How to use these cardiology practice questions
These ten single-best-answer cases cover common cardiology decisions: acute coronary syndromes, arrhythmias, heart failure, valve disease and cardiac emergencies. They are subject revision questions, not a representation of any one examination’s format. Read each question as it appears, choose the best option, then use the explanation to check both your answer and your reasoning.
For each case, identify the key finding first. Then ask what action, diagnosis or threshold follows from it. If you miss a question, note whether the gap was recognising a pattern, recalling a criterion or choosing the next step. Local protocols can differ, so check current guidance where a treatment detail depends on the setting.
1. Recognising an acute STEMI
This question tests whether you prioritise reperfusion when the ECG and symptoms indicate an acute coronary occlusion. A MySummaries practice question on STEMI might look like this:
A 58-year-old presents with 50 minutes of central chest pressure and diaphoresis. ECG shows ST elevation in leads II, III and aVF. He is haemodynamically stable. What is the most appropriate next step?
The symptoms and regional ST elevation indicate acute STEMI. Reperfusion should be organised urgently; do not delay for a troponin result when the ECG establishes the diagnosis. An outpatient test is not appropriate in an acute presentation.
The key is not to let haemodynamic stability reassure you into delay. A normal or pending biomarker result does not rule out an acute STEMI when the clinical picture and ECG are clear.
2. Managing unstable atrial fibrillation
This case tests the distinction between rate control in a stable patient and immediate rhythm treatment when the arrhythmia is causing instability. A MySummaries question on that decision could read:
A 76-year-old with atrial fibrillation has a ventricular rate of 160/min, blood pressure 78/48 mmHg, confusion and acute pulmonary oedema. What is the immediate rhythm-management step?
Hypotension, altered mental state and pulmonary oedema indicate haemodynamic instability. Synchronized cardioversion is the immediate rhythm-management step. Rate-control drugs may worsen hypotension and are not a substitute for urgent cardioversion in this situation.
The strongest distractor is intravenous rate control: it can be considered in selected stable patients, but this patient needs urgent treatment of the unstable rhythm. Anticoagulation remains important to assess, but it does not replace immediate stabilisation.
3. Applying the diagnostic criteria for pericarditis
This question checks whether you can use the clinical criteria rather than relying on one test result. A MySummaries question might present the findings this way:
A 29-year-old has sharp chest pain that worsens on inspiration and lying flat, and improves when sitting forward. The ECG shows widespread ST elevation with PR depression. Which interpretation is best?
Typical pleuritic, positional chest pain and characteristic ECG changes are two of the four commonly used diagnostic criteria for acute pericarditis. An effusion and raised troponin are not required. Troponin elevation may indicate associated myocardial involvement.
The useful habit is to count criteria: characteristic pain, a pericardial rub, typical ECG changes and a new or worsening effusion. A raised troponin can change the assessment, but it is not a prerequisite for the diagnosis.
4. Choosing foundational treatment for HFrEF
This case tests knowledge of a core disease-modifying treatment and whether you assume diabetes is required for an SGLT2 inhibitor. A MySummaries question on HFrEF could look like this:
A 63-year-old with stable, symptomatic heart failure has a left ventricular ejection fraction of 35%. Renal function is suitable, and there is no diabetes. Which statement about an SGLT2 inhibitor is correct?
SGLT2 inhibitors such as dapagliflozin and empagliflozin reduce heart-failure events in eligible patients with HFrEF, including those without diabetes. They are part of foundational treatment alongside other appropriate disease-modifying therapies; loop diuretics have a different role in managing congestion.
The strongest distractor confuses symptom relief with disease modification. Loop diuretics help relieve fluid overload; they do not replace the foundational therapies used to improve outcomes. Check renal function, contraindications and local prescribing guidance for an individual patient.
5. Identifying severe aortic stenosis on echocardiography
This question tests recall of the echocardiographic measurements used to identify severe aortic stenosis. A MySummaries question might be:
An echocardiogram reports a peak aortic jet velocity of 4.2 m/s, a mean gradient of 43 mmHg and an aortic valve area of 0.8 cm². How should these findings be interpreted?
A peak velocity of at least 4.0 m/s, mean gradient of at least 40 mmHg and valve area of 1.0 cm² or less are conventional severe aortic stenosis thresholds. These measurements are concordant with severe disease in this case.
Learn the thresholds as a set, but interpret them with the clinical picture and technical quality of the study. If measurements are discordant, further assessment may be needed rather than forcing a severity label from one number.
6. Taking cultures when endocarditis is suspected
This case tests the sequence of investigation and treatment in a patient who is stable enough for samples to be collected first. A MySummaries question could be framed as follows:
A haemodynamically stable patient has fever, a new murmur and suspected infective endocarditis. There is no immediate indication for emergency antimicrobial treatment. What should be done before starting antibiotics?
In a stable patient with suspected infective endocarditis, obtain multiple peripheral blood-culture sets before antibiotics to improve the chance of identifying the organism. Do not delay urgent treatment in an unstable patient; the sequence depends on clinical urgency.
The key qualification is stability. Culture collection before antibiotics is valuable when it can be done promptly and safely; it should not become a reason to postpone emergency treatment in a deteriorating patient.
7. Treating torsades de pointes
This question checks the immediate treatment for torsades, a polymorphic ventricular tachycardia associated with a prolonged QT interval. A MySummaries practice question might show:
A patient with a prolonged QT interval develops recurrent episodes of torsades de pointes. Which treatment is specifically indicated even if the measured serum magnesium is normal?
Intravenous magnesium sulfate is indicated for torsades de pointes, including when the serum magnesium concentration is normal. Also assess and correct contributing factors such as QT-prolonging medicines and electrolyte abnormalities; instability or pulselessness requires emergency resuscitation management.
Do not confuse torsades with a regular narrow-complex tachycardia: adenosine is not the treatment for this rhythm. The wider response includes reviewing medicines and correcting electrolyte disturbances that may prolong repolarisation.
8. Recognising cardiac tamponade
This case tests whether you respond to the combination of circulatory compromise and an effusion, rather than treating the scan as an incidental finding. A MySummaries question on tamponade might look like this:
A patient with a large pericardial effusion becomes hypotensive and tachycardic. Bedside echocardiography shows right atrial and right ventricular diastolic collapse. What is the most appropriate definitive intervention?
Hypotension with echocardiographic chamber collapse supports haemodynamically significant tamponade. Urgent pericardial drainage is the definitive intervention. Diuresis can reduce preload and worsen the physiology; routine follow-up is inappropriate in an unstable patient.
In practice, organise urgent specialist support and choose the safest available drainage approach for the patient and setting. A large effusion alone does not always mean tamponade; the haemodynamic effect matters.
9. Treating symptomatic obstructive hypertrophic cardiomyopathy
This question tests first-line symptom management in a patient with left ventricular outflow tract obstruction. A MySummaries question might present it like this:
A patient with hypertrophic cardiomyopathy has exertional breathlessness and a dynamic left ventricular outflow tract gradient. There is no contraindication to beta blockade. Which medication class is generally used first to relieve symptoms?
A non-vasodilating beta blocker is generally used first for symptoms in obstructive hypertrophic cardiomyopathy when tolerated. By reducing heart rate and contractility, it can improve filling and reduce dynamic obstruction. Vasodilators and unnecessary preload reduction may worsen obstruction in some patients.
The important phrase is “obstructive” disease. Medication choices depend on symptoms, blood pressure, comorbidities and specialist assessment; do not apply the same approach automatically to every patient with hypertrophic cardiomyopathy.
10. Managing stable regular narrow-complex SVT
The final question tests the initial sequence for a stable regular narrow-complex tachycardia. A MySummaries practice question could be:
A 24-year-old has palpitations and a regular narrow-complex tachycardia at 190/min. Blood pressure is normal and there are no signs of shock or heart failure. What is an appropriate initial management step?
For a haemodynamically stable patient with a regular narrow-complex tachycardia, a vagal manoeuvre is an appropriate initial step. If it fails, further management may include adenosine when appropriate, following local protocols. Unstable patients require a different urgent approach.
The stability assessment determines the pathway. Once the rhythm is controlled, clarify the likely mechanism and whether further evaluation or prevention is appropriate; the immediate question is about safe first-line management.
Review the marks you lose
A useful review separates weak topics from careless errors. Track your percentage in each area and how often you have practised it. A low score after repeated attempts points to a concept that needs rebuilding; one isolated error may need only a quick correction.
A MySummaries weak-area view for these questions might look like this:
For every wrong answer, write the missing decision in a single sentence: for example, “unstable AF requires synchronized cardioversion.” If the same point costs marks twice, turn it into a focused recall prompt rather than rereading the whole topic. A remediation prompt could be:
You lost this mark twice: in a haemodynamically unstable patient with atrial fibrillation, what is the immediate rhythm-management step?
Return to missed questions after a delay and explain the answer aloud in your own words. That checks whether you can retrieve the decision, not just recognise it when you see it. For clinical practice, use current local guidance and seek senior or specialist input when a patient’s condition is urgent or complex.
How MySummaries helps
Build a cardiology revision board from your own notes, then use it to generate practice questions and turn repeated errors into review cards. You can work from your own PDFs, slides or photographed notes in MySummaries.