FCPS IMM Cardiology MCQs: High-Yield Practice Questions & Prep

Sample FCPS IMM Medicine cardiology MCQs covering ACS, valvular disease, cardiomyopathy, arrhythmias and pericardial disease, each with the reasoning behind the answer.

Cardiology is the largest block in the IMM Medicine paper and the one where clinical vignettes are most predictable. Acute coronary syndromes, valvular lesions, cardiomyopathies, endocarditis and arrhythmias account for most of the questions. Below is a sample set in the style you will see on exam day, with the reasoning after each answer.

Sample Cardiology MCQs

1. A patient has chest pain with no significant ECG changes and an elevated troponin. What is the diagnosis?

A) Non-ST elevation myocardial infarction ✅
B) Unstable angina
C) ST elevation myocardial infarction
D) Stable angina

Why: Raised troponin indicates myocardial necrosis, and without ST elevation it is an NSTEMI. Unstable angina has a normal troponin.

2. A stable patient has an aortic aneurysm larger than 5 cm and unequal pulses. What is the most appropriate investigation?

A) ECG
B) Angiography
C) CT scan ✅
D) Echo

Why: CT scan defines the size, extent and relation of an aortic aneurysm to branch vessels and is used to plan repair.

3. An old patient presents with chronic atrial fibrillation with rapid ventricular rate. Which of the following is the best treatment for him?

A) Diuretics
B) Amiodarone
C) Digoxin
D) Beta blockers ✅

Why: Beta blockers (or rate-limiting calcium channel blockers) are first-line for rate control in AF, and digoxin is reserved for patients with heart failure or who are sedentary.

4. A female presents with chest pain. ECG shows inferior wall myocardial infarction with a heart rate of 40/min. What is the best initial treatment?

A) Pacemaker
B) Inj adrenaline
C) Observe and monitor
D) Inj atropine ✅
E) IV fluids

Why: Symptomatic bradycardia in inferior MI is caused by increased vagal tone or AV nodal ischaemia and responds to IV atropine.

5. A patient has pulseless ventricular tachycardia. What should he receive?

A) Shock only once ✅
B) Lidocaine
C) Shock twice
D) Shock 3 times
E) Amiodarone

Why: Current guidelines give a single shock followed immediately by 2 minutes of CPR, rather than a stacked series of 3 shocks. Adrenaline follows after the 3rd shock, together with amiodarone.

6. A patient with recurrent falls and a history of myocardial infarction has anterior T-wave inversion on ECG and a double apical impulse. Which investigation should be carried out?

A) Echocardiography ✅
B) CBC
C) Holter monitoring
D) ETT

Why: Echocardiography is the best test to look for left ventricular aneurysm or dyskinesia after MI, and for cardiomyopathy.

7. A patient develops a new murmur after myocardial infarction. What is the most suitable investigation?

A) ETT
B) Holter
C) ECG
D) Thallium scan
E) Echocardiography ✅

Why: A new murmur after infarction suggests papillary muscle rupture or a ventricular septal rupture, and echocardiography confirms both.

8. A 34-year-old has a systolic murmur. CXR shows absent peripheral lung markings, and the ECG shows right ventricular hypertrophy. What is the diagnosis?

A) Mitral stenosis
B) Pulmonary oedema
C) Pulmonary stenosis ✅
D) Aortic stenosis

Why: A systolic murmur with right ventricular hypertrophy and post-stenotic dilatation on imaging points to pulmonary stenosis.

How to Approach Cardiology for IMM

Learn the classic murmur, pulse and JVP signatures cold, since vignettes often give only those clues.
For ACS, know reperfusion options and timing, the first drug to give, and which coronary artery matches which ECG leads.
For arrhythmias, decide first whether the patient is stable, because that alone picks between drugs and cardioversion.

Browse every Cardiology question on its own: Cardiology MCQs.

Keep Practising

These questions come from HighYield's FCPS IMM Medicine QBank, which holds over 2,400 clinical-vignette MCQs with an explanation for every answer. The first 20 questions are free in Tutor mode, so you can judge the explanation quality before unlocking the full bank.