Medicine MCQ Daily

  Question : A 65-year-old man with chronic systolic heart failure (HFrEF) is started on medical therapy. Which of the following drugs has been shown to reduce mortality in HFrEF? Options: A. Furosemide B. Digoxin C. ACE inhibitors (e.g., Enalapril) D. Nitrates alone ✅ Answer: C. ACE inhibitors (e.g., Enalapril) Explanation : HFrEF (EF <40%) management includes drugs that improve survival, reduce hospitalization, and relieve symptoms. ACE inhibitors / ARBs: Reduce mortality and morbidity. Decrease afterload, inhibit maladaptive RAAS activation, reduce LV remodeling. Beta-blockers (e.g., Carvedilol, Metoprolol succinate): Also improve survival in chronic HFrEF. Reduce sympathetic overdrive, prevent arrhythmias, improve EF over time. Mineralocorticoid receptor antagonists (e.g., Spironolactone): Reduce mortality in selected patients with HFrEF (EF ≤35%). Furosemide (loop diuretic): Symptomatic relief (reduces congestion) but does not improve survival. Digoxin : Improves symptoms a...

  Question : A 70-year-old man presents with exertional dyspnea, chest pain, and syncope. On examination, there is a crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids, and delayed carotid upstroke. What is the most likely diagnosis? Options: A. Mitral regurgitation B. Aortic regurgitation C. Aortic stenosis D. Pulmonic stenosis ✅ Answer: C. Aortic stenosis Explanation : Classic triad of aortic stenosis: Exertional dyspnea (most common presenting symptom due to LV hypertrophy and diastolic dysfunction). Angina (due to increased myocardial oxygen demand). Syncope (especially on exertion, due to fixed cardiac output). Physical exam findings : Systolic ejection murmur: Crescendo-decrescendo, best heard at the right upper sternal border, radiates to the carotids. Delayed and diminished carotid upstroke: “Pulsus parvus et tardus”. LV heave may be present due to left ventricular hypertrophy. Pathophysiology : Progressive calcification of the...

  Question : A 58-year-old man presents with sudden severe retrosternal chest pain radiating to the jaw, associated with sweating and nausea. ECG shows ST-segment elevation in leads V1–V4. Which of the following is the most likely diagnosis? Options: A. Inferior wall myocardial infarction B. Lateral wall myocardial infarction C. Anterior wall myocardial infarction D. Pericarditis ✅ Answer: C. Anterior wall myocardial infarction Explanation : Clinical features: Severe retrosternal chest pain radiating to jaw or left arm, sweating, nausea, and vomiting are classic ACS symptoms. ECG interpretation: ST-segment elevation in V1–V4 indicates anterior wall MI, usually due to occlusion of the left anterior descending (LAD) artery. ST elevation in II, III, aVF → inferior MI (RCA occlusion). ST elevation in I, aVL, V5–V6 → lateral MI (LCx or diagonal LAD branch). Management: Immediate reperfusion therapy: primary PCI (preferred) or thrombolysis if PCI not available. Antiplatelet therapy (aspi...

  Question : A 60-year-old man presents with syncope and dizziness. On ECG, there is progressive PR interval prolongation followed by a dropped QRS complex. What is the most likely type of heart block? Options: A. First-degree AV block B. Second-degree AV block Type II C. Second-degree AV block Type I (Mobitz I / Wenckebach) D. Third-degree AV block ✅ Answer: C. Second-degree AV block Type I (Mobitz I / Wenckebach ) Explanation : Mobitz I (Wenckebach) is characterized by progressive prolongation of the PR interval until a QRS complex is dropped. Usually occurs at the AV node level and is often asymptomatic but can cause dizziness or mild syncope in some patients. Mobitz II (Type II): PR interval remains constant before sudden dropped QRS; usually below AV node (His-Purkinje system) and more dangerous, often requiring pacemaker. First-degree AV block: PR interval is prolonged (>200 ms) but no dropped QRS. Third-degree (complete) AV block: No conduction from atria to ventricles; a...

  Question : A 45-year-old woman presents with episodic palpitations, headache, and sweating. On examination, her blood pressure is 180/110 mmHg, and she has tachycardia. Laboratory tests reveal elevated plasma metanephrines. What is the most likely diagnosis? Options: A. Hyperthyroidism B. Essential hypertension C. Pheochromocytoma D. Cushing’s syndrome ✅ Answer: C. Pheochromocytoma Explanation : Clinical triad: episodic headache, palpitations, and sweating are classic for pheochromocytoma, a catecholamine-secreting tumor of the adrenal medulla. Paroxysmal hypertension is common; sustained hypertension may also be seen. Lab findings: elevated plasma or urinary metanephrines confirm catecholamine excess. Differential diagnosis: Hyperthyroidism → palpitations, tachycardia, weight loss, heat intolerance; usually no episodic severe hypertension. Essential hypertension → chronic, not paroxysmal; no catecholamine excess. Cushing’s syndrome → features include central obesity, moon face, ...

 Question: A 55-year-old man presents with dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. On examination, he has bibasal crackles, elevated jugular venous pressure, and an S3 heart sound. Echocardiography shows reduced ejection fraction of 35%. What is the most likely diagnosis? Options: A. Constrictive pericarditis B. Systolic heart failure (HFrEF) C. Diastolic heart failure (HFpEF) D. Restrictive cardiomyopathy ✅ Answer: B. Systolic heart failure (HFrEF) Explanation: This patient has classic symptoms of heart failure: dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Physical signs: bibasal crackles (pulmonary congestion), elevated JVP (right-sided pressure), S3 gallop (ventricular systolic dysfunction). Echocardiography shows reduced ejection fraction (<40%), which defines HFrEF (heart failure with reduced ejection fraction). Diastolic heart failure (HFpEF) typically presents with preserved EF (>50%), often in elderly hypertensive patient...

Question: A patient with chronic hypertension develops LVH (left ventricular hypertrophy) on ECG . Which of the following is the most common type of LVH pattern? Options: A. Concentric hypertrophy B. Eccentric hypertrophy C. Asymmetric septal hypertrophy D. Dilated hypertrophy ✅ Answer: A. Concentric hypertrophy Explanation: Chronic pressure overload (e.g., hypertension) → concentric LVH: thickened walls, normal cavity. Volume overload (e.g., aortic/mitral regurgitation ) → eccentric LVH. References: Harrison’s Principles of Internal Medicine , 21st Edition, Ch. 222; UpToDate: Left ventricular hypertrophy in adults . 

 Question A 60-year-old man presents with sudden severe chest pain radiating to his left arm. ECG shows ST-segment elevation in leads II, III, and aVF . Which coronary artery is most likely occluded? A. Left anterior descending artery (LAD) B. Right coronary artery (RCA) C. Left circumflex artery (LCx) D. Posterior descending artery (PDA) Answer B. Right coronary artery (RCA) Explanation ST elevation in II, III, and aVF indicates an inferior wall myocardial infarction . The RCA typically supplies the inferior wall of the heart. LAD usually causes anterior wall MI (V1–V4), LCx causes lateral wall MI (I, aVL, V5–V6). Early recognition is crucial for reperfusion therapy . Key Point Inferior MI → ST elevation in II, III, aVF → RCA occlusion.