AMC MCQ Cardiovascular Medicine 2 — Questions and Answers
Question 1: A 65-year-old man presents with crushing central chest pain radiating to the left arm for 40 minutes. ECG shows ST elevation in leads II, III and aVF. Which coronary artery is most likely occluded?
- Right coronary artery (Correct answer)
- Left anterior descending artery
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
Inferior STEMI (leads II, III, aVF) most commonly results from right coronary artery occlusion.
Question 2: Which medication should be avoided in a patient with an inferior STEMI complicated by right ventricular infarction and hypotension?
- Glyceryl trinitrate (Correct answer)
- Aspirin
- Heparin
- Clopidogrel
Correct answer: Glyceryl trinitrate
Nitrates reduce preload and can cause severe hypotension in preload-dependent right ventricular infarction.
Question 3: A patient with acute coronary syndrome receives fibrinolysis. Which finding best indicates successful reperfusion?
- Resolution of ST elevation by more than 50% (Correct answer)
- Rise in troponin
- Onset of chest pain
- Widening QRS complex
Correct answer: Resolution of ST elevation by more than 50%
Greater than 50% resolution of ST elevation within 60-90 minutes indicates successful reperfusion.
Question 4: What is the recommended door-to-balloon time target for primary percutaneous coronary intervention in STEMI?
- Within 90 minutes (Correct answer)
- Within 4 hours
- Within 6 hours
- Within 12 hours
Correct answer: Within 90 minutes
Primary PCI should be performed within 90 minutes of first medical contact for best outcomes.
Question 5: A 58-year-old diabetic woman presents with epigastric discomfort, nausea and fatigue but no chest pain. ECG shows new ST depression. What is the most likely diagnosis?
- Atypical acute coronary syndrome (Correct answer)
- Gastro-oesophageal reflux
- Cholecystitis
- Anxiety attack
Correct answer: Atypical acute coronary syndrome
Women and diabetics often present with atypical ACS symptoms such as epigastric pain and fatigue.
Question 6: Which troponin pattern best supports an acute myocardial infarction rather than a chronic elevation?
- A rising and falling troponin with a significant delta (Correct answer)
- A stable persistently elevated troponin
- An undetectable troponin
- A troponin that only rises after 24 hours without change
Correct answer: A rising and falling troponin with a significant delta
A dynamic rise and fall in troponin distinguishes acute MI from chronic elevation seen in renal disease or heart failure.
Question 7: Which long-term medication has the strongest evidence for reducing mortality after myocardial infarction with reduced ejection fraction?
- Beta-blocker (Correct answer)
- Calcium channel blocker
- Digoxin
- Loop diuretic
Correct answer: Beta-blocker
Beta-blockers reduce mortality post-MI, particularly in patients with reduced ejection fraction.
AMC MCQ Cardiovascular Medicine 2
A 65-year-old man presents with crushing central chest pain radiating to the left arm for 40 minutes.
ECG shows ST elevation in leads II, III and aVF.
Which coronary artery is most likely occluded?