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Sample 1·Cardiology
A 58-year-old male presents with sudden onset central chest pain radiating to the left arm, diaphoresis, and nausea for 45 minutes. ECG shows 3mm ST elevation in leads II, III, aVF. What is the most appropriate immediate management?
- AOral aspirin only and observe
- ✓Primary PCI within 90 minutes
- CThrombolysis after CT chest
- DStart beta-blockers and admit
Explanation
Inferior STEMI requires immediate reperfusion. Primary PCI within 90 minutes of first medical contact is the gold standard when available.
Sample 2·Cardiology
A 65-year-old has severe aortic stenosis with syncope. Which is the most appropriate management?
- ABeta-blocker
- ✓Aortic valve replacement
- CBalloon angioplasty of coronaries
- DACE inhibitor
Explanation
Symptomatic severe AS (angina, syncope, heart failure) is an indication for AVR; medical therapy alone is inadequate.
Sample 3·Cardiology
A 70-year-old with hypertension is started on ramipril. Two weeks later potassium is 5.9 mmol/L and creatinine has risen by 40%. What is the most likely underlying cause?
- APrimary hyperaldosteronism
- ✓Bilateral renal artery stenosis
- CType 4 renal tubular acidosis
- DRhabdomyolysis
Explanation
Bilateral RAS causes marked creatinine rise and hyperkalaemia after ACE inhibitor initiation.
Sample 4·Cardiology
A 55-year-old woman has intermittent palpitations. ECG shows an irregularly irregular rhythm with no P waves. What is the first-line rate control agent in a patient without heart failure?
- ADigoxin
- BAmiodarone
- ✓Bisoprolol
- DVerapamil IV
Explanation
Beta-blockers (bisoprolol) are first-line rate control in AF without heart failure or contraindications.
Sample 5·Cardiology
A 40-year-old presents with pleuritic chest pain relieved by leaning forward. ECG shows widespread saddle-shaped ST elevation and PR depression. Diagnosis?
- AAcute MI
- ✓Acute pericarditis
- CPulmonary embolism
- DAortic dissection
Explanation
Widespread concave ST elevation with PR depression and positional pain is diagnostic of acute pericarditis.
