arrhythmias** (e.g., ventricular premature beats, bradycardia, AV blocks) in addition to altered ST-T wave morphology. - The ECG alone, showing only repolarization changes characteristic of digoxin, does not confirm toxicity without clinical correlation or evidence of arrhythmias. [Practice more NEET-PG 2017 questions on OnCourse]

Q: A 70-year-old hypertensive woman presents with dyspnea, nausea and feeling of impending doom. ECG shows:

Myocardial infarction. ***Myocardial infarction*** - The ECG shows **ST-segment elevations** in leads V1, V2, V3, and V4, indicating an anterior myocardial infarction. - The patient's symptoms of dyspnea, nausea, and a feeling of impending doom are classic for an **acute coronary syndrome**, especially in an older hypertensive woman. - The ST elevation is **localized to contiguous leads** (precordial leads V1-V4), which is characteristic of **acute MI** rather than diffuse changes. *PSVT* - **Paroxysmal supraventricular tachycardia (PSVT)** is characterized by a narrow complex tachycardia with a regular rhythm and typically absent or retrograde P waves. - The ECG clearly shows **sinus rhythm** with visible P waves and significant ST changes, which are not features of PSVT. *Prinzmetal angina* - **Prinzmetal angina** (variant angina) is characterized by transient **ST-segment elevation** due to coronary artery spasm, occurring at rest. - While it can cause ST elevation, the persistent and widespread nature of the ST elevation in multiple precordial leads makes an **acute myocardial infarction** more likely, especially with the patient's severe symptoms. *Normal tracing* - A **normal ECG** would not show any significant ST-segment changes, T-wave inversions, or pathological Q waves. - The presented ECG clearly demonstrates significant **ST-segment elevations** in several leads, indicating an acute cardiac event. *Pericarditis* - **Acute pericarditis** can cause ST-segment elevation, but typically presents with **diffuse ST elevations** across multiple leads (including limb leads) with **PR depression**. - The ST elevations in pericarditis are typically **concave upward** (saddle-shaped), whereas MI shows **convex ST elevations**. - The **localized ST elevation** in the precordial leads without widespread changes makes MI more likely than pericarditis. [Practice more NEET-PG 2017 questions on OnCourse]

Question 1

Which of the following finding is shown in the chest leads?

Accepted Answer

Digoxin

Answer

Myocardial ischemia

Answer

Myocardial injury

Answer

Digoxin toxicity

Question 2

A hypertensive 50-year-old patient presents with diffuse chest pain at rest for 1 hour. CPK-MB is normal and ECG is given below. Which of the following is correct?

Accepted Answer

Unstable angina

Answer

Coronary artery dissection

Answer

Hibernating myocardium

Answer

Normal tracing

Answer

NSTEMI

Question 3

ECG of a patient had ST segment elevation in V1-V6, lead I and AVL. Which of the following branches is involved?

Accepted Answer

1

Answer

2

Answer

3

Answer

4

Answer

5

Question 4

A 70-year-old hypertensive woman presents with dyspnea, nausea and feeling of impending doom. ECG shows:

Accepted Answer

Myocardial infarction

Answer

PSVT

Answer

Prinzmetal angina

Answer

Normal tracing

Answer

Pericarditis

Question 5

A 35-year-old lady has been diagnosed with anxiety neurosis by her psychiatrist. She came to you for second opinion. Comment on the diagnosis based on ECG.

Accepted Answer

WPW syndrome

Answer

Sinus tachycardia

Answer

Multifocal atrial tachycardia

Answer

Atrial fibrillation

Answer

Supraventricular tachycardia

Question 6

Cannon A waves are seen in the JVP of a patient. ECG shows:

Accepted Answer

Third degree heart block

Answer

First degree heart block

Answer

Second degree heart block

Answer

Mobitz II heart block

Question 7

A patient develops missed beats after thrombolysis for MI. ECG shows:

Accepted Answer

Mobitz I heart block

Answer

Mobitz II heart block

Answer

Complete heart block

Answer

Sick sinus syndrome

Question 8

A marathon runner develops occasional missed beats. ECG shows:

Accepted Answer

Wenckebach phenomenon

Answer

Mobitz II heart block

Answer

Complete heart block

Answer

Sinus bradycardia

Answer

First-degree AV block

Question 9

A 68-year-old postoperative patient who has undergone thyroidectomy presents with muscle cramps. ECG shows?

Accepted Answer

Prolonged QT interval

Answer

Short QT interval

Answer

ST elevation

Answer

ST depression

Question 10

The given ECG of a neonate born to a mother with SLE shows?

Accepted Answer

Complete heart block

Answer

Mobitz I heart block

Answer

Mobitz II heart block

Answer

Sick sinus syndrome

NEET-PG 2017

Internal Medicine

Pediatrics