Cardiology: variant angina: 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: variant angina

Sample item

A 38-year-old woman who smokes has episodes of central chest pain at rest, usually between 3 and 5 am. During one episode the ECG shows transient ST elevation in the inferior leads that resolves with sublingual nitroglycerin. Coronary angiography shows no fixed obstruction. Which drug class should be avoided or used with caution?

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

The answer and the reasoning

B. Non-selective beta-blockers

This is Prinzmetal variant angina from coronary artery spasm. Treatment is calcium channel blockers and nitrates, plus smoking cessation and avoidance of triggers such as cocaine. Non-selective beta-blockers can leave alpha-mediated coronary vasoconstriction unopposed and aggravate spasm.

Option by option

  • A. Calcium channel blockers

    Calcium channel blockers are first-line, as they relax coronary smooth muscle.

  • B. Non-selective beta-blockers (correct)

    Unopposed alpha stimulation can intensify vasospasm, so non-selective beta-blockers are avoided.

  • C. Long-acting nitrates

    Nitrates relieve and prevent spasm by vasodilatation.

  • D. Statins

    Statins are safe and are used for general vascular risk reduction.

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, Non-selective beta-blockers. This is Prinzmetal variant angina from coronary artery spasm.

Why is "Calcium channel blockers" not the answer?

Calcium channel blockers are first-line, as they relax coronary smooth muscle.

Why is "Long-acting nitrates" not the answer?

Nitrates relieve and prevent spasm by vasodilatation.

Why is "Statins" not the answer?

Statins are safe and are used for general vascular risk reduction.

What concept does this question test?

It tests Cardiology: variant angina in General Medicine. Treatment is calcium channel blockers and nitrates, plus smoking cessation and avoidance of triggers such as cocaine. Non-selective beta-blockers can leave alpha-mediated coronary vasoconstriction unopposed and aggravate spasm.

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: variant angina?

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.