Cardiac test interpretation MCQs With Answer

Introduction: This set of Cardiac Test Interpretation MCQs with Answers is tailored for M.Pharm students focusing on clinical pharmacy practice. It emphasizes interpretation of common cardiac investigations—ECG patterns, cardiac biomarkers (troponin, CK‑MB, BNP/NT‑proBNP), echocardiography findings, Holter and stress testing—linking laboratory and electrocardiographic data to clinical decision making and drug therapy implications. Questions probe kinetics of biomarkers, recognition of ischemic and non‑ischemic ECG changes, limitations and confounders of tests (renal dysfunction, obesity, drugs), and selection of appropriate tests for reinfarction or arrhythmia detection. Use these MCQs for self‑assessment, exam preparation, and to deepen understanding of test interpretation in pharmacotherapeutic contexts.

Q1. Which electrocardiographic finding is considered diagnostic for ST‑elevation myocardial infarction (STEMI)?

• New onset left bundle branch block without ST changes
• ST‑segment elevation in two contiguous leads
• Isolated T‑wave inversion in inferior leads
• Q waves alone without ST changes

Correct Answer: ST‑segment elevation in two contiguous leads

Q2. Which leads most reliably reflect an anterior wall myocardial infarction on a 12‑lead ECG?

• Leads II, III, aVF
• Leads V1–V4
• Leads I and aVL only
• Leads V5–V6 and aVL

Correct Answer: Leads V1–V4

Q3. How does a non‑ST elevation myocardial infarction (NSTEMI) typically present compared with STEMI?

• Normal troponin with ST‑elevation
• Elevated troponin without persistent ST‑segment elevation
• ST‑elevation without biomarker rise
• Q waves with normal troponin

Correct Answer: Elevated troponin without persistent ST‑segment elevation

Q4. What is the typical time course of cardiac troponin I/T after acute myocardial injury?

• Rises within 3–4 hours, peaks at 12–24 hours, remains elevated for 7–10 days
• Rises within 30 minutes, peaks at 2 hours, returns to baseline at 24 hours
• Rises after 48 hours and persists for months
• Constantly elevated only in acute pulmonary embolism

Correct Answer: Rises within 3–4 hours, peaks at 12–24 hours, remains elevated for 7–10 days

Q5. Which statement best describes CK‑MB kinetics useful for detecting reinfarction?

• CK‑MB rises at 24–48 hours and remains elevated for 2 weeks
• CK‑MB is undetectable after myocardial injury
• CK‑MB rises in 4–6 hours, peaks ~24 hours, returns to baseline by 48–72 hours
• CK‑MB kinetics are identical to troponin and therefore not useful for reinfarction

Correct Answer: CK‑MB rises in 4–6 hours, peaks ~24 hours, returns to baseline by 48–72 hours

Q6. Which BNP value is most consistent with acute heart failure in the appropriate clinical context?

• BNP <50 pg/mL
• BNP 50–100 pg/mL
• BNP >100 pg/mL
• BNP >10,000 pg/mL required for diagnosis

Correct Answer: BNP >100 pg/mL

Q7. Which condition commonly causes chronically elevated troponin levels and can confound MI interpretation?

• Acute appendicitis
• Chronic kidney disease
• Osteoarthritis
• Vitamin D deficiency

Correct Answer: Chronic kidney disease

Q8. What characteristic ECG pattern is classically seen in acute pericarditis?

• Localized ST‑elevation in V1–V2 only
• Diffuse ST‑segment elevation with PR‑segment depression
• ST‑segment depression in inferior leads exclusively
• Wide QRS complexes with tall R waves

Correct Answer: Diffuse ST‑segment elevation with PR‑segment depression

Q9. Which progression of ECG changes is typical for severe hyperkalemia?

• Flattened T waves progressing to U waves
• Peaked tall T waves progressing to widened QRS and sine‑wave pattern
• Prolonged PR interval with new Q waves
• Shortened QT interval and ST‑elevation

Correct Answer: Peaked tall T waves progressing to widened QRS and sine‑wave pattern

Q10. Which electrocardiographic criterion defines left ventricular hypertrophy by Sokolow–Lyon?

• R in V1 + S in V6 >20 mm
• S in V1 + R in V5 or V6 ≥35 mm
• QRS duration >120 ms with ST‑elevation
• R in lead II >15 mm

Correct Answer: S in V1 + R in V5 or V6 ≥35 mm

Q11. Which group of drugs is most associated with QT‑interval prolongation and torsades de pointes?

• Beta‑blockers and ACE inhibitors
• Drugs that block hERG potassium channels such as certain antiarrhythmics, macrolides, and antipsychotics
• Statins and fibrates
• Loop diuretics exclusively

Correct Answer: Drugs that block hERG potassium channels such as certain antiarrhythmics, macrolides, and antipsychotics

Q12. What ECG features define a complete right bundle branch block (RBBB)?

• rsR’ pattern in V1–V2 with QRS duration ≥120 ms
• Diffuse ST‑elevation in all leads
• Low voltage QRS in limb leads only
• Short PR interval with delta waves

Correct Answer: rsR’ pattern in V1–V2 with QRS duration ≥120 ms

Q13. Which statement correctly contrasts NT‑proBNP with BNP?

• NT‑proBNP has a shorter half‑life and is unaffected by renal function
• NT‑proBNP has a longer half‑life and is more affected by renal function and age
• BNP is only elevated in renal failure and not in heart failure
• NT‑proBNP is exclusively used to diagnose pulmonary embolism

Correct Answer: NT‑proBNP has a longer half‑life and is more affected by renal function and age

Q14. In interpreting diagnostic tests, what does a highly sensitive test with a negative result indicate (SnNOut)?

• A negative result effectively rules out the disease
• A negative result confirms the disease
• Sensitivity has no role in ruling out disease
• A negative result should always be ignored

Correct Answer: A negative result effectively rules out the disease

Q15. What is the normal range for left ventricular ejection fraction (LVEF) on transthoracic echocardiography?

• LVEF 20–35%
• LVEF 36–50%
• LVEF approximately 55–70%
• LVEF >90% physiologic normal

Correct Answer: LVEF approximately 55–70%

Q16. What is the primary clinical use of 24–48 hour Holter monitoring in cardiology?

• To measure serum electrolyte changes over time
• To document frequency and type of intermittent arrhythmias and correlate with symptoms
• To perform continuous blood pressure monitoring only
• To replace echocardiography for structural assessment

Correct Answer: To document frequency and type of intermittent arrhythmias and correlate with symptoms

Q17. How does obesity affect BNP levels when evaluating suspected heart failure?

• Obesity raises BNP levels, increasing false positives
• Obesity lowers BNP levels, potentially masking heart failure
• Obesity has no effect on BNP
• Obesity converts BNP to NT‑proBNP

Correct Answer: Obesity lowers BNP levels, potentially masking heart failure

Q18. On an exercise stress ECG, which finding is most indicative of myocardial ischemia?

• ≥1 mm horizontal or downsloping ST‑segment depression in leads during stress
• Global ST‑segment elevation in all leads during recovery
• Increase in heart rate without ST changes
• Isolated premature atrial complexes only

Correct Answer: ≥1 mm horizontal or downsloping ST‑segment depression in leads during stress

Q19. When troponin is elevated in myocarditis versus acute coronary syndrome, which approach helps differentiate the causes?

• Assume coronary thrombosis unless BNP is low
• Both cause troponin rise; use clinical context, coronary angiography or cardiac MRI to differentiate
• Troponin is never elevated in myocarditis
• Only CK‑MB can distinguish myocarditis from MI

Correct Answer: Both cause troponin rise; use clinical context, coronary angiography or cardiac MRI to differentiate

Q20. Which cardiac enzyme is preferred for detecting reinfarction after an initial MI due to its shorter return to baseline?

• Troponin T
• Myoglobin
• CK‑MB
• LDH isoenzymes only

Correct Answer: CK‑MB

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