Cardiovascular system: right ventricular infarction: practice question

A Physiology 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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Physiology · Cardiovascular system: right ventricular infarction

Sample item

A man with an inferior wall myocardial infarction becomes hypotensive with a raised jugular venous pressure and clear lung fields. Sublingual nitrates drop his blood pressure further. What is the best explanation?

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

The answer and the reasoning

B. The failing right ventricle depends on high preload, which nitrates reduce

Right ventricular infarction reduces output to the left heart, so left filling depends on a high right-sided preload. Venodilators like nitrates fall preload and cause profound hypotension. Treatment is cautious intravenous fluids.

Option by option

  • A. Aortic dissection involving the coronary ostium

    Dissection would not explain the response to nitrates.

  • B. The failing right ventricle depends on high preload, which nitrates reduce (correct)

    Correct. A preload-dependent failing right ventricle is made worse by venodilators.

  • C. Left ventricular failure with pulmonary congestion

    Left failure would produce crackles and pulmonary congestion, which are absent.

  • D. Cardiac tamponade from free wall rupture

    Tamponade would show pulsus paradoxus and muffled sounds and is rarer than this picture.

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.

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Questions about this Physiology question

What is the answer to this Physiology question?

The best answer is B, The failing right ventricle depends on high preload, which nitrates reduce. Right ventricular infarction reduces output to the left heart, so left filling depends on a high right-sided preload.

Why is "Aortic dissection involving the coronary ostium" not the answer?

Dissection would not explain the response to nitrates.

Why is "Left ventricular failure with pulmonary congestion" not the answer?

Left failure would produce crackles and pulmonary congestion, which are absent.

Why is "Cardiac tamponade from free wall rupture" not the answer?

Tamponade would show pulsus paradoxus and muffled sounds and is rarer than this picture.

What concept does this question test?

It tests Cardiovascular system: right ventricular infarction in Physiology. Venodilators like nitrates fall preload and cause profound hypotension. Treatment is cautious intravenous fluids.

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 Cardiovascular system: right ventricular infarction?

For each system, sketch the key graph (pressure–volume loop, oxygen dissociation curve, nephron handling) and explain it aloud. Then use the flashcards and the other Physiology 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.