{"id":67979,"date":"2026-10-24T17:45:30","date_gmt":"2026-10-24T12:15:30","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=67979"},"modified":"2026-10-24T17:45:34","modified_gmt":"2026-10-24T12:15:34","slug":"new-series-of-interactive-cardiology-mcqs-11","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/new-series-of-interactive-cardiology-mcqs-11\/","title":{"rendered":"New Series of Interactive Cardiology MCQs 11"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<!-- Cardiology MCQs Part 11 (Full 25 Questions) - WordPress Safe Custom HTML Block -->\n<script src=\"https:\/\/cdn.tailwindcss.com?plugins=forms,typography,aspect-ratio\"><\/script>\n<script>\n  tailwind.config = {\n    corePlugins: {\n      preflight: false,\n    }\n  }\n<\/script>\n\n<div id=\"mcq11-quiz-wrapper\" class=\"font-sans bg-slate-950 text-slate-100 p-4 md:p-8 rounded-3xl max-w-4xl mx-auto shadow-2xl relative overflow-hidden my-8 border border-solid border-purple-500\/20\" style=\"box-sizing: border-box;\">\n  \n  <!-- Background Accents -->\n  <div class=\"absolute top-0 left-0 w-full h-full pointer-events-none opacity-10 bg-[radial-gradient(ellipse_at_center,_var(--tw-gradient-stops))] from-blue-500 via-indigo-900 to-slate-950\"><\/div>\n  \n  <!-- Header Banner -->\n  <div class=\"relative text-center pb-6 border-b border-solid border-purple-500\/25 mb-8\">\n    <div class=\"inline-block bg-gradient-to-r from-red-600 via-pink-600 to-purple-600 text-white font-black text-xs md:text-sm px-4 py-1.5 rounded-full uppercase tracking-wider shadow-lg mb-3 animate-pulse\">\n      \u2764\ufe0f Advanced Cardiology Series &#8211; Part 11\n    <\/div>\n    <h1 class=\"text-3xl md:text-5xl font-extrabold tracking-tight text-transparent bg-clip-text bg-gradient-to-r from-cyan-300 via-blue-400 to-indigo-400 m-0\">\n      Interactive Cardiology MCQs #11\n    <\/h1>\n    <p class=\"text-sm md:text-lg text-slate-300 mt-2 max-w-2xl mx-auto font-medium\">\n      Post-Graduate Level Clinical &#038; Hemodynamic Masterclass\n    <\/p>\n  <\/div>\n\n  <!-- Real-Time Floating Scoreboard -->\n  <div class=\"sticky top-4 z-40 bg-slate-900\/90 backdrop-blur-md border-2 border-solid border-blue-500\/40 rounded-2xl p-4 mb-8 shadow-xl flex flex-wrap items-center justify-between gap-4\">\n    <div class=\"flex items-center gap-3\">\n      <div class=\"text-3xl\">\ud83c\udfc6<\/div>\n      <div>\n        <div class=\"text-[10px] uppercase font-extrabold tracking-widest text-blue-300\">Live Scoreboard<\/div>\n        <div class=\"text-lg md:text-2xl font-black text-cyan-300 flex items-center gap-1\">\n          <span id=\"mcq11-correct-count\">0<\/span><span class=\"text-slate-500 text-sm md:text-lg\">\/ 25 Correct<\/span>\n        <\/div>\n      <\/div>\n    <\/div>\n    <div class=\"flex items-center gap-2 bg-slate-950\/80 px-4 py-2 rounded-xl border border-solid border-slate-800\">\n      <span class=\"text-xs font-bold text-slate-400 uppercase tracking-wider\">Progress:<\/span>\n      <div class=\"w-24 md:w-36 bg-slate-800 h-3 rounded-full overflow-hidden\">\n        <div id=\"mcq11-progress-bar\" class=\"bg-gradient-to-r from-blue-500 to-cyan-400 h-full w-0 transition-all duration-300 rounded-full\"><\/div>\n      <\/div>\n      <span class=\"text-xs font-bold text-cyan-300\"><span id=\"mcq11-answered-count\">0<\/span>\/25<\/span>\n    <\/div>\n  <\/div>\n\n  <!-- Quiz Questions Container -->\n  <div class=\"space-y-8 relative\">\n\n    <!-- Q1 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q1<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          A 68-year-old man with symptomatic heart failure with reduced ejection fraction (LVEF 28%) and left bundle branch block (QRS duration 160 ms) undergoes successful cardiac resynchronization therapy (CRT-D) implantation. Which echocardiographic parameter assessed post-implant best reflects acute correction of mechanical dyssynchrony?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Peak early mitral inflow velocity (E wave) reflects filling pressures rather than mechanical dyssynchrony resolution.\">A. Peak E-wave velocity deceleration time<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Reduction in septal-to-posterior wall motion delay (SPWMD) or elimination of apical rocking and circumferential strain delay indicates successful restoration of mechanical synchrony following CRT.\">B. Elimination of septal flash and apical rocking with improved circumferential strain uniformity<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Tricuspid annular plane systolic excursion (TAPSE) evaluates right ventricular longitudinal function, not left ventricular dyssynchrony.\">C. Increased tricuspid annular plane systolic excursion (TAPSE)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Aortic root dimension is a structural anatomic measurement unaffected by electrical pacing synchronization.\">D. Widening of the aortic root dimension during systole<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q2 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q2<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which of the following histologic findings is considered the diagnostic hallmark of cardiac sarcoidosis on endomyocardial biopsy?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Aschoff bodies containing Anitschkow cells are characteristic of acute rheumatic carditis.\">A. Aschoff bodies with Anitschkow cells<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Non-caseating granulomas surrounded by lymphocytes, often accompanied by multinucleated giant cells, represent the characteristic histopathologic hallmark of cardiac sarcoidosis.\">B. Non-caseating granulomas with multinucleated giant cells<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Eosinophilic infiltration and extensive myocyte necrosis are classic for hypersensitivity or eosinophilic myocarditis.\">C. Diffuse eosinophilic infiltration with myocyte necrosis<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Extracellular amyloid fibril deposition binding Congo red with apple-green birefringence defines cardiac amyloidosis.\">D. Congo red positive extracellular fibrillar protein deposits<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q3 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q3<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          In a patient with severe primary mitral regurgitation who is asymptomatic and has normal left ventricular function (LVEF 65%, LVESD 38 mm), what is the guideline-directed indication for surgical mitral valve repair?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Asymptomatic patients with preserved LV dimensions do not meet Class I triggers for immediate surgery.\">A. Class I recommendation for immediate open surgical repair<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"When LVESD reaches &gt;= 40 mm or LVEF drops to &lt;= 60%, or if new-onset atrial fibrillation or pulmonary hypertension develops, surgery becomes a Class I indication. Currently, this patient is below the threshold, making serial monitoring appropriate (Class I for surveillance).\">B. Class I recommendation for serial clinical and echocardiographic surveillance every 6 to 12 months<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Prophylactic beta-blocker therapy halts neither mechanical volume overload nor progressive annular dilation in severe degenerative MR.\">C. Immediate initiation of high-dose sacubitril\/valsartan to reverse valve leakage<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Routine early prophylactic surgical intervention in asymptomatic patients with normal LV size is a Class IIa\/IIb indication only under specific repair-center conditions.\">D. Immediate percutaneous mitral balloon valvuloplasty<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q4 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q4<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which cellular mechanism accounts for early afterdepolarizations (EADs) that can trigger torsades de pointes in congenital long QT syndrome?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"EADs occur during phase 2 or phase 3 of the cardiac action potential due to reactivation of L-type calcium channels or inward sodium window currents during prolonged repolarization.\">A. Reactivation of L-type calcium channels or Na+ window currents during prolonged phase 2 or 3 repolarization<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Delayed afterdepolarizations (DADs) are mediated by calcium overload and spontaneous sarcoplasmic reticulum calcium release via ryanodine receptors during diastole (phase 4).\">B. Spontaneous diastolic sarcoplasmic reticulum calcium release via ryanodine receptors (phase 4 DADs)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Upregulation of ATP-sensitive potassium currents causes action potential shortening, not prolongation and EADs.\">C. Massive hyperpolarization via ATP-sensitive outward potassium channels<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Inactivation of inward rectifier potassium currents (IK1) governs resting membrane potential maintenance rather than plateau phase depolarizations.\">D. Complete permanent blockade of inward rectifier potassium current (IK1)<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q5 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q5<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which scoring system is validated for assessing bleeding risk in patients with atrial fibrillation initiated on oral anticoagulation to identify and modify reversible bleeding risk factors?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"CHA2DS2-VASc estimates stroke risk in atrial fibrillation.\">A. CHA2DS2-VASc Score<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"The HAS-BLED score (Hypertension, Abnormal renal\/liver function, Stroke, Bleeding history, Labile INR, Elderly, Drugs\/alcohol) is the standard guideline-recommended tool to evaluate bleeding risk.\">B. HAS-BLED Score<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"GRACE score estimates mortality and ischemic risk in acute coronary syndromes.\">C. GRACE Risk Score<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"TIMI risk score predicts mortality and ischemic events in STEMI\/NSTEMI.\">D. TIMI Risk Index<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q6 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q6<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          In a patient with acute ST-elevation myocardial infarction (STEMI) presenting with cardiogenic shock, what is the primary indication for placement of a temporary mechanical circulatory support device such as an Impella microaxial pump?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Microaxial LV mechanical support unloads the left ventricle, reduces myocardial oxygen consumption, and maintains systemic perfusion during high-risk PCI or profound cardiogenic shock.\">A. Left ventricular unloading, reduction of myocardial workload, and maintenance of systemic perfusion during high-risk reperfusion<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Temporary percutaneous pumps are not designed to induce chronic cardiac reverse remodeling over years.\">B. Permanent long-term destination therapy recovery of myocardial fibrosis<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Mechanical support devices increase or maintain coronary perfusion pressure, they do not cause coronary vasospasm.\">C. Intentional induction of coronary vasospasm to prevent reperfusion injury<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Temporary pumps aspirate blood from the LV and expel it into the aorta; they do not function as right-sided atrial shunts.\">D. Right atrial decompression bypassing the tricuspid valve<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q7 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q7<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which anatomical structure forms the boundaries of the Triangle of Koch, a crucial landmark during electrophysiological ablation of the AV node or slow pathway in AVNRT?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"The Triangle of Koch is bounded by the coronary sinus os, the tendon of Todaro, and the septal leaflet of the tricuspid valve.\">A. Coronary sinus os, tendon of Todaro, and septal leaflet of the tricuspid valve<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"The crista terminalis and Eustachian valve are situated in the lateral right atrium, unrelated to Koch's triangle.\">B. Crista terminalis, Eustachian valve, and crista supraventricularis<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"The mitral annulus and left atrial appendage pertain to left-sided structures.\">C. Mitral annulus, left atrial appendage, and pulmonary venous orifice<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"The moderator band is an intracavitary RV muscle bundle connecting the septum to the base of the anterior papillary muscle.\">D. Moderator band, crista supraventricularis, and pulmonic valve ring<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q8 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q8<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which of the following pharmacologic therapies has demonstrated definitive mortality benefit and reduction in heart failure hospitalizations in patients with heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 41-49%)?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Guideline-directed medical therapies proven in HFrEF (SGLT2 inhibitors, ARNIs\/ACE inhibitors, beta-blockers, and MRAs) have demonstrated beneficial effects in HFmrEF (LVEF 41-49%), particularly SGLT2 inhibitors and guideline-directed neurohormonal blockers.\">A. SGLT2 inhibitors and guideline-directed neurohormonal antagonists (ACEI\/ARB\/ARNI, beta-blockers, MRAs)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Routine high-dose nitrates alone without hydralazine lack general mortality benefit across HFmrEF cohorts.\">B. High-dose sublingual nitroglycerin monotherapy<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Short-acting dihydropyridine calcium channel blockers lack survival benefit in heart failure.\">C. Nifedipine immediate-release capsules<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Class IC antiarrhythmics increase mortality in structural heart disease and impaired systolic function.\">D. Flecainide maintenance therapy<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q9 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q9<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which physical examination sign involves an inspiratory increase in jugular venous pressure (instead of the normal inspiratory decline)?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Corrigan sign refers to water-hammer pulses in aortic regurgitation.\">A. Corrigan Sign<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Kussmaul sign refers to a paradoxical rise or lack of decline in jugular venous pressure during inspiration, classically seen in constrictive pericarditis, restrictive cardiomyopathy, and severe right ventricular failure.\">B. Kussmaul Sign<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Musset sign is head bobbing synchronous with the heartbeat in severe aortic regurgitation.\">C. Musset Sign<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Quincke pulse is capillary pulsations in the nail beds seen in aortic regurgitation.\">D. Quincke Pulse<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q10 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q10<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which imaging technique utilizes myocardial flow reserve (MFR) quantification via PET or stress cardiac MRI to detect microvascular angina and epicardial multivessel coronary disease when standard obstructive angiography is normal?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Standard transthoracic echocardiography visualizes wall motion but does not quantify myocardial blood flow reserve.\">A. Standard resting transthoracic echocardiography<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Quantitative myocardial perfusion imaging via PET or stress CMR measures absolute myocardial blood flow (mL\/min\/g) at rest and hyperemia, yielding myocardial flow reserve (MFR) to diagnose coronary microvascular dysfunction.\">B. Quantitative myocardial perfusion PET or stress CMR imaging measuring myocardial flow reserve (MFR)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Routine 12-lead resting electrocardiography lacks the sensitivity to evaluate dynamic microvascular flow reserve.\">C. Serial resting 12-lead electrocardiography<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Plain chest radiography evaluates thoracic bony and pulmonary parenchymal structures.\">D. Plain posteroanterior chest radiography<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q11 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q11<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which cardiac condition is classically associated with the insertion of a pacing lead across the tricuspid valve resulting in severe secondary tricuspid regurgitation?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Right ventricular pacing leads can mechanically interfere with tricuspid leaflet coaptation, cause adhesion, or lead perforation, resulting in significant pacemaker-induced tricuspid regurgitation.\">A. Pacemaker or ICD lead-induced tricuspid valve impingement and regurgitation<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Ebstein anomaly is a congenital malformation featuring downward displacement of septal and posterior tricuspid leaflets into the RV.\">B. Congenital Ebstein anomaly of the tricuspid valve<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Carcinoid heart disease produces fibrous plaque deposits on right-sided valves due to serotonin secretion, not pacing leads.\">C. Carcinoid heart syndrome secondary to neuroendocrine tumor<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Rheumatic fever predominantly affects left-sided valves (mitral and aortic), rarely causing isolated tricuspid involvement without prior left-sided disease.\">D. Acute rheumatic fever with isolated tricuspid valvulitis<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q12 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q12<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which pharmacologic reversal agent is specifically approved for the rapid reversal of dabigatran anticoagulant effects in life-threatening bleeding or urgent surgery?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Andexanet alfa is the specific reversal agent for factor Xa inhibitors (apixaban and rivaroxaban).\">A. Andexanet alfa<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Idarucizumab is a humanized monoclonal antibody fragment specifically designed to bind to dabigatran and rapidly neutralize its anticoagulant effect.\">B. Idarucizumab<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Protamine sulfate reverses unfractionated and low-molecular-weight heparin.\">C. Protamine sulfate<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Vitamin K is used for slow reversal of vitamin K antagonists like warfarin.\">D. Phytomenadione (Vitamin K1)<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q13 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q13<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          What is the primary hemodynamic consequence of an unrestrictive ventricular septal defect (VSD) with a large left-to-right shunt left untreated into adulthood?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Chronic large left-to-right shunts impose chronic volume overload on pulmonary circulation, eventually causing irreversible pulmonary vascular remodeling, pulmonary hypertension, and Eisenmenger syndrome.\">A. Development of irreversible pulmonary vascular obstructive disease and Eisenmenger syndrome<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Systemic arterial hypotension is not a direct consequence of a left-to-right intracardiac shunt.\">B. Refractory systemic arterial hypotension<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Coronary slow flow is not directly mediated by ventricular septal defects.\">C. Isolated isolated coronary slow flow phenomenon<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Systemic hypertension is driven by vascular resistance and arterial stiffness, not intracardiac shunts.\">D. Accelerated systemic arterial hypertension<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q14 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q14<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which type of aortic dissection according to the Stanford classification involves the ascending aorta regardless of the site of the primary intimal tear?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Stanford Type A dissections involve the ascending aorta and require urgent surgical evaluation, whereas Type B dissections are confined to the descending aorta distal to the left subclavian artery.\">A. Stanford Type A<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Stanford Type B dissections strictly spare the ascending aorta.\">B. Stanford Type B<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"DeBakey Type III involves only the descending thoracic\/abdominal aorta.\">C. DeBakey Type III<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Isolated descending aortic dissection corresponds to Type B \/ DeBakey III.\">D. Isolated descending thoracic aortic dissection<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q15 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q15<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which of the following parameters measured during invasive coronary angiography defines a functionally significant coronary stenosis amenable to revascularization in the absence of ischemic symptoms?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"An angiographic diameter stenosis of 50-70% is often indeterminate without physiological assessment.\">A. Diameter stenosis between 50% and 70% by visual estimation<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"A fractional flow reserve (FFR) &lt;= 0.80 or instantaneous wave-free ratio (iFR) &lt;= 0.89 confirms functional ischemia and guides revascularization.\">B. Fractional Flow Reserve (FFR) &lt;= 0.80 or instantaneous wave-free ratio (iFR) &lt;= 0.89<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"An FFR above 0.80 indicates non-ischemic stenosis where revascularization is generally deferred.\">C. Fractional Flow Reserve (FFR) &gt;= 0.90<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Minimum lumen area alone without physiological validation lacks universal cutoff standards for all epicardial vessels.\">D. Minimum lumen area &gt; 4.0 mm&sup2; in the left main coronary artery<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q16 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q16<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which cardiac rhythm disturbance is characterized by an irregular-irregular rhythm with at least three distinct P-wave morphologies in a single ECG lead, commonly associated with severe pulmonary disease?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Typical atrial flutter features regular sawtooth flutter waves (macro-reentrant circuit).\">A. Typical Atrial Flutter<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Multifocal Atrial Tachycardia (MAT) is defined by an irregular-irregular rhythm with varying P-wave morphologies (at least 3 distinct shapes) and variable PR intervals, frequently seen in chronic obstructive pulmonary disease (COPD) exacerbations.\">B. Multifocal Atrial Tachycardia (MAT)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Atrioventricular nodal reentrant tachycardia is regular and narrow complex.\">C. Atrioventricular Nodal Reentrant Tachycardia (AVNRT)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Ventricular fibrillation is chaotic without discernible P waves or organized QRS complexes.\">D. Ventricular Fibrillation<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q17 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q17<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which medical therapy is indicated for primary prevention of sudden cardiac death in an adult patient with genetic Long QT Syndrome Type 1 (LQTS1) presenting with recurrent syncopal episodes despite optimal beta-blocker therapy?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Class IC antiarrhythmics are strictly contraindicated due to proarrhythmia.\">A. Flecainide oral loading<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"According to guidelines, implantable cardioverter-defibrillator (ICD) implantation combined with non-selective beta-blockers is indicated for patients with LQTS who experience syncope or cardiac arrest while on adequate beta-blocker therapy.\">B. Implantable cardioverter-defibrillator (ICD) implantation combined with ongoing beta-blocker therapy<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Digoxin increases intracellular calcium and can trigger arrhythmogenesis in LQTS.\">C. Immediate intravenous digoxin administration<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Atropine increases sinus rate and can provoke adrenergic-triggered arrhythmias in LQTS1.\">D. Chronic oral atropine therapy<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q18 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q18<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which echocardiographic measurement is best utilized to assess right ventricular systolic function independently of geometry in patients with pulmonary hypertension?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Left ventricular ejection fraction evaluates LV function, not RV function.\">A. Left ventricular ejection fraction via biplane Simpson method<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and RV myocardial performance index (Tei index) or peak systolic tissue velocity (S') are standard parameters for assessing RV systolic function.\">B. Tricuspid annular plane systolic excursion (TAPSE) and RV free wall longitudinal strain<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Aortic valve VTI evaluates LV outflow tract stroke volume, not RV function.\">C. Aortic valve velocity-time integral (VTI)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Mitral E\/e' ratio evaluates left ventricular filling pressures.\">D. Mitral inflow E\/e&apos; tissue Doppler ratio<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q19 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q19<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which pathological feature differentiates rheumatic mitral stenosis from degenerative calcific mitral annular stenosis?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Rheumatic heart disease classically produces commissural fusion, leaflet tip thickening, and chordal shortening\/fusion, whereas degenerative calcific stenosis affects the fibrous annulus sparing the leaflet tips.\">A. Commissural fusion, leaflet tip thickening, and subvalvular chordal fusion<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Isolated calcium deposition limited exclusively to the posterior annular ring defines degenerative annular calcification.\">B. Isolated calcium deposition limited exclusively to the posterior annular ring without commissural involvement<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Primary myxomatous degeneration with leaflet redundancy and elongation defines mitral valve prolapse.\">C. Myxomatous leaflet redundancy with chordal elongation<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Absence of any fibrous tissue remodeling characterizes normal aging.\">D. Complete absence of fibrous tissue remodeling and normal leaflet pliability<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q20 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q20<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which pharmacological class of antianginal medications acts primarily by inhibiting the late sodium current (INa) in cardiomyocytes, reducing intracellular sodium and calcium overload without altering heart rate or blood pressure?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Ivabradine inhibits If channels in the sinus node to lower heart rate.\">A. Sinus node If channel inhibitors (Ivabradine)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Ranolazine inhibits the late sodium current (INa), preventing intracellular calcium overload via Na+\/Ca2+ exchange and improving myocardial relaxation and oxygen supply-demand balance.\">B. Late sodium current inhibitors (Ranolazine)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Phosphodiesterase-5 inhibitors induce systemic and pulmonary vasodilation via cGMP accumulation.\">C. Phosphodiesterase-5 inhibitors (Sildenafil)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Soluble guanylate cyclase stimulators activate sGC to promote vasodilation and anti-fibrotic effects.\">D. Soluble guanylate cyclase stimulators (Vericiguat)<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q21 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q21<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which genetic mutation and inheritance pattern is classically linked to Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"CPVT type 1 is caused by mutations in the cardiac ryanodine receptor gene (RYR2) inherited in an autosomal dominant pattern, while recessive forms involve calsequestrin (CASQ2).\">A. Ryanodine receptor gene (RYR2) mutations with autosomal dominant inheritance<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Dystrophin gene mutations cause X-linked Duchenne muscular dystrophy cardiomyopathy.\">B. Dystrophin gene mutations with X-linked recessive inheritance<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Transthyretin gene mutations cause familial amyloid cardiomyopathy.\">C. Transthyretin (TTR) gene mutations with autosomal recessive inheritance<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"SCN5A mutations are associated with Brugada syndrome and long QT type 3.\">D. SCN5A sodium channel gene mutations with mitochondrial maternal inheritance<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q22 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q22<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which diagnostic modality is considered the gold standard for confirming anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome in infants and adults?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Transthoracic echocardiography is highly suggestive when visualizing the left coronary originating from the pulmonary trunk with retrograde flow, but invasive coronary angiography or CCTA provides definitive anatomical confirmation.\">A. Resting 12-lead electrocardiography<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Coronary computed tomography angiography (CCTA) or invasive selective coronary angiography provides definitive anatomical visualization of the anomalous left coronary artery arising from the pulmonary artery trunk.\">B. Coronary CT angiography or invasive selective coronary angiography<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Right heart catheterization alone measures pressures without selective coronary artery origin delineation.\">C. Right heart catheterization with oximetry shunt run<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Cardiopulmonary exercise testing evaluates functional capacity rather than coronary anatomy.\">D. Cardiopulmonary exercise stress testing (CPET)<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q23 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q23<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which hemodynamic parameter differentiates vasodilatory septic shock from cardiogenic shock in a patient presenting with multi-organ hypoperfusion?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Septic shock features profound systemic vasodilation with low systemic vascular resistance (SVR) and high cardiac index, whereas cardiogenic shock features elevated SVR and low cardiac index.\">A. Systemic vascular resistance (SVR) and cardiac index<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Arterial oxygen saturation can be variable and does not differentiate the underlying circulatory shock etiology.\">B. Arterial oxygen saturation measured via pulse oximetry<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Total leukocyte count evaluates systemic inflammatory status rather than direct vascular hemodynamics.\">C. Peripheral leukocyte count and band neutrophil percentage<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Serum creatinine evaluates renal filtration function across all shock states.\">D. Serum creatinine and blood urea nitrogen ratio<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q24 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q24<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          Which pharmacological class of pulmonary arterial hypertension (PAH) therapy acts as a prostacyclin receptor agonist promoting pulmonary vasodilation and inhibition of platelet aggregation?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Endothelin receptor antagonists (e.g., bosentan, ambrisentan) block endothelin-1 vasoconstrictive pathways.\">A. Endothelin receptor antagonists (e.g., Bosentan)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Prostacyclin analogues and receptor agonists (e.g., epoprostenol, treprostinil, selexipag) stimulate prostacyclin receptors, causing potent vasodilation and anti-platelet aggregation effects.\">B. Prostacyclin analogues and IP receptor agonists (e.g., Selexipag, Epoprostenol)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Phosphodiesterase-5 inhibitors (e.g., sildenafil) enhance nitric oxide-mediated cGMP vasodilation.\">C. Phosphodiesterase-5 inhibitors (e.g., Sildenafil)<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Soluble guanylate cyclase stimulators (e.g., riociguat) synergize with endogenous nitric oxide.\">D. Soluble guanylate cyclase stimulators (e.g., Riociguat)<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n    <!-- Q25 -->\n    <div class=\"quiz-card bg-slate-900\/60 border border-solid border-slate-800 rounded-2xl p-5 md:p-6 shadow-lg transition-all duration-300\" data-answered=\"false\">\n      <div class=\"flex items-start gap-3 mb-4\">\n        <span class=\"bg-blue-950 text-cyan-300 font-extrabold px-3 py-1.5 rounded-lg text-sm border border-solid border-blue-500\/30\">Q25<\/span>\n        <h3 class=\"text-lg md:text-xl font-bold text-slate-100 m-0 leading-snug\">\n          What is the primary mechanism of action of tafamidis in the management of transthyretin (TTR) cardiac amyloidosis?\n        <\/h3>\n      <\/div>\n      <div class=\"grid grid-cols-1 md:grid-cols-2 gap-3 mb-4\">\n        <button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Hepatic clearance via LDL receptors is the mechanism of PCSK9 inhibitors for hypercholesterolemia.\">A. Upregulation of hepatic LDL receptor recycling<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"true\" data-explanation=\"Tafamidis is a selective transthyretin stabilizer that binds to the thyroxine binding sites on TTR tetramers, preventing tetramer dissociation and subsequent amyloid fibril formation.\">B. Stabilization of the transthyretin (TTR) tetramer to prevent dissociation and amyloid fibril deposition<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Direct systemic fibrinolysis is the mechanism of tissue plasminogen activator (tPA).\">C. Enzymatic degradation of existing thrombi via plasminogen activation<\/button><button type=\"button\" class=\"opt-btn text-left p-4 rounded-xl border-2 border-solid border-slate-800 bg-slate-950 hover:bg-slate-900 transition-all text-sm md:text-base font-semibold text-slate-300 cursor-pointer\" data-correct=\"false\" data-explanation=\"Mineralocorticoid receptor antagonism is the mechanism of spironolactone and eplerenone.\">D. Competitive antagonism of renal mineralocorticoid receptors<\/button>\n      <\/div>\n      <div class=\"feedback-box hidden p-4 rounded-xl text-sm md:text-base leading-relaxed\"><\/div>\n    <\/div>\n\n  <\/div>\n<\/div>\n\n<script>\n  let mcq11Correct = 0;\n  let mcq11Answered = 0;\n  const mcq11Total = 25;\n\n  document.querySelectorAll('#mcq11-quiz-wrapper .quiz-card').forEach(card => {\n    const buttons = card.querySelectorAll('.opt-btn');\n    buttons.forEach(btn => {\n      btn.addEventListener('click', function() {\n        if (card.getAttribute('data-answered') === 'true') return;\n        card.setAttribute('data-answered', 'true');\n        mcq11Answered++;\n\n        document.getElementById('mcq11-answered-count').innerText = mcq11Answered;\n        const pct = (mcq11Answered \/ mcq11Total) * 100;\n        document.getElementById('mcq11-progress-bar').style.width = pct + '%';\n\n        buttons.forEach(b => {\n          b.disabled = true;\n          b.classList.remove('hover:bg-slate-900', 'cursor-pointer');\n          b.classList.add('opacity-50', 'cursor-not-allowed');\n        });\n\n        const isCorrect = this.getAttribute('data-correct') === 'true';\n        const explanation = this.getAttribute('data-explanation');\n\n        if (isCorrect) {\n          mcq11Correct++;\n          document.getElementById('mcq11-correct-count').innerText = mcq11Correct;\n          this.classList.remove('opacity-50', 'border-slate-800', 'bg-slate-950');\n          this.classList.add('bg-emerald-950\/80', 'border-emerald-500', 'text-emerald-200', 'opacity-100', 'border-2');\n          this.innerHTML += ' <span class=\"font-bold\">&#10004; CORRECT!<\/span>';\n        } else {\n          this.classList.remove('opacity-50', 'border-slate-800', 'bg-slate-950');\n          this.classList.add('bg-rose-950\/80', 'border-rose-500', 'text-rose-200', 'opacity-100', 'border-2');\n          this.innerHTML += ' <span class=\"font-bold\">&#10006; INCORRECT<\/span>';\n\n          buttons.forEach(b => {\n            if (b.getAttribute('data-correct') === 'true') {\n              b.classList.remove('opacity-50', 'border-slate-800', 'bg-slate-950');\n              b.classList.add('bg-emerald-950\/40', 'border-emerald-500\/55', 'text-emerald-200', 'opacity-100', 'border-2');\n              b.innerHTML += ' <span class=\"font-bold\">&#10004; (Correct)<\/span>';\n            }\n          });\n        }\n\n        const feedback = card.querySelector('.feedback-box');\n        feedback.innerHTML = `\n          <div class=\"font-extrabold uppercase tracking-widest text-xs mb-2 ${isCorrect ? 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[&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":67980,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-67979","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>New Series of Interactive Cardiology MCQs 11 - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/new-series-of-interactive-cardiology-mcqs-11\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"New Series of Interactive Cardiology MCQs 11 - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"\u2764\ufe0f Advanced Cardiology Series &#8211; Part 11 Interactive Cardiology MCQs #11 Post-Graduate Level Clinical &#038; Hemodynamic Masterclass \ud83c\udfc6 Live Scoreboard 0\/ 25 Correct Progress: 0\/25 Q1 A 68-year-old man with symptomatic heart failure with reduced ejection fraction (LVEF 28%) and left bundle branch block (QRS duration 160 ms) undergoes successful cardiac resynchronization therapy (CRT-D) implantation. 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