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 32-year-old man has palpitations and presents with an irregular, very rapid wide-complex tachycardia of 220 per minute with varying QRS morphology. His resting ECG earlier showed a short PR and a delta wave. He is haemodynamically stable. Which drug should be avoided?

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

The answer and the reasoning

C. Intravenous verapamil

Pre-excited atrial fibrillation in Wolff-Parkinson-White syndrome conducts rapidly down the accessory pathway. AV nodal blockers such as verapamil, diltiazem, adenosine, digoxin and beta-blockers can promote conduction through the accessory pathway and may precipitate ventricular fibrillation. Procainamide or ibutilide slow the pathway, and DC cardioversion is used if unstable.

Option by option

  • A. Synchronised DC cardioversion

    Cardioversion is the safe treatment, especially if unstable.

  • B. Intravenous procainamide

    Procainamide slows conduction in the accessory pathway and is an accepted option.

  • C. Intravenous verapamil (correct)

    Correct. AV nodal blockade favours accessory pathway conduction and can cause VF.

  • D. Intravenous ibutilide

    Ibutilide is an acceptable option as it prolongs refractoriness of the pathway.

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 C, Intravenous verapamil. Pre-excited atrial fibrillation in Wolff-Parkinson-White syndrome conducts rapidly down the accessory pathway.

Why is "Synchronised DC cardioversion" not the answer?

Cardioversion is the safe treatment, especially if unstable.

Why is "Intravenous procainamide" not the answer?

Procainamide slows conduction in the accessory pathway and is an accepted option.

Why is "Intravenous ibutilide" not the answer?

Ibutilide is an acceptable option as it prolongs refractoriness of the pathway.

What concept does this question test?

It tests Cardiology in General Medicine. AV nodal blockers such as verapamil, diltiazem, adenosine, digoxin and beta-blockers can promote conduction through the accessory pathway and may precipitate ventricular fibrillation. Procainamide or ibutilide slow the pathway, and DC cardioversion is used if unstable.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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.