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.

Try it

General Medicine · Cardiology

Sample item

A 22-year-old athlete collapses during sport. Examination reveals a harsh ejection systolic murmur at the left sternal edge that becomes louder on standing or on the Valsalva manoeuvre, and softer on squatting. What is the most likely diagnosis?

AVentricular septal defectBAortic valve stenosisCHypertrophic obstructive cardiomyopathyDMitral regurgitation from prolapse

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

The answer and the reasoning

C. Hypertrophic obstructive cardiomyopathy

In hypertrophic obstructive cardiomyopathy, dynamic left ventricular outflow obstruction intensifies when preload or afterload falls, as with Valsalva or standing. Squatting and handgrip raise preload and afterload and soften the murmur. It is a leading cause of sudden death in young athletes.

Option by option

A. Ventricular septal defect
A ventricular septal defect gives a pansystolic murmur that does not change this way.
B. Aortic valve stenosis
Fixed aortic stenosis murmurs soften with Valsalva because of reduced flow.
C. Hypertrophic obstructive cardiomyopathy (correct)
Correct. A murmur louder on Valsalva and softer on squatting is the hallmark of HOCM.
D. Mitral regurgitation from prolapse
Mitral prolapse murmur also increases on standing but is a late systolic murmur with a click, not an ejection murmur with collapse in an athlete.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Hypertrophic obstructive cardiomyopathy. In hypertrophic obstructive cardiomyopathy, dynamic left ventricular outflow obstruction intensifies when preload or afterload falls, as with Valsalva or standing.

Why is "Ventricular septal defect" not the answer?

A ventricular septal defect gives a pansystolic murmur that does not change this way.

Why is "Aortic valve stenosis" not the answer?

Fixed aortic stenosis murmurs soften with Valsalva because of reduced flow.

Why is "Mitral regurgitation from prolapse" not the answer?

Mitral prolapse murmur also increases on standing but is a late systolic murmur with a click, not an ejection murmur with collapse in an athlete.

What concept does this question test?

It tests Cardiology in General Medicine. Squatting and handgrip raise preload and afterload and soften the murmur. It is a leading cause of sudden death in young athletes.

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.