# AMC MCQ Cardiology Questions: 10 Free Practice MCQs

> 10 free AMC MCQ cardiology questions with answers and explanations, from a bank of 77 cardiology questions. Try them now, no sign up.

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Last updated: 2026-10-29

Ten AMC MCQ-style cardiology questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 77 cardiology questions and many more across every topic.

1. 1 / 10  
A 60-year-old male with Heart Failure with reduced Ejection Fraction (HFrEF, EF 30%) remains symptomatic (NYHA Class II-III) despite optimal doses of Ramipril and Bisoprolol.  
What new drug class is replacing ACE inhibitors as first-line/switch therapy?  
Show answer

**Answer: C.** ARNI (Sacubitril/Valsartan)

**Why:** Angiotensin Receptor-Neprilysin Inhibitors (ARNI, Sacubitril/Valsartan) are recommended to replace ACE inhibitors or ARBs in patients with symptomatic HFrEF despite optimal background medical therapy. Sacubitril inhibits neprilysin, increasing natriuretic peptides, while Valsartan blocks the AT1 receptor.

  * **A.** Incorrect. Digoxin provides symptom control in atrial fibrillation or advanced heart failure but does not confer a primary mortality benefit in HFrEF.
  * **B.** Incorrect. Non-dihydropyridine calcium channel blockers (Verapamil/Diltiazem) have negative inotropic effects and are contraindicated in HFrEF.
  * **D.** Incorrect. Aspirin is indicated for secondary prevention of ischaemic heart disease but does not replace ACE inhibitors in heart failure management.  
Sources: Heart Foundation Guidelines
2. 2 / 10  
A 58-year-old woman presents to the general practice clinic with a 30-minute history of retrosternal chest pain that she describes as crushing and radiating to her left arm. She is diaphoretic and anxious.  
What is the most critical immediate next step in the clinical management of this patient?  
Show answer

**Answer: A.** Call 000 for emergency transfer, perform a 12-lead ECG, and administer 300mg of oral soluble Aspirin

**Why:** In patients presenting with suspected acute coronary syndrome (ACS) in a primary care setting, the immediate priorities are to call for emergency transfer (000 in Australia), obtain a 12-lead ECG (to check for STEMI requiring urgent reperfusion), and administer a loading dose of soluble Aspirin (300 mg) to inhibit platelet aggregation.

  * **B.** An outpatient stress test is unsafe for a patient presenting with an active acute coronary syndrome.
  * **C.** Troponin tests should not delay the transfer of patients with suspected acute ischemic chest pain to an acute care facility.
  * **D.** Ruling out reflux must not delay the life-saving management of a potential myocardial infarction.  
Sources: National Heart Foundation of Australia / CSANZ ACS Guidelines; Therapeutic Guidelines (eTG) — Cardiology
3. 3 / 10  
A 58-year-old man presents with a 3-month history of chest tightness that occurs when walking up steep hills and resolves within 5 minutes of rest. He has a history of hypertension and dyslipidemia.  
Which of the following is the recommended first-line non-invasive investigation to diagnose stable coronary artery disease in this patient?  
Show answer

**Answer: D.** Coronary Computed Tomography Angiography (CCTA)

**Why:** For patients presenting with new-onset suspected stable angina, anatomical imaging with Coronary Computed Tomography Angiography (CCTA) is now the recommended first-line investigation. CCTA is highly sensitive for detecting coronary stenosis and helps guide preventive therapy.

  * **A.** Modern guidelines no longer recommend exercise ECG as first-line due to its lower sensitivity and specificity compared to anatomical imaging.
  * **B.** Invasive angiography is an invasive procedure reserved for patients at high risk of events, or those with inconclusive non-invasive testing.
  * **C.** Stress echo is a functional test that can be used if CCTA is contraindicated or unavailable, but CCTA is preferred first-line.  
Sources: CSANZ Stable Angina Guidelines; eTG complete — Cardiology
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5. 4 / 10  
A 64-year-old woman is admitted to the emergency department with sudden-onset shortness of breath and pleuritic chest pain. On assessment, her blood pressure is 80/50 mmHg, heart rate is 128 bpm, respiratory rate is 28 breaths per minute, and oxygen saturation is 88% on high-flow oxygen. A bedside echocardiogram reveals acute right ventricular strain.  
Which of the following is the most appropriate immediate next step in management?  
Show answer

**Answer: A.** Administer systemic thrombolytic therapy (e.g., Alteplase) immediately

**Why:** This patient has a massive (high-risk) pulmonary embolism, characterized by hemodynamic instability (systolic BP < 90 mmHg). In unstable patients, diagnostic CTPA is often unsafe due to the risk of cardiac arrest during transfer. Bedside echocardiogram showing right ventricular overload is sufficient to justify immediate reperfusion therapy (systemic thrombolysis with alteplase or tenecteplase) alongside supportive resuscitation.

  * **B.** Transferring a hemodynamically unstable patient out of the resuscitation bay for a CTPA is unsafe and should be avoided.
  * **C.** LMWH is the treatment of choice for hemodynamically stable PE, but unstable massive PE requires rapid thrombolysis, not just anticoagulation.
  * **D.** Needle thoracocentesis is indicated for tension pneumothorax, not for acute pulmonary embolism causing obstructive shock.  
Sources: eTG complete — Cardiovascular — Pulmonary Embolism; ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism
6. 5 / 10  
A 28-year-old woman in her second trimester of pregnancy presents with acute-onset pleuritic chest pain and breathlessness. On examination, her heart rate is 105 bpm, respiratory rate is 22/min, and oxygen saturation is 96% on room air. Her chest X-ray is normal.  
Which of the following is the most appropriate next diagnostic step to investigate suspected pulmonary embolism (PE) in this pregnant patient?  
Show answer

**Answer: D.** Perform a ventilation-perfusion (V/Q) lung scan

**Why:** In pregnant patients with suspected PE and a normal chest X-ray, a ventilation-perfusion (V/Q) scan is the preferred imaging modality. This is because V/Q scans deliver less radiation to the mother's breast tissue compared to CTPA, minimizing lifetime breast cancer risk.

  * **A.** D-dimer levels naturally rise during pregnancy, making a positive result non-specific and of limited diagnostic value.
  * **B.** CTPA is preferred if the chest X-ray is abnormal, but V/Q scan is preferred if the X-ray is normal due to breast radiation risks.
  * **C.** Limbs ultrasound is useful if there are leg symptoms, but a negative ultrasound does not rule out PE in a patient presenting with respiratory symptoms.  
Sources: RANZCOG Guidelines on Thromboembolism in Pregnancy; eTG complete
7. 6 / 10  
A 34-year-old IV drug user presents to the emergency department with fever, lethargy, and a new systolic murmur. Transesophageal echocardiogram (TEE) demonstrates a 1.2 cm mobile vegetation on the tricuspid valve.  
Which of the following combinations of findings would satisfy the modified Duke criteria for a definite diagnosis of Infective Endocarditis?  
Show answer

**Answer: A.** Two positive blood cultures for Staphylococcus aureus and the echocardiogram vegetation

**Why:** The modified Duke criteria are used to diagnose infective endocarditis. A definite clinical diagnosis requires: 2 major criteria; OR 1 major and 3 minor criteria; OR 5 minor criteria. Typical blood cultures and diagnostic echocardiographic findings are both major criteria.

  * **B.** This combination only represents 2 minor criteria, which is insufficient for a definite diagnosis.
  * **C.** This represents 1 major and 1 minor criterion, which classifies as possible, not definite, endocarditis.
  * **D.** These are minor criteria. Definite diagnosis requires either 2 major, 1 major and 3 minor, or 5 minor criteria.  
Sources: Therapeutic Guidelines (eTG) — Infective Endocarditis; Cardiology Society of Australia and New Zealand (CSANZ) Guidelines
8. 7 / 10  
A 76-year-old woman with a history of hypertension and a previous ischemic stroke 2 years ago is diagnosed with new-onset, non-valvular atrial fibrillation.  
Which of the following is the most appropriate long-term stroke prevention strategy for this patient?  
Show answer

**Answer: A.** Start an oral anticoagulant, preferably a Direct Oral Anticoagulant (DOAC) such as Apixaban or Rivaroxaban

**Why:** Patients with atrial fibrillation should be assessed for stroke risk using the CHA2DS2-VA score (or CHA2DS2-VASc). A score of 2 or more in men or 3 or more in women warrants oral anticoagulation. This patient has a prior stroke (2 points), age > 75 (2 points), female gender (1 point), and hypertension (1 point), making her risk extremely high. DOACs are recommended first-line over Warfarin due to a lower risk of intracranial hemorrhage and ease of use.

  * **B.** Aspirin is inferior to anticoagulation for stroke prevention in atrial fibrillation and does not offer a favorable risk-benefit ratio.
  * **C.** Dual antiplatelet therapy is less effective than oral anticoagulants and carries a similar risk of major bleeding.
  * **D.** A prior stroke is a permanent risk factor, placing the patient at very high risk of recurrence.  
Sources: National Heart Foundation of Australia / CSANZ Atrial Fibrillation Guidelines; AMH
9. 8 / 10  
A 74-year-old woman receiving haemodialysis misses a session. Potassium is 7.2 mmol/L, and ECG shows absent P waves and a widening QRS complex. Which cellular mechanism explains these changes?  
Which of the following describes the cellular mechanism by which hyperkalemia causes these ECG changes?  
Show answer

**Answer: D.** A less negative resting membrane potential in cardiac myocytes inactivates sodium channels, slowing depolarisation and conduction.

**Why:** Raised extracellular potassium reduces the transmembrane potassium gradient and makes the resting membrane potential less negative. With sustained depolarisation, fast voltage-gated sodium channels become inactivated, reducing phase 0 upstroke velocity and slowing conduction. This contributes to PR prolongation, loss of P waves and QRS widening.

  * **A.** Hyperkalemia depolarizes (hypopolarizes) the resting membrane, not hyperpolarizes it (which would make it more negative).
  * **B.** Hyperkalemia affects potassium-regulated membrane potentials; calcium channel blockade is a separate drug mechanism.
  * **C.** Hyperkalemia causes bradycardia, conduction blocks, and eventual asystole, not sinus tachycardia.  
Sources: Therapeutic Guidelines: Cardiovascular, hyperkalaemia, Australia; Lilly, Pathophysiology of Heart Disease
10. 9 / 10  
A 60-year-old patient with type 2 diabetes and heart failure with reduced ejection fraction (HFrEF) is commenced on Dapagliflozin 10 mg daily.  
Which of the following describes the cellular mechanism of action of this class of medication in the kidney?  
Show answer

**Answer: C.** Inhibition of sodium-glucose cotransporter 2 (SGLT2) in the proximal convoluted tubule

**Why:** Sodium-glucose cotransporter 2 (SGLT2) is located in the proximal convoluted tubule of the kidney and is responsible for reabsorbing approximately 90% of filtered glucose. SGLT2 inhibitors (like dapagliflozin and empagliflozin) block this transporter, causing glucosuria. In HFrEF, their osmotic diuretic and natriuretic effects reduce preload and afterload, improving cardiovascular outcomes.

  * **A.** This is the mechanism of action of aldosterone antagonists like spironolactone.
  * **B.** This is the mechanism of action of loop diuretics like furosemide.
  * **D.** DPP-4 inhibitors act on the incretin system to increase insulin secretion; they do not act directly on SGLT2 cotransporters.  
Sources: Australian Medicines Handbook (AMH); National Heart Foundation of Australia / CSANZ Heart Failure Guidelines
11. 10 / 10  
A 48-year-old woman presents to her GP with a 2-day history of unilateral left calf swelling and pain after a long-haul flight from London to Sydney. On examination, there is mild calf tenderness and 2 cm asymmetry in calf circumference, but no signs of severe venous occlusion.  
According to the diagnostic pathway for suspected Deep Vein Thrombosis (DVT), what is the most appropriate next step?  
Show answer

**Answer: A.** Calculate the Wells score to determine pre-test probability

**Why:** The diagnostic approach to suspected DVT begins with calculating the Wells clinical prediction rule. If the Wells score is low, a highly sensitive D-dimer is used to rule out DVT. If the Wells score is high, a compressive venous duplex ultrasound is indicated.

  * **B.** Unilateral swelling after a long flight carries a moderate-to-high risk of DVT and cannot be ignored without diagnostic testing.
  * **C.** Venograms are invasive and rarely used; initial assessment starts with clinical scoring and ultrasound in the community.
  * **D.** Therapeutic anticoagulation should not be started prior to imaging unless diagnostic testing is delayed for over 4 hours.  
Sources: THANZ Guidelines; NICE CKS (aligned with AU practice)

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