Q.1 Which of the following is the most common initial presenting symptom of acute myocardial infarction?
Chest pain
Dyspnea
Syncope
Palpitations
Explanation - Chest pain is the most common initial presenting symptom of acute myocardial infarction, often described as pressure or heaviness.
Correct answer is: Chest pain
Q.2 In a patient with suspected acute coronary syndrome, which ECG change is most indicative of ST-elevation myocardial infarction (STEMI)?
ST depression
T wave inversion
ST elevation
U wave inversion
Explanation - ST elevation in contiguous leads on ECG is a hallmark of STEMI and indicates full-thickness myocardial injury.
Correct answer is: ST elevation
Q.3 Which cardiac enzyme is most specific for myocardial infarction?
AST
CK-MB
Troponin I/T
LDH
Explanation - Troponins are highly specific and sensitive biomarkers for myocardial infarction, remaining elevated for days after injury.
Correct answer is: Troponin I/T
Q.4 What is the first step in the management of a patient with ventricular fibrillation?
CPR
IV adrenaline
Immediate defibrillation
Amiodarone
Explanation - Immediate defibrillation is the priority in ventricular fibrillation, as it is the only effective treatment to restore rhythm.
Correct answer is: Immediate defibrillation
Q.5 Which drug is contraindicated in inferior wall myocardial infarction with right ventricular involvement?
Nitrates
Aspirin
Morphine
Oxygen
Explanation - Nitrates reduce preload, which can worsen hypotension in right ventricular infarction.
Correct answer is: Nitrates
Q.6 What is the most common cause of sudden cardiac arrest in adults?
Bradyarrhythmia
Pulmonary embolism
Ventricular fibrillation
Asystole
Explanation - Ventricular fibrillation is the most common cause of sudden cardiac arrest in adults.
Correct answer is: Ventricular fibrillation
Q.7 Which artery is most commonly occluded in an anterior wall myocardial infarction?
Right coronary artery
Left circumflex artery
Left anterior descending artery
Posterior descending artery
Explanation - Anterior wall myocardial infarctions are most often due to occlusion of the left anterior descending artery.
Correct answer is: Left anterior descending artery
Q.8 A patient presents with chest pain radiating to the left arm, diaphoresis, and nausea. What is the most likely diagnosis?
Gastroesophageal reflux
Acute myocardial infarction
Panic attack
Pulmonary embolism
Explanation - Classic symptoms of myocardial infarction include chest pain with radiation, sweating, and nausea.
Correct answer is: Acute myocardial infarction
Q.9 Which of the following is a risk factor for acute coronary syndrome?
Smoking
Exercise
High HDL
Low blood pressure
Explanation - Smoking is a major modifiable risk factor for coronary artery disease and acute coronary syndromes.
Correct answer is: Smoking
Q.10 What is the most appropriate initial antiplatelet therapy in suspected myocardial infarction?
Clopidogrel
Aspirin
Warfarin
Heparin
Explanation - Aspirin should be given immediately to all patients with suspected myocardial infarction unless contraindicated.
Correct answer is: Aspirin
Q.11 Which complication is most likely within the first 24 hours of myocardial infarction?
Ventricular septal rupture
Cardiac tamponade
Arrhythmias
Left ventricular aneurysm
Explanation - Arrhythmias are the most common early complication following myocardial infarction.
Correct answer is: Arrhythmias
Q.12 Which clinical finding is most suggestive of cardiogenic shock?
Warm extremities
Hypotension with pulmonary edema
Bradycardia
Bounding pulses
Explanation - Cardiogenic shock is characterized by hypotension and pulmonary congestion due to pump failure.
Correct answer is: Hypotension with pulmonary edema
Q.13 Which medication reduces myocardial oxygen demand by lowering heart rate and contractility?
Nitrates
Beta-blockers
Aspirin
Furosemide
Explanation - Beta-blockers reduce myocardial oxygen demand by decreasing heart rate, blood pressure, and contractility.
Correct answer is: Beta-blockers
Q.14 Which type of myocardial infarction is associated with ST depression on ECG?
STEMI
NSTEMI
Both STEMI and NSTEMI
Neither STEMI nor NSTEMI
Explanation - NSTEMI typically presents with ST depression and T wave inversion on ECG.
Correct answer is: NSTEMI
Q.15 Which of the following is the most important reversible cause of pulseless electrical activity (PEA)?
Hypovolemia
Asthma
Hypertension
Hyperthyroidism
Explanation - Hypovolemia is one of the most common reversible causes of PEA and must be corrected rapidly.
Correct answer is: Hypovolemia
Q.16 What is the recommended door-to-balloon time for primary PCI in STEMI management?
30 minutes
60 minutes
90 minutes
120 minutes
Explanation - Guidelines recommend a door-to-balloon time of ≤90 minutes for primary PCI in STEMI.
Correct answer is: 90 minutes
Q.17 Which condition can mimic acute myocardial infarction on ECG?
Pericarditis
Asthma
Pneumonia
Peptic ulcer disease
Explanation - Pericarditis can present with diffuse ST elevation that mimics myocardial infarction.
Correct answer is: Pericarditis
Q.18 What is the most important immediate treatment for a patient in asystole?
Defibrillation
CPR and epinephrine
Amiodarone
Synchronized cardioversion
Explanation - Asystole requires immediate CPR and administration of epinephrine; defibrillation is not indicated.
Correct answer is: CPR and epinephrine
Q.19 Which electrolyte imbalance increases the risk of ventricular arrhythmias?
Hypokalemia
Hypernatremia
Hypercalcemia
Hyponatremia
Explanation - Hypokalemia predisposes to ventricular arrhythmias by prolonging repolarization.
Correct answer is: Hypokalemia
Q.20 What is the classic triad of cardiac tamponade?
Fever, chest pain, hypotension
Hypotension, muffled heart sounds, jugular venous distension
Syncope, chest pain, tachycardia
Cyanosis, cough, edema
Explanation - Beck’s triad of tamponade includes hypotension, muffled heart sounds, and jugular venous distension.
Correct answer is: Hypotension, muffled heart sounds, jugular venous distension
Q.21 Which antiarrhythmic is recommended for refractory ventricular fibrillation?
Amiodarone
Lidocaine
Adenosine
Atropine
Explanation - Amiodarone is recommended after defibrillation and CPR for refractory ventricular fibrillation.
Correct answer is: Amiodarone
Q.22 Which of the following is a sign of left-sided heart failure?
Peripheral edema
Ascites
Pulmonary edema
Hepatomegaly
Explanation - Left-sided heart failure causes pulmonary congestion leading to pulmonary edema.
Correct answer is: Pulmonary edema
Q.23 What is the first-line therapy for unstable supraventricular tachycardia?
Adenosine
Amiodarone
Synchronized cardioversion
Beta-blockers
Explanation - Unstable SVT requires immediate synchronized cardioversion to restore sinus rhythm.
Correct answer is: Synchronized cardioversion
Q.24 Which of the following is most likely to cause pulseless ventricular tachycardia?
Coronary artery disease
Asthma
Anemia
GERD
Explanation - Ischemic heart disease is the leading cause of ventricular tachycardia and fibrillation.
Correct answer is: Coronary artery disease
Q.25 Which ECG finding is suggestive of hyperkalemia?
Peaked T waves
Flattened T waves
ST depression
U waves
Explanation - Tall, peaked T waves are characteristic of hyperkalemia on ECG.
Correct answer is: Peaked T waves