Cardiology: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology

Sample item

A 65-year-old man has palpitations, chest pain and a blood pressure of 80/50 mmHg. His ECG shows irregularly irregular narrow-complex tachycardia at 170 per minute. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Synchronised direct current cardioversion

Tachyarrhythmia with hypotension or chest pain is haemodynamically unstable, and electrical cardioversion is the treatment of choice. The shock is synchronised to the R wave to avoid precipitating ventricular fibrillation. Rate control drugs are for stable patients.

Option by option

  • A. Intravenous digoxin

    Digoxin acts too slowly for an unstable patient.

  • B. Synchronised direct current cardioversion (correct)

    Correct. Prompt synchronised shock restores rhythm in an unstable patient.

  • C. Intravenous adenosine

    Adenosine is used for regular supraventricular tachycardia, not to treat atrial fibrillation.

  • D. Oral beta-blocker and outpatient review

    Oral therapy and review is unsafe in a hypotensive patient.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Synchronised direct current cardioversion. Tachyarrhythmia with hypotension or chest pain is haemodynamically unstable, and electrical cardioversion is the treatment of choice.

Why is "Intravenous digoxin" not the answer?

Digoxin acts too slowly for an unstable patient.

Why is "Intravenous adenosine" not the answer?

Adenosine is used for regular supraventricular tachycardia, not to treat atrial fibrillation.

Why is "Oral beta-blocker and outpatient review" not the answer?

Oral therapy and review is unsafe in a hypotensive patient.

What concept does this question test?

It tests Cardiology in General Medicine. The shock is synchronised to the R wave to avoid precipitating ventricular fibrillation. Rate control drugs are for stable patients.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.