AMC MCQ - Australian Medical Council Multiple Choice Questions Cardiovascular Medicine Questions and Answers 1 — Questions and Answers
Question 1: A 68-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with a 2-hour history of central crushing chest pain radiating to his left arm. His ECG shows ST-segment elevation in leads II, III, and aVF. According to the 2025 Australian clinical guidelines for the management of acute coronary syndromes, what is the most appropriate immediate management step?
- Administer intravenous thrombolysis
- Arrange for urgent primary percutaneous coronary intervention (PCI) (Correct answer)
- Administer a loading dose of clopidogrel and await troponin results
- Perform an urgent echocardiogram to assess for wall motion abnormalities
Correct answer: Arrange for urgent primary percutaneous coronary intervention (PCI)
The 2025 Australian clinical guidelines for diagnosing and managing acute coronary syndromes strongly recommend urgent primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI), now termed acute coronary occlusion myocardial infarction (ACOMI), if it can be performed in a timely manner. The ECG findings are consistent with an inferior STEMI/ACOMI, which is a time-critical medical emergency requiring immediate reperfusion to restore blood flow and salvage myocardial tissue. While thrombolysis is an option if PCI is not available within the recommended timeframes, PCI is superior. Awaiting troponin results would cause an unnecessary and harmful delay in treatment. An echocardiogram is useful for diagnosis and assessing complications but should not delay reperfusion therapy.
Question 2: A 75-year-old woman is newly diagnosed with heart failure with a reduced ejection fraction (HFrEF) of 35%. She has a history of hypertension but no prior myocardial infarction. According to the 2018 National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand guidelines, which combination of medications is recommended as first-line therapy to improve survival?
- A diuretic, digoxin, and a beta-blocker
- An ACE inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist (MRA) (Correct answer)
- An angiotensin receptor blocker (ARB), a calcium channel blocker, and aspirin
- A statin, an ACE inhibitor, and a diuretic
Correct answer: An ACE inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist (MRA)
The 2018 Australian heart failure guidelines recommend a three-pronged approach for all patients with HFrEF to reduce mortality and hospitalisations. This includes an ACE inhibitor (or an ARB if not tolerated), a beta-blocker (specifically, carvedilol, bisoprolol, or metoprolol succinate), and a mineralocorticoid receptor antagonist (spironolactone or eplerenone). Diuretics are used for symptom control (fluid overload) but do not have a proven mortality benefit. Digoxin is a second-line agent for symptom control. Calcium channel blockers (like verapamil and diltiazem) are generally avoided in HFrEF. Statins are indicated for atherosclerotic disease, not primarily for HFrEF itself.
Question 3: Which of the following is the recommended target for low-density lipoprotein cholesterol (LDL-C) for secondary prevention in a patient who has had an acute coronary syndrome, according to the 2025 Australian clinical guidelines?
- < 2.5 mmol/L
- < 2.0 mmol/L
- < 1.8 mmol/L
- < 1.4 mmol/L and at least a 50% reduction from baseline (Correct answer)
Correct answer: < 1.4 mmol/L and at least a 50% reduction from baseline
The 2025 Australian clinical guideline for diagnosing and managing acute coronary syndromes recommends a more aggressive LDL-C target for secondary prevention. For patients post-ACS, the target is an LDL-C level of < 1.4 mmol/L and a reduction of at least 50% from the baseline level. This reflects evidence showing further benefit from achieving the lowest possible LDL-C levels in this high-risk population. The other options represent older, less stringent targets.
Question 4: A 55-year-old male is diagnosed with hypertension during a routine check-up. His clinic blood pressure is consistently 165/100 mmHg. He has no other medical conditions and his cardiovascular disease risk is assessed as low. According to the National Heart Foundation of Australia's 2016 guidelines, what is the most appropriate initial step in management?
- Commence immediate dual antihypertensive therapy
- Recommend lifestyle modifications only and review in 3-6 months
- Commence monotherapy with a thiazide diuretic or ACE inhibitor (Correct answer)
- Arrange for 24-hour ambulatory blood pressure monitoring before starting treatment
Correct answer: Commence monotherapy with a thiazide diuretic or ACE inhibitor
According to the 2016 National Heart Foundation of Australia guidelines, for a patient at low absolute cardiovascular disease risk with persistent blood pressure ≥ 160/100 mmHg, antihypertensive drug therapy should be started. The guidelines recommend initiating treatment with a single first-line agent, such as an ACE inhibitor, ARB, calcium channel blocker, or thiazide diuretic. Dual therapy is typically reserved for those with significantly higher BP or who do not respond to monotherapy. Lifestyle modification alone is insufficient for this level of hypertension. While ambulatory monitoring is useful to confirm the diagnosis and rule out 'white coat' hypertension, the guidelines recommend starting therapy for persistent BP at this level in low-risk individuals.
Question 5: A 45-year-old woman with a history of rheumatic heart disease and a prosthetic mitral valve requires a major dental procedure (tooth extraction). According to Australian guidelines on the prevention of infective endocarditis, which of the following is true regarding antibiotic prophylaxis?
- Antibiotic prophylaxis is no longer recommended for any dental procedures.
- She should receive a single dose of amoxicillin 1 hour before the procedure. (Correct answer)
- Prophylaxis is only required if she has a fever on the day of the procedure.
- Prophylaxis with intravenous vancomycin is the standard of care for all high-risk patients.
Correct answer: She should receive a single dose of amoxicillin 1 hour before the procedure.
Australian guidelines recommend antibiotic prophylaxis for the prevention of infective endocarditis only for patients with the highest risk cardiac conditions undergoing specific high-risk procedures. A prosthetic heart valve is a high-risk condition, and a dental extraction is a high-risk procedure. The standard recommended regimen for patients who are not allergic to penicillin is a single oral dose of 2g of amoxicillin, taken 60 minutes before the procedure. Vancomycin is an alternative for patients with a high-risk penicillin allergy.
Question 6: A 70-year-old man presents with an irregularly irregular pulse and is diagnosed with atrial fibrillation. His CHA2DS2-VASc score is 4. He has no history of bleeding disorders. According to the Australian guidelines for the management of atrial fibrillation, what is the most appropriate long-term management for stroke prevention?
- Aspirin 100mg daily
- Aspirin and clopidogrel dual therapy
- Warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC) (Correct answer)
- No antithrombotic therapy is required
Correct answer: Warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC)
The Australian guidelines for atrial fibrillation management recommend using the CHA2DS2-VASc score to stratify stroke risk. A score of 2 or greater in males indicates a high risk of stroke, and oral anticoagulation is strongly recommended. Either warfarin (with a target INR of 2.0-3.0) or a NOAC (such as apixaban, rivaroxaban, or dabigatran) is the treatment of choice. Aspirin monotherapy or dual antiplatelet therapy is no longer considered adequate for stroke prevention in this high-risk population.
AMC MCQ - Australian Medical Council Multiple Choice Questions Cardiovascular Medicine Questions and Answers 1
A 68-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with a 2-hour history of central crushing chest pain radiating to his left arm.
His ECG shows ST-segment elevation in leads II, III, and aVF.
According to the 2025 Australian clinical guidelines for the management of acute coronary syndromes, what is the most appropriate immediate management step?