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Cardiology Exam
Course: Cardiology
Total Questions: 25
1. A 55-year-old male presents to the emergency department with sudden onset of severe, tearing chest pain radiating to his back. His blood pressure is 210/120 mmHg in the right arm and 160/90 mmHg in the left arm. On auscultation, a new diastolic murmur is noted. Which of the following is the most likely diagnosis?
A) Acute myocardial infarction B) Pericarditis C) Aortic dissection D) Pulmonary embolism
2. A 68-year-old patient with a history of heart failure with reduced ejection fraction (HFrEF) is considering an implantable cardioverter-defibrillator (ICD). Which of the following criteria is most crucial for establishing primary prevention indication for an ICD in this patient?
A) New York Heart Association (NYHA) Class IV symptoms despite optimal medical therapy B) Ejection fraction of 45% with a QRS duration of 100 ms C) Ejection fraction of 30% or less at least 3 months post-MI or 90 days after optimal medical therapy initiation D) Frequent episodes of non-sustained ventricular tachycardia documented on Holter monitoring
3. A 30-year-old pregnant woman in her second trimester presents with palpitations and lightheadedness. An ECG reveals a narrow-complex tachycardia with a regular rhythm at 180 bpm and no discernible P waves. Vagal maneuvers are unsuccessful. Which of the following is the most appropriate initial pharmacological intervention?
A) Adenosine B) Diltiazem C) Metoprolol D) Amiodarone
4. During cardiac catheterization, a patient is found to have significant stenosis in the left main coronary artery. Which of the following anatomical characteristics is most important to consider when deciding between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery for this lesion?
A) Patient's age and overall frailty score B) Left ventricular ejection fraction C) SYNTAX score and presence of multi-vessel disease D) Patient's preference and willingness to undergo surgery
5. A 72-year-old male with chronic kidney disease (CKD) presents with an irregularly irregular rhythm on ECG, consistent with atrial fibrillation. His CHA2DS2-VASc score is 4. Which anticoagulant is generally preferred for stroke prevention in this patient given his CKD (eGFR 25 mL/min/1.73m2)?
A) Warfarin B) Dabigatran C) Rivaroxaban D) Apixaban
6. A patient undergoing elective surgery develops sudden cardiac arrest. The rhythm is identified as ventricular fibrillation (VF). Which of the following is the most immediate and critical intervention?
A) Administration of intravenous epinephrine B) Initiation of high-quality chest compressions C) Delivery of an unsynchronized direct current shock (defibrillation) D) Placement of an advanced airway
7. Which of the following cellular mechanisms is primarily responsible for the prolonged plateau phase (phase 2) of the cardiac action potential?
A) Rapid efflux of potassium ions through delayed rectifier channels B) Influx of sodium ions through fast voltage-gated channels C) Influx of calcium ions through L-type calcium channels D) Efflux of chloride ions through specific chloride channels
8. A 45-year-old male presents with exertional chest pain, syncope, and a harsh crescendo-decrescendo systolic murmur best heard at the right upper sternal border, radiating to the carotid arteries. His ECG shows left ventricular hypertrophy. Which valvular heart disease is most consistent with these findings?
D) Surgical resection of the RVOT
13. A 65-year-old patient with congestive heart failure is prescribed sacubitril/valsartan. Which of the following laboratory values would necessitate careful monitoring due to potential adverse effects of this medication combination?
A) Serum creatinine and potassium levels B) Thyroid stimulating hormone (TSH) C) Liver function tests (LFTs) D) Glycosylated hemoglobin (HbA1c)
14. Which of the following findings on an electrocardiogram (ECG) is most indicative of an old, resolved myocardial infarction?
A) ST-segment elevation in contiguous leads B) New onset left bundle branch block C) Pathological Q waves in contiguous leads D) T-wave inversion in multiple leads
15. A patient is prescribed clopidogrel after a percutaneous coronary intervention (PCI). Which of the following mechanisms of action describes clopidogrel's antiplatelet effect?
A) Inhibits cyclooxygenase-1 (COX-1) to reduce thromboxane A2 synthesis B) Blocks the P2Y12 adenosine diphosphate (ADP) receptor on platelets C) Directly inhibits factor Xa in the coagulation cascade D) Enhances the activity of antithrombin III, leading to thrombin inhibition
16. Which physical examination finding is most suggestive of tricuspid regurgitation?
A) Pulsus alternans B) Corrigan's pulse (water-hammer pulse) C) Prominent V waves in the jugular venous pulse (JVP) D) Fixed splitting of the second heart sound (S2)
17. A 50-year-old obese male presents with recent onset nocturnal dyspnea. Physical exam reveals crackles at the lung bases and peripheral edema. An echocardiogram shows concentric left ventricular hypertrophy. His blood pressure is consistently elevated. Which type of cardiomyopathy is most likely responsible for his symptoms?
A) Dilated cardiomyopathy B) Hypertrophic obstructive cardiomyopathy (HOCM) C) Restrictive cardiomyopathy D) Hypertensive cardiomyopathy
18. Which structure electrically insulates the atria from the ventricles, preventing direct conduction of impulses, except through the atrioventricular (AV) node?
A) Chordae tendineae B) Interventricular septum C) Fibrous skeleton of the heart D) Papillary muscles
19. A 70-year-old patient with a history of recurrent syncope and a consistently documented heart rate of 35 bpm on multiple ECGs, without reversible causes, is being evaluated. Which intervention is most appropriate for this patient?
A) Initiation of a beta-blocker to control rhythm B) Referral for permanent pacemaker implantation C) Administration of intravenous atropine D) Observation with serial ECGs
20. Calculate the mean arterial pressure (MAP) for a patient with a blood pressure of 140/ mmHg.
A) 90 mmHg B) 100 mmHg C) 110 mmHg D) 120 mmHg
21. A 3-day-old neonate presents with cyanosis and a single, loud second heart sound (S2). An echocardiogram reveals transposition of the great arteries (TGA) with an intact ventricular septum. Which of the following is the most critical intervention to improve oxygenation in the immediate term?
A) Administration of sildenafil B) Surgical arterial switch operation C) Prostaglandin E1 infusion D) Loop diuretic administration
Answer Key
1. C 2. C 3. A 4. C
5. D 6. C 7. C 8. B
9. B 10. D 11. C 12. C
13. A 14. C 15. B 16. C
17. D 18. C 19. B 20. B
21. C 22. C 23. C 24. C
25. B
