Q.1 Which of the following is the most common cause of myocardial infarction?
Atherosclerosis
Hypertension
Vasculitis
Coronary artery spasm
Explanation - Atherosclerotic plaque rupture with subsequent thrombosis is the most common cause of myocardial infarction.
Correct answer is: Atherosclerosis
Q.2 Which heart sound is associated with mitral stenosis?
S1 accentuation
Wide splitting of S2
S3 gallop
Fixed split of S2
Explanation - Mitral stenosis leads to delayed closure of the mitral valve, causing a loud S1.
Correct answer is: S1 accentuation
Q.3 Which valve is most commonly affected in infective endocarditis among intravenous drug users?
Aortic valve
Mitral valve
Pulmonic valve
Tricuspid valve
Explanation - In IV drug users, bacteria directly enter the venous system and first affect the tricuspid valve.
Correct answer is: Tricuspid valve
Q.4 Which ECG finding is most characteristic of atrial fibrillation?
Sawtooth waves
Absent P waves with irregular rhythm
ST elevation
U waves
Explanation - Atrial fibrillation is identified by absent P waves and irregularly irregular ventricular rhythm.
Correct answer is: Absent P waves with irregular rhythm
Q.5 Which drug is used as a first-line therapy in chronic stable angina?
Beta-blockers
Digoxin
Amiodarone
Loop diuretics
Explanation - Beta-blockers reduce myocardial oxygen demand and are first-line in chronic stable angina management.
Correct answer is: Beta-blockers
Q.6 Which of the following is a modifiable risk factor for coronary artery disease?
Age
Male sex
Hypertension
Family history
Explanation - Hypertension is a modifiable risk factor, unlike age, sex, and genetics.
Correct answer is: Hypertension
Q.7 What is the most common cause of secondary hypertension?
Renal artery stenosis
Hyperthyroidism
Cushing’s syndrome
Pheochromocytoma
Explanation - Renal artery stenosis causes secondary hypertension via activation of the renin-angiotensin system.
Correct answer is: Renal artery stenosis
Q.8 What is the most sensitive cardiac biomarker for myocardial infarction?
CK-MB
Troponin I/T
LDH
Myoglobin
Explanation - Cardiac troponins are highly specific and sensitive for myocardial injury.
Correct answer is: Troponin I/T
Q.9 Which of the following murmurs increases in intensity with inspiration?
Mitral regurgitation
Aortic stenosis
Tricuspid regurgitation
Mitral stenosis
Explanation - Right-sided murmurs like tricuspid regurgitation increase with inspiration (Carvallo’s sign).
Correct answer is: Tricuspid regurgitation
Q.10 Which condition is associated with pulsus paradoxus?
Aortic stenosis
Cardiac tamponade
Hypertrophic cardiomyopathy
Atrial fibrillation
Explanation - Pulsus paradoxus is a marked fall in systolic BP during inspiration, seen in cardiac tamponade.
Correct answer is: Cardiac tamponade
Q.11 Which antihypertensive is contraindicated in pregnancy?
Methyldopa
Labetalol
ACE inhibitors
Hydralazine
Explanation - ACE inhibitors are teratogenic and contraindicated in pregnancy.
Correct answer is: ACE inhibitors
Q.12 Which type of heart failure is characterized by preserved ejection fraction?
Systolic heart failure
Diastolic heart failure
High-output failure
Right-sided failure
Explanation - Diastolic failure is due to impaired relaxation and filling but preserved contractility.
Correct answer is: Diastolic heart failure
Q.13 Which artery is most commonly involved in an anterior wall myocardial infarction?
Right coronary artery
Circumflex artery
Left anterior descending artery
Posterior descending artery
Explanation - The LAD supplies the anterior wall and is the most common site for occlusion in MI.
Correct answer is: Left anterior descending artery
Q.14 Which of the following is the most common congenital heart disease?
Tetralogy of Fallot
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Explanation - VSD is the most common congenital heart defect, often presenting with a pansystolic murmur.
Correct answer is: Ventricular septal defect
Q.15 Which condition is associated with a water hammer pulse?
Aortic regurgitation
Mitral regurgitation
Aortic stenosis
Tricuspid regurgitation
Explanation - Aortic regurgitation causes bounding peripheral pulses due to wide pulse pressure.
Correct answer is: Aortic regurgitation
Q.16 Which of the following drugs reduces mortality in chronic heart failure?
Furosemide
Digoxin
ACE inhibitors
Nifedipine
Explanation - ACE inhibitors reduce afterload and have proven mortality benefit in heart failure.
Correct answer is: ACE inhibitors
Q.17 What is the target LDL level for high-risk cardiovascular patients?
<160 mg/dL
<130 mg/dL
<100 mg/dL
<70 mg/dL
Explanation - For very high-risk patients, LDL should be reduced below 70 mg/dL.
Correct answer is: <70 mg/dL
Q.18 Which electrolyte disturbance predisposes to digoxin toxicity?
Hyperkalemia
Hypokalemia
Hypernatremia
Hyponatremia
Explanation - Low potassium enhances digoxin binding to Na/K-ATPase, increasing toxicity risk.
Correct answer is: Hypokalemia
Q.19 Which physical finding is classically seen in constrictive pericarditis?
Kussmaul’s sign
Pulsus paradoxus
Wide pulse pressure
Fixed splitting of S2
Explanation - In constrictive pericarditis, jugular venous pressure rises with inspiration (Kussmaul’s sign).
Correct answer is: Kussmaul’s sign
Q.20 Which drug is preferred in rate control of atrial fibrillation with heart failure?
Verapamil
Diltiazem
Beta-blockers
Digoxin
Explanation - Digoxin slows AV node conduction and is safe in heart failure compared to calcium channel blockers.
Correct answer is: Digoxin
Q.21 Which condition shows a paradoxical splitting of the second heart sound?
Aortic stenosis
Left bundle branch block
Right bundle branch block
Pulmonary stenosis
Explanation - Paradoxical splitting occurs when aortic valve closure is delayed, as in LBBB.
Correct answer is: Left bundle branch block
Q.22 Which antihypertensive drug class protects kidneys in diabetic patients?
Thiazides
ACE inhibitors
Beta-blockers
Calcium channel blockers
Explanation - ACE inhibitors reduce intraglomerular pressure and slow diabetic nephropathy progression.
Correct answer is: ACE inhibitors
Q.23 Which of the following is a common side effect of amiodarone?
Hypothyroidism
Hypoglycemia
Hypercalcemia
Hypertension
Explanation - Amiodarone contains iodine and can cause hypothyroidism as a side effect.
Correct answer is: Hypothyroidism
Q.24 Which of the following is the treatment of choice for symptomatic bradycardia?
Atropine
Amiodarone
Adenosine
Digoxin
Explanation - Atropine is an anticholinergic agent used as first-line therapy for bradycardia.
Correct answer is: Atropine
Q.25 Which congenital heart defect is associated with Turner syndrome?
Coarctation of the aorta
VSD
ASD
Tetralogy of Fallot
Explanation - Turner syndrome is strongly associated with coarctation of the aorta.
Correct answer is: Coarctation of the aorta