MCQ Quiz- Cardiology

MCQ Quiz: Cardiology

by

Cardiovascular disease remains a leading cause of morbidity and mortality, making cardiology a cornerstone of pharmacy practice. From managing chronic conditions like hypertension and heart failure to responding to acute events like myocardial infarction, pharmacists play a vital role. This quiz, designed for PharmD students, will test your integrated knowledge of cardiovascular pathophysiology, pharmacology, and evidence-based therapeutic guidelines to ensure you are prepared to provide optimal patient care.

1. A patient with hypertension and diabetes has a blood pressure of 150/95 mmHg. According to major guidelines, which of the following medication classes would be an appropriate first-line choice?

  • Loop diuretic
  • Alpha-blocker
  • ACE inhibitor
  • Non-dihydropyridine calcium channel blocker

Answer: ACE inhibitor

2. The primary mechanism of action of angiotensin-converting enzyme (ACE) inhibitors is to block the conversion of:

  • Angiotensin I to Angiotensin II.
  • Angiotensin II to Aldosterone.
  • Renin to Angiotensin I.
  • Bradykinin to inactive peptides.

Answer: Angiotensin I to Angiotensin II.

3. What is the primary pathophysiological feature of heart failure with reduced ejection fraction (HFrEF)?

  • Impaired ventricular relaxation and filling.
  • Impaired ventricular contraction and ejection.
  • Thickening of the pericardial sac.
  • Aortic valve stenosis.

Answer: Impaired ventricular contraction and ejection.

4. According to current guidelines, which of the following medication classes is NOT considered a cornerstone of Guideline-Directed Medical Therapy (GDMT) for HFrEF?

  • ACE Inhibitor/ARB/ARNI
  • Beta-Blocker
  • SGLT2 Inhibitor
  • Dihydropyridine Calcium Channel Blocker

Answer: Dihydropyridine Calcium Channel Blocker

5. A patient presents with symptoms of an acute coronary syndrome (ACS) and the ECG shows ST-segment elevation. This finding is most indicative of:

  • Unstable angina.
  • NSTEMI (Non-ST-Elevation Myocardial Infarction).
  • STEMI (ST-Elevation Myocardial Infarction).
  • Prinzmetal’s angina.

Answer: STEMI (ST-Elevation Myocardial Infarction).

6. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is a standard of care after:

  • A new diagnosis of hypertension.
  • Placement of a coronary artery stent.
  • Initiation of statin therapy.
  • A VTE diagnosis.

Answer: Placement of a coronary artery stent.

7. A patient needs to start a high-intensity statin for secondary prevention of ASCVD. Which of the following regimens is considered high-intensity?

  • Pravastatin 20 mg daily
  • Simvastatin 20 mg daily
  • Atorvastatin 80 mg daily
  • Lovastatin 40 mg daily

Answer: Atorvastatin 80 mg daily

8. The primary goal of statin therapy is to lower which lipid parameter?

  • High-density lipoprotein (HDL)
  • Triglycerides (TG)
  • Low-density lipoprotein (LDL).
  • Total cholesterol

Answer: Low-density lipoprotein (LDL).

9. What is the most commonly reported side effect of statin therapy that leads to discontinuation?

  • Hepatotoxicity
  • Myopathy or muscle pain.
  • Persistent dry cough
  • Peripheral edema

Answer: Myopathy or muscle pain.

10. In a patient with atrial fibrillation, the CHADS₂-VASc score is used to assess the risk of:

  • Bleeding
  • Myocardial infarction
  • Stroke.
  • Heart failure exacerbation

Answer: Stroke.

11. Which of the following is a primary advantage of using a Direct Oral Anticoagulant (DOAC) over warfarin for stroke prevention in atrial fibrillation?

  • DOACs require frequent INR monitoring.
  • DOACs have fewer drug-drug interactions and a more predictable dose-response.
  • DOACs have a readily available and inexpensive reversal agent for all drugs in the class.
  • DOACs are significantly less expensive.

Answer: DOACs have fewer drug-drug interactions and a more predictable dose-response.

12. The underlying pathophysiology of atherosclerosis involves:

  • The development of fibrous plaques and lipid deposition within the arteries.
  • A sudden spasm of the coronary arteries.
  • An electrical conduction abnormality in the heart.
  • A bacterial infection of the heart valves.

Answer: The development of fibrous plaques and lipid deposition within the arteries.

13. Which class of diuretics is most effective for providing rapid symptom relief in a patient with acute decompensated heart failure and significant fluid overload?

  • Potassium-sparing diuretics
  • Thiazide diuretics
  • Loop diuretics.
  • Carbonic anhydrase inhibitors

Answer: Loop diuretics.

14. A persistent, dry cough is a well-known side effect associated with which class of antihypertensive medications?

  • Angiotensin II Receptor Blockers (ARBs)
  • Beta-Blockers
  • ACE Inhibitors.
  • Calcium Channel Blockers

Answer: ACE Inhibitors.

15. Pharmacogenomic testing for CYP2C19 is most relevant for predicting the response to which antiplatelet agent?

  • Aspirin
  • Ticagrelor
  • Prasugrel
  • Clopidogrel.

Answer: Clopidogrel.

16. Which part of the cardiac conduction system is considered the natural pacemaker of the heart?

  • Atrioventricular (AV) node
  • Sinoatrial (SA) node.
  • Bundle of His
  • Purkinje fibers

Answer: Sinoatrial (SA) node.

17. Nitroglycerin is used for stable ischemic heart disease because it primarily causes:

  • Increased myocardial oxygen demand.
  • Venodilation, which reduces preload and myocardial oxygen demand.
  • A significant increase in heart rate.
  • A potent anti-inflammatory effect.

Answer: Venodilation, which reduces preload and myocardial oxygen demand.

18. What is a compelling indication for using an aldosterone antagonist in a patient with heart failure?

  • HFrEF (NYHA class II-IV) to reduce morbidity and mortality.
  • A baseline potassium level greater than 5.5 mEq/L.
  • The presence of hyperlipidemia.
  • A history of gout.

Answer: HFrEF (NYHA class II-IV) to reduce morbidity and mortality.

19. In heart failure, the body’s compensatory activation of the Renin-Angiotensin-Aldosterone System (RAAS) and Sympathetic Nervous System (SNS) is ultimately:

  • Beneficial for long-term cardiac function.
  • Maladaptive, leading to cardiac remodeling and progression of the disease.
  • Only relevant in the acute setting.
  • The primary target for diuretic therapy.

Answer: Maladaptive, leading to cardiac remodeling and progression of the disease.

20. Which of the following medications should generally be avoided in a patient with bilateral renal artery stenosis?

  • Amlodipine
  • Metoprolol
  • Lisinopril
  • Furosemide

Answer: Lisinopril

21. A patient’s ASCVD risk score is used to estimate the:

  • 10-year risk of developing a first atherosclerotic cardiovascular event.
  • Lifetime risk of developing heart failure.
  • Immediate risk of having a stroke.
  • 1-year risk of a bleeding event.

Answer: 10-year risk of developing a first atherosclerotic cardiovascular event.

22. Which beta-blockers are most commonly used in the management of HFrEF due to proven mortality benefits in clinical trials?

  • Atenolol, nadolol, propranolol
  • Metoprolol succinate, carvedilol, bisoprolol.
  • Sotalol, acebutolol, pindolol
  • Labetalol, esmolol, nebivolol

Answer: Metoprolol succinate, carvedilol, bisoprolol.

23. The primary difference between dihydropyridine (DHP) and non-dihydropyridine (non-DHP) calcium channel blockers is that:

  • DHPs are more selective for vascular smooth muscle, while non-DHPs also have significant effects on cardiac conduction and contractility.
  • Non-DHPs cause reflex tachycardia.
  • DHPs are primarily used for arrhythmias.
  • Non-DHPs are preferred for treating peripheral edema.

Answer: DHPs are more selective for vascular smooth muscle, while non-DHPs also have significant effects on cardiac conduction and contractility.

24. What is the therapeutic INR range for a patient on warfarin for atrial fibrillation?

  • 1.0 – 1.5
  • 1.5 – 2.0
  • 2.0 – 3.0.
  • 3.5 – 4.5

Answer: 2.0 – 3.0.

25. A patient with asthma should use which type of beta-blocker with caution, if one is needed?

  • A cardioselective beta-1 blocker.
  • A non-selective beta-blocker.
  • Any beta-blocker is considered safe.
  • An alpha-blocker instead.

Answer: A non-selective beta-blocker.

26. Sacubitril, part of an angiotensin receptor-neprilysin inhibitor (ARNI), works by:

  • Blocking the AT1 receptor.
  • Inhibiting the enzyme neprilysin, which increases levels of beneficial natriuretic peptides.
  • Directly stimulating beta-1 receptors.
  • Blocking sodium-glucose transport in the kidney.

Answer: Inhibiting the enzyme neprilysin, which increases levels of beneficial natriuretic peptides.

27. What is a key counseling point for a patient starting a nitrate patch?

  • To apply it to the same spot every day.
  • To ensure a “nitrate-free” interval of 10-12 hours each day to prevent tolerance.
  • To cut the patch in half if they experience a headache.
  • To wear the patch continuously 24/7.

Answer: To ensure a “nitrate-free” interval of 10-12 hours each day to prevent tolerance.

28. Shared decision-making in the context of starting a statin involves:

  • The pharmacist telling the patient they must take the medication.
  • The patient deciding on a dose without clinical input.
  • A discussion between the clinician and patient about the risks and benefits to align therapy with the patient’s values.
  • Choosing the medication based on the lowest cost only.

Answer: A discussion between the clinician and patient about the risks and benefits to align therapy with the patient’s values.

29. The term “venous thromboembolism” (VTE) encompasses which two conditions?

  • Myocardial infarction and ischemic stroke
  • Atrial fibrillation and heart failure
  • Deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • Hypertension and dyslipidemia

Answer: Deep vein thrombosis (DVT) and pulmonary embolism (PE).

30. Which laboratory value is a key biomarker for diagnosing and assessing the severity of heart failure?

  • Serum creatinine
  • Hemoglobin A1c
  • B-type Natriuretic Peptide (BNP) or NT-proBNP.
  • Alanine transaminase (ALT)

Answer: B-type Natriuretic Peptide (BNP) or NT-proBNP.

31. In rate control strategy for atrial fibrillation, the goal is to:

  • Restore and maintain normal sinus rhythm.
  • Prevent the ventricles from beating too rapidly.
  • Eliminate the need for anticoagulation.
  • Increase the heart rate to over 100 bpm.

Answer: Prevent the ventricles from beating too rapidly.

32. Peripheral edema is a common side effect of which class of antihypertensive agents?

  • ACE inhibitors
  • Dihydropyridine calcium channel blockers.
  • Beta-blockers
  • Loop diuretics

Answer: Dihydropyridine calcium channel blockers.

33. What is the mechanism of action for ezetimibe?

  • It inhibits HMG-CoA reductase in the liver.
  • It inhibits the absorption of cholesterol at the brush border of the small intestine.
  • It is a PCSK9 inhibitor.
  • It binds bile acids in the intestine.

Answer: It inhibits the absorption of cholesterol at the brush border of the small intestine.

34. A patient on digoxin should be monitored for toxicity, which is increased by:

  • Hyperkalemia (high potassium)
  • Hypermagnesemia (high magnesium)
  • Hypokalemia (low potassium).
  • Normal renal function

Answer: Hypokalemia (low potassium).

35. A hypertensive emergency is differentiated from hypertensive urgency by the:

  • Absolute blood pressure reading alone.
  • Presence of acute target-organ damage.
  • Patient’s subjective report of a headache.
  • Time of day the blood pressure is measured.

Answer: Presence of acute target-organ damage.

36. A key component of cardiac muscle contraction is the influx of which ion into the cell?

  • Sodium
  • Potassium
  • Calcium.
  • Chloride

Answer: Calcium.

37. The P-wave on an electrocardiogram (ECG) represents:

  • Ventricular depolarization.
  • Ventricular repolarization.
  • Atrial depolarization.
  • The resting state of the heart.

Answer: Atrial depolarization.

38. Which of the following is a non-pharmacologic lifestyle modification recommended for a patient with hypertension?

  • Increasing sodium intake.
  • Adopting the DASH diet.
  • Starting a smoking habit.
  • Reducing physical activity.

Answer: Adopting the DASH diet.

39. For a patient with HFrEF, SGLT2 inhibitors have been shown to:

  • Increase the risk of heart failure hospitalizations.
  • Reduce the risk of cardiovascular death and hospitalization for heart failure.
  • Significantly increase blood pressure.
  • Have no effect on cardiovascular outcomes.

Answer: Reduce the risk of cardiovascular death and hospitalization for heart failure.

40. The primary role of PCSK9 inhibitors in treating dyslipidemia is to:

  • Decrease cholesterol absorption in the gut.
  • Significantly lower LDL cholesterol by increasing the number of LDL receptors on the liver.
  • Inhibit the synthesis of cholesterol in the liver.
  • Lower triglyceride levels only.

Answer: Significantly lower LDL cholesterol by increasing the number of LDL receptors on the liver.

41. The process of performing medication reconciliation upon hospital discharge is critical for preventing adverse events in cardiology patients because:

  • It helps identify and resolve discrepancies between inpatient and outpatient medication lists.
  • It ensures the patient is discharged with only brand-name medications.
  • It is the primary method for billing the hospital stay.
  • It confirms the patient’s diagnosis.

Answer: It helps identify and resolve discrepancies between inpatient and outpatient medication lists.

42. A patient with heart failure should be advised to avoid which over-the-counter medication for pain?

  • Acetaminophen
  • NSAIDs (e.g., ibuprofen, naproxen)
  • Lidocaine patch
  • Capsaicin cream

Answer: NSAIDs (e.g., ibuprofen, naproxen)

43. The QRS complex on an ECG represents what electrical activity in the heart?

  • Atrial depolarization
  • Ventricular repolarization
  • Ventricular depolarization.
  • AV node delay

Answer: Ventricular depolarization.

44. Cardiovascular health disparities are a significant concern, often linked to:

  • Genetic factors only.
  • Patient preferences for certain drugs.
  • Social determinants of health, such as socioeconomic status and access to care.
  • The color of the medication.

Answer: Social determinants of health, such as socioeconomic status and access to care.

45. What is the main therapeutic effect of a beta-blocker in a patient with stable angina?

  • It increases heart rate and contractility.
  • It decreases myocardial oxygen demand by reducing heart rate, blood pressure, and contractility.
  • It causes significant vasodilation of the coronary arteries.
  • It prevents platelet aggregation.

Answer: It decreases myocardial oxygen demand by reducing heart rate, blood pressure, and contractility.

46. Which of the following is a common symptom of left-sided heart failure?

  • Peripheral edema and ascites
  • Jugular venous distension
  • Dyspnea (shortness of breath) and orthopnea.
  • Hepatomegaly

Answer: Dyspnea (shortness of breath) and orthopnea.

47. From a medicinal chemistry perspective, the acidic functional group on an ACE inhibitor like lisinopril is crucial for:

  • Binding to the zinc ion in the active site of the angiotensin-converting enzyme.
  • Increasing its oral bioavailability.
  • Preventing the side effect of cough.
  • Making the drug taste better.

Answer: Binding to the zinc ion in the active site of the angiotensin-converting enzyme.

48. In treating VTE, the initial period of parenteral anticoagulation (e.g., with heparin) followed by a transition to an oral agent is known as:

  • Monotherapy
  • Extended therapy
  • Bridging therapy.
  • Prophylactic therapy

Answer: Bridging therapy.

49. Amiodarone has a very long half-life and numerous drug interactions primarily because it:

  • Is not metabolized by the liver.
  • Is a potent inhibitor of multiple CYP450 enzymes.
  • Is eliminated unchanged by the kidneys.
  • Binds irreversibly to all tissues.

Answer: Is a potent inhibitor of multiple CYP450 enzymes.

50. The ultimate goal of managing chronic cardiovascular conditions like hypertension and dyslipidemia is to:

  • Achieve a specific lab value regardless of side effects.
  • Prescribe the highest number of medications possible.
  • Prevent long-term cardiovascular events like heart attacks and strokes.
  • Ensure the patient is on the newest available medications.

Answer: Prevent long-term cardiovascular events like heart attacks and strokes.

Leave a Comment