Page |1
MIDTERM MODULES: CARDIORESPIRATORY & ENDOCRINE Original Questions
with Answers & Rationales
MODULE 1: CARDIOVASCULAR FUNCTION
1. A patient presents with chest pain that occurs predictably
with exertion and is relieved by rest. The pain is described as
substernal pressure radiating to the left arm. The most likely
diagnosis is:
A) Unstable angina
B) Stable angina
C) Myocardial infarction
D) Pericarditis
Answer: B
Rationale: Stable angina is predictable, occurs with exertion,
and is relieved by rest or nitroglycerin. Unstable angina occurs
at rest or with increasing frequency. MI pain is prolonged.
Pericarditis is sharp and improved by leaning forward.
2. Which cardiac biomarker is the MOST specific for myocardial
infarction?
, Page |2
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) LDH
Answer: C
Rationale: Cardiac troponins are the most specific and sensitive
biomarkers for myocardial injury, rising within 3–6 hours and
remaining elevated for 7–14 days.
3. The first-line treatment for acute STEMI within 90 minutes of
presentation is:
A) Thrombolytics only
B) Percutaneous coronary intervention (PCI)
C) Coronary artery bypass grafting
D) Observation only
Answer: B
Rationale: PCI is the preferred reperfusion strategy when it can
be performed within 90 minutes. Thrombolytics are used when
PCI is not available.
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of
4. The appropriate management is:
, Page |3
A) Aspirin only
B) No anticoagulation
C) Oral anticoagulation (DOAC or warfarin)
D) Clopidogrel only
Answer: C
Rationale: CHA₂DS₂-VASc ≥ 2 in men (≥ 3 in women) indicates
significant stroke risk requiring oral anticoagulation.
5. Which medication class is CONTRAINDICATED in heart failure
with reduced ejection fraction (HFrEF)?
A) ACE inhibitors
B) Beta blockers
C) Non-dihydropyridine calcium channel blockers (verapamil,
diltiazem)
D) Diuretics
Answer: C
Rationale: Non-dihydropyridine CCBs have negative inotropic
effects and worsen HFrEF. ACE inhibitors, beta blockers, and
diuretics are standard therapy.
6. The hallmark physical finding of pericarditis is:
, Page |4
A) Diastolic murmur
B) Pericardial friction rub
C) S3 gallop
D) Systolic ejection click
Answer: B
Rationale: A pericardial friction rub is the classic finding in
pericarditis, caused by inflamed pericardial layers rubbing
together.
7. A patient presents with sudden "tearing" chest pain radiating
to the back, BP 180/100 in the right arm and 140/80 in the left
arm. The most likely diagnosis is:
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Tension pneumothorax
Answer: B
Rationale: Aortic dissection: sudden tearing pain with BP
differential ≥ 20 mm Hg between arms—a medical emergency.
8. The target blood pressure for most adults per ACC/AHA
guidelines is:
MIDTERM MODULES: CARDIORESPIRATORY & ENDOCRINE Original Questions
with Answers & Rationales
MODULE 1: CARDIOVASCULAR FUNCTION
1. A patient presents with chest pain that occurs predictably
with exertion and is relieved by rest. The pain is described as
substernal pressure radiating to the left arm. The most likely
diagnosis is:
A) Unstable angina
B) Stable angina
C) Myocardial infarction
D) Pericarditis
Answer: B
Rationale: Stable angina is predictable, occurs with exertion,
and is relieved by rest or nitroglycerin. Unstable angina occurs
at rest or with increasing frequency. MI pain is prolonged.
Pericarditis is sharp and improved by leaning forward.
2. Which cardiac biomarker is the MOST specific for myocardial
infarction?
, Page |2
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) LDH
Answer: C
Rationale: Cardiac troponins are the most specific and sensitive
biomarkers for myocardial injury, rising within 3–6 hours and
remaining elevated for 7–14 days.
3. The first-line treatment for acute STEMI within 90 minutes of
presentation is:
A) Thrombolytics only
B) Percutaneous coronary intervention (PCI)
C) Coronary artery bypass grafting
D) Observation only
Answer: B
Rationale: PCI is the preferred reperfusion strategy when it can
be performed within 90 minutes. Thrombolytics are used when
PCI is not available.
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of
4. The appropriate management is:
, Page |3
A) Aspirin only
B) No anticoagulation
C) Oral anticoagulation (DOAC or warfarin)
D) Clopidogrel only
Answer: C
Rationale: CHA₂DS₂-VASc ≥ 2 in men (≥ 3 in women) indicates
significant stroke risk requiring oral anticoagulation.
5. Which medication class is CONTRAINDICATED in heart failure
with reduced ejection fraction (HFrEF)?
A) ACE inhibitors
B) Beta blockers
C) Non-dihydropyridine calcium channel blockers (verapamil,
diltiazem)
D) Diuretics
Answer: C
Rationale: Non-dihydropyridine CCBs have negative inotropic
effects and worsen HFrEF. ACE inhibitors, beta blockers, and
diuretics are standard therapy.
6. The hallmark physical finding of pericarditis is:
, Page |4
A) Diastolic murmur
B) Pericardial friction rub
C) S3 gallop
D) Systolic ejection click
Answer: B
Rationale: A pericardial friction rub is the classic finding in
pericarditis, caused by inflamed pericardial layers rubbing
together.
7. A patient presents with sudden "tearing" chest pain radiating
to the back, BP 180/100 in the right arm and 140/80 in the left
arm. The most likely diagnosis is:
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Tension pneumothorax
Answer: B
Rationale: Aortic dissection: sudden tearing pain with BP
differential ≥ 20 mm Hg between arms—a medical emergency.
8. The target blood pressure for most adults per ACC/AHA
guidelines is:
