Assistant Professor in Cardiology 2026 — Kerala PSC PYQ Practice with Answers

Correct answer (Option D):\nOnly statement 1 is true. The SA node is indeed predominantly subepicardial in location, situated at the junction of the superior vena cava and right atrium.\nStatement 2 is false: the AV node is subendocardial, not subepicardial — it lies at the apex of Koch's triangle.\nStatement 3 is false: the slow pathway is posteroinferior (not anterosuperior) to Koch's triangle, near the coronary sinus os.\nStatement 4 is false: the penetrating bundle (Bundle of His) traverses the central fibrous body below the membranous septum, not below the septal leaflet of the Tricuspid Valve.\nOption D is correct.\n\nWhy others are wrong:\nOption A requires all 4 to be true — statements 2, 3, and 4 are incorrect.\nOption B requires statements 1, 2, and 4 to be true — statement 2 is false.\nOption C requires statements 1 and 3 — statement 3 is false.\n\nStudy tip:\nKoch's triangle boundaries: Todaro's tendon superiorly, tricuspid annulus inferiorly, coronary sinus os posteroinferiorly. The AV node sits at its apex. Slow pathway ablation targets the posteroinferior region.

Correct answer (Option B):\nStatements 1, 2, and 4 are true; only statement 3 is false.\nStatement 1 is true: septum secundum develops as a muscular infolding of atrial tissue to the right of septum primum.\nStatement 2 is true: the most common secundum ASD results from deficiency (excessive resorption) of the septum primum, leaving an inadequate flap to cover the foramen ovale.\nStatement 4 is true: sinus venosus ASD is not a defect within the true atrial septum — it results from malalignment between the venous sinus and the atrial wall.\nStatement 3 is false: the limbus of fossa ovalis (the muscular rim) is present on the RIGHT side of the atrial septum (right atrium side), not the left. It is seen on the right atrial surface by echocardiography. Option B is correct.\n\nWhy others are wrong:\nOption A is incorrect because statement 3 is false.\nOption C incorrectly excludes statement 2, which is true.\nOption D incorrectly excludes statement 1, which is true.\n\nStudy tip:\nThe limbus (annulus ovalis) is the rim of the fossa ovalis on the RA side. Sinus venosus ASDs (superior or inferior type) are associated with partial anomalous pulmonary venous return and are not true septal defects.

Correct answer (Option C):\nStatements 2 and 3 are true; statements 1 and 4 are false.\nStatement 1 is false: by the Law of Laplace, wall stress = (Pressure × Radius) / (2 × Wall Thickness). Wall stress is directly related to pressure and radius, and inversely related to wall thickness — not directly related to wall thickness.\nStatement 2 is true: the Bowditch staircase (treppe) phenomenon describes the progressive increase in contractile force with increasing heart rate.\nStatement 3 is true: the Anrep effect is indeed a slow adaptation to increased afterload, distinct from the beat-to-beat Frank-Starling mechanism.\nStatement 4 is false: the atrial pressure-volume loop has a figure-of-8 shape (two loops), not an ellipse. The ventricular loop resembles a rectangle/trapezoid. Option C is correct.\n\nWhy others are wrong:\nOption A is wrong because statements 1 and 4 are false.\nOption B is wrong because statement 2 is true (should not be excluded).\nOption D is wrong because statement 1 is false (should be excluded) but so is 4.\n\nStudy tip:\nLaplace Law: Wall Stress = P × R / (2h). Remember: thicker wall → lower wall stress (hypertrophy is a compensatory mechanism). Atrial P-V loop: figure-of-8 with two components — atrial systole and passive filling loops.

Correct answer (Option A):\nAll four statements are true.\nStatement 1 is true: coronary artery calcium (CAC) scoring is recommended by ACC/AHA guidelines for reclassifying borderline cardiovascular risk patients (7.5–20% 10-year ASCVD risk) to guide statin initiation decisions.\nStatement 2 is true: CT is superior to TEE for differentiating pannus (fibrous ingrowth, hyperdense, fixed) from thrombus (hypodense, mobile) in prosthetic valve dysfunction due to better tissue characterization.\nStatement 3 is true: CT calcium scoring of the aortic valve (heavily calcified = true severe AS) helps confirm true severity in low-flow, low-gradient aortic stenosis cases.\nStatement 4 is true: CT angiography is the investigation of choice for pre-TAVR planning — it evaluates annular dimensions, peripheral access, aortic root anatomy, and coronary ostia heights. Option A is correct.\n\nWhy others are wrong:\nOptions B, C, and D incorrectly exclude statements that are actually true.\n\nStudy tip:\nPre-TAVR CT protocol evaluates: aortic annulus size, iliofemoral access, coronary height (risk of obstruction), aortic root morphology, and calcification distribution. CAC score of 0 supports deferring statin therapy in borderline-risk patients.

Correct answer (Option B):\nThis lesion is classified as Type B2 because it has two or more Type B characteristics.\nType B characteristics present in this lesion:\n1. Ostial location (ostio-proximal LAD) — Type B feature\n2. Length > 10mm (18mm lesion) — Type B feature\n3. Heavy calcification — Type B feature\n4. Angulation 45°–90° (75°) — Type B feature\nSince the lesion has multiple (>1) Type B characteristics, it is classified as Type B2 rather than B1.\nGood antegrade visualization of distal vessel excludes Type C (which requires poor distal visualization).\nType C would require: >2cm length, excessive tortuosity, degenerated vein graft, or total occlusion >3 months. Option B is correct.\n\nWhy others are wrong:\nOption A (Type B1): requires only one Type B characteristic — this lesion has multiple.\nOption C (Type A): requires short <10mm, concentric, easily accessible, non-calcified — not applicable here.\nOption D (Type C): requires >20mm length, extreme tortuosity, or poor distal vessel — not met here.\n\nStudy tip:\nACC/AHA lesion classification: Type A = low risk, >85% success. Type B1 = one B feature, moderate risk. Type B2 = two or more B features, higher risk. Type C = high risk, <60% success. Key Type B features: eccentric, moderate tortuosity, irregular contour, moderate/heavy calcium, ostial, bifurcation, 45–90° angulation, length 10–20mm.