Prometric Exam Questions for Cardiology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the CRD5751 Paper

The cardiology specialist paper (CRD5751) is written for the cardiology registrar: acute coronary syndromes, heart failure, arrhythmias, valve disease, hypertension and the emergencies that arrive at night. It leans on current ESC and ACC guidance, and it expects you to know the numbers: ejection fraction thresholds, CHA₂DS₂-VASc, valve gradients and drug doses. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the cardiologist guide. For timed papers use the Cardiology specialist bank, about 3,000 questions.

Acute coronary syndromes

Question 1

A 58-year-old with a non-ST-elevation myocardial infarction has a GRACE score above 140 and ongoing chest pain. The timing of invasive coronary angiography should be:

1. Within 2 hours, as for STEMI
2. Early, within 24 hours, with dual antiplatelet therapy and anticoagulation started now
3. Elective in six weeks
4. Only if troponin rises further

Answer: B. High-risk NSTE-ACS (high GRACE score, dynamic ST changes, raised troponin) warrants an early invasive strategy within 24 hours. Immediate angiography is for refractory angina, haemodynamic instability or life-threatening arrhythmia.

Question 2

After a drug-eluting stent for ACS in a patient without high bleeding risk, the default duration of dual antiplatelet therapy is:

1. 1 month
2. 12 months with aspirin plus a P2Y12 inhibitor, with shorter or de-escalated regimens where bleeding risk is high
3. Lifelong dual therapy for everyone
4. Aspirin alone from day one

Answer: B. Twelve months remains the default after ACS; ticagrelor or prasugrel is preferred over clopidogrel unless contraindicated. Bleeding-risk tools guide shortening or de-escalation.

Question 3

Three days after an anterior STEMI, a patient develops a new harsh pansystolic murmur, hypotension and pulmonary oedema. Echo shows a left-to-right shunt at the septum. The management is:

1. Beta blocker and discharge
2. Haemodynamic support with vasodilators or an intra-aortic balloon pump as a bridge, and urgent surgical or percutaneous repair of the ventricular septal rupture
3. Thrombolysis
4. Observation only

Answer: B. Post-infarction VSD carries very high mortality without closure. Stabilise, image and refer for surgery; papillary muscle rupture and free-wall rupture are the other mechanical complications to recognise.

Heart failure

Question 4

A patient with heart failure and an ejection fraction of 30% is on an ACE inhibitor and a beta blocker. Which additional therapies form part of guideline-directed foundational treatment?

1. Digoxin and a nitrate for everyone
2. A mineralocorticoid receptor antagonist, an SGLT2 inhibitor, and switching the ACE inhibitor to sacubitril/valsartan
3. Calcium channel blockers
4. Long-term intravenous inotropes

Answer: B. The four pillars of HFrEF therapy are an ARNI (or ACE inhibitor/ARB), a beta blocker, an MRA and an SGLT2 inhibitor, started early and together where tolerated. Diuretics relieve congestion but do not change prognosis.

Question 5

A patient with HFrEF, ejection fraction 28%, remains in NYHA class III on optimal medical therapy with a QRS of 160 ms and left bundle branch block in sinus rhythm. The device indicated is:

1. A standard single-chamber pacemaker
2. Cardiac resynchronisation therapy, with a defibrillator where primary prevention criteria are met
3. No device; increase diuretics
4. Implantable loop recorder

Answer: B. LBBB with a QRS of 150 ms or more, EF 35% or less and symptoms despite therapy is the strongest indication for CRT. An ICD is added for primary prevention in most of these patients.

Arrhythmias and anticoagulation

Question 6

A 76-year-old man with new atrial fibrillation has hypertension and diabetes. His CHA₂DS₂-VASc score and the preferred anticoagulant are:

1. Score 2; aspirin
2. Score 4; a direct oral anticoagulant in preference to warfarin, in the absence of mechanical valves or moderate-to-severe mitral stenosis
3. Score 1; no anticoagulation
4. Score 4; clopidogrel

Answer: B. Age 75 or over scores 2, hypertension 1 and diabetes 1. DOACs are preferred in non-valvular AF; warfarin remains for mechanical valves and significant mitral stenosis. Antiplatelets are not a substitute.

Question 7

A patient has a regular narrow-complex tachycardia at 180/min, is stable, and vagal manoeuvres fail. The next step is:

1. Intravenous adenosine 6 mg rapid bolus, then 12 mg if needed, with ECG recording during administration
2. Synchronised cardioversion
3. Oral digoxin
4. Amiodarone infusion

Answer: A. Adenosine terminates most AV-nodal re-entrant and orthodromic AV re-entrant tachycardias. Cardioversion is reserved for instability. Avoid adenosine in pre-excited AF and in severe asthma.

Question 8

A patient on warfarin for a mechanical mitral valve has an INR of 8 with no bleeding. The management is:

1. Continue warfarin at the same dose
2. Withhold warfarin and give low-dose oral vitamin K, recheck INR in 24 hours, and resume at a reduced dose once in range
3. Give prothrombin complex concentrate
4. Switch to a DOAC

Answer: B. Without bleeding, an INR above 8 is managed with omission and a small vitamin K dose; prothrombin complex concentrate is reserved for major bleeding. DOACs are contraindicated with mechanical valves.

Valvular disease and structural heart disease

Question 9

An 80-year-old has severe symptomatic aortic stenosis (mean gradient 48 mmHg, valve area 0.7 cm²) and is considered intermediate surgical risk. The appropriate treatment is:

1. Medical therapy only
2. Aortic valve intervention, with transcatheter or surgical replacement chosen by the heart team according to age, anatomy and risk
3. Balloon valvuloplasty as definitive therapy
4. Watchful waiting until syncope occurs

Answer: B. Symptomatic severe AS has a poor prognosis without valve replacement. TAVI is favoured in older and higher-risk patients with suitable anatomy; surgery in younger, low-risk patients.

Question 10

A 30-year-old woman from the Indian subcontinent has exertional dyspnoea, a loud S1 and a mid-diastolic rumble with an opening snap. Echo shows a mitral valve area of 1.2 cm². The most likely aetiology and preferred intervention are:

1. Degenerative disease; open surgery only
2. Rheumatic mitral stenosis; percutaneous mitral balloon commissurotomy if the valve anatomy is suitable and there is no left atrial thrombus
3. Mitral prolapse; beta blockers
4. Endocarditis; antibiotics

Answer: B. Rheumatic heart disease remains common among candidates' home populations and across the Gulf. Balloon commissurotomy is first line for suitable valves; surgery for calcified valves, significant regurgitation or thrombus.

Question 11

A 22-year-old athlete collapsed during training. Echo shows asymmetric septal hypertrophy of 22 mm with a resting outflow gradient. Which finding most increases his risk of sudden death and strengthens the case for an ICD?

1. A heart rate of 55 at rest
2. Unexplained syncope, non-sustained VT on monitoring, a family history of sudden death and massive hypertrophy
3. Mild mitral regurgitation
4. Normal blood pressure

Answer: B. Hypertrophic cardiomyopathy risk is scored from wall thickness, syncope, family history, NSVT, outflow gradient and left atrial size. Competitive sport is restricted; beta blockers treat symptoms.

Hypertension, endocarditis and emergencies

Question 12

A 45-year-old has a blood pressure of 165/100 mmHg confirmed on ambulatory monitoring, with diabetes. The initial pharmacological approach is:

1. A single low-dose drug and review in six months
2. Dual low-dose combination therapy, usually an ACE inhibitor or ARB with a calcium channel blocker or thiazide-like diuretic, targeting below 130/80 if tolerated
3. Beta blocker alone
4. No treatment until end-organ damage appears

Answer: B. Most patients need two drugs to reach target; single-pill combinations improve adherence. ACE inhibitors or ARBs are favoured in diabetes. Lifestyle measures continue alongside.

Question 13

A patient with a prosthetic aortic valve has fever, new regurgitation and vegetations on echo. Blood cultures grow Staphylococcus aureus. Which feature is an indication for early surgery?

1. Fever on day one of antibiotics
2. Heart failure from valve dysfunction, uncontrolled infection such as abscess or persistent bacteraemia, or large vegetations with embolic events
3. A single positive blood culture
4. Mild anaemia

Answer: B. Prosthetic valve endocarditis with S. aureus has a high surgical requirement. Heart failure, uncontrolled infection and prevention of embolism are the three surgical indications; the endocarditis team decides timing.

Question 14

A patient has sudden hypotension, muffled heart sounds, raised JVP and pulsus paradoxus after a pacemaker lead insertion. Echo shows a large effusion with right atrial collapse. The treatment is:

1. Intravenous diuretics
2. Urgent pericardiocentesis, with surgical drainage if bleeding continues or drainage fails
3. Beta blocker
4. Observation

Answer: B. Cardiac tamponade is a clinical and echocardiographic diagnosis needing immediate drainage. Diuretics and vasodilators worsen it by reducing preload.

Question 15

A 65-year-old has a tearing chest pain radiating to the back, a blood pressure of 190/110 mmHg, and CT shows a dissection confined to the descending aorta without malperfusion. Initial management is:

1. Immediate thrombolysis
2. Intravenous beta blockade to a heart rate of about 60 and systolic pressure of 100 to 120 mmHg, analgesia, and vascular surgical review; endovascular repair for complications
3. Aspirin and heparin
4. Discharge with oral antihypertensives

Answer: B. Uncomplicated type B dissection is managed medically with anti-impulse therapy. Type A dissection needs emergency surgery. Antithrombotic therapy is contraindicated.

How to use these questions

• Know the current guideline thresholds: timing of angiography, DAPT duration, HF pillars, CRT and ICD criteria, valve intervention criteria.
• Memorise the scores: GRACE, CHA₂DS₂-VASc, HAS-BLED, HCM risk, Duke criteria.
• Cover the emergencies: tamponade, dissection, mechanical complications of MI, unstable arrhythmias.
• Practise under time in the Cardiology bank with the error-log method.

Other specialty banks are listed in specialty question banks for doctors, and the internal medicine set is in internal medicine sample questions. When you hold eligibility, join the doctor talent pool; cardiologists are among the highest-paid and most requested specialists in the Gulf.

Frequently asked questions

How many questions are in the cardiology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include interventional and electrophysiology content?

At the level of indications, timing and complications, not procedural technique.

Can a DM or MRCP with cardiology training skip the exam?

Often, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.