AMC MCQ Cardiovascular Medicine 3 — Questions and Answers
Question 1: A 72-year-old man with heart failure presents with worsening dyspnoea, orthopnoea and bilateral basal crepitations. Which investigation best confirms decompensated heart failure?
- B-type natriuretic peptide (Correct answer)
- Serum potassium
- D-dimer
- C-reactive protein
Correct answer: B-type natriuretic peptide
Elevated BNP or NT-proBNP supports a diagnosis of decompensated heart failure.
Question 2: Which class of drug is first-line for symptomatic relief of pulmonary congestion in acute heart failure?
- Intravenous loop diuretic (Correct answer)
- Oral beta-blocker
- Calcium channel blocker
- Statin
Correct answer: Intravenous loop diuretic
IV loop diuretics such as frusemide relieve pulmonary congestion in acute decompensated heart failure.
Question 3: A patient with HFrEF is already on an ACE inhibitor and beta-blocker but remains symptomatic with an ejection fraction of 30%. Which agent reduces mortality next?
- Spironolactone (Correct answer)
- Amlodipine
- Verapamil
- Ivabradine alone
Correct answer: Spironolactone
A mineralocorticoid receptor antagonist like spironolactone reduces mortality in symptomatic HFrEF.
Question 4: Which examination finding most specifically indicates elevated right atrial pressure in heart failure?
- Raised jugular venous pressure (Correct answer)
- Bilateral ankle oedema
- Tachycardia
- Cool peripheries
Correct answer: Raised jugular venous pressure
A raised JVP directly reflects elevated right atrial pressure and is a specific sign of congestion.
Question 5: A patient on an ACE inhibitor develops a persistent dry cough. What is the most appropriate substitute?
- Angiotensin receptor blocker (Correct answer)
- Beta-blocker
- Calcium channel blocker
- Thiazide diuretic
Correct answer: Angiotensin receptor blocker
An ARB provides similar benefit without the bradykinin-mediated cough of ACE inhibitors.
Question 6: Which addition to standard therapy has been shown to reduce hospitalisation in HFrEF by inhibiting sodium-glucose co-transport?
- SGLT2 inhibitor (Correct answer)
- Digoxin
- Hydralazine alone
- Ivabradine
Correct answer: SGLT2 inhibitor
SGLT2 inhibitors such as dapagliflozin reduce heart failure hospitalisation regardless of diabetes status.
Question 7: A patient with heart failure has a regular pulse, QRS duration of 160 ms with left bundle branch block, and EF of 28% despite optimal medication. Which device therapy is indicated?
- Cardiac resynchronisation therapy (Correct answer)
- Single-chamber pacemaker
- Loop recorder
- Intra-aortic balloon pump
Correct answer: Cardiac resynchronisation therapy
CRT improves outcomes in HFrEF with a wide QRS and LBBB by resynchronising ventricular contraction.
AMC MCQ Cardiovascular Medicine 3
A 72-year-old man with heart failure presents with worsening dyspnoea, orthopnoea and bilateral basal crepitations.
Which investigation best confirms decompensated heart failure?