Multiple Choice Questions (MCQ)

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Category: Cardiology--->Ischaemic heart disease
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Question 1# Print Question

A 60-year-old hypertensive patient presents to the ED with chest pain. The pain came on very suddenly in the left chest whilst he was lifting a heavy plant pot. The pain is difficult to localize. The intensity has been constant and remains persistent. En route to hospital it has changed location to the left side of the lower thoracic back. He has recently had treatment for thoracic back pain from a chiropractor. He is sweating (looks unwell) and anxious but has no shortness of breath. Blood pressure is 160/90 mmHg, heart rate is 100 bpm and saturations are 99% on room air. The ECG does not show acute ST change. D-dimer is 1700 ng/mL (normal < 500 ng/mL), and troponin is awaited.
Based on the information available, what is the most likely diagnosis?

A. Acute coronary syndrome
B. Pulmonary embolism
C. Acute aortic syndrome
D. Musculoskeletal pain
E. Pericarditis

Question 2# Print Question

You review a 65-year-old male on the post-take ward round who has been referred by his GP with a 2-week history of exertional chest pain. There have been no episodes at rest and he has improved since the GP started him on bisoprolol 2.5 mg od. His resting ECG shows no ischaemia and troponin tests are negative. He has a family history of ischaemic heart disease but no other risk factors.
Which investigation would you recommend?

A. CT coronary angiogram
B. Invasive coronary angiogram
C. Exercise treadmill test
D. Stress echo
E. Nuclear perfusion scan

Question 3# Print Question

A 45-year-old woman presents with ongoing chest pain. Immediate observations reveal BP 140/80 mmHg, heart rate 90 bpm, and saturations 99% on room air.
What should you do next?

A. Administer oxygen
B. Administer analgesia
C. Give aspirin 300 mg
D. Perform a 12-lead ECG
E. Gain IV access

Question 4# Print Question

You review a 55-year-old woman in clinic who has been referred by her GP with recent chest pains. You feel that the nature of the pains is atypical for ischaemia although they are reproduced with exertion. She has no identifiable risk factors for ischaemic heart disease and the resting ECG is normal.
What would you recommend?

A. CT coronary angiogram
B. Reassure—no further tests required
C. Invasive coronary angiogram
D. Exercise treadmill test
E. Myocardial perfusion scan

Question 5# Print Question

Angiography of a patient who had redo coronary artery bypass grafting in 1987. He had three grafts and has a recurrence of angina.

The following RAO angiogram shows?


A. Aortic diverticulum
B. Right coronary graft stump
C. Left coronary system graft stump
D. LIMA graft
E. Aortic pseudoaneurysm

Category: Cardiology--->Ischaemic heart disease
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