Ischemic heart disease – atherosclerosis MCQs With Answer

Ischemic heart disease – atherosclerosis MCQs With Answer is an essential review for B.Pharm students preparing for exams and professional practice. This concise, keyword-rich introduction covers pathophysiology of atherosclerosis, coronary artery disease mechanisms, risk factors (hypertension, dyslipidemia, diabetes, smoking), clinical presentation, diagnostic markers, and pharmacologic treatments such as antiplatelets, statins, beta-blockers, nitrates, ACE inhibitors, and reperfusion strategies. Focused on pharmacology and therapeutics, these MCQs reinforce critical concepts like plaque formation, LDL oxidation, inflammation, and secondary prevention. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary pathological process underlying ischemic heart disease?

• Myocardial fibrosis
• Valvular calcification
• Coronary atherosclerosis
• Pericardial inflammation

Correct Answer: Coronary atherosclerosis

Q2. Which lipoprotein is most strongly associated with development of atherosclerotic plaques?

• High-density lipoprotein (HDL)
• Very low-density lipoprotein (VLDL)
• Low-density lipoprotein (LDL)
• Chylomicrons

Correct Answer: Low-density lipoprotein (LDL)

Q3. Which cell type is primarily responsible for transforming oxidized LDL into foam cells in atherosclerotic plaques?

• Endothelial cells
• Smooth muscle cells
• Macrophages
• Platelets

Correct Answer: Macrophages

Q4. Which inflammatory marker is commonly measured as a risk predictor for cardiovascular events?

• C-reactive protein (CRP)
• Alanine aminotransferase (ALT)
• Creatine kinase (CK)
• Amylase

Correct Answer: C-reactive protein (CRP)

Q5. Which class of drugs is first-line for lowering LDL cholesterol to reduce atherosclerosis progression?

• Bile acid sequestrants
• Fibrates
• Statins (HMG-CoA reductase inhibitors)
• Nicotinic acid

Correct Answer: Statins (HMG-CoA reductase inhibitors)

Q6. What is the main mechanism of action of aspirin in preventing myocardial infarction?

• Inhibition of angiotensin-converting enzyme
• Irreversible inhibition of platelet cyclooxygenase-1 (COX-1)
• Blocking P2Y12 receptor
• Increasing nitric oxide synthesis

Correct Answer: Irreversible inhibition of platelet cyclooxygenase-1 (COX-1)

Q7. Which antiplatelet drug is a reversible P2Y12 receptor inhibitor commonly used in acute coronary syndromes?

• Clopidogrel
• Prasugrel
• Ticagrelor
• Aspirin

Correct Answer: Ticagrelor

Q8. Which imaging modality is considered the gold standard for diagnosing significant coronary artery stenosis?

• Coronary angiography (invasive)
• Chest X-ray
• Transthoracic echocardiography
• Carotid Doppler ultrasound

Correct Answer: Coronary angiography (invasive)

Q9. In the pathogenesis of atherosclerosis, endothelial dysfunction leads to increased permeability and which of the following?

• Decreased LDL entry into intima
• Enhanced LDL retention and oxidation
• Immediate plaque rupture
• Vasodilation and reduced thrombosis

Correct Answer: Enhanced LDL retention and oxidation

Q10. Which enzyme modification of LDL is a key step that promotes uptake by macrophages?

• Proteolytic cleavage
• Oxidation of LDL
• Glycosylation of LDL
• Sulfation of LDL

Correct Answer: Oxidation of LDL

Q11. Which drug class reduces myocardial oxygen demand primarily by lowering heart rate and contractility?

• Nitrates
• Beta-blockers
• Calcium channel blockers (dihydropyridine)
• Thrombolytics

Correct Answer: Beta-blockers

Q12. Which nitrate formulation is commonly used for immediate relief of angina symptoms?

• Oral isosorbide mononitrate scheduled dose
• Intravenous nitroprusside
• Sublingual nitroglycerin
• Topical hydralazine

Correct Answer: Sublingual nitroglycerin

Q13. Which of the following is a contraindication to using nitrates?

• Concurrent use of phosphodiesterase-5 inhibitors (e.g., sildenafil)
• Stable angina
• Hypertensive emergency
• Recent myocardial infarction

Correct Answer: Concurrent use of phosphodiesterase-5 inhibitors (e.g., sildenafil)

Q14. Which anticoagulant is often used during percutaneous coronary intervention (PCI) to prevent thrombosis?

• Warfarin
• Unfractionated heparin
• Low molecular weight heparin administered orally
• Rivaroxaban single dose

Correct Answer: Unfractionated heparin

Q15. Which biomarker is most specific for myocardial necrosis and commonly used to diagnose acute myocardial infarction?

• C-reactive protein (CRP)
• Troponin I/T
• Myoglobin only
• BNP (B-type natriuretic peptide)

Correct Answer: Troponin I/T

Q16. Which plaque characteristic defines a “vulnerable plaque” most likely to rupture and cause thrombosis?

• Thick fibrous cap and small lipid core
• Large lipid-rich necrotic core with thin fibrous cap
• Complete calcification
• Absence of inflammatory cells

Correct Answer: Large lipid-rich necrotic core with thin fibrous cap

Q17. Which antihypertensive class provides mortality benefit after myocardial infarction by reducing remodeling?

• ACE inhibitors
• Alpha-blockers
• Hydralazine monotherapy
• Calcium supplements

Correct Answer: ACE inhibitors

Q18. Which of the following is a major side effect associated with high-dose statin therapy?

• Myopathy and elevated creatine kinase
• Hypoglycemia
• QT prolongation
• Bronchospasm

Correct Answer: Myopathy and elevated creatine kinase

Q19. During acute STEMI (ST-elevation myocardial infarction), the preferred reperfusion strategy within the first 90–120 minutes is:

• Immediate long-term anticoagulation only
• Primary percutaneous coronary intervention (PCI)
• Elective coronary artery bypass grafting (CABG)
• Only high-dose statin therapy

Correct Answer: Primary percutaneous coronary intervention (PCI)

Q20. Thrombolytic therapy in myocardial infarction acts primarily by:

• Inhibiting platelet aggregation
• Converting plasminogen to plasmin to lyse fibrin
• Blocking thrombin receptors
• Stabilizing atherosclerotic plaque

Correct Answer: Converting plasminogen to plasmin to lyse fibrin

Q21. Which drug is a fibrate used mainly to lower triglycerides and may modestly raise HDL?

• Fenofibrate
• Atorvastatin
• Ezetimibe
• Niacin

Correct Answer: Fenofibrate

Q22. Which agent reduces intestinal absorption of cholesterol by inhibiting the Niemann-Pick C1-Like 1 (NPC1L1) transporter?

• Ezetimibe
• Colestipol
• Gemfibrozil
• Lovastatin

Correct Answer: Ezetimibe

Q23. Which adverse effect is most associated with high-dose niacin therapy?

• Facial flushing
• Hyperkalemia
• Neutropenia
• QT prolongation

Correct Answer: Facial flushing

Q24. Which cholesterol fraction is considered cardioprotective and inversely correlated with risk of atherosclerosis?

• LDL cholesterol
• HDL cholesterol
• VLDL cholesterol
• IDL cholesterol

Correct Answer: HDL cholesterol

Q25. Which of the following best describes stable angina?

• Chest pain at rest with no exertion triggers
• Predictable chest pain with exertion relieved by rest or nitrates
• New-onset severe chest pain unrelieved by nitroglycerin
• Chest pain caused by pericarditis

Correct Answer: Predictable chest pain with exertion relieved by rest or nitrates

Q26. In the management of acute coronary syndrome, dual antiplatelet therapy typically includes aspirin and which other agent?

• An ACE inhibitor
• A P2Y12 inhibitor (e.g., clopidogrel)
• A beta-blocker
• Warfarin

Correct Answer: A P2Y12 inhibitor (e.g., clopidogrel)

Q27. Which scoring system estimates 10-year risk of coronary heart disease using age, cholesterol, blood pressure, smoking, and diabetes?

• CHADS2 score
• Framingham risk score
• APACHE II
• Glasgow Coma Scale

Correct Answer: Framingham risk score

Q28. What is the main rationale for using high-intensity statin therapy after an acute coronary syndrome?

• To treat heart failure directly
• To rapidly lower LDL and stabilize plaques
• To increase triglyceride synthesis
• To cause vasodilation of coronary arteries

Correct Answer: To rapidly lower LDL and stabilize plaques

Q29. Which of the following is a mechanism by which HDL protects against atherosclerosis?

• Delivering cholesterol to arterial wall
• Reverse cholesterol transport from macrophages
• Promoting LDL oxidation
• Enhancing platelet aggregation

Correct Answer: Reverse cholesterol transport from macrophages

Q30. Which condition describes myocardial ischemia severe enough to cause myocardial cell death?

• Stable angina
• Myocardial infarction
• Angina pectoris
• Variant angina

Correct Answer: Myocardial infarction

Q31. Which clinical sign is most indicative of left ventricular failure secondary to ischemic heart disease?

• Peripheral pitting edema only
• Pulmonary rales and dyspnea
• Jaundice
• Hepatomegaly without pulmonary symptoms

Correct Answer: Pulmonary rales and dyspnea

Q32. Which anti-anginal medication primarily acts by increasing cyclic GMP and causing venodilation?

• Nitrate (nitroglycerin)
• Beta-blocker (metoprolol)
• ACE inhibitor (enalapril)
• Statin (simvastatin)

Correct Answer: Nitrate (nitroglycerin)

Q33. Which genetic condition greatly accelerates atherosclerosis due to markedly elevated LDL from birth?

• Familial hypercholesterolemia
• Familial combined hyperlipidemia
• Abetalipoproteinemia
• Familial LCAT deficiency

Correct Answer: Familial hypercholesterolemia

Q34. Which receptor on platelets is targeted by clopidogrel to inhibit aggregation?

• Glycoprotein IIb/IIIa
• Thromboxane A2 receptor
• P2Y12 ADP receptor
• PAR-1 thrombin receptor

Correct Answer: P2Y12 ADP receptor

Q35. Which of the following is a key difference between stable and unstable angina?

• Unstable angina is predictable with exertion
• Stable angina occurs at rest and indicates plaque rupture
• Unstable angina often results from plaque rupture and thrombosis
• Stable angina always progresses to MI within 24 hours

Correct Answer: Unstable angina often results from plaque rupture and thrombosis

Q36. Which anticoagulant class directly inhibits thrombin (factor IIa)?

• Direct thrombin inhibitors (e.g., dabigatran)
• Factor Xa inhibitors (e.g., rivaroxaban)
• Heparin alone does not affect thrombin
• Vitamin K antagonists only increase thrombin

Correct Answer: Direct thrombin inhibitors (e.g., dabigatran)

Q37. A patient with acute coronary syndrome has ST depressions on ECG. This most likely indicates:

• STEMI affecting full-thickness myocardium
• Ischemia or non-ST-elevation myocardial infarction (NSTEMI)
• Pericarditis exclusively
• Normal variant not requiring treatment

Correct Answer: Ischemia or non-ST-elevation myocardial infarction (NSTEMI)

Q38. Which lifestyle modification has the greatest impact on reducing cardiovascular risk?

• Regular smoking cessation
• Occasional alcohol use
• Reducing sleep to 4 hours/night
• Eating high-saturated-fat diet

Correct Answer: Regular smoking cessation

Q39. Which drug class can cause reflex tachycardia and should be chosen carefully in ischemic heart disease?

• Dihydropyridine calcium channel blockers (e.g., amlodipine)
• Non-dihydropyridine calcium channel blockers (e.g., verapamil)
• Beta-blockers
• ACE inhibitors

Correct Answer: Dihydropyridine calcium channel blockers (e.g., amlodipine)

Q40. Which complication is a direct consequence of widespread myocardial necrosis after large MI?

• Cardiogenic shock
• Pulmonary embolism unrelated to heart
• Isolated peripheral neuropathy
• Gastric ulceration only

Correct Answer: Cardiogenic shock

Q41. In secondary prevention after MI, which medication reduces mortality by preventing ventricular remodeling and improving survival?

• ACE inhibitor (e.g., lisinopril)
• Short-acting nitrates only
• Proton pump inhibitor
• Topical nitroglycerin only

Correct Answer: ACE inhibitor (e.g., lisinopril)

Q42. Which trial demonstrated the benefit of statin therapy in primary and secondary prevention of coronary events?

• ALLHAT
• SCALE
• 4S (Scandinavian Simvastatin Survival Study)
• WHI

Correct Answer: 4S (Scandinavian Simvastatin Survival Study)

Q43. Which diagnostic test provides information on myocardial perfusion and can detect ischemia during stress?

• Stress myocardial perfusion imaging (nuclear stress test)
• Baseline ECG only
• Plain chest radiograph
• Serum amylase measurement

Correct Answer: Stress myocardial perfusion imaging (nuclear stress test)

Q44. After placing a drug-eluting stent, prolonged use of which therapy is recommended to reduce stent thrombosis risk?

• Short-term beta-blocker therapy only
• Dual antiplatelet therapy (aspirin + P2Y12 inhibitor)
• High-dose vitamin K supplementation
• Oral anticoagulation without antiplatelets

Correct Answer: Dual antiplatelet therapy (aspirin + P2Y12 inhibitor)

Q45. Which factor primarily contributes to atherothrombotic occlusion immediately after plaque rupture?

• Platelet activation and aggregation on exposed subendothelial collagen
• Increased HDL-mediated cholesterol efflux
• Vasodilation preventing clot formation
• Reduction in circulating fibrinogen

Correct Answer: Platelet activation and aggregation on exposed subendothelial collagen

Q46. What is the pharmacological effect of PCSK9 inhibitors in lipid management?

• They inhibit cholesterol absorption in the gut
• They increase LDL receptor recycling, lowering LDL levels
• They block HMG-CoA reductase
• They raise triglyceride production

Correct Answer: They increase LDL receptor recycling, lowering LDL levels

Q47. Which electrocardiographic change is classic for an acute transmural infarction?

• Pathological Q waves and ST elevation in contiguous leads
• Isolated T-wave flattening only
• Sinus bradycardia as the sole finding
• Low-voltage limb leads only

Correct Answer: Pathological Q waves and ST elevation in contiguous leads

Q48. Which metabolic abnormality accelerates atherogenesis by promoting LDL glycation and endothelial dysfunction?

• Hypothyroidism
• Hyperglycemia in diabetes mellitus
• Hypokalemia
• Hypermagnesemia

Correct Answer: Hyperglycemia in diabetes mellitus

Q49. Which drug is preferred for rapid platelet inhibition in the catheterization laboratory during PCI because of its fast onset and intravenous administration?

• Oral clopidogrel loading dose only
• Intravenous glycoprotein IIb/IIIa inhibitors (e.g., abciximab)
• Oral aspirin only
• Oral statin immediate effect

Correct Answer: Intravenous glycoprotein IIb/IIIa inhibitors (e.g., abciximab)

Q50. Long-term secondary prevention after ischemic heart disease typically includes which combination?

• Statin, ACE inhibitor/ARB, beta-blocker, antiplatelet therapy, and lifestyle changes
• Only short courses of antibiotics
• High-dose corticosteroids indefinitely
• Exclusive reliance on herbal supplements

Correct Answer: Statin, ACE inhibitor/ARB, beta-blocker, antiplatelet therapy, and lifestyle changes

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