MCQ cardiology for SHO of Internal Medicine

The document is a comprehensive multiple-choice question (MCQ) set designed for rapid assessment and reinforcement of cardiology knowledge. It includes a diverse range of case-based questions, requiring participants to evaluate clinical presentations, interpret diagnostic findings, and determine appropriate management strategies. The test format involves timed questions, enhancing decision-making skills under pressure, which is particularly valuable for medical students, residents, and healthcare professionals preparing for exams or clinical practice.

Each question presents a real-world clinical scenario involving patients with cardiovascular conditions. The cases cover a broad spectrum of diseases, including ischemic heart disease, arrhythmias, valvular disorders, cardiomyopathies, pericardial diseases, congenital heart conditions, and vascular emergencies such as aortic dissection. By simulating actual clinical encounters, the MCQs encourage critical thinking and application of theoretical knowledge.

One of the recurring themes in the questions is the differentiation of similar cardiac conditions. For example, a case of a 55-year-old man with sudden chest pain but no ECG abnormalities requires the participant to consider potential diagnoses such as anxiety, aortic dissection, myocarditis, pericarditis, or pneumothorax. Similarly, a case of an elderly woman with palpitations and a cold, painful leg challenges the test-taker to distinguish between acute arterial plaque rupture, deep venous thrombosis, or peripheral embolism. These scenarios reinforce the importance of clinical reasoning and decision-making in cardiology.

Another key aspect of the MCQs is ECG interpretation. Several questions focus on identifying conduction abnormalities, arrhythmias, and ischemic changes. Participants must recognize classic ECG patterns such as ST-segment elevations in myocardial infarction, atrial fibrillation, bundle branch blocks, and AV conduction delays. For instance, one question presents an 85-year-old man with recurrent episodes of lightheadedness and syncope, prompting the test-taker to diagnose a specific type of atrioventricular block.

In addition to diagnosis, the test emphasizes treatment selection and management principles. Many questions assess knowledge of pharmacological and non-pharmacological interventions. Medications such as beta-blockers, anticoagulants, antiarrhythmics, and vasopressors are frequently discussed, requiring an understanding of their indications, contraindications, and mechanisms of action. For instance, one scenario presents a hypertensive patient with atrial fibrillation and asks for the most appropriate drug to control heart rate. Another question focuses on the acute management of a patient with suspected aortic dissection, emphasizing blood pressure control and surgical intervention.

1. You Have 30 Seconds F or E ach Q uestion May The L uck B e W ith Y ou

2. What diagnosis should be confirmed or excluded next? A 55 year old man with a history of poorly controlled hypertension presents with a history of sudden-onset central chest pain. There are no diagnostic electrocardiogram (ECG) abnormalities, and an interval troponin concentration is not diagnostic of myocardial infarction. A. Anxiety B. Aortic dissection C. Myocarditis D. Pericarditis E. Pneumothorax

3. What is the most likely diagnosis? An 80 year old woman with a history of palpitation presents with a painful left leg. On examination, pulse rate is 80 beats/min and irregular, blood pressure (BP) 170/96 mmHg. The left leg is pale, cold, and sensation is reduced. The popliteal, dorsalis pedis and posterior tibial pulses cannot be felt. Her only regular medications are aspirin and digoxin. A. Acute arterial plaque rupture with lower limb ischaemia B. Deep venous thrombosis with secondary reduction of arterial blood flow C. Dissection of the femoral artery due to uncontrolled hypertension D. Peripheral embolism with lower limb ischaemia E. Reduced lower limb perfusion due to cardiac failure

4. What are these findings most compatible with? A 50 year old man is assessed because of 3 weeks of fever and influenza-like symptoms. Examination findings are tachycardia (heart rate 105 beats/min), and a large pulse pressure, BP 140/45 mmHg. Initially it was thought a murmur was present but repeat examination reveals no murmur. Investigations reveal no evidence of chest or urinary infection. A. Acute myocarditis B. Acute viral pericarditis C. Infective endocarditis affecting the aortic valve D. Infective endocarditis affecting the tricuspid valve E. Influenza

5. What is the most likely explanation for these findigs ? You assess a 62 year old woman 2 days after treatment for anterior myocardial infarction. On examination she is tachycardic and tachypnoeic , and has a harsh systolic murmur radiating to the right side of the chest. There are fine inspiratory crepitations audible at the lung bases. A. Acute aortic incompetence B. Left ventricular free wall rupture C. Papillary muscle rupture and mitral incompetence D. Post-infarction pericarditis with pericardial rub E. Rupture of the interventricular septum

6. Which of the following statements is true? A 55 year old man with type 2 diabetes presents with a 1-hour history of severe central chest pain. A. A normal baseline troponin and elevated 6-hour troponin level is suspicious of myocardial infarction B. A normal ECG excludes myocardial infarction C. A normal initial troponin level excludes myocardial infarction D. Failure of chest pain to resolve with nitrates confirms myocardial infarction E. T-wave inversion on the ECG confirms myocardial infarction

7. From this history, which of the following most likely explains her symptoms? A 72 year old hypertensive woman presents with a history of sudden-onset, rapid, irregular palpitation. She has had several episodes over the previous 3 months, which have resolved within 1 hour. She feels tired and slightly lightheaded during episodes. A. Atrial fibrillation B. Sinus arrhythmia C. Supraventricular tachycardia D. Ventricular ectopic beats ( extrasystoles ) E. Ventricular tachycardia

8. Which of the following physical signs would be expected in this situation? A 65 year old female presents with chest pain, and the 12-lead ECG shows evidence of acute inferior myocardial infarction complicated by hypotension. An echocardiogram is performed and shows markedly reduced movement of the right ventricular walls, indicating that right ventricular infarction has occurred. Left ventricular function is only mildly impaired. A. Tachycardia, a late systolic murmur and ascites B. Tachycardia, and absent jugular venous pulse because of inability to develop right heart pressure C. Tachycardia, acute development of peripheral oedema and acute ascites D. Tachycardia, basal crepitations and a third heart sound E. Tachycardia, elevated jugular venous pulse due to failure of right ventricular pump function, and hepatomegaly

9. Which of the following drugs is the most suitable agent to control heart rate in this patient? A 71 year old woman with a history of hypertension presents with fatigue and rapid, irregular palpitations. She normally takes enalapril for blood pressure control. Clinical examination reveals an irregularly irregular pulse, rate 125 beats/min, and BP 128/86 mmHg. Cardiovascular examination is otherwise normal. A 12-lead ECG is performed, which shows atrial fibrillation with poor ventricular rate control, but no other abnormality. A. Adenosine B. Amiodarone C. β- blocker D. Flecainide E. Lidocaine

10. Examine the rhythm strip below. Which conduction abnormality does this show? An 85 year old man presents with a 6-month history of sudden episodes of lightheadedness, which last up to 15 seconds. He is admitted to hospital with an episode of syncope resulting in facial injury. A. Complete (third-degree) AV block B. Left bundle branch block C. Mobitz type II second-degree AV block D. Sinus bradycardia E. Wenckebach ( Mobitz type I) second-degree AV block

11. Which of the following rhythms is NOT commonly associated with sick sinus syndrome ( sinoatrial disease)? A. Atrial fibrillation B. Atrial tachycardia C. Sinus bradycardia D. Sinus pauses E. Ventricular tachycardia

12. Which of the following should be used first in attempting to terminate this rhythm? A . Direct current cardioversion B. Intravenous adenosine C. Intravenous β- blocker D. Oral β- blocker E. Vagal manoeuvres, e.g. Valsalva manoeuvre The ECG below shows a regular, narrow complex tachycardia in a patient presenting with sudden-onset, rapid palpitation.

13. Which of the following congenital conditions is the most likely explanation for this presentation? A 17 year old male presents to the emergency department with an episode of collapse. Witnesses report he became extremely blue at the time of collapse, which occurred on walking. The patient tells you he has a history of congenital heart disease. On examination you note he is centrally cyanosed. A. Coarctation of the aorta B. Congenital heart block C. Patent foramen ovale D. Tetralogy of Fallot E. Wolff–Parkinson–White syndrome

14. Which of the following conditions explains this clinical presentation? A 21 year old man presents with a recent history of an influenza-like illness initially characterised by fever, myalgia and headache. He develops pleuritic -type chest discomfort and breathlessness. On examination, pulse is 105 beats/min and regular; BP 105/60 mmHg. The JVP is not elevated. Heart sounds 1 and 2 are present with a loud to-and-fro harsh sound present in systole and diastole. A. Acute viral pericarditis B. Aortic valve endocarditis C. Mitral valve endocarditis D. Persistent ductus arteriosus E. Pulmonary embolism

15. What is the most likely cause of this patient’s sudden collapse? A 48 year old woman with no significant previous medical history collapses while running a marathon. Despite attempts at resuscitation, she does not survive. Postmortem examination reveals asymmetric left ventricular hypertrophy with disproportionate thickening of the interventricular septum. A postmortem diagnosis of hypertrophic cardiomyopathy is made . A. Atrial fibrillation B. Left ventricular failure C. Pulmonary embolism D. Right ventricular failure E. Ventricular arrhythmia

16. Which of the following treatments is known to reduce her risk of sudden death? A 30 year old woman has recently been diagnosed with dilated cardiomyopathy. Her diagnosis was made with echocardiography, which showed moderate left ventricular dilatation and impairment. She has noticed herself becoming increasingly fatigued on moderate exertion. Her younger sister died suddenly the previous year and she is very worried about the risk of sudden death. A. Aspirin B. β- blocker (e.g. metoprolol ) C. Calcium channel blocker (e.g. verapamil) D. Loop diuretic (e.g. furosemide) E. Percutaneous coronary intervention (PCI)

17. Which of the following factors is most likely to have precipitated this illness? A 55 year old woman presents with a history of acute, severe, constricting central chest pain associated with anterior ST segment elevation on the 12-lead ECG. She immediately undergoes coronary angiography, which shows no evidence of coronary artery disease and no coronary occlusion. An echocardiogram shows left ventricular apical dilatation, with normal left ventricular basal contraction. A. Acute emotional stress B. Cigarette smoking C. Excessive alcohol consumption D. Genetic factors E. Viral infection

18. Which of the following statements is true? A 75 year old male smoker presents with a 6-week history of progressive exertional breathlessness and fatigue. Latterly he has noticed his ankles swelling in the afternoon. On examination, pulse is 100 beats/min and regular; BP 92/60 mmHg. The JVP is elevated and rises on inspiration. Heart sounds are quiet and there are no added sounds. There is bilateral pitting oedema to the knees. A chest X-ray is requested, which shows apparent cardiomegaly with a globular cardiac silhouette. You suspect a possible pericardial effusion. A. A large effusion can be a sign of malignancy B. A pericardial rub is always heard if the effusion is large C. An ECG is the best investigation to confirm the diagnosis D. High-dose diuretic therapy will resolve the pericardial effusion E. In symptomatic patients, cardiac surgery is required to remove the pericardial fluid

19. What is the most common ECG change in patients with pulmonary embolism? A 46 year old man has recently fractured his leg, which is in a plaster cast. He suddenly becomes very breathless, unwell and collapses. The attending doctor suspects a pulmonary embolus from a deep vein thrombosis. The doctor performs an ECG. A. Anterior T-wave inversion B. Atrial fibrillation C. ‘S1Q3T3’ D. Sinus tachycardia E. ST elevation

20. What is the most likely cause? A 72 year old woman has had ‘indigestion’ for 4 days with vomiting and sweating. She presents to the emergency department where a delayed presentation inferior ST segment elevation myocardial infarction is diagnosed. She has already developed Q waves in leads II, III and aVF . One day after admission to hospital, she suddenly deteriorates with severe breathlessness, low blood pressure and sudden onset of pulmonary oedema . A. Acute papillary muscle rupture B. Acute pericarditis C. Atrial septal defect D. Free wall rupture E. Mural thrombus

21. Which of the following is known to reduce mortality? A 65 year old man with known hypertension presents with severe central chest pain that radiates between his shoulder blades. He is sweaty with a BP of 200/100 mmHg in his right arm, a pale left arm and an ECG showing sinus tachycardia. His chest X-ray shows mediastinal widening and a computed tomography scan shows a type A aortic dissection. A. Anticoagulation B. Control of the blood pressure C. Emergency repair of the ascending aorta D. Intravenous β- blockade E. Prevention of limb or renal ischaemia

22. How You Did ?

23. Answer Keys B D C E A A E C C E 11. E 12. D 13. A 14. E 15. B 16. A 17. A 18. D 19. A 20. C