TEC Cardiologia Practice Questions - TEC - Título de Especialista em Cardiologia (Sociedade Brasileira de Cardiologia AMB) Exam - TEC Cardiologia Practice Questions - TEC - Título de Especialista em Cardiologia (Sociedade Brasileira de Cardiologia AMB) Exam

Question 1

A 58-year-old man presents to an emergency department in a community hospital without percutaneous coronary intervention (PCI) capabilities experiencing 90 minutes of severe retrosternal crushing chest pain radiating to his left jaw. The 12-lead electrocardiogram (ECG) reveals 3.5 mm ST-segment elevation in leads V1–V4 with reciprocal ST depression in leads II, III, and aVF. The estimated transfer time to the nearest tertiary hemodynamics center for primary PCI is 150 minutes. According to the Diretriz da Sociedade Brasileira de Cardiologia sobre Tratamento do Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST (SBC STEMI Guidelines), which reperfusion strategy is most appropriate?

Immediate transfer for primary PCI regardless of transfer delay, since mechanical reperfusion is always superior to pharmacologic fibrinolysis. Immediate administration of a fibrin-specific fibrinolytic agent (such as Tenecteplase or Alteplase) followed by routine transfer to a PCI-capable center for coronary angiography within 2 to 24 hours (pharmacoinvasive strategy). Immediate administration of full-dose intravenous unfractionated heparin and dual antiplatelet therapy while awaiting emergency transfer for rescue PCI only if clinical symptoms persist. Initiation of intravenous nitroglycerin and beta-blocker therapy with delayed elective coronary angiography scheduled during the hospitalization index.

Correct Answer:

Immediate administration of a fibrin-specific fibrinolytic agent (such as Tenecteplase or Alteplase) followed by routine transfer to a PCI-capable center for coronary angiography within 2 to 24 hours (pharmacoinvasive strategy).

Question 2

A 72-year-old woman with a history of hypertension, type 2 diabetes mellitus, and a transient ischemic attack (TIA) 6 months ago is admitted with an acute non-ST-segment elevation myocardial infarction (NSTEMI / IAMSST). Coronary angiography reveals an 85% culprit lesion in the proximal left anterior descending (LAD) artery, and a drug-eluting stent (DES) is successfully deployed. When selecting guideline-directed dual antiplatelet therapy (DAPT), which P2Y12 inhibitor is strictly contraindicated in this patient?

Clopidogrel Ticagrelor Prasugrel Cangrelor

Correct Answer:

Prasugrel

Question 3

On day 4 following an acute inferior STEMI treated with delayed primary PCI to the right coronary artery (RCA), a 64-year-old man develops sudden-onset respiratory distress, diaphoresis, and cold extremities. Physical examination reveals blood pressure 82/50 mmHg, heart rate 118 bpm, bilateral diffuse pulmonary crackles, and a new harsh grade 4/6 holosystolic murmur radiating to the axilla. Transthoracic echocardiography demonstrates hyperdynamic left ventricular systolic function with acute severe mitral regurgitation due to posteromedial papillary muscle rupture. What anatomical feature explains why the posteromedial papillary muscle is significantly more susceptible to ischemic rupture than the anterolateral papillary muscle?

The posteromedial papillary muscle has a solitary vascular supply from the posterior descending artery (arising from the RCA or LCx), whereas the anterolateral papillary muscle receives a dual blood supply from both the LAD and LCx. The posteromedial papillary muscle is subjected to higher mechanical shear stress because it attaches exclusively to the anterior mitral leaflet. The posteromedial papillary muscle receives a dual vascular supply from the marginal branches of the circumflex artery and diagonal branches of the LAD. The anterolateral papillary muscle is predominantly composed of fibrous collagen and lacks vulnerable myocardial vasculature.

Correct Answer:

Question 4

A 45-year-old woman presents with typical acute ischemic chest pain, dynamic T-wave inversions in V2–V6, and a significant rise and fall of high-sensitivity cardiac troponin I (hs-cTnI: 2,450 ng/L; 99th percentile URL: 16 ng/L). Urgent coronary angiography demonstrates completely normal epicardial coronary arteries without angiographic evidence of stenosis, dissection, or thrombus (

Coronary computed tomography angiography (CCTA) with plaque subtraction. Cardiac Magnetic Resonance (CMR) imaging with late gadolinium enhancement and T1/T2 parametric mapping. Radionuclide myocardial perfusion scintigraphy (SPECT) with 99mTc-sestamibi. Transesophageal echocardiography (TEE) with agitated saline bubble study.

Correct Answer:

Cardiac Magnetic Resonance (CMR) imaging with late gadolinium enhancement and T1/T2 parametric mapping.

Question 5

A 52-year-old non-smoking man with well-controlled hypertension presents to the cardiology outpatient clinic reporting intermittent substernal chest tightness triggered by brisk uphill walking, relieved within 3 minutes of rest. Resting 12-lead ECG is normal, and resting transthoracic echocardiogram shows an LVEF of 62% without regional wall motion abnormalities. His calculated pre-test probability (PTP) for obstructive coronary artery disease is intermediate (22%). According to the Diretriz Brasileira de Doença Coronariana Crônica (SBC Guidelines on Chronic Coronary Disease), which diagnostic test is considered an optimal first-line anatomical examination in this symptomatic patient with intermediate clinical probability?

Coronary Computed Tomography Angiography (CCTA / Angio-TC de artérias coronárias). Right and left heart catheterization with endomyocardial biopsy. Exercise treadmill testing (teste ergométrico) without electrocardiographic monitoring. Intravascular ultrasound (IVUS) of the left anterior descending artery via radial access.

Correct Answer:

Coronary Computed Tomography Angiography (CCTA / Angio-TC de artérias coronárias).

Question 1

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Prepare with the TEC Cardiologia Practice Questions - TEC - Título de Especialista em Cardiologia (Sociedade Brasileira de Cardiologia AMB) Exam practice quiz. This question bank includes 100 questions covering year-old, mmhg, presents, guidelines, and left. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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TEC Cardiologia Practice Questions - TEC - Título de Especialista em Cardiologia (Sociedade Brasileira de Cardiologia AMB) Exam

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TEC Cardiologia Practice Questions - TEC - Título de Especialista em Cardiologia (Sociedade Brasileira de Cardiologia AMB) Exam

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