Cardiology

Common MCQs

Part I & II Collections

2018 – 2022 (2022 Part I only) -

KFSHRCJ
Corrected
by
Ahmed Al Ansari

2018
1. 32 year old female known to have mitral stenosis, she is completely asymptomatic, with
very normal vital signs and heart rate, echocardiogram showed the following: Mitral valve area
severe ← of 0.9, mild mitral regurgitation and no LA clot, what is the most appropriate
< to management: ↳ moderate MR or LA clot contraindicated which the Patient
a. Mitral valve placement. doesn't have
b. Percutaneous balloon valvotomy
contraindication =PBmc
c. Beta-blocker and follow up in 6 months. Asymptomatic very
+
severe + no

d. Lasix and follow up in 6 months.

2. A 57 year old gentleman presented with severe angina (Chest pain that is more when
exercising and relieved by rest), refractory to medical therapy, currently presenting with
mild shortness of breath and echocardiography showed Decreased EF, how would you
proceed with investigating this patient:
a. Exercise ECG.
b. CT angiography.
c. Coronary angiography.
d. Dobutamine stress test.

3. A 66 year old gentleman known to have hypertension and dyslipidemia, presented with
angina and angiography was done and showed significant lesions in the left main artery,
left circumflex, and obtuse marginal, echo showed a normal EF what should be your next
step:
multivessel Disease
a. Staged PCI.
b. CABG.
c. Single vessel PCI.

4. A 32-year-old gentleman presented with severe retrosternal chest pain (no further
prescription of the pain), and the following ECG: What would be the best management?
a. Indomethacin.
b. Thrombolytics.

Pericarditis
 - cyanosis
Young -

clubbing
\
systolic murmur
" single Heat sound
Heave
5. A 16 year-old boy presented to the cardiology clinic with clubbing, cyanosis,
Cardiovascular examination showed a single heart sound, ejection systolic murmurs over
the left 2 nd intercostal space, with parasternal heave, which of the following is the most
likely diagnosis:
a. Tetralogy of fallot. cyanotic
b. Essiminger syndrome.
c. Isolated congenital pulmonary stenosis

6. A young patient presented with difficulty standing and the following ECG, what should
be done:
a. Correct sodium level.
b. Correct potassium.
c. Correct hypothermia. weakness + Prolonged QT
d. Correct calcium level.

7. A patient presented 4 weeks post MI with knee and pleuritic chest pain what would be he
best treatment:
a. Aspirin 600 mg every 4 hours. Dressler syndrome
b. Colchicine 3 times daily.
c. Prednisone 20 mg per day.
d. Indomethacin.

8. A 39 year old female patient presented to the ER after she fell down in the market for
few seconds, her symptoms were preceded with nausea, dizziness, ECG upon arrival was
normal as well as other vital signs, including HR and BP, How do you want to further
investigate her:
a. Tilt table test.
b. Echocardiogram. Vasovagal
c. Electrophysiology study.
d. Holter 24-48 hours.
9. An elderly female patient had MI 9 months ago, and is presenting with recurrent
dizziness and palpitation and the following ECG, what should be your best next step:
a. Ablation. The Question needs
b. Amrinone. to provide EF
c. Biventricular pacing.
d. ICD.

monomorphic
VT

10. A patient known to have reduced ejection fraction heart failure on ACEI and beta
blockers, EF 30%, renal function normal creatinine and K 4.3, what should you add to the
management:
On OMT ↓ EF t normal Renal fine
a. Spironolactone. t

b. Amlodipine.
c. Hydralazine and nitrates

11. Which of the following medication has the best mortality effect on the heart:
a. Secubtril/valsartan.

12. A 66 year old black male presented with hypertension which of the following is the best
antihypertensive medications:
a. Candesartan.
b. Amlodipine.
c. Lisinopril.

13. The best antihypertensive medication in gout:

a. Losartan.
b. Thiazides.
c. Lisinopril.
 14. A patient presented with shortness of breath, orthopnea, and lower limb swelling, on
examination the patient had a high JIV that is worse with inspiration, significant lower
limb edema, hepatomegaly, and cardiovascular examination revealed an audible S1+ S2
with a loud sharp sound after S2 most likely diagnosis:
a. Restrictive cardiomyopathy.
Kuss sign + Right sided Hft
knock
b. Dilated cardiomyopathy.
c. Chronic constrictive pericarditis

15. Patient is known to have severe aortic stenosis and is going for urgent cholecystectomy
what should be done:
a. TAVI prior to surgery.
b. Aortic valve replacement prior to surgery.
c. Proceed to the surgery with hemodynamic monitoring

16. A patient known to have thyrotoxicosis presented with Afib with rapid ventricular
response, he was dizzy and hypotensive on presentation and underwent successful
cardioversion, post cardioversion ECG showed ST elevation and his cardiac enzymes
showed a high CK and a persistently normal troponin, what should be done:
? a. Anticoagulate. Acs
Rules out
b. PCI. c. Thrombolytic. <
d. CHADVASc and decide if further anticoagulation is required ← not applicable to anepsiode due
to thyrotoxicosis

17. Patient was referred to you as he is having PVC that was resistant to multiple and
maximum doses of medical therapy, on ECG he had frequent PVC and echo showed
decreased EF which of the following is the best next management plan:
a. CRT device.
b. Ablation.
c. Follow up

18. Which of the following medication should be discontinued in the perioperative period:
a. Statin.
b. Beta- blocker.
c. ACEI.

19. A young patient is known to have peri-membranous VSD, his dentist called you to ask
for your opinion regarding IE prophylaxis as the patient is going for a dental extraction,
what is your advise:
a. Give ampicillin orally prior to the procedure.
b. Give IV ampicillin prior to the dental extraction.
c. No need for prophylaxis.

20. A pregnant lady was found to have a soft 2/6 ejection systolic murmurs over the right
sternal border, that becomes softer with expiration and standing, no thrills and no
radiation what should be done next:
a. Reassurance.
b. Echocardiogram. Innocent
murmur
21. A patient presented with pain on the calf that gets worse with exercise and is relived
with rest, ABI was done and was equal to 0.96 what should you do next:
a. ABI before and after exercise.
b. CT angiography for the lower limb vessels.
c. Cilostazol.

22. A patient presented with his history of lower limb claudication, impotence and on
examination had decreased femoral pulses, what does he have:
a. Leriche syndrome

23. A Patient presented with tearing chest pain radiating to the back and a BP 220/100,
investigation confirmed the diagnosis of aortic dissection, which of the following is the best
next treatment:
a. Urgent surgical referral.
b. IV osmolol.
c. IV nitroprusside

24. Patient was referred to you for resistant hypertension, on examination she is short, has
a webbed neck, what is the most likely cause of hypertension:
a. Aortic coarcotation.
b. Renal artery stenosis. Turner
c. Hyperaldostrenism.

25. Target INR after mechanical aortic valve replacement with no additional risk factor:
a. 2.
b. 2.5.
c. 3.
d. 3.5.

26. Which of the following is an indication for surgery in infective endocarditis:

a. Vegetation that is 5 mm in diameter.
b. Embolic phenomena.
c. First degree AV block. → Peri valvular abscess
d. Staph aureaus positive blood culture.

27. Patient presented with chest pain, ECG showed ST elevation in leads II, III, AVF, on
examination his JVP was noticed to be high, which of the following medications is
absolutely contraindicated:
a. Thrombolytics. RV MI
b. Nitroglycerin.
c. IV fluid.
28. Patient referred to you with substernal chest pain that occurs after 2 minutes of
walking, ECG showed RBBB, which of the following is the best next investigation:
a. Exercise ECG stress test.
b. Myocardial perfusion scan.
c. Dobutamine echocardiography.
d. CT angiography.

29. Patient was referred to you from the family medicine for an abnormal ECG that is
shown, what should be done:
a. Observe.
b. Echocardiogram.
c. Electrophysiology study.
d. Cath.

30. Patient presented with myocardial infarction and underwent Cath, he is currently
asymptomatic and is being discharged home, when can he drive:
a. He can never drive.
b. After 1 week. CABG : 4 weeks
c. After 2 weeks.
d. After 4 weeks.

31. Patient is known to have atrial fibrillation on oral apixiban and is going for
appendectomy, how should her anticoagulation be managed in the perioperative period:
a. Omit 2 doses prior to the surgery.
b. Hold Apixiban on the day of the surgery.
c. Hold 2 days prior to the surgery. d. Stop bridge before and after
 32. A female patient who is known to have Afib, on Apixiban, she is going for breast biopsy, low Risk

which of the following is the most appropriate management of her anticoagulation: Procedure
a. Continue on Apixiban.
✓ b. Omit 2 doses and bridge with heparin.
c. Stop the apixiban prior to the procedure with no bridging.

33. Patient with fixed split of S2 and systolic murmur in left second intercostal space:
ASD
Pathological split[edit] The different types of split S2 can be associated with medical conditions: (See above) • [4]
✓ Split during inspiration: normal. Wide splitting: seen in conditions that delay RV emptying (pulmonic • stenosis,
RBBB). Delay in RV emptying causes delayed pulmonic sound (regardless of breath); it is an exaggeration of
normal splitting sounds. Split during expiration: Reverse splitting indicates pathology. Aortic • stenosis,
hypertrophic cardiomyopathy, left bundle branch block (LBBB), and a ventricular pacemaker could all cause a
reverse splitting of the [5] second heart sound. Split during both inspiration and expiration: • If splitting does not
vary with inspiration, it is termed a "fixed split • such as an atrial septal [6] S2" and is usually due to a septal defect,
defect (ASD). The ASD creates a left to right shunt that increases the blood flow to the right side of the heart,
thereby causing the pulmonary valve to close later than the aortic valve independent of inspiration/expiration. A
bundle branch block either LBBB or RBBB, (although RBBB is • known to be associated only with S1 split), will
produce continuous splitting but the degree of splitting will still vary with respiration. When the pulmonary valve
closes before the aortic valve, this is known as a On physical exam, paradoxical splitting is appreciated [7]
"paradoxically split S2". as increased splitting on expiration relative to inspiration, versus normal splitting where
inspiration will increase splitting. It is seen in conditions that delay left ventricular emptying (e.g., aortic stenosis,
left bundle branch block).

34. Patient on statin develope mylagia:

✓ Change to other type and keep monitoring

35. Patient with pericarditis:

✓ High dose aspirin and colichicin if after MI.

36. Patient with SVT:

✓ Adenosine

37. Patient with AF with unstable VS:

✓ Cardioversion

38. Best inotrop/vasopressor in cardiogenic shock

Norepinephrine

✓ Consider IV dobutamine to increase cardiac output (class IIb; level of • evidence, C) If there is a need to maintain
systolic blood pressure in the presence of • persistent hypoperfusion, consider vassopressors; norepinephrine is
prefered to dopamine (class IIb; level of evidence, B)
 39. Patient with EF:
ICD /CRT (in one answer)
Indications for Device Therapy in Heart Failure Implantable Cardioverter-Defibrillator (for primary prevention) and

:
a NYHA class II or III while taking guideline-directed medical therapy Expectation of survival >1 year and Either of
the following: Ischemic cardiomyopathy ≥40 days post MI or nonischemic cardiomyopathy with ejection fraction
≤35% (primary prevention) History of hemodynamically significant ventricular arrhythmia or cardiac arrest
(secondary prevention)
Biventricular Pacemaker (cardiac resynchronization therapy) All of the following
: Indications for Device Therapy in Heart Failure Implantable Cardioverter-Defibrillator (for primary prevention)
NYHA class II to IV Ejection fraction ≤35% On guideline-directed medical therapy Ventricular dyssynchrony
(LBBB with a QRS duration ≥150 msec)

40. Question about beck triad Components of Beck's Triad for acute cardiac tamponade:
Hypotension with a narrowed pulse pressure Jugular venous distention Muffled heart sounds

2019

1. Mitral stenosis with afib: Valvular Afib

✓
Warfarin regardless of chads

2. Mid diastolic murmur radiating to left sternal border, wt is the jvp sign expected?
Giant A wave If the scenario was suggestive of TS C Increase with inspiration]

3. Case of Platypnea and desating with wide fixed split ?

✓ ASD

4. Catheter ablation definitive management for WPW on Ecg finding with family hx of
sudden death in his brother !
Depends on symptoms & EP study
5. Patient found to have breast cancer, referred to cardiology as pre-operative assessment,
her ECG showed short QT what to do next ?
✓ Hypercalcemia
Calcium level

6. Patient with ECG showed atrial flutter, what is your management ?

✓ Rivaroxban

7. A 60 year old man asymptomatic with multiple comorbidities , diabetes , hypertension

and dyslipidemia, what to do?
A- Calcium coronary score
✓ B- Statin
C- Therapeutic life style modifications
Probably given the

estimated 10
year
ASCVD Risk
 8. Patient with marfan syndrome and MVP , What is the best for dx ?
A- Ehco ??? If the Question was for Mvp echo would be correct
only
9. Patient with high risk factor (DM , HTN , CKD ) with ECG showed LBBB, what is the
best stress test?
B- Adenosine MPI
✓ C- Dobutamine image
D- Exercise stress test

10. Patient with typical scenario of RVI & low BP 80/50 , next step ?
A- IV Fluid
✓ B- Dobutamine infusion
C- Dopamine

11. Patient with severe MR & mild stenosis high LVSD= 44 high pulmonary artery
pressure = 55 what to do next ? and EF must be between 30 -60%
Disagree → A- mitral valve replacement
b-mitral valve repair "
"" ᵗ MR → MV Repair > Replacement
-

12. Patient with sever degenerative aortic stenosis asymptomatic, what's your next step ?
A- Dobutamine echo

y
B- excise stress

13. A case of Murmur * tricuspid regurgitation ?

Holosystolic murmur ( TR )

14. Patient with Picture of murmur of bicuspid aortic, what is the most associated type
type?
A- Rheumatic
✓ B- congenital
C- endocarditis

15. Patient with fever and MS murmurs and diastolic click?

✓ Atrial myxoma ↳ not
only fever constitutional symptoms
will be there
,

16. Patient with lower limb edema & pulsatile hepatomegaly?

✓ Constrictive pericarditis
any Right sided HF
17. Patient post MI with plural effusion and fever?
Post MI syndrome

18. Best ttt for HOCM With hx of family 1 st degree death ?

A- septal myectomy → if sx Refractory to Drug Rx
✓ B- ICD
and

Obstructive
Pathology
( Gradient _
50mm Hg)
 19. Post- PCI with DAPT and abciximab and heparin, platelet is 7 with epistaxis ; What is
✓ the most likely Cause if thrombocytopenia ?
Abciximab

20. A young patient with no risk factors Post sinus surgery best prophylactic?
✓ A- Stocks
B- early mobilization

21. Patient cardiac on bisoprolol, captopril , Aspirin & other medication, developed facial
swelling , knee pain , borderline hyponatremia hypokalemia what is the cause?
✓ captopril . angioedema Pic should be 9kt

23. Patient with high BP 220/120 with trace protein ( no end organ damage ) ?
A- Thiazide and lisnolopril
✓ B- Iv labetalol
C- Iv nitroglycerin
D- Oral Lasix

24. Patient with MS has tachycardia, how to ttt ?

✓ Beta blocker

25. Which type of pericarditis came with normal ECG?

A- Rheumatic
✓ B- Uremic
C- Post MI

26. Case of afib with rapid response what to give? Question not clear
? Procanimide / digoxin / atenolol? and starts e- current vitals
approach
stable us unstable
27. Case of unstable angina dx

28. Constrictive pericarditis diagnosis

29. Tricuspid stenosis jvp pattern prominat a wave?

✓
30 Heart failure stages ( its written in Pocket) they didnt mean the NYHA classification.

31. A patient with HFrEF, has history of ACEi induced cough. On metoprolol. What to
add?
✓ A- Valsartan not add , DK Acei and Replace e- valsarlan

never Acei BARB

give
 2020
1- Patient on routine check-up has mid-diastolic murmur with ejection click, decrease with
✓ squatting, what is the diagnosis?
Answer is:- Mitral valve prolapse ..

2- Long case about aortic regurgitation and asking about treatment?

✓ Answer is:- Aortic valve replacement ..
N.B: read the indications of valve replacement ..

3- Case about diastolic murmur with Bisferen pulse, what is the diagnosis?
✓ Answer is:- Aortic regurgitation ..

4- Patient with murmur similar to aortic stenosis but increases with Valsalva maneuver, what is
✓ the diagnosis?
Answer is:- HOCM ..

5- Late complication of rheumatic fever?

A- Pan carditis ..
B- Arthritis ..

÷
C- Chorea ..
D- Subcutaneous nodule ..
Jaccoud arthropathy is a late and benign complication. However, the question listed arthritis, not arthropathy
All Musculocutneous complications happen early in the course of ARF : Arthritis, Subcutaneous Nodules, and Erythema
marginatum.
Sydenham's Choera is another benign and self-limiting complication, but it has the LONGEST LATENCY
PERIOD! It is the answer

6- Patient with hx of AMI came with palpitation& irregular cannon a wave (ECG given that was
regular & wide colmplex)
A- Antidromic SVT
B- Ventricular tachycardia
N.B: answer depends on ECG you have to carefully differentiate between them ..

7- Patient has prosthetic aortic valve and fever, blood culture showed MRSA, TTE is normal,
what is the next step?
Answer is:- TEE ..

8- Patient with a syncopal attack, looks like vasovagal, what you will do?
Answer is:- ECHO and head-tilt test ..

9-The patientt is giving a history that he is suddenly developed an attack of dizziness while he is
sitting on his office, the peripheral vision became black, his friend said that he was pale during
the attack, what you will do? (I don't remember the exact answer but one of them is carotid massage)
Carotid sinus massage indicated in patients > 40 years old with syncope of unknown origin compatible with a reflex
mechanism
If ECHO normal , ECG normal,

then i would consider CSM

if scenario was
vasovagal =
Tie Table Test
10- Case about aortic stenosis murmur, systolic ejection murmur, what is the diagnosis?
Answer is:- Aortic stenosis ..

11- female not known to have any medical illness came with chest pain relieved by leaning
forward and ECG showed diffuse ST elevation, what is the diagnosis?
Answer is:- Acute pericarditis ..

12- Patient with heart failure developed A fib, what is the best rate control for him?
A- Digoxin ..
B- Atenolol ..

13- Post cardiac arrest, what is the recommendation regarding body temperature?
A- No need ..
B- Keep rectal temperature at 32 using cold blanket ..
C- Keep rectal temperature at 32 using cooling device ..

Targeted temperature management (TTM) refers to carefully controlling the body temperature following return of
spontaneous circulation (ROSC) after cardiac arrest, usually to a precise target temperature between 32 and 37.5 degrees C
for ≥ 24 hours, with the aim of reducing brain injury.

14- Which parameter indicates hypovolemic shock?

Answer is:- High SVR, low cardiac output, low PCWP ..

15- Case of suspected infective endocarditis, with blood culture +ve for staph aureus, what do
you need else to confirm the diagnosis?
Answer is:- Echo evidence of vegetation .. Zmaj
lmajt 3 minor
major
5 minor
16- Patient with VSD for dental extraction, dentist worried about infective endocarditis
prophylaxis, what is your advice?
Answer is:- No prophylaxis is needed ..
17- Patient with mitral valve prolapse for dental extraction, dentist worried about infective
endocarditis prophylaxis, what is your advice?
Answer is:- no prophylaxis needed ..

18- Patient came with dizziness and syncope, picture of ECG showed complete heart block, what
do you expect to find on examination?
Answer is:- Cannon a wave ..

19- Patient diagnosed with atrial fibrillation, he is diabetic and hypertensive with mild mitral
-

stenosis, which anticoagulation you will give?

Answer is:- Warfarin ..

20- What is the main source of BNP?

Answer is:- Ventricle ..

21- Patient did PCI 8 months ago on Aspirin, Clopidogril, simvastatin, which drug should be
stopped before surgery?
Answer is:- Clopidogrel ..

22- What is the most common association with sinus venosus ASD?
N.B: commonly repeated question in previous exams ..

Drainage of the Palm

Vein into the RA
anomalous
Frequently 91W

23. STEMI with ST-elevation (ECG shown) in V2-V5 & 1mm aVL, what's the location?
A- Anterolateral MI
B- Anterospetal MI
C- Anterior MI
D- Posterior MI
24. Post MI with successful PCI When is it safe to drive?
Answer is:- 1 Week ..

25. Pregnant with Pre-eclampsia, muscle power 4, afterward ECG shows Prolonged PR &
QT, Dx?
Answer is:- HyperMg..

26. Patient with fever and MS murmur and diastolic click, Echo shows left atrial mass?
✗A- Infective Endocarditis → no click
B- Atrial Myxoma
mum

27. Decompensated HF with EF of 25% and inferior hypokinesia, improved with diuresis,
post-discharge f/u?
Following ADHF within IWK Should be scheduled
early followup
=

A- 1 week
MKSAP

28. Young with syncope, Systolic murmur, increases with standing & decrease hand grip,
what's the cause?
A- HOCM
B- AS

29. Young patient referred from the family medicine clinic with a picture of pericarditis,
normal ECG showed, likely dx?
A- Uremic Definitely not young
B- Viral Answer uremia
C- Post-MI
Repealed Q
30. A patient presented with STEMI, what is the strongest risk factor for
interventricular septal rupture?
Risf factor for IV Rupture
' '

A- tPA therapy, uptodale

B- First MI,
C- collateral blood vessels around the infarction,
D- or anterior MI.? equal freq in Ant + noant

iipfodate
'

31. Female presented with ballooning apical heart after her husband died. Dx?
Answer is:- Takatsubo..

32. 30s patient with severe Aortic regurgitation, EF: 55%, LVEDD: 64, she is asymptomatic,
what is recommended regarding pregnancy?
A- "Surgery before conception"
B- " Pregnancy is contraindicated"
N.B: Women with asymptomatic aortic
C- "Proceed with pregnancy"
regurgitation (stage B or C1) and preserved LV
D- "Proceed with pregnancy with regular f/u" systolic function tolerate pregnancy well.
 33. Patient with TIA, Echo was done showed small ASD with left to to right shunt ,
management??
A- PFO closure Probably question was about PFO not ASD
table from uptodate
B- Follow-up
C- Warfarin
D- "Plavix +Aspirin

34. HTN on two medications (including ACEi) with Afib on ECG, what to give?
✓ A- Metoprolol
B- ARB

35. Non-ischemic CMP, EF 25, on ACE, beta blocker, Lasix, spironolactone 25% potassium
✓ 5.5 coming with HF, sinus rhythm, QRS 130, Management? QRS 130
A- Answer is:- CRTD

36. Heart failure EF 25 due to CABG after optimal medical

therapy
✓ Answer is:- ICD never pick KD before 0Mt

37. Pt with PAD symptoms, ABI is 0.96, what to do next?

✓ Answer is:- ABI with Exercise

38. ICD is indicated in who?

✓ Answer is:- 60 yrs EF 20% NYHA ClassIV despite medical therapy.

39. Edema and HF, what meds to avoid?

✓ Answer is:- thiazolidinediones

40. HTN with eye emergency (Foundoscopy hemorrhages), what treatment?

✓ Answer is:- IV labetalol

41. HTN with S4 & HF sx, what will found on Echo?

A- Diastolic failure not clear , as Dilated CMP → 53

B- Dilated LV
Question
C- Low EF missing key features
42. Male has AS but normal EF , no symptoms , what do ?
A- Follow up
D- Replace valve
✓
 2021
1. A patient presented with chest pain and you found lead II, III and AVF ST- elevation on
ECG.
Which of the following medications is contraindicated?
A. Nitroglycerine
✓ Only if Hypertensive
B. Aspirin C. IVF
↑ Jvp RVMI )
Clear
lungs
2. Patient admitted as a case of COVID-19 positive, admission, he is a known smoker.
during admission developed chest pain. TropI: POSITIVE. ECG: ST depression in II, III,
AVF, V1-V4 , What is the most likely diagnosis? If patient had Diff STR
A. Myopericarditis (NOT SURE) < no ST
Elevation in ECG ↳
B. Anterior wall STEMI < myo pericarditis
Both incorrect
C. Anterior wall non-STEMI ¥ STEM 1 in Anterior leads
↳ Type 2Mt
(µ, Noaa, ↳ Ant STEMI
↳◦ cordial Mt with non obstructive coronary Artery
3. A patient is known to have angina pectoris class II and you found LBBB in ECG.
Which of the following is proper test?
A. Angiogram Depends on the Pretest Prob 7901 → Angie .

B. CT angiography
C. Exercise testing with ECG if to -90% would do Myocardial Perfusion
D. Exercise testing with Echo as he has LBBB

4. A patient presented with worsening SOB. ECHO done showing EF=50% and
hypertrophic LV with diastolic dysfunction. What is the most likely diagnosis?
✓ A. HFrEF
B. HFpEF

5. A patient is known CAD and HF. He is on Lisinopril, BB, spironolactone. Still

symptomatic. He has EF=30% and LBBB with QRS=160. Which of the following is the best
management?
✓ A. Cardiac resynchronization therapy
B. ICD

6. A 43-year-old male present with palpitation and light headedness. He doesn’t have HF,
HTN, DM or MI. No history of stroke. Which of the following is the proper management?
A. Warfarin
B. Clopidogrel

:
C. Dabigatran
D. No need for anticoagulation (CHA2DS2-VASc score 0)

7. Long case scenario of palpitation and syncope. Mg=0.5, Ca=low. ECG: Torsade de point.
What is the most likely diagnosis?
A. Polymorphic V-tach
B. Monomorphic V-tach
8. Long scenario of CKD patient presented with positional chest pain. Examination is
notable for pericardial rub. Cr= high, urea= high What is the most appropriate
management?
A. hemodialysis

9. A patient presented with worsening LL swelling. Examination: clear lungs, muffled

heart sounds, raised JVP and hypotension. ECHO: free space anterior and posteriorly.
ECHO image: clear pericardial effusion. What is the next step in management?
A. Pericardiocentesis
B. BB
C. Diuretics

10. Short scenario (don’t remember). Examination notable for late diastolic murmur best
heard at LLSB.
A. AR (not sure) → usually early Diastolic murmur
B. MR → Sys
would want us to Pick
C. TR sys
→
Probably AR doubt they
,

D. PR → Diust
PR over AR

11. Late systolic murmur at the apex with mid-systolic click best heard at standing position.
What is the diagnosis?
A. MVP

12. A scenario with written "rib notching on CXR. What is the most likely diagnosis?
A. Coarctation of aorta

13. A case of infective endocarditis and C/S showing MSSA. What is the best management?
A. Nafcillin, rifampin and gentamicin. answers for Prosthetic valve

B. Vancomycin, rifampin and gentamycin

14. A case about thoracic aortic aneurism of 4.5 cm. Which of the following medications
can reduce progression?
A. BB

15. Scenario of AV block. Which of the following findings will be seen on examination?
A. Canon a wave

16. A known case of IHD on aspirin, clopidogrel, atorvastatin and lisinopril is prepared for
OR. Which of the following medications should be stopped?
A. Aspirin
B. Clopidogrel away defer if Possible
C. Atorvastatin
D. Lisinopril
Minimum 6M of DAPT
17. A patient with typical signs and symptoms of hyperthyroidism. Which of the following
is expected complication?
A. Atrial fibrilation

18. Fixed splitting of S2:

ASD

19. Typical scenario of acute pericarditis with diffuse ST elevation and friction rub
Ibuprofen and colchicine

20. Echo finding of cardiac tamponade:

RV diastolic collapse

21. Shock parameters with low SVR:

Only cause of ↓
Distributive shock SVR

22. HFrEF on maximal medical therapy:

Add Sacubutril/valsartan

23. ECG of a patient with COPD and MAT:

IV Verapamil away treat COPD first Patient is
unless
-
very sick
- - - - -
- -
- -
- - -
- -

24. ECG of a patient with Torsade de pointes around the

- -
-
-
' '

-
_
←
Twisting
ecg Baseline
-
- - _

-
- -
.

25. Antihypertensive medication on lisinopril, amlodipine, indapamide:

Add beta blocker Uptodale add MRA then BB
:

need more information

26. NSTEMI admitted for medical therapy:
Aspirin and ticagrelor

27. ECG of anterolateral STEMI (I, avL, V1-V6)

28. ECG of STEMI second degree AV block in (2:1) conduction

?
29. Middle-aged male smoker with history of angina one year ago and high lipid profile:
Atorvastatin 20 mg daily Established ASCVD High dose statin=

30. NVE methicillin sensitive staphylococcus aureus treatment:

native → Naficillin or cefazolin 6 wks →

31. Infective endocarditis with signs of heart failure:

Vancomycin + Gentamicin + Rifampin and cardiac surgery referral
This answer is for PvE (staph A. or
empiric staph )

32. Patient with MI s/p PCI came with fever and pleural effusion:
Post myocardial injury syndrome
33. Atrial flutter with ESRD
?

34. Patient with thyrotoxicosis developed atrial fibrillation with rapid ventricular response.
After cardioversion developed STEMI but patient is asymptomatic:
Rivaroxaban ? Didn't understand the scenario

35. Patient with heart failure and S3 and S4 gallop heard:

Diastolic dysfunction can't HFPEF e- Heart
Sounds
Diagnose

36. Patient presented with history of depression as well as convulsions and dilated pupil.
ECG was shown (long QT):
Tricyclic antidepressant toxicity

37. Patient with impotence, claudication and absence of femoral pulses:

Leriche syndrome

38. Young male patient heavy smoker with symptoms of PAD and cold limb with
diminished peripheral pulses, Angio showed occlusion and collateral:
Abstinence of smoking

39. SLE patient with shortness of breath for 3 months, chest and cardiovascular
examination were normal:
Echocardiogram
Pulmonary Hypertension

40. 2 scenarios about hypertensive emergency with evidence of end organ damage:
IV labetalol

41. Contraindicated in heart failure:

TZDs

42. Next step in CPR:

Resume CPR
2022
1- A 44-year-old male complaining of palpitation, no DM, HTN, or any other chronic
illnesses, on examination: - HR: 110, ECG: A. fib, what should be next?
A- BISOPROLOL+ASA Best option on the list
B- Dabigatran
used in Afib
C- Adenosine Aspirin
no
longer
D- Digoxin and Lidocaine

* Low CHA2DVAS2 score but the only valid option is Beta blocker + ASA.

2- Postpartum female presents with severe sharp chest pain that was radiated to the back,
on examination: absent pulse on the Left upper limb, BP: 120\80, CT image was provided,
what is the most likely diagnosis?
(INSERT IMAGE)
A- PE
B- Aortic dissection

3- Patient had Hx of DVT 2 times, complaining of SOB, on examination: load P2, what
should be the initial next step?
A- Echo
B- Right heart catheterization

*Pulmonary HTN likely CTPEH, they are asking about PHTN diagnostic steps.

4- Patient presents with history suggestive of PAD, on examination: femoral pulse was
intact, but the popliteal and dorsalis pedis pulses were absent, which artery is occluded?
A- Common iliac
B- Internal iliac
C- Superficial femoral
D- Posterior tibialis

5- 45-year-old Black patient, recently diagnosed with HTN, what is the best medication to
start?
From
A- ACEI up todate
B- BB /
CCB
C- ARBs Black -
thiazide
D- Thiazide

6- What is the source of Brain Natriuretic Peptide?

A- Atrium
B- Brain
C- Ventricle

*ANP: from the Atria

*BNP: from the Ventricle
7- A 30-year-old male came with sharp chest pain, radiated to the neck and shoulder, on
examination, auscultation: pericardial friction rub only, CXR: wide cardiac silhouette
(they mentioned it clearly, no pic), Next?
A- Discharge on Ibuprofen don't forget colchicine
B- CT chest
C- Echo
D- Send the patient for Cardiac Cath

8- Another scenario I don’t remember the details but was typical pic of pericarditis (chest
pain improving in sitting, worsening in supine), ECG pic: I,II, III, avF, V4-V6 ST elevation,
Trop positive, what is the diagnosis?
A- Myopericarditis
B- Inferolateral MI C- Anterior MI

*There were 2 questions confused many.

-one with Pericarditis picture + Troponin leak = Myopericarditis
-one with NSTEMI (chest tightness, ST depression + Troponin leak)

9- Patient has chronic chest pain, ECG was unremarkable, what is next?
Answer is:- Stress ECG

10- Case of staph aureus +ve infective endocarditis, TTE: unremarkable , Next?
Answer is:- TEE

11- Pregnant with GA 30 weeks diagnosed with HTN 168/98, what is the management?
A- ACEI
B- Methyldopa

12- Patient known case of HTN was not controlled on 3 anti-HTN medications, what is
next? one must be diuretic
a

A- 24-hr urinary metanephrine

13- Case of dyslipidemia with TG came with mmol range, was 300 and high LDL, what is
the management?
LDL > 190
A- Statin
B- Fenofibrate
N.B: the units of this Q in mmol should know how to convert

14- Patient post MI 8 mon ago, on ASA, Clopidogrel and statin, he was planned for elective
surgery, which medication should be stopped?
A- ASA
B- Plavix
C- Statin
15- Patient was found to have murmur radiated to the back between the scapula, CXR:
bilateral rib notching written in Q no image shown , what is the most likely diagnosis?
Answer is: - Aortic Coarctation

16- Patient COVID-19 positive complaining of chest pain, Troponin positive, ECG wide ST
elevation, with typical presentation of pericarditis what is the diagnosis?
Answer is: - Myoprecarditis

17- An 80-year-old male presents with history of exertional syncope, on examination:

typical murmur of aortic stenosis was heard, his mean pressure gradient is 120 mmHg,
ECG was provided shows LVH, what is next?
Answer is:- Aortic valve replacement

18- 55-year-old male case of HOCM (the typical findings on echo were mentioned), O.E:
there was an obvious ejection systolic murmur that becomes load with Valsalva, decrease
with hand grip what is the diagnosis?
Answer is:-
1-HOCM
2- Aortic stenosis