Cardiology — MCQs

A 62-year-old woman presents with stable exertional chest tightness over 3 months. Examination and ECG are normal. Her clinic blood pressure is 145/88 mmHg with a heart rate of 72 bpm. She has no contraindications to beta-blockers or rate-limiting calcium channel blockers. According to NICE guidelines for stable angina, what is the most appropriate first-line anti-anginal medication?

Q102

A 58-year-old man with type 2 diabetes mellitus attends for cardiovascular risk assessment. He is a non-smoker with a BMI of 28 kg/m². His blood pressure is 138/82 mmHg. Fasting lipids show total cholesterol 6.2 mmol/L, HDL 1.1 mmol/L. His HbA1c is 58 mmol/mol. He has no history of cardiovascular disease or familial hypercholesterolaemia. According to NICE guidelines, which tool should be used to assess his cardiovascular risk?

Cardiology UK Medical PG Practice Questions and MCQs

Question 101: A 62-year-old woman presents with stable exertional chest tightness over 3 months. Examination and ECG are normal. Her clinic blood pressure is 145/88 mmHg with a heart rate of 72 bpm. She has no contraindications to beta-blockers or rate-limiting calcium channel blockers. According to NICE guidelines for stable angina, what is the most appropriate first-line anti-anginal medication?

A. Amlodipine 5mg once daily
B. Bisoprolol 2.5mg once daily (Correct Answer)
C. Diltiazem modified-release 120mg twice daily
D. Isosorbide mononitrate 30mg twice daily
E. Nicorandil 10mg twice daily

Explanation: ***Bisoprolol 2.5mg once daily*** - According to **NICE guidelines (CG126)**, the first-line treatment for stable angina is either a **beta-blocker** or a **rate-limiting calcium channel blocker**. - **Bisoprolol** is a cardioselective beta-blocker that reduces myocardial oxygen demand by lowering the **heart rate** and contractility. *Amlodipine 5mg once daily* - Amlodipine is a **dihydropyridine calcium channel blocker** which acts primarily via peripheral vasodilation rather than rate-limiting effects. - It is typically utilized as a **second-line** option or in combination with a beta-blocker, but not as initial monotherapy if a beta-blocker is suitable. *Diltiazem modified-release 120mg twice daily* - While diltiazem is a **rate-limiting calcium channel blocker** and a valid first-line choice, beta-blockers like bisoprolol are often preferred in clinical practice due to superior **prognostic benefits**. - It is usually reserved as an alternative first-line option for patients who cannot tolerate or have **contraindications** to beta-blockers. *Isosorbide mononitrate 30mg twice daily* - This is a **long-acting nitrate** used primarily for symptom relief by causing venous and arterial vasodilation. - It is considered a **second-line** treatment according to NICE guidelines, to be added only if first-line agents are insufficient or contraindicated. *Nicorandil 10mg twice daily* - Nicorandil is a **potassium-channel activator** with nitrate-like effects used for the symptomatic control of angina. - It is classified as a **second-line** agent and is not recommended as a first-line monotherapy for stable angina.

Question 102: A 58-year-old man with type 2 diabetes mellitus attends for cardiovascular risk assessment. He is a non-smoker with a BMI of 28 kg/m². His blood pressure is 138/82 mmHg. Fasting lipids show total cholesterol 6.2 mmol/L, HDL 1.1 mmol/L. His HbA1c is 58 mmol/mol. He has no history of cardiovascular disease or familial hypercholesterolaemia. According to NICE guidelines, which tool should be used to assess his cardiovascular risk?

A. Framingham risk score
B. ASSIGN score
C. No formal risk assessment needed; offer statin based on diabetes diagnosis (Correct Answer)
D. QRISK3 calculation
E. JBS3 calculator

Explanation: ***No formal risk assessment needed; offer statin based on diabetes diagnosis*** - According to **NICE guidelines**, patients with **Type 2 Diabetes Mellitus** are already considered at increased cardiovascular risk. - For individuals with **Type 2 Diabetes** aged **40 years or older**, a formal risk assessment tool is not required; they should be offered **Atorvastatin 20mg** for primary prevention. *Framingham risk score* - This is an older risk assessment tool that is **no longer recommended** by current NICE guidelines for use in the UK. - It has largely been replaced by QRISK tools, which are **better calibrated** for the UK population. *ASSIGN score* - The **ASSIGN score** is primarily used in **Scotland** under SIGN guidelines, not the NICE guidelines followed in England and Wales. - It incorporates factors like **social deprivation** but is not the specified tool for this patient population under NICE. *QRISK3 calculation* - **QRISK3** is used for primary prevention in patients **without** established cardiovascular disease or conditions already conferring high risk. - It should **not be used** for patients with **Type 2 Diabetes mellitus**, where statin eligibility is determined by the diagnosis itself and age. *JBS3 calculator* - The **JBS3 calculator** provides a patient's **lifetime risk** of cardiovascular disease and 'heart age', which can be useful for patient engagement. - It is not the primary tool mandated by NICE for deciding statin initiation thresholds in individuals with established risk factors like Type 2 Diabetes.

Practice by Chapter

Acute coronary syndromes

Practice Questions

Atrial fibrillation and anticoagulation

Practice Questions

Cardiovascular risk assessment (QRISK)

Practice Questions

Heart failure (HFrEF, HFpEF)

Practice Questions

Hypertension diagnosis and management

Practice Questions

Stable angina

Practice Questions

Valvular heart disease

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Cardiology — MCQs

Cardiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?