Multiple Choice Questions (MCQ)

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Category: Cardiology--->Ischaemic heart disease
Page: 3

Question 11#Print Question

 One of your patients has discrete angiographically significant lesions in the mid right coronary artery and the mid left anterior descending coronary artery. He is 60 years old and is not diabetic. He has ongoing class 2 anginal symptoms despite optimal dose of a beta-blocker and a long-acting nitrate.

What do you recommend?

a. CABG will be associated with a greater mortality benefit compared with PCI
b. The risk of stroke will be significantly lower with PCI
c. Add a third oral antianginal and then reconsider revascularization
d. The likelihood of repeat revascularization is higher with PCI
e. Revascularization is recommended for prognostic reasons

Question 12#Print Question

A 45-year-old diabetic male patient has returned to clinic following a recent angiogram. He has stable class 2 angina and is currently on aspirin 75 mg od, atorvastatin 40 mg nocte, and bisoprolol  2.5 mg as antianginal treatment. His symptoms have improved since starting the beta-blocker. The angiogram showed severe plaque in the proximal left anterior descending artery and discrete simple lesions in the mid circumflex and right coronary arteries. The echocardiogram has shown moderate LV impairment.

What do you recommend?

a. Titrate the beta-blocker and add a calcium-channel blocker or long-acting nitrate—reassess symptoms
b. Titrate the beta-blocker and add an ACE inhibitor—reassess symptoms and LV function
c. CABG for prognostic and symptomatic improvement
d. PCI guided by ischaemia via a functional imaging test
e. Multi-vessel PCI or CABG for symptomatic treatment

Question 13#Print Question

Which one of the following is true of atherosclerotic plaque formation?

a. It is an acute inflammatory disease of the vascular intima
b. It is characterized by the accumulation and modification of cholesterol esters on the luminal surface of the endothelium
c. Macrophages bind and phagocytose oxidized LDL to form foam cells
d. Typically form away from branch points
e. Endothelial dysfunction as a result of an insult to the endothelium is characterized by increased nitric oxide release

Question 14#Print Question

Atherosclerotic plaque rupture is the most common event leading to clinically relevant ischaemia.

Which one of the following statements regarding this process is not true?

a. Thin-capped fibroatheromas are most prone to cap disruption and thrombus formation
b. Fracture of the fibrous cap allows platelets, clotting factors, and inflammatory cells to come into contact with the thrombogenic necrotic lipid core, leading to thrombus
c. Disrupted plaques can be accurately identified by optical coherence tomography
d. Plaque rupture will always result in some degree of clinical ischaemia (ACS)
e. Patients presenting with an ACS who have a ruptured plaque identified during angiography can be managed without stenting

Question 15#Print Question

Which one of the following statements regarding the new generation of antiplatelet drugs is not true?

a. Clopidogrel, prasugrel, and ticagrelor all inhibit the same receptor (P2Y12 ADP receptor)
b. Clopidogrel and prasugrel are irreversible inhibitors, whereas ticagrelor is reversible
c. Clopidogrel and prasugrel are both prodrugs which are metabolized to the active form, whereas ticagrelor acts directly
d. Ticagrelor requires twice daily maintenance, whereas clopidogrel and prasugrel are once daily
e. All are converted to the active metabolite by the hepatic cytochrome enzyme (CYP3A4) pathway

Category: Cardiology--->Ischaemic heart disease
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