Final Year MBBS
KMU Past Paper Practice
Chest Pain, Ischemic Heart Disease, Cardiac Rhythm Disorders & Cardiac Interventions
20 A-type Single Best Answer MCQs • KMU-style clinical reasoning and applied revision
MCQ 1
A 58-year-old man with chronic exertional angina remains symptomatic despite lifestyle modification. His resting pulse is 92/min and blood pressure is normal. A drug is prescribed to reduce myocardial oxygen demand by slowing the heart rate and reducing contractility. Which drug class best achieves this effect?
Options:
- Antiplatelet agents
- Beta-adrenergic blockers
- Lipid-lowering agents
- Anticoagulants
- Fibrinolytic agents
MCQ 2
A patient with known ischemic heart disease develops exertional chest tightness. Sublingual nitrate therapy rapidly improves his symptoms. Which physiological effect most directly contributes to this symptomatic benefit?
Options:
- Increased myocardial contractility
- Increased systemic vascular resistance
- Increased platelet activation
- Reduced cardiac preload and myocardial oxygen demand
- Increased atrioventricular conduction
MCQ 3
A patient is being treated for suspected acute coronary syndrome. Aspirin is administered early in management in the absence of a contraindication. Which therapeutic effect is most important in this setting?
Options:
- Reduction of platelet aggregation
- Direct dissolution of an established thrombus
- Reduction of ventricular automaticity
- Suppression of atrioventricular conduction
- Direct coronary stent expansion
MCQ 4
A 62-year-old man is discharged after treatment for myocardial infarction. His lipid profile remains abnormal, but he asks why lipid-lowering therapy is needed when he no longer has chest pain. What is the main rationale?
Options:
- It terminates recurrent supraventricular tachycardia
- It restores atrioventricular conduction
- It provides immediate relief of acute angina
- It replaces the need for risk-factor control
- It reduces future atherosclerotic cardiovascular risk
MCQ 5
During post-MI follow-up, a patient has no recurrent chest pain, but echocardiography demonstrates markedly impaired left ventricular systolic function. Why is this finding clinically important?
Options:
- It excludes future rhythm complications
- It confirms normal myocardial recovery
- It identifies increased risk after myocardial infarction
- It removes the need for secondary prevention
- It proves that coronary arteries are unobstructed
MCQ 6
A general practitioner reviews a patient with established ischemic heart disease who continues to smoke cigarettes despite treatment. Which intervention addresses an important modifiable driver of recurrent coronary events?
Options:
- Routine permanent pacing
- Structured smoking-cessation support
- Repeated electrical cardioversion
- Long-term bed rest
- Routine coronary angiography at every visit
MCQ 7
An ECG obtained during routine review shows sinus rhythm with every P wave followed by a QRS complex, but the PR interval is consistently prolonged. The patient is asymptomatic. Which conduction abnormality is present?
Options:
- Second-degree AV block Mobitz I
- Second-degree AV block Mobitz II
- Complete AV block
- Supraventricular tachycardia
- First-degree AV block
MCQ 8
An ECG shows progressive lengthening of the PR interval over successive beats until one P wave is not followed by a QRS complex. The cycle then repeats. Which diagnosis best fits this pattern?
Options:
- Second-degree AV block Mobitz I
- First-degree AV block
- Second-degree AV block Mobitz II
- Complete AV block
- Atrial fibrillation
MCQ 9
A patient with recurrent dizziness has an ECG showing constant PR intervals in conducted beats, with occasional P waves suddenly not followed by QRS complexes. Which conduction abnormality is most likely?
Options:
- First-degree AV block
- Mobitz I AV block
- Sinus arrhythmia
- Mobitz II AV block
- Atrial fibrillation
MCQ 10
A 29-year-old patient presents with abrupt palpitations. ECG confirms a regular narrow-complex supraventricular tachycardia. Blood pressure is normal. Vagal manoeuvres do not terminate the rhythm. Which pharmacological approach is most appropriate next at undergraduate management level?
Options:
- Immediate long-term anticoagulation
- Routine fibrinolytic therapy
- Rapid-acting AV nodal blockade with adenosine
- Immediate permanent pacemaker implantation
- Emergency coronary bypass surgery
MCQ 11
A patient with atrial fibrillation is hemodynamically stable but has persistent palpitations and a rapid ventricular response. Which immediate therapeutic goal is most appropriate before considering longer-term rhythm strategy?
Options:
- Control the ventricular rate
- Perform emergency coronary stenting
- Insert a permanent ventricular pacemaker
- Administer fibrinolytic therapy
- Perform unsynchronized defibrillation
MCQ 12
A patient with recurrent symptomatic SVT has repeated episodes despite appropriate medical treatment. The electrophysiology team proposes a definitive catheter-based procedure. What is the principle of this treatment?
Options:
- Opening an obstructed epicardial coronary artery
- Creating an arterial bypass around a coronary lesion
- Providing continuous anticoagulation through a catheter
- Eliminating tissue responsible for the abnormal electrical circuit
- Measuring serum biomarkers from the coronary circulation
MCQ 13
A cardiologist plans invasive coronary imaging in a patient with significant ischemic symptoms. Which description best represents the basic method of coronary angiography?
Options:
- Recording electrical activity through surface chest electrodes
- Passing an arterial catheter and using contrast to visualize coronary vessels
- Using external ultrasound to measure the ventricular rate
- Delivering a synchronized electrical shock across the chest
- Applying radiofrequency energy to an atrial pathway
MCQ 14
A patient with symptomatic advanced conduction disease is scheduled for permanent pacemaker implantation. Which description best explains how pacing supports cardiac rhythm?
Options:
- It dissolves thrombus within the coronary circulation
- It directly lowers serum cholesterol concentration
- It removes an atherosclerotic plaque surgically
- It suppresses all atrial activity permanently
- It delivers electrical impulses when intrinsic cardiac activation is inadequate
MCQ 15
A patient with ischemic heart disease is being considered for revascularization because disabling symptoms continue despite appropriate medical treatment. Which factor is most important when deciding whether catheter-based or surgical revascularization is suitable?
Options:
- Presence of any isolated premature beat
- Patient’s resting respiratory rate alone
- Anatomical extent and pattern of coronary disease
- Presence of sinus rhythm on one ECG
- Absence of fever during assessment
MCQ 16
A patient recovering after myocardial infarction asks whether he should avoid physical activity permanently. He is clinically stable and has entered follow-up. Which advice best reflects the role of cardiac rehabilitation?
Options:
- All physical activity should remain prohibited indefinitely
- Exercise should begin without medical assessment
- Rehabilitation is needed only after recurrent infarction
- Graded recovery should be combined with risk-factor and lifestyle management
- Rehabilitation replaces prescribed cardiovascular medication
MCQ 17
During primary-care follow-up after myocardial infarction, a patient reports new recurrent chest discomfort occurring with progressively less exertion than before. What is the most appropriate response?
Options:
- Arrange prompt reassessment for recurrent ischemia
- Reassure the patient because treatment was already completed
- Stop cardiovascular medications until symptoms settle
- Advise the patient to avoid mentioning symptoms unless severe
- Delay further assessment until the next annual review
MCQ 18
A 6-month-old infant has intermittent episodes of unexplained irritability and poor feeding. During an episode, the pulse is extremely rapid and regular. Which investigation should be obtained during symptoms to establish the rhythm diagnosis?
Options:
- Exercise stress testing
- Serum lipid profile
- Coronary angiography
- Adult exercise ECG
- 12-lead electrocardiogram
MCQ 19
Parents of an infant with documented SVT ask why follow-up remains necessary even though the child is currently well. Which explanation is most appropriate?
Options:
- The child requires coronary bypass surgery later
- Episodes may recur and treatment response should be monitored
- Every episode causes permanent myocardial infarction
- Normal feeding excludes future rhythm problems
- Follow-up is primarily required to assess cholesterol levels
MCQ 20
A patient who survived an acute myocardial infarction reports low mood, fear of physical activity and poor adherence because he believes normal life is no longer possible. Which aspect of post-MI care is most appropriate?
Options:
- Focus exclusively on repeated cardiac biomarkers
- Avoid discussion of emotional concerns during cardiac follow-up
- Address psychosocial recovery together with adherence and rehabilitation
- Recommend indefinite social and occupational withdrawal
- Replace medical follow-up with reassurance alone