Pance Cardiology Exam
Final Test Review
(Questions & Solutions)
2025
1
,Coronary Artery Disease & Ischemia
1. Multiple Choice
A 58-year-old male with a history of hypertension and smoking presents
with substernal chest pain lasting 30 minutes, radiating to his left arm,
nausea, and diaphoresis. His EKG shows ST-elevation in leads II, III, and
aVF. What is the most appropriate initial management?
A) Administer nitroglycerin and aspirin and observe
B) Immediate coronary angiography with possible PCI
C) Start intravenous heparin and beta-blockers, discharge home
D) Start thrombolytic therapy if PCI unavailable after 12 hours
ANS: B) Immediate coronary angiography with possible PCI
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior STEMI.
Immediate revascularization with PCI is recommended within 90 minutes
to limit myocardial damage.
2. Fill-in-the-Blank
The biochemical marker most specific for myocardial injury and preferred
for diagnosing acute myocardial infarction is ________________.
ANS: Troponin I or Troponin T
Rationale: Troponins are cardiac-specific proteins released during
myocardial injury and remain elevated for days, allowing for accurate
diagnosis.
3. True/False
Stable angina is characterized by predictable chest pain brought on by
exertion and relieved by rest or nitroglycerin.
ANS: True
Rationale: Stable angina results from fixed atherosclerotic plaques
causing demand ischemia; symptoms are reproducible with exertion.
2
,4. Multiple Response
Which of the following are common risk factors for coronary artery
disease? (Select all that apply)
A) Diabetes mellitus
B) Hyperlipidemia
C) Obstructive sleep apnea
D) Hypothyroidism
ANS: A) Diabetes mellitus, B) Hyperlipidemia, C) Obstructive sleep apnea
Rationale: These conditions contribute to endothelial dysfunction and
atherosclerosis, increasing CAD risk. Hypothyroidism is not a direct risk
factor.
Dysrhythmias & Conduction
5. Multiple Choice
A patient with palpitations has an EKG showing a narrow complex
tachycardia at 180 bpm with no visible P waves. Vagal maneuvers were
ineffective. What is the most likely diagnosis?
A) Atrial fibrillation
B) Atrial flutter
C) Paroxysmal supraventricular tachycardia (PSVT)
D) Ventricular tachycardia
ANS: C) Paroxysmal supraventricular tachycardia (PSVT)
Rationale: PSVT often presents with a narrow complex tachycardia and
absent or retrograde P waves; vagal maneuvers sometimes may fail.
6. Fill-in-the-Blank
In complete heart block (third-degree AV block), the hallmark EKG finding
is ________________, indicating complete dissociation between atrial
and ventricular activity.
ANS: atrioventricular dissociation
Rationale: In third-degree block, the atria and ventricles beat
3
, independently due to complete conduction block.
7. True/False
In atrial fibrillation, the irregularly irregular rhythm results from multiple
chaotic atrial impulses conducting irregularly to the ventricles.
ANS: True
Rationale: This results in irregular ventricular response and absence of
discrete P waves.
8. Multiple Response
Which medications are used to control ventricular rate during atrial
fibrillation? (Select all that apply)
A) Digoxin
B) Amiodarone
C) Beta-blockers
D) Calcium channel blockers (non-dihydropyridine)
ANS: A) Digoxin, C) Beta-blockers, D) Calcium channel blockers (non-
dihydropyridine)
Rationale: These slow AV nodal conduction to control ventricular rate.
Amiodarone is usually for rhythm control.
Heart Failure
9. Multiple Choice
A 65-year-old man with hypertension develops dyspnea on exertion and
lower extremity edema. Echocardiogram shows an ejection fraction of
35%. Which of the following medications has been shown to improve
mortality in this patient?
A) Lisinopril
B) Furosemide
C) Digoxin
D) Hydralazine
ANS: A) Lisinopril
4
Final Test Review
(Questions & Solutions)
2025
1
,Coronary Artery Disease & Ischemia
1. Multiple Choice
A 58-year-old male with a history of hypertension and smoking presents
with substernal chest pain lasting 30 minutes, radiating to his left arm,
nausea, and diaphoresis. His EKG shows ST-elevation in leads II, III, and
aVF. What is the most appropriate initial management?
A) Administer nitroglycerin and aspirin and observe
B) Immediate coronary angiography with possible PCI
C) Start intravenous heparin and beta-blockers, discharge home
D) Start thrombolytic therapy if PCI unavailable after 12 hours
ANS: B) Immediate coronary angiography with possible PCI
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior STEMI.
Immediate revascularization with PCI is recommended within 90 minutes
to limit myocardial damage.
2. Fill-in-the-Blank
The biochemical marker most specific for myocardial injury and preferred
for diagnosing acute myocardial infarction is ________________.
ANS: Troponin I or Troponin T
Rationale: Troponins are cardiac-specific proteins released during
myocardial injury and remain elevated for days, allowing for accurate
diagnosis.
3. True/False
Stable angina is characterized by predictable chest pain brought on by
exertion and relieved by rest or nitroglycerin.
ANS: True
Rationale: Stable angina results from fixed atherosclerotic plaques
causing demand ischemia; symptoms are reproducible with exertion.
2
,4. Multiple Response
Which of the following are common risk factors for coronary artery
disease? (Select all that apply)
A) Diabetes mellitus
B) Hyperlipidemia
C) Obstructive sleep apnea
D) Hypothyroidism
ANS: A) Diabetes mellitus, B) Hyperlipidemia, C) Obstructive sleep apnea
Rationale: These conditions contribute to endothelial dysfunction and
atherosclerosis, increasing CAD risk. Hypothyroidism is not a direct risk
factor.
Dysrhythmias & Conduction
5. Multiple Choice
A patient with palpitations has an EKG showing a narrow complex
tachycardia at 180 bpm with no visible P waves. Vagal maneuvers were
ineffective. What is the most likely diagnosis?
A) Atrial fibrillation
B) Atrial flutter
C) Paroxysmal supraventricular tachycardia (PSVT)
D) Ventricular tachycardia
ANS: C) Paroxysmal supraventricular tachycardia (PSVT)
Rationale: PSVT often presents with a narrow complex tachycardia and
absent or retrograde P waves; vagal maneuvers sometimes may fail.
6. Fill-in-the-Blank
In complete heart block (third-degree AV block), the hallmark EKG finding
is ________________, indicating complete dissociation between atrial
and ventricular activity.
ANS: atrioventricular dissociation
Rationale: In third-degree block, the atria and ventricles beat
3
, independently due to complete conduction block.
7. True/False
In atrial fibrillation, the irregularly irregular rhythm results from multiple
chaotic atrial impulses conducting irregularly to the ventricles.
ANS: True
Rationale: This results in irregular ventricular response and absence of
discrete P waves.
8. Multiple Response
Which medications are used to control ventricular rate during atrial
fibrillation? (Select all that apply)
A) Digoxin
B) Amiodarone
C) Beta-blockers
D) Calcium channel blockers (non-dihydropyridine)
ANS: A) Digoxin, C) Beta-blockers, D) Calcium channel blockers (non-
dihydropyridine)
Rationale: These slow AV nodal conduction to control ventricular rate.
Amiodarone is usually for rhythm control.
Heart Failure
9. Multiple Choice
A 65-year-old man with hypertension develops dyspnea on exertion and
lower extremity edema. Echocardiogram shows an ejection fraction of
35%. Which of the following medications has been shown to improve
mortality in this patient?
A) Lisinopril
B) Furosemide
C) Digoxin
D) Hydralazine
ANS: A) Lisinopril
4
