Interactive Cardiology MCQs 31: Coronary Artery Disease
⚡ Advanced Cardiology Series – Part 31
Interactive Cardiology MCQs #31
Post-Graduate Level Masterclass: Coronary Artery Disease
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Q1
During invasive physiological assessment of an intermediate coronary lesion, what are the clinically validated diagnostic thresholds for FFR and iFR indicating hemodynamic significance?
Q2
Optical Coherence Tomography (OCT) offers significantly higher spatial resolution than Intravascular Ultrasound (IVUS). What is the primary technical limitation of OCT compared to IVUS?
Q3
The landmark ISCHEMIA trial evaluated patients with stable coronary artery disease and moderate-to-severe ischemia. What was its primary conclusion regarding an initial invasive strategy versus conservative medical therapy?
Q4
In a hemodynamically stable STEMI patient presenting with multivessel CAD, what is the recommended strategy for non-culprit lesions based on the COMPLETE trial?
Q5
Based on the SYNTAX, EXCEL, and NOBLE trials, in patients with unprotected Left Main Coronary Artery (LMCA) disease, CABG remains superior to PCI in which specific patient population?
Q6
On Optical Coherence Tomography (OCT), what is the hallmark morphological feature of a ‘vulnerable plaque’ most likely to cause an acute coronary syndrome?
Q7
A 40-year-old female presents with an NSTEMI. Angiography reveals Spontaneous Coronary Artery Dissection (SCAD) in the mid-LAD with TIMI 3 flow. She is hemodynamically stable and pain-free. What is the most appropriate management?
Q8
The diagnosis of MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) requires universal criteria for acute MI, but specifically mandates that coronary angiography shows no stenosis greater than or equal to what percentage?
Q9
In a patient diagnosed with Vasospastic (Prinzmetal) Angina, which class of medications is strictly contraindicated because it can exacerbate coronary vasospasm by leaving alpha-receptors unopposed?
Q10
According to current ESC guidelines, what is the default recommended duration of Dual Antiplatelet Therapy (DAPT) for a patient with Chronic Coronary Syndrome (stable angina) who undergoes elective PCI with a Drug-Eluting Stent (DES) and has standard bleeding risk?
Q11
A patient presenting with a STEMI undergoes successful primary PCI. What is the standard guideline-recommended duration of Dual Antiplatelet Therapy (DAPT) post-procedure, assuming no high bleeding risk?
Q12
Ticagrelor is a potent antiplatelet agent used in ACS. How does its pharmacological mechanism differ from that of Clopidogrel and Prasugrel?
Q13
Prasugrel is a highly potent P2Y12 inhibitor. According to the TRITON-TIMI 38 trial, in which patient population is Prasugrel strictly contraindicated due to an unacceptably high risk of fatal intracranial hemorrhage?
Q14
Stent thrombosis is a catastrophic complication. By standard ARC (Academic Research Consortium) definitions, ‘Late Stent Thrombosis’ occurs within what specific timeframe following stent implantation?
Q15
An ECG reveals ST-segment elevation in leads II, III, and aVF. Which specific ECG finding strongly suggests that the Right Coronary Artery (RCA) is occluded PROXIMAL to the right ventricular branch, causing concurrent Right Ventricular infarction?
Q16
Coronary dominance is anatomically determined by which artery supplies the Posterior Descending Artery (PDA) and the posterolateral branches. In approximately what percentage of the general population is the heart ‘Right Dominant’?
Q17
A patient is pain-free in the ER but their ECG demonstrates deep, symmetric, biphasic T wave inversions in leads V2 and V3 without significant Q waves or ST elevation. This is highly specific for Wellens’ Syndrome. What does this pattern indicate?
Q18
Which ECG pattern is recognized as a ‘STEMI equivalent’ indicating acute acute LAD occlusion, characterized by upsloping ST depression (greater than 1mm) at the J-point continuing into tall, positive, symmetrical hyperacute T waves in the precordial leads?
Q19
During coronary angiography for suspected vasospastic angina, a provocation test is performed. Which two pharmacological agents are most commonly injected intracoronary to provoke spasm for diagnostic purposes?
Q20
Anomalous Aortic Origin of a Coronary Artery (AAOCA) is a rare congenital condition causing sudden cardiac death in young athletes. Which specific anatomical variant carries the highest “malignant” risk?
Q21
According to the latest ESC Guidelines on Dyslipidaemias, what is the target LDL-C level for a patient at ‘very high cardiovascular risk’ (e.g., secondary prevention post-MI)?
Q22
PCSK9 inhibitors (e.g., Alirocumab, Evolocumab) drastically lower LDL-C levels. How exactly does PCSK9 inhibition achieve this effect at the cellular level?
Q23
The REDUCE-IT trial demonstrated significant cardiovascular risk reduction using icosapent ethyl in statin-treated patients. What specific lipid abnormality must be present to qualify a patient for this therapy?
Q24
When assessing myocardial viability before CABG in a patient with severe ischemic cardiomyopathy, a Cardiac PET scan evaluates both perfusion and metabolism. What specific PET ‘mismatch’ pattern indicates viable, hibernating myocardium that will benefit from revascularization?
Q25
During complex PCI, Rotational Atherectomy (e.g., Rotablator) is utilized. What is the primary angiographic and lesion characteristic that necessitates the use of rotational atherectomy prior to stenting?
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About The Author
Johnson Francis
Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal