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Question 1

1. Which of the following regurgitant fractions would be considered severe aortic valve regurgitation?
   A. 30%
   B. 40%
   C. 50% D. 70%

Answer 1

1. Which of the following regurgitant fractions would be considered severe aortic valve regurgitation?
   A. 30%
   B. 40%
   C. 50% (answer) D. 70%

Question 2

2. A 23-year-old has a mild-diastolic rumble and sharp early diastolic sound. What is the likely explanation?
   A. Mitral stenosis B. Aortic stenosis
   C. Tricuspid regurgitation
   D. Pulmonary hypertension

Answer 2

2. A 23-year-old has a mild-diastolic rumble and sharp early diastolic sound. What is the likely explanation?
   A. Mitral stenosis (answer) B. Aortic stenosis
   C. Tricuspid regurgitation
   D. Pulmonary hypertension

Question 3

3. A 56-year-old man comes to the emergency department with acute heart failure. What is the most appropriate initial management?
   A. Intravenous nitroglycerin B. Oral furosemide
   C. Subcutaneous heparin
   D. Immediate thrombolysis
4. A 63-year-old man presents with exertional dyspnea, a heart murmur, and a calcified aortic valve. The mean aortic gradient is 52 mmHg, and valve area is 0.8 cm2. What is the next best step?
   A. Balloon valvuloplasty
   B. Medical management
   C. Aortic valve replacement operation after coronary angiogram D. Lifestyle modification

Answer 3

3. A 56-year-old man comes to the emergency department with acute heart failure. What is the most appropriate initial management?
   A. Intravenous nitroglycerin (answer) B. Oral furosemide
   C. Subcutaneous heparin
   D. Immediate thrombolysis
4. A 63-year-old man presents with exertional dyspnea, a heart murmur, and a calcified aortic valve. The mean aortic gradient is 52 mmHg, and valve area is 0.8 cm2. What is the next best step?
   A. Balloon valvuloplasty
   B. Medical management
   C. Aortic valve replacement operation after coronary angiogram (answer) D. Lifestyle modification

Question 4

5. Which of the following statements about angina pectoris is true?
   A. It is characterized by sharp, stabbing pain.
   B. Pain is relieved by sitting upright.
   C. It is typically described as burning, heavy, or squeezing pain relieved by nitroglycerin.
   D. It is often caused by valvular heart disease.
6. Which drugs can cause lower extremity peripheral edema?
   A. ACE inhibitors
   B. Calcium channel blockers C. Beta blockers
   D. Diuretics

Answer 4

5. Which of the following statements about angina pectoris is true?
   A. It is characterized by sharp, stabbing pain.
   B. Pain is relieved by sitting upright.
   C. It is typically described as burning, heavy, or squeezing pain relieved by (answer) nitroglycerin.
   D. It is often caused by valvular heart disease.
6. Which drugs can cause lower extremity peripheral edema?
   A. ACE inhibitors
   B. Calcium channel blockers (answer) C. Beta blockers
   D. Diuretics

Question 5

7. Which of the following best describes the sound of mitral regurgitation?
   A. Systolic ejection murmur heard in the apical position, radiating to the axilla
   B. Continuous murmur heard over the sternal border
   C. Diastolic murmur with a loud S1
   D. Crescendo-decrescendo systolic murmur
8. Which of the following statements about syncope is correct?
   A. It is always due to cardiac conditions.
   B. Neurally mediated syncope includes vasovagal, situational, and carotid sinus hypersensitivity.
   C. Syncope never occurs in young, healthy individuals.
   D. Syncope is not associated with bradycardia.

Answer 5

7. Which of the following best describes the sound of mitral regurgitation?
   A. Systolic ejection murmur heard in the apical position, radiating to the axilla (answer) B. Continuous murmur heard over the sternal border
   C. Diastolic murmur with a loud S1
   D. Crescendo-decrescendo systolic murmur
8. Which of the following statements about syncope is correct?
   A. It is always due to cardiac conditions.
   B. Neurally mediated syncope includes vasovagal, situational, and carotid sinus hypersensitivity. (answer)
   C. Syncope never occurs in young, healthy individuals.
   D. Syncope is not associated with bradycardia.

Question 6

9. A murmur is heard at the fourth left intercostal space along the left sternal border. Which valve is likely involved?
   A. Aortic valve
   B. Mitral valve
   C. Tricuspid valve D. Pulmonary valve
10. Which type of heart sound is expected in a patient with mitral stenosis?
    A. A systolic ejection click
    B. A high-pitched diastolic murmur best heard at the cardiac apex C. A low-pitched diastolic murmur best heard at the apex D. A continuous murmur over the sternal border

Answer 6

9. A murmur is heard at the fourth left intercostal space along the left sternal border. Which valve is likely involved?
   A. Aortic valve
   B. Mitral valve
   C. Tricuspid valve (answer) D. Pulmonary valve
10. Which type of heart sound is expected in a patient with mitral stenosis?
    A. A systolic ejection click
    B. A high-pitched diastolic murmur best heard at the cardiac apex C. A low-pitched diastolic murmur best heard at the apex (answer) D. A continuous murmur over the sternal border

Question 7

11. Which of the following describes splinter hemorrhages?
    A. Horizontal lines under the nails due to trauma
    B. Tiny vertical blood clots under the nails, often associated with infective endocarditis
    C. Nail discoloration due to liver disease
    D. Longitudinal ridges due to vitamin deficiency
12. Which clinical sign is associated with lower extremity peripheral venous disease?
    A. Decreased pulses
    B. Skin ulcers and edema C. Pain relieved by walking
    D. Cold, cyanotic toes

Answer 7

11. Which of the following describes splinter hemorrhages?
    A. Horizontal lines under the nails due to trauma
    B. Tiny vertical blood clots under the nails, often associated with infective endocarditis (answer)
    C. Nail discoloration due to liver disease
    D. Longitudinal ridges due to vitamin deficiency
12. Which clinical sign is associated with lower extremity peripheral venous disease?
    A. Decreased pulses
    B. Skin ulcers and edema (answer) C. Pain relieved by walking
    D. Cold, cyanotic toes

Question 8

13. Which of the following is considered asymptomatic organ damage in hypertension?
    A. Pulse pressure >60 mmHg B. Resting heart rate >90 bpm
    C. Systolic BP >180 mmHg
    D. Presence of retinal hemorrhages
14. Which of the following statements about pulsus paradoxus is correct?
    A. It is an inspiratory increase in BP >10 mmHg.
    B. It is an abnormally large inspiratory decline (>10 mmHg) in systemic BP. C. It is a normal physiological response to deep breathing.
    D. It is primarily associated with mitral stenosis.

Answer 8

13. Which of the following is considered asymptomatic organ damage in hypertension?
    A. Pulse pressure >60 mmHg (answer) B. Resting heart rate >90 bpm
    C. Systolic BP >180 mmHg
    D. Presence of retinal hemorrhages
14. Which of the following statements about pulsus paradoxus is correct?
    A. It is an inspiratory increase in BP >10 mmHg.
    B. It is an abnormally large inspiratory decline (>10 mmHg) in systemic BP. (answer) C. It is a normal physiological response to deep breathing.
    D. It is primarily associated with mitral stenosis.

Question 9

15. Which of the following statements about cyanosis is correct?
    A. Central cyanosis is caused by vasoconstriction in extremities.
    B. Central cyanosis is caused by diseases of the heart or lungs, or abnormal hemoglobin. C. Peripheral cyanosis is seen in severe anemia.
    D. Cyanosis is always indicative of hypoxemia.
16. Which of the following is a precipitating cause of high-output cardiac failure?
    A. Hypothyroidism
    B. Thyrotoxicosis C. Pulmonary hypertension D. Aortic stenosis

Answer 9

15. Which of the following statements about cyanosis is correct?
    A. Central cyanosis is caused by vasoconstriction in extremities. (answer)
    B. Central cyanosis is caused by diseases of the heart or lungs, or abnormal hemoglobin. C. Peripheral cyanosis is seen in severe anemia.
    D. Cyanosis is always indicative of hypoxemia.
16. Which of the following is a precipitating cause of high-output cardiac failure?
    A. Hypothyroidism
    B. Thyrotoxicosis (answer) C. Pulmonary hypertension D. Aortic stenosis

Question 10

17. Arterial thrombosis after plaque rupture is initiated by which factor?
    A. Collagen
    B. Platelet-activating factor
    C. Tissue factor
    D. Endothelin
18. Which one of the following statements about heart failure is false?
    A. Most patients have heart failure with preserved LV systolic function.
    B. Heart failure can result from diastolic dysfunction.
    C. Pulmonary edema is a common complication.
    D. Increased preload is a compensatory mechanism in heart failure.

Answer 10

17. Arterial thrombosis after plaque rupture is initiated by which factor?
    A. Collagen
    B. Platelet-activating factor C. Tissue factor (answer) D. Endothelin
18. Which one of the following statements about heart failure is false?
    A. Most patients have heart failure with preserved LV systolic function. (answer)
    B. Heart failure can result from diastolic dysfunction.
    C. Pulmonary edema is a common complication.
    D. Increased preload is a compensatory mechanism in heart failure.

Question 11

19. Which myocardial necrosis marker raises at the very last after an ST elevation MI?
    A. Troponin I
    B. Lactate dehydrogenase (LDH) C. Creatine kinase (CK)
    D. Myoglobin
20. Which one of the following markers rises earliest after an ST elevation MI?
    A. Troponin T
    B. Lactate dehydrogenase (LDH) C. Creatine kinase (CK)
    D. Myoglobin

Answer 11

19. Which myocardial necrosis marker raises at the very last after an ST elevation MI?
    A. Troponin I
    B. Lactate dehydrogenase (LDH) (answer) C. Creatine kinase (CK)
    D. Myoglobin
20. Which one of the following markers rises earliest after an ST elevation MI?
    A. Troponin T
    B. Lactate dehydrogenase (LDH) C. Creatine kinase (CK)
    D. Myoglobin (answer)

Question 12

21. A 55-year-old man undergoes an exercise treadmill test. His Duke treadmill score is -6. What does this indicate?
    A. Low risk of coronary artery disease
    B. Moderate risk of coronary artery disease
    C. High risk of coronary artery disease D. No clinical significance
22. Which of the following is a risk factor for sudden death in hypertrophic cardiomyopathy?
    A. Asymptomatic bradycardia
    B. Syncope during exercise C. Resting hypertension
    D. None of the above

Answer 12

21. A 55-year-old man undergoes an exercise treadmill test. His Duke treadmill score is -6. What does this indicate?
    A. Low risk of coronary artery disease
    B. Moderate risk of coronary artery disease
    C. High risk of coronary artery disease (answer) D. No clinical significance
22. Which of the following is a risk factor for sudden death in hypertrophic cardiomyopathy?
    A. Asymptomatic bradycardia
    B. Syncope during exercise (answer) C. Resting hypertension
    D. None of the above

Question 13

23. The absolute indications for terminating an exercise test include all of the following except:
    A. New chest pain
    B. A fall in systolic BP >10 mmHg
    C. Sustained ventricular tachycardia
    D. Increased exercise capacity
24. A 78-year-old man presents with progressive dyspnea (NYHA Class III). In addition to an echocardiogram, what is the next appropriate test to assess heart failure?
    A. Troponin I levels
    B. Brain natriuretic peptide (BNP) measurement C. Chest X-ray
    D. Right heart catheterization

Answer 13

23. The absolute indications for terminating an exercise test include all of the following except:
    A. New chest pain
    B. A fall in systolic BP >10 mmHg
    C. Sustained ventricular tachycardia
    D. Increased exercise capacity (answer)
24. A 78-year-old man presents with progressive dyspnea (NYHA Class III). In addition to an echocardiogram, what is the next appropriate test to assess heart failure?
    A. Troponin I levels
    B. Brain natriuretic peptide (BNP) measurement (answer) C. Chest X-ray
    D. Right heart catheterization

Question 14

25. Sudden cardiac death in patients >35 years old is most commonly associated with:
    A. Cardiomyopathy
    B. Coronary artery disease C. Aortic dissection
    D. Hypertensive emergencies
26. Which form of congenital heart disease is commonly associated with Wolff-Parkinson- White syndrome?
    A. Tetralogy of Fallot
    B. Ebstein anomaly C. Patent ductus arteriosus D. Coarctation of the aorta

Answer 14

25. Sudden cardiac death in patients >35 years old is most commonly associated with:
    A. Cardiomyopathy
    B. Coronary artery disease (answer) C. Aortic dissection
    D. Hypertensive emergencies
26. Which form of congenital heart disease is commonly associated with Wolff-Parkinson- White syndrome?
    A. Tetralogy of Fallot
    B. Ebstein anomaly (answer) C. Patent ductus arteriosus D. Coarctation of the aorta

Question 15

27. Which of the following statements about coronary arteries is true?
    A. A dominant left coronary artery supplies the posterior descending artery.
    B. A dominant right coronary artery gives rise to the posterior descending artery. C. The left coronary artery always supplies the AV node.
    D. Coronary dominance does not affect perfusion territories.
28. All of the following are high-risk features of the TIMI risk score except:
    A. Tachycardia
    B. Elevated cardiac biomarkers
    C. Age >65 years
    D. Recent use of aspirin

Answer 15

27. Which of the following statements about coronary arteries is true?
    A. A dominant left coronary artery supplies the posterior descending artery.
    B. A dominant right coronary artery gives rise to the posterior descending artery. (answer) C. The left coronary artery always supplies the AV node.
    D. Coronary dominance does not affect perfusion territories.
28. All of the following are high-risk features of the TIMI risk score except:
    A. Tachycardia (answer)
    B. Elevated cardiac biomarkers
    C. Age >65 years
    D. Recent use of aspirin

Question 16

29. Which of the following is not included in the differential diagnosis for ECG ST elevations?
    A. Pericarditis
    B. Left ventricular hypertrophy C. Coronary vasospasm
    D. Aortic stenosis
30. Which of the following is NOT a common cause of continuous murmurs?
    A. Patent ductus arteriosus
    B. Arteriovenous fistula
    C. Aortic stenosis and regurgitation D. Coarctation of the aorta

Answer 16

29. Which of the following is not included in the differential diagnosis for ECG ST elevations?
    A. Pericarditis
    B. Left ventricular hypertrophy (answer) C. Coronary vasospasm
    D. Aortic stenosis
30. Which of the following is NOT a common cause of continuous murmurs?
    A. Patent ductus arteriosus
    B. Arteriovenous fistula
    C. Aortic stenosis and regurgitation (answer) D. Coarctation of the aorta

Question 17

31. A 20-year-old woman has an early diastolic murmur best heard at the left sternal border during expiration. What is the most appropriate next step in management?
    A. No intervention; reassure the patient B. Echocardiography
    C. Chest X-ray
    D. Blood cultures
32. Which marker of myocardial necrosis is most specific for myocardial infarction?
    A. Troponin I B. Myoglobin
    C. Lactate dehydrogenase (LDH)
    D. Creatine kinase (CK-MB)

Answer 17

31. A 20-year-old woman has an early diastolic murmur best heard at the left sternal border during expiration. What is the most appropriate next step in management?
    A. No intervention; reassure the patient B. Echocardiography (answer)
    C. Chest X-ray
    D. Blood cultures
32. Which marker of myocardial necrosis is most specific for myocardial infarction?
    A. Troponin I (answer) B. Myoglobin
    C. Lactate dehydrogenase (LDH)
    D. Creatine kinase (CK-MB)

Question 18

33. Which of the following drugs is least likely to slow conduction through the AV node?
    A. Amiodarone
    B. Adenosine
    C. Lidocaine D. Verapamil
34. Which of the following ECG findings is LEAST likely associated with acute pericarditis?
    A. Diffuse ST elevation B. PR depression
    C. Q waves
    D. Low voltage QRS

Answer 18

33. Which of the following drugs is least likely to slow conduction through the AV node?
    A. Amiodarone
    B. Adenosine
    C. Lidocaine (answer) D. Verapamil
34. Which of the following ECG findings is LEAST likely associated with acute pericarditis?
    A. Diffuse ST elevation B. PR depression
    C. Q waves (answer)
    D. Low voltage QRS

Question 19

35. In a patient with Wolff-Parkinson-White syndrome, which of the following arrhythmias is most concerning?
    A. Atrial fibrillation B. Ventricular tachycardia
    C. Sinus bradycardia
    D. Multifocal atrial tachycardia
36. Which of the following conditions is most likely to cause a widened pulse pressure?
    A. Aortic regurgitation B. Pulmonary stenosis
    C. Mitral stenosis
    D. Hypertrophic cardiomyopathy

Answer 19

35. In a patient with Wolff-Parkinson-White syndrome, which of the following arrhythmias is most concerning?
    A. Atrial fibrillation (answer) B. Ventricular tachycardia
    C. Sinus bradycardia
    D. Multifocal atrial tachycardia
36. Which of the following conditions is most likely to cause a widened pulse pressure?
    A. Aortic regurgitation (answer) B. Pulmonary stenosis
    C. Mitral stenosis
    D. Hypertrophic cardiomyopathy

Question 20

37. In which of the following disorders is the development of pulmonary hypertension primarily due to increased pulmonary blood flow?
    A. Eisenmenger syndrome
    B. Ostium primum atrial septal defect
    C. Chronic obstructive pulmonary disease (COPD) D. Left ventricular failure
38. A 32-year-old woman has dyspnea on exertion, an opening snap, and a mid-diastolic rumble at the apex. What is the most likely diagnosis?
    A. Mitral stenosis B. Aortic regurgitation
    C. Tricuspid regurgitation
    D. Pulmonary hypertension

Answer 20

37. In which of the following disorders is the development of pulmonary hypertension primarily due to increased pulmonary blood flow?
    A. Eisenmenger syndrome
    B. Ostium primum atrial septal defect (answer)
    C. Chronic obstructive pulmonary disease (COPD) D. Left ventricular failure
38. A 32-year-old woman has dyspnea on exertion, an opening snap, and a mid-diastolic rumble at the apex. What is the most likely diagnosis?
    A. Mitral stenosis (answer) B. Aortic regurgitation
    C. Tricuspid regurgitation
    D. Pulmonary hypertension

Question 21

39. Which of the following therapies is NOT a class I recommendation for patients with unstable coronary syndromes?
    A. Dual antiplatelet therapy B. Statins
    C. Nitrate therapy D. Beta-blockers
40. Which of the following findings is most indicative of tricuspid valve regurgitation?
    A. Pansystolic murmur that increases with inspiration B. Early diastolic murmur best heard at the apex
    C. Crescendo-decrescendo murmur at the left sternal border
    D. Systolic murmur radiating to the neck

Answer 21

39. Which of the following therapies is NOT a class I recommendation for patients with unstable coronary syndromes?
    A. Dual antiplatelet therapy B. Statins
    C. Nitrate therapy (answer) D. Beta-blockers
40. Which of the following findings is most indicative of tricuspid valve regurgitation?
    A. Pansystolic murmur that increases with inspiration (answer) B. Early diastolic murmur best heard at the apex
    C. Crescendo-decrescendo murmur at the left sternal border
    D. Systolic murmur radiating to the neck

Question 22

41. A 56-year-old woman with hypertension and elevated potassium levels needs treatment for hypertension. Which medication is most appropriate?
    A. Amlodipine B. Lisinopril
    C. Spironolactone
    D. Hydrochlorothiazide
42. Which of the following is NOT a common risk factor for stroke in patients with atrial fibrillation?
    A. Hypertension
    B. Diabetes
    C. Dyslipidemia D. Age >65

Answer 22

41. A 56-year-old woman with hypertension and elevated potassium levels needs treatment for hypertension. Which medication is most appropriate?
    A. Amlodipine (answer) B. Lisinopril
    C. Spironolactone
    D. Hydrochlorothiazide
42. Which of the following is NOT a common risk factor for stroke in patients with atrial fibrillation?
    A. Hypertension
    B. Diabetes
    C. Dyslipidemia (answer) D. Age >65

Question 23

43. Which of the following is NOT a high-output cause of heart failure?
    A. Severe anemia
    B. Thyrotoxicosis
    C. Chronic kidney disease D. Paget’s disease
44. Which of the following is TRUE regarding atrial septal defects?
    A. Most commonly present with cyanosis in infancy
    B. Always result in left-to-right shunting
    C. Commonly lead to Eisenmenger syndrome if untreated D. Are always asymptomatic in adults

Answer 23

43. Which of the following is NOT a high-output cause of heart failure?
    A. Severe anemia
    B. Thyrotoxicosis
    C. Chronic kidney disease (answer) D. Paget’s disease
44. Which of the following is TRUE regarding atrial septal defects?
    A. Most commonly present with cyanosis in infancy
    B. Always result in left-to-right shunting
    C. Commonly lead to Eisenmenger syndrome if untreated (answer) D. Are always asymptomatic in adults

Question 24

45. A 76-year-old woman presents with a holosystolic murmur at the 5th intercostal space, midclavicular line, with symptoms of dyspnea and leg swelling. What is the most likely cause?
    A. Mitral regurgitation B. Aortic stenosis
    C. Pulmonary regurgitation
    D. Tricuspid stenosis
46. Which of the following findings is associated with infective endocarditis?
    A. Janeway lesions B. Xanthomas
    C. Butterfly rash
    D. Elevated anti-dsDNA antibodies

Answer 24

45. A 76-year-old woman presents with a holosystolic murmur at the 5th intercostal space, midclavicular line, with symptoms of dyspnea and leg swelling. What is the most likely cause?
    A. Mitral regurgitation (answer) B. Aortic stenosis
    C. Pulmonary regurgitation
    D. Tricuspid stenosis
46. Which of the following findings is associated with infective endocarditis?
    A. Janeway lesions (answer) B. Xanthomas
    C. Butterfly rash
    D. Elevated anti-dsDNA antibodies

Question 25

47. Which of the following is the earliest ECG finding in hyperkalemia? A. Flattened T waves B. Peaked T waves C. QRS widening D. ST depression 48. Which of the following cardiac conditions is most commonly associated with carcinoid syndrome? A. Mitral stenosis B. Aortic regurgitation C. Tricuspid stenosis D. Pulmonary regurgitation

Answer 25

47. Which of the following is the earliest ECG finding in hyperkalemia? A. Flattened T waves B. Peaked T waves (answer) C. QRS widening D. ST depression 48. Which of the following cardiac conditions is most commonly associated with carcinoid syndrome? A. Mitral stenosis B. Aortic regurgitation C. Tricuspid stenosis (answer) D. Pulmonary regurgitation

Question 26

49. What is the predominant cause of sudden cardiac death in patients <35 years old? A. Coronary artery disease B. Hypertrophic cardiomyopathy C. Aortic dissection D. Pulmonary embolism 50. Which of the following markers is elevated in type 5 myocardial infarction? A. CK-MB B. Troponin I C. Lactate dehydrogenase (LDH) D. Brain natriuretic peptide (BNP)

Answer 26

49. What is the predominant cause of sudden cardiac death in patients <35 years old? A. Coronary artery disease B. Hypertrophic cardiomyopathy (answer) C. Aortic dissection D. Pulmonary embolism 50. Which of the following markers is elevated in type 5 myocardial infarction? A. CK-MB (answer) B. Troponin I C. Lactate dehydrogenase (LDH) D. Brain natriuretic peptide (BNP)

Question 27

51. Which of the following drugs is considered first-line therapy for a patient with hyperlipidemia and triglycerides >500 mg/dL? A. Atorvastatin B. Gemfibrozil C. Ezetimibe D. Niacin 51. Which of the following findings on auscultation is most likely associated with aortic stenosis? A. Holosystolic murmur radiating to the axilla B. Late-peaking crescendo-decrescendo murmur at the right upper sternal border C. Continuous murmur heard best at the left sternal border D. Low-pitched diastolic murmur at the apex

Answer 27

51. Which of the following drugs is considered first-line therapy for a patient with hyperlipidemia and triglycerides >500 mg/dL? A. Atorvastatin B. Gemfibrozil (answer) C. Ezetimibe D. Niacin 51. Which of the following findings on auscultation is most likely associated with aortic stenosis? A. Holosystolic murmur radiating to the axilla B. Late-peaking crescendo-decrescendo murmur at the right upper sternal border (answer) C. Continuous murmur heard best at the left sternal border D. Low-pitched diastolic murmur at the apex

Question 28

52. Which of the following markers is elevated in the earliest stage of infective endocarditis? A. C-reactive protein (CRP) B. Erythrocyte sedimentation rate (ESR) C. Troponin I D. Lactate dehydrogenase (LDH) 53. Which of the following is the most common cause of tricuspid regurgitation? A. Right ventricular dilation due to left-sided heart failure B. Pulmonary embolism C. Endocarditis D. Congenital abnormalities

Answer 28

52. Which of the following markers is elevated in the earliest stage of infective endocarditis? A. C-reactive protein (CRP) (answer) B. Erythrocyte sedimentation rate (ESR) C. Troponin I D. Lactate dehydrogenase (LDH) 53. Which of the following is the most common cause of tricuspid regurgitation? A. Right ventricular dilation due to left-sided heart failure (answer) B. Pulmonary embolism C. Endocarditis D. Congenital abnormalities

Question 29

54. Which of the following ECG findings is most likely seen in a patient with pulmonary embolism? A. ST elevation in leads V2-V4 B. S1Q3T3 pattern C. Wide QRS complexes D. Peaked T waves 55. Which of the following forms of congenital heart disease is least likely to be cyanotic in infancy? A. Tetralogy of Fallot B. Transposition of the great arteries C. Atrial septal defect D. Truncus arteriosus

Answer 29

54. Which of the following ECG findings is most likely seen in a patient with pulmonary embolism? A. ST elevation in leads V2-V4 B. S1Q3T3 pattern (answer) C. Wide QRS complexes D. Peaked T waves 55. Which of the following forms of congenital heart disease is least likely to be cyanotic in infancy? A. Tetralogy of Fallot B. Transposition of the great arteries C. Atrial septal defect (answer) D. Truncus arteriosus

Question 30

56. Which of the following is the definitive treatment for hypertrophic cardiomyopathy in patients with severe symptoms? A. Beta-blockers B. Septal myectomy C. Implantable cardioverter-defibrillator (ICD) D. Amiodarone 57. Which of the following statements about coronary dominance is true? A. Right dominance is the most common pattern. B. Left dominance leads to higher rates of ischemia. C. Co-dominance is associated with inferior myocardial infarctions. D. Coronary dominance is determined by the left anterior descending artery.

Answer 30

56. Which of the following is the definitive treatment for hypertrophic cardiomyopathy in patients with severe symptoms? A. Beta-blockers B. Septal myectomy (answer) C. Implantable cardioverter-defibrillator (ICD) D. Amiodarone 57. Which of the following statements about coronary dominance is true? A. Right dominance is the most common pattern. (answer) B. Left dominance leads to higher rates of ischemia. C. Co-dominance is associated with inferior myocardial infarctions. D. Coronary dominance is determined by the left anterior descending artery.

Question 31

58. Which of the following is NOT a typical finding in cardiac tamponade? A. Pulsus paradoxus B. Elevated jugular venous pressure C. Distant heart sounds D. Wide pulse pressure 59. Which of the following antiarrhythmic drugs has the least effect on prolonging the QT interval? A. Amiodarone B. Sotalol C. Lidocaine D. Dofetilide

Answer 31

58. Which of the following is NOT a typical finding in cardiac tamponade? A. Pulsus paradoxus B. Elevated jugular venous pressure C. Distant heart sounds D. Wide pulse pressure (answer) 59. Which of the following antiarrhythmic drugs has the least effect on prolonging the QT interval? A. Amiodarone B. Sotalol C. Lidocaine (answer) D. Dofetilide

Question 32

60. Which of the following markers is used to monitor the progression of heart failure? A. Creatine kinase B. Brain natriuretic peptide (BNP) C. C-reactive protein (CRP) D. Troponin T 61. A 72-year-old man is diagnosed with aortic stenosis. Which of the following features suggests severe disease? A. Mid-peaking systolic murmur B. Delayed and weak carotid pulse C. Wide pulse pressure D. Soft S4 sound

Answer 32

60. Which of the following markers is used to monitor the progression of heart failure? A. Creatine kinase B. Brain natriuretic peptide (BNP) (answer) C. C-reactive protein (CRP) D. Troponin T 61. A 72-year-old man is diagnosed with aortic stenosis. Which of the following features suggests severe disease? A. Mid-peaking systolic murmur B. Delayed and weak carotid pulse (answer) C. Wide pulse pressure D. Soft S4 sound

Question 33

62. Which of the following conditions is NOT included in the differential diagnosis of a widened mediastinum on chest X-ray? A. Aortic dissection B. Large pericardial effusion C. Cardiac tamponade D. Thoracic aortic aneurysm 63. Which of the following is a characteristic feature of pulmonary hypertension? A. Decreased pulmonary vascular resistance B. Enlarged pulmonary arteries on imaging C. Cyanosis with exercise tolerance D. Increased cardiac output

Answer 33

62. Which of the following conditions is NOT included in the differential diagnosis of a widened mediastinum on chest X-ray? A. Aortic dissection B. Large pericardial effusion C. Cardiac tamponade (answer) D. Thoracic aortic aneurysm 63. Which of the following is a characteristic feature of pulmonary hypertension? A. Decreased pulmonary vascular resistance B. Enlarged pulmonary arteries on imaging (answer) C. Cyanosis with exercise tolerance D. Increased cardiac output

Question 34

64. Which of the following murmurs increases with Valsalva maneuver? A. Mitral regurgitation B. Hypertrophic cardiomyopathy murmur C. Tricuspid regurgitation D. Aortic stenosis 65. What is the most common cause of sudden cardiac death in athletes? A. Myocardial infarction B. Hypertrophic cardiomyopathy C. Coronary artery dissection D. Aortic rupture

Answer 34

64. Which of the following murmurs increases with Valsalva maneuver? A. Mitral regurgitation B. Hypertrophic cardiomyopathy murmur (answer) C. Tricuspid regurgitation D. Aortic stenosis 65. What is the most common cause of sudden cardiac death in athletes? A. Myocardial infarction B. Hypertrophic cardiomyopathy (answer) C. Coronary artery dissection D. Aortic rupture

Question 35

66. Which of the following drugs is most appropriate for managing hypertension in a patient with chronic kidney disease? A. Amlodipine B. Lisinopril C. Metoprolol D. Hydrochlorothiazide 67. Which of the following conditions is associated with a paradoxical embolism? A. Patent ductus arteriosus B. Atrial septal defect with right-to-left shunting C. Eisenmenger syndrome with left-to-right shunting D. Hypertrophic cardiomyopathy

Answer 35

66. Which of the following drugs is most appropriate for managing hypertension in a patient with chronic kidney disease? A. Amlodipine B. Lisinopril (answer) C. Metoprolol D. Hydrochlorothiazide 67. Which of the following conditions is associated with a paradoxical embolism? A. Patent ductus arteriosus B. Atrial septal defect with right-to-left shunting (answer) C. Eisenmenger syndrome with left-to-right shunting D. Hypertrophic cardiomyopathy

Question 36

66. Which of the following drugs is most appropriate for managing hypertension in a patient with chronic kidney disease? A. Amlodipine B. Lisinopril C. Metoprolol D. Hydrochlorothiazide 67. Which of the following conditions is associated with a paradoxical embolism? A. Patent ductus arteriosus B. Atrial septal defect with right-to-left shunting C. Eisenmenger syndrome with left-to-right shunting D. Hypertrophic cardiomyopathy

Answer 36

66. Which of the following drugs is most appropriate for managing hypertension in a patient with chronic kidney disease? A. Amlodipine B. Lisinopril (answer) C. Metoprolol D. Hydrochlorothiazide 67. Which of the following conditions is associated with a paradoxical embolism? A. Patent ductus arteriosus B. Atrial septal defect with right-to-left shunting (answer) C. Eisenmenger syndrome with left-to-right shunting D. Hypertrophic cardiomyopathy

Question 37

1. Which of the following regurgitant fractions would be considered severe aortic valve regurgitation?
 A) 30%
 B) 40%
 C) 50% D) 60%
 2. A 23-year-old has a mild-diastolic rumble and sharp early diastolic sound. What is the likely explanation?
 A) Aortic stenosis
 B) Tricuspid regurgitation
 C) Mitral stenosis 
 D) Pulmonary hypertension


Answer 37

1. Which of the following regurgitant fractions would be considered severe aortic valve regurgitation?
 A) 30%
 B) 40%
 C) 50% (answer)
 D) 60%
 2. A 23-year-old has a mild-diastolic rumble and sharp early diastolic sound. What is the likely explanation?
 A) Aortic stenosis
 B) Tricuspid regurgitation
 C) Mitral stenosis (answer)
 D) Pulmonary hypertension


Question 38

3. A 56-year-old man comes to the emergency department with symptoms of heart failure. Which of the following treatments is appropriate?
 A) Oral aspirin
 B) Intravenous furosemide
 C) Intravenous nitroglycerin 
 D) Beta-blockers
 4. A 63-year-old man presents with exertional dyspnea and a heart murmur. Echocardiography shows an aortic valve area of 0.8 cm2. What is the next best step?
 A) Medical management with beta-blockers
 B) Repeat echocardiography in 6 months
 C) Aortic valve replacement after coronary angiogram D) Percutaneous balloon valvuloplasty


Answer 38

3. A 56-year-old man comes to the emergency department with symptoms of heart failure. Which of the following treatments is appropriate?
 A) Oral aspirin
 B) Intravenous furosemide
 C) Intravenous nitroglycerin (answer)
 D) Beta-blockers
 4. A 63-year-old man presents with exertional dyspnea and a heart murmur. Echocardiography shows an aortic valve area of 0.8 cm2. What is the next best step?
 A) Medical management with beta-blockers
 B) Repeat echocardiography in 6 months
 C) Aortic valve replacement after coronary angiogram (answer)
 D) Percutaneous balloon valvuloplasty


Question 39

5. Which of the following statements about angina pectoris is true?
 A) Pain is usually localized to the left arm.
 B) It is not relieved by nitroglycerin.
 C) Substernal, characterized by burning, heavy, or squeezing pain relieved by rest or nitroglycerin. 
 D) It does not occur with emotional stress.
 6. Which drugs can cause lower extremity peripheral edema?
 A) Beta-blockers
 B) Diuretics
 C) Calcium channel blockers 
 D) ACE inhibitors


Answer 39

5. Which of the following statements about angina pectoris is true?
 A) Pain is usually localized to the left arm.
 B) It is not relieved by nitroglycerin.
 C) Substernal, characterized by burning, heavy, or squeezing pain relieved by rest or nitroglycerin. (answer)
 D) It does not occur with emotional stress.
 6. Which drugs can cause lower extremity peripheral edema?
 A) Beta-blockers
 B) Diuretics
 C) Calcium channel blockers (answer)
 D) ACE inhibitors


Question 40

7. Which of the following best describes the sound of mitral regurgitation?
 A) High-pitched diastolic murmur radiating to the carotids
 B) Low-pitched diastolic murmur heard at the apex
 C) Systolic ejection murmur heard at the apex and radiating to the axilla 
 D) Continuous machinery murmur
 8. Which of the following statements about syncope is correct?
 A) It is always associated with cardiac arrhythmias.
 B) Neurally mediated syncope includes only vasovagal syncope.
 C) Neurally mediated syncope includes vasovagal, situational syncope, and carotid sinus syndrome. D) It is never associated with postural hypotension.


Answer 40

7. Which of the following best describes the sound of mitral regurgitation?
 A) High-pitched diastolic murmur radiating to the carotids
 B) Low-pitched diastolic murmur heard at the apex
 C) Systolic ejection murmur heard at the apex and radiating to the axilla (answer)
 D) Continuous machinery murmur
 8. Which of the following statements about syncope is correct?
 A) It is always associated with cardiac arrhythmias.
 B) Neurally mediated syncope includes only vasovagal syncope.
 C) Neurally mediated syncope includes vasovagal, situational syncope, and carotid sinus syndrome. (answer)
 D) It is never associated with postural hypotension.