1.

Which of the following statements accurately describes the mechanism by which endothelial
dysfunction contributes to coronary artery disease?
A) Endothelial dysfunction decreases nitric oxide production, which increases arterial
stiffness.
B) Endothelial dysfunction leads to reduced levels of endothelin-1, promoting vasodilation.
C) Endothelial dysfunction causes an increase in cyclic GMP levels, which reduces platelet
aggregation.
D) Endothelial dysfunction enhances fatty acid oxidation, leading to lipid accumulation.
2. Differentiating chest pain caused by gastrointestinal issues from cardiac chest pain often
involves which of the following clinical approaches?
A) Administration of a high-dose proton pump inhibitor
B) Use of sublingual nitroglycerin to relieve symptoms
C) Observation of pain response to deep breathing and palpation
D) Immediate cardiac catheterization
3. Which component of the medical history is most predictive of a cardiac etiology of chest pain?
A) Duration of pain less than 20 minutes
B) Pain worsened by physical exertion
C) Pain relief after consumption of food
D) Presence of a rash
4. In the context of coronary artery disease, which type of angina is characterized by chest pain
occurring at rest due to coronary artery spasm?
A) Stable angina
B) Unstable angina
C) Prinzmetal angina
D) Effort angina
5. What is the primary pathophysiological process underlying the transition from stable angina
to myocardial infarction?
A) Sudden rupture of an atherosclerotic plaque
B) Gradual narrowing of the coronary artery
C) Development of collateral circulations
D) Hypertrophy of the left ventricular wall
6. Which of the following risk factors is NOT commonly associated with coronary artery disease?
A) Hyperlipidemia
B) Sedentary lifestyle
C) High dietary intake of omega-3 fatty acids
D) Smoking
7. The concept of 'silent ischemia' in coronary artery disease refers to which phenomenon?
A) Ischemia that occurs without an increase in heart rate
B) Ischemia that does not result in detectable symptoms
C) Ischemia that resolves without medical intervention
D) Ischemia that is only detectable by ECG changes
8. Which of the following diagnostic tests provides the most direct assessment of coronary
artery patency?
A) Transthoracic echocardiography
 B) Cardiac magnetic resonance imaging
C) Coronary angiography
D) Stress electrocardiography
9. Regarding the pathophysiology of coronary artery disease, which molecule is primarily
responsible for mediating vasoconstriction?
A) Nitric oxide
B) Endothelin-1
C) Adenosine
D) Acetylcholine
10. Which factor most significantly accelerates the progression of atherosclerotic plaques?
A) Elevated HDL cholesterol levels
B) Increased shear stress
C) Decreased plasma levels of LDL cholesterol
D) Chronic inflammation

11. What is the typical electrocardiographic finding in a patient experiencing Prinzmetal angina?
A) Prolonged QT interval
B) ST-segment elevation
C) Q waves
D) Inverted T waves
12. Which type of myocardial infarction is characterized by the absence of ST-segment elevation
on an ECG?
A) STEMI
B) NSTEMI
C) Silent MI
D) Subendocardial MI
13. In the diagnosis of coronary artery disease, what is the significance of detecting elevated
levels of high-sensitivity C-reactive protein (hs-CRP)?
A) Directly correlates with the severity of coronary stenosis
B) Indicates the presence of active plaque rupture
C) Suggests systemic inflammation and a higher risk of atherosclerosis
D) Confirms the diagnosis of myocardial infarction
14. What is the main clinical utility of performing a stress test in a patient suspected of having
coronary artery disease?
A) To measure the patient's maximum oxygen consumption
B) To assess the functional capacity and inducible ischemia
C) To determine the patient's resting heart rate variability
D) To visualize the coronary artery anatomy
15. Which imaging modality provides the most detailed visualization of coronary artery anatomy
and plaque characteristics?
A) Coronary CT angiography
B) Nuclear stress test
C) Conventional angiography
 D) Doppler ultrasound of the carotid artery
16. The use of which medication class is primarily aimed at preventing the progression of unstable
angina to myocardial infarction?
A) Beta-blockers
B) ACE inhibitors
C) Anticoagulants
D) Antiplatelet agents
17. What is the role of myocardial perfusion imaging in the evaluation of coronary artery disease?
A) It quantifies the degree of fixed atherosclerotic stenosis.
B) It identifies areas of myocardial necrosis.
C) It detects regions of reversible ischemia during stress.
D) It measures the velocity of blood flow through the coronary arteries.
18. Which of the following is a hallmark symptom of acute myocardial infarction?
A) Transient sharp chest pain
B) Prolonged crushing chest pain with diaphoresis
C) Pain radiating to the right shoulder
D) Pain that improves with coughing
19. Which finding on physical examination would most suggest a non-cardiac origin of chest pain?
A) Pain reproducible with palpation
B) Pain accompanied by dyspnea
C) Diaphoresis during episodes of pain
D) Pain that is positional
20. Regarding coronary artery disease, the term 'triple vessel disease' refers to what?
A) Involvement of the left anterior descending artery, circumflex artery, and right coronary
artery
B) Presence of three distinct atherosclerotic plaques in one coronary artery
C) Involvement of any three arteries, including minor branches
D) Three consecutive episodes of acute coronary syndrome without myocardial infarction

21. Which biomarker is most useful for distinguishing between myocardial infarction and
myocarditis in a Mozambican hospital setting, where advanced imaging might not be
available?

A) A) Troponin I

B) B) C-reactive protein

C) C) Erythrocyte sedimentation rate

D) D) Myoglobin

22. In the assessment of a patient with suspected acute coronary syndrome in Mozambique, what
complicates the interpretation of troponin levels in the presence of HIV/AIDS and
antiretroviral therapy?

A) A) Troponin levels may be chronically elevated without acute coronary syndrome.

B) B) HIV medications interfere with the assay used to measure troponin.

D) D) Antiretroviral therapy causes a rapid turnover of troponin.

23. Considering Mozambique's epidemiological profile, which cardiac condition should be

A) A) Aortic dissection

B) B) Pericarditis

C) C) Pulmonary embolism

D) D) Ventricular hypertrophy

24. Which diagnostic strategy is most appropriate for a Mozambican patient with low-risk chest
pain and no clear signs of acute coronary syndrome?

A) A) Immediate coronary angiography

B) B) High-sensitivity troponin testing at presentation and three hours later

C) C) Discharge with outpatient follow-up in a cardiology clinic

D) D) 24-hour Holter monitoring

25. In a resource-limited setting like Mozambique, what is the primary challenge in using risk
scores like the TIMI score for chest pain evaluation?

A) A) Lack of patient understanding and cooperation

B) B) Incomplete data for accurate scoring

C) C) Scores developed in Western populations may not be applicable

D) D) All of the above

26. For a Mozambican patient with chest pain and a history of traditional medicine use, what is a
crucial aspect to consider when planning management?

A) A) Potential interactions between traditional remedies and prescribed cardiac

B) B) The influence of traditional beliefs on compliance with diagnostic procedures

C) C) The possibility of misdiagnosis due to attribution of symptoms to spiritual causes

D) D) All of the above

27. What is the most likely cause of acute chest pain in a young adult in Mozambique with no
history of cardiac disease but a high burden of familial tuberculosis?

A) A) Costochondritis
 B) B) Pleurisy

C) C) Rheumatic heart disease

D) D) Pulmonary embolism

28. In managing a patient with unstable angina in a Mozambican hospital, which factor must be
prioritized to prevent progression to myocardial infarction?

A) A) Rapid administration of antiplatelet therapy

B) B) Immediate stress testing

C) C) Scheduling for elective angiography

D) D) Long-term lifestyle modification counselling

29. What complicates the management of chest pain in elderly patients in Mozambique,
considering typical socio-economic conditions?

A) A) High prevalence of polypharmacy

B) B) Coexistence of multiple chronic conditions

C) C) Limited access to healthcare facilities

D) D) Both B and C

30. Which approach is most effective in educating Mozambican communities about the signs and
symptoms of coronary heart disease to improve early presentation?

A) A) Community workshops led by healthcare professionals

B) B) Radio broadcasts and local television programs on health education

C) C) Distribution of educational pamphlets at local markets

D) D) Training local community leaders to disseminate information

31. In the context of Mozambique, what is the most prevalent cause of chest pain related to
infectious diseases?

A) A) Tuberculosis

B) B) HIV/AIDS-related complications

C) C) Malaria

D) D) Pneumonia

32. Considering the healthcare system in Mozambique, which diagnostic tool is most commonly
available for initial assessment of chest pain in rural clinics?
 A) A) Cardiac MRI

B) B) Echocardiography

C) C) Electrocardiogram (ECG)

D) D) Coronary angiography

33. Which of the following factors significantly complicates the differential diagnosis of chest pain
in Mozambique?

A) A) High prevalence of rheumatic heart disease

B) B) Predominant genetic predisposition to hypertension

C) C) Limited access to specialist cardiac care

D) D) Over-reliance on traditional medicine

34. What is the leading risk factor for coronary heart disease in the Mozambican population?

A) A) High-fat diet

B) B) Physical inactivity

C) C) Smoking

D) D) Genetic predisposition

35. Which statement best describes the challenge of treating coronary heart diseases in
Mozambique?

A) A) There is a widespread availability of advanced cardiac life support services.

B) B) Herbal and traditional remedies are often preferred over conventional medicine.

C) C) There is a high ratio of cardiologists to the population.

D) D) All citizens have equal access to healthcare facilities.

36. In Mozambique, how does the prevalence of HIV/AIDS impact the management of chest pain?

A) A) HIV/AIDS is unrelated to chest pain and does not affect its management.

B) B) HIV increases the risk of certain cardiomyopathies which may present with chest
pain.

C) C) Anti-retroviral therapy used in HIV treatment effectively reduces the incidence of

D) D) HIV-positive patients are less likely to report symptoms of chest pain due to social
stigma.

37. What role do mobile health clinics play in the management of chest pain in remote areas of
Mozambique?
 A) A) They primarily provide chronic care management for diabetes and hypertension.

B) B) They offer specialized cardiac diagnostic services such as echocardiography.

C) C) They are essential for initial screening and referral for advanced cardiac care.

D) D) They focus on delivering vaccinations and have no role in managing chest pain.

38. Which type of angina is most likely to be under-diagnosed in Mozambique due to typical
presentation subtleties?

A) A) Stable angina

B) B) Unstable angina

C) C) Prinzmetal's angina

D) D) Microvascular angina

39. Considering Mozambique's tropical climate, how does this affect the clinical presentation of
coronary artery disease?

A) A) Higher incidence of dehydration-related complications

B) B) Increased cases of heat-induced myocardial infarction

C) C) Reduced typical symptoms due to acclimatization to heat

D) D) No significant effect noted in clinical studies

40. What is a major barrier to implementing evidence-based guidelines for the management of
acute coronary syndromes in Mozambique?

A) A) Excessive reliance on imported medications

B) B) Lack of local clinical research

C) C) Insufficient training in guideline-adherent practices

D) D) All of the above

41. Which intervention is most effective at a community level to reduce the incidence of coronary
heart diseases in Mozambique?

A) A) Community-based health education programs

B) B) Importation of advanced diagnostic tools

C) C) Governmental regulation of tobacco products

D) D) Expansion of urban healthcare facilities

42. In rural Mozambique, which symptom of heart disease is often misinterpreted as a non-
cardiac condition?
 A) A) Sweating

B) B) Nausea

C) C) Shortness of breath

D) D) Chest pain

43. How does the prevalence of infectious diseases in Mozambique complicate the differential
diagnosis of chest pain?

A) A) Infectious diseases rarely present with chest pain.

B) B) They often mask the symptoms of cardiac conditions.

C) C) They are easily distinguishable from cardiac symptoms.

D) D) Treatments for infectious diseases alleviate cardiac symptoms as well.

44. Which healthcare strategy has the most potential to improve cardiac care in Mozambique?

A) A) Introduction of more cardiac rehabilitation centers

B) B) Training more healthcare workers in basic cardiac life support

C) C) Increasing availability of generic medications

D) D) Integrating traditional healers into formal healthcare settings

45. What is the typical patient pathway for managing acute chest pain in Mozambique's major
cities like Maputo?

A) A) Immediate access to catheterization labs

B) B) Evaluation at a primary health center followed by referral

C) C) Direct consultation with a cardiologist

D) D) Self-treatment at home until symptoms resolve

46. Considering the dietary habits in Mozambique, which dietary component is most likely linked
to the rising incidence of coronary heart diseases?

A) A) High consumption of seafood

B) B) Low intake of fresh fruits and vegetables

C) C) High intake of red meat

D) D) Consumption of processed foods

47. What is a common misconception about heart disease in Mozambique that affects patient
outcomes?

A) A) It is primarily a disease of the elderly.

C) C) It is always associated with severe chest pain.

D) D) It is less serious than infectious diseases.

48. In the treatment of coronary heart diseases, what factor most limits the use of thrombolytic
therapy in rural areas of Mozambique?

A) A) Patient refusal due to cultural beliefs

B) B) Lack of available trained medical personnel

C) C) High cost of thrombolytic drugs

D) D) Unavailability of diagnostic facilities to confirm diagnosis

49. Which traditional practice might indirectly contribute to the mismanagement of chest pain in
Mozambique?

A) A) Consultation with traditional healers before seeking formal medical advice

B) B) Preference for herbal remedies over pharmaceuticals

C) C) Rituals that stress physical endurance

D) D) All of the above

50. How does Mozambique's status as a developing country impact its healthcare providers'
ability to manage cardiac emergencies effectively?

A) A) Limited access to ongoing medical education

B) B) Insufficient numbers of specialized healthcare providers

C) C) Both A and B

D) D) None of the above