CLINICAL MEDICINE TEST BANK EXAM | 2026
UPDATE WITH COMPLETE SOLUTIONS.
SECTION 1: CARDIOLOGY
1. A 55-year-old man with a 40 pack-year smoking history presents with
substernal chest pain that occurs with exertion and is relieved by rest. What is
the most likely diagnosis?
• A) Unstable angina
• B) Stable angina
• C) NSTEMI
• D) STEMI
Correct Answer: B
Rationale: Stable angina is characterized by predictable chest pain triggered by
exertion or stress and relieved by rest or nitroglycerin. The pattern is reproducible
and stable over time. Unstable angina occurs at rest or with minimal exertion and
is more unpredictable.
2. A patient presents with acute chest pain. ECG shows ST-segment elevation in
leads V1–V4. Which coronary artery is most likely occluded?
• A) Right coronary artery (RCA)
• B) Left anterior descending artery (LAD)
• C) Left circumflex artery (LCx)
• D) Left main coronary artery
Correct Answer: B
Rationale: ST elevation in V1–V4 indicates an anterior wall MI, which is caused by
,occlusion of the left anterior descending (LAD) artery. Inferior MI (II, III, aVF) is
caused by RCA occlusion. Lateral MI (I, aVL, V5–V6) is caused by LCx occlusion.
3. A patient with acute chest pain has ST elevation in leads II, III, and aVF. What
is the most likely diagnosis?
• A) Anterior STEMI
• B) Inferior STEMI
• C) Lateral STEMI
• D) Posterior STEMI
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, most
commonly caused by occlusion of the right coronary artery (RCA). These leads view
the inferior surface of the heart.
4. Which medication should be administered immediately to a patient with
suspected STEMI?
• A) Morphine
• B) Aspirin
• C) Nitroglycerin
• D) Heparin
Correct Answer: B
Rationale: Aspirin should be given immediately (preferably 324 mg chewed) to all
patients with suspected STEMI. It reduces mortality by inhibiting platelet
aggregation. Nitroglycerin and morphine are used for pain and symptoms; heparin
is also used but aspirin is the first priority.
,5. The "door-to-balloon" time goal for primary PCI in STEMI is:
• A) < 60 minutes
• B) < 90 minutes
• C) < 120 minutes
• D) < 150 minutes
Correct Answer: B
*Rationale: The ACC/AHA guideline recommends a door-to-balloon time of ≤ 90
minutes for primary PCI in STEMI. If PCI is not available within 90 minutes,
fibrinolysis should be considered within 30 minutes of arrival.*
6. A patient with NSTEMI has ongoing chest pain despite maximal medical
therapy. What is the appropriate next step?
• A) Administer tPA
• B) Urgent coronary angiography and PCI
• C) Increase beta-blocker dose
• D) Discharge with outpatient follow-up
Correct Answer: B
*Rationale: High-risk NSTEMI patients (ongoing chest pain, hemodynamic
instability, dynamic ECG changes) should undergo urgent invasive coronary
angiography within 2–24 hours. tPA is not indicated for NSTEMI.*
7. Which of the following is a contraindication to thrombolytic therapy in
STEMI?
• A) Age > 75 years
• B) History of stroke within 3 months
• C) Hypertension (BP 150/90)
, • D) Diabetes mellitus
Correct Answer: B
*Rationale: A history of hemorrhagic stroke or ischemic stroke within the previous
3 months is an absolute contraindication to thrombolytic therapy. Age > 75 is a
relative contraindication. BP > 185/110 is a contraindication, but 150/90 is
acceptable.*
8. The most common cause of sudden cardiac death in adults is:
• A) Ventricular tachycardia
• B) Ventricular fibrillation
• C) Asystole
• D) Pulseless electrical activity
Correct Answer: B
Rationale: Ventricular fibrillation is the most common cause of sudden cardiac
death, often occurring in the setting of acute MI. It is treated with immediate
defibrillation and CPR.
9. A patient with heart failure has dyspnea on exertion, orthopnea, and
paroxysmal nocturnal dyspnea. What classification of heart failure symptoms is
this?
• A) NYHA Class I
• B) NYHA Class II
• C) NYHA Class III
• D) NYHA Class IV
Correct Answer: C
Rationale: NYHA Class III: Patients have symptoms with less than ordinary activity
UPDATE WITH COMPLETE SOLUTIONS.
SECTION 1: CARDIOLOGY
1. A 55-year-old man with a 40 pack-year smoking history presents with
substernal chest pain that occurs with exertion and is relieved by rest. What is
the most likely diagnosis?
• A) Unstable angina
• B) Stable angina
• C) NSTEMI
• D) STEMI
Correct Answer: B
Rationale: Stable angina is characterized by predictable chest pain triggered by
exertion or stress and relieved by rest or nitroglycerin. The pattern is reproducible
and stable over time. Unstable angina occurs at rest or with minimal exertion and
is more unpredictable.
2. A patient presents with acute chest pain. ECG shows ST-segment elevation in
leads V1–V4. Which coronary artery is most likely occluded?
• A) Right coronary artery (RCA)
• B) Left anterior descending artery (LAD)
• C) Left circumflex artery (LCx)
• D) Left main coronary artery
Correct Answer: B
Rationale: ST elevation in V1–V4 indicates an anterior wall MI, which is caused by
,occlusion of the left anterior descending (LAD) artery. Inferior MI (II, III, aVF) is
caused by RCA occlusion. Lateral MI (I, aVL, V5–V6) is caused by LCx occlusion.
3. A patient with acute chest pain has ST elevation in leads II, III, and aVF. What
is the most likely diagnosis?
• A) Anterior STEMI
• B) Inferior STEMI
• C) Lateral STEMI
• D) Posterior STEMI
Correct Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, most
commonly caused by occlusion of the right coronary artery (RCA). These leads view
the inferior surface of the heart.
4. Which medication should be administered immediately to a patient with
suspected STEMI?
• A) Morphine
• B) Aspirin
• C) Nitroglycerin
• D) Heparin
Correct Answer: B
Rationale: Aspirin should be given immediately (preferably 324 mg chewed) to all
patients with suspected STEMI. It reduces mortality by inhibiting platelet
aggregation. Nitroglycerin and morphine are used for pain and symptoms; heparin
is also used but aspirin is the first priority.
,5. The "door-to-balloon" time goal for primary PCI in STEMI is:
• A) < 60 minutes
• B) < 90 minutes
• C) < 120 minutes
• D) < 150 minutes
Correct Answer: B
*Rationale: The ACC/AHA guideline recommends a door-to-balloon time of ≤ 90
minutes for primary PCI in STEMI. If PCI is not available within 90 minutes,
fibrinolysis should be considered within 30 minutes of arrival.*
6. A patient with NSTEMI has ongoing chest pain despite maximal medical
therapy. What is the appropriate next step?
• A) Administer tPA
• B) Urgent coronary angiography and PCI
• C) Increase beta-blocker dose
• D) Discharge with outpatient follow-up
Correct Answer: B
*Rationale: High-risk NSTEMI patients (ongoing chest pain, hemodynamic
instability, dynamic ECG changes) should undergo urgent invasive coronary
angiography within 2–24 hours. tPA is not indicated for NSTEMI.*
7. Which of the following is a contraindication to thrombolytic therapy in
STEMI?
• A) Age > 75 years
• B) History of stroke within 3 months
• C) Hypertension (BP 150/90)
, • D) Diabetes mellitus
Correct Answer: B
*Rationale: A history of hemorrhagic stroke or ischemic stroke within the previous
3 months is an absolute contraindication to thrombolytic therapy. Age > 75 is a
relative contraindication. BP > 185/110 is a contraindication, but 150/90 is
acceptable.*
8. The most common cause of sudden cardiac death in adults is:
• A) Ventricular tachycardia
• B) Ventricular fibrillation
• C) Asystole
• D) Pulseless electrical activity
Correct Answer: B
Rationale: Ventricular fibrillation is the most common cause of sudden cardiac
death, often occurring in the setting of acute MI. It is treated with immediate
defibrillation and CPR.
9. A patient with heart failure has dyspnea on exertion, orthopnea, and
paroxysmal nocturnal dyspnea. What classification of heart failure symptoms is
this?
• A) NYHA Class I
• B) NYHA Class II
• C) NYHA Class III
• D) NYHA Class IV
Correct Answer: C
Rationale: NYHA Class III: Patients have symptoms with less than ordinary activity
