1. What is the former term for chronic coronary syndromes?

a. Acute coronary syndrome

b. Unstable angina

c. Stable angina

d. Coronary artery disease

2. According to the Global Burden of Disease data, what percentage of mortality worldwide is
attributed to cardiovascular disease?

a. 12.38%

b. 17.08%

c. 25.69%

d. 31.8%

3. Who is credited with the original description of stable angina?

a. William Heberden

b. Serban Balanescu

c. Neubauer S.

d. Cheng V.

4. During which phase of the cardiac cycle is myocardial blood flow mainly in diastole?

a. Systole

b. Early diastole

c. Mid-diastole

d. Late diastole

5. What is the most sensitive layer of the myocardium to ischemia?

a. Epicardial

b. Midmyocardial

c. Subendocardial

d. Intraventricular
6. What are the two main sources of energy for the normal myocardium under optimal perfusion and
metabolic conditions?

a. Glycogen and lactate

b. Free fatty acids (FFA) and glucose

c. Pyruvate and lactate

d. ATP and creatine phosphate

7. What is the primary energy source during glucose oxidation in the myocardium?

a. ATP

b. Pyruvate

c. Free fatty acids

d. Lactate

8. Which metabolic change occurs during myocardial ischemia when oxygen is limited or
unavailable?

a. Increased FFA oxidation

b. Enhanced glucose oxidation

c. Anaerobic glycolysis

d. Elevated lactate production

9. What is the main cause of myocardial ischemia and angina, according to historical beliefs?

a. Epicardial stenosis

b. Intraventricular pressure

c. Intramural pressure

d. Coronary artery disease alone

10. What does INOCA stand for in the context of myocardial ischemia?

a. Ischemia with Non-Obstructive Coronary Arteries

b. Non-Obstructive Coronary Artery Disease

c. Obstructive Coronary Artery Disease

d. Ischemic Heart Disease

11. Which of the following is a potential mechanism of myocardial ischemia in chronic coronary
syndromes?

a. Vasospasm

b. Microvascular dysfunction

c. Atherosclerosis

d. All of the above

12. What is the primary aim of the Canadian Cardiovascular Society grading of angina severity?

a. Assessing metabolic risk factors

b. Evaluating left ventricular ejection fraction

c. Assessing the severity of myocardial ischemia

d. Identifying the need for revascularization

13. What is the main purpose of the Duke score in the context of exercise testing?

a. Assessing the severity of angina

b. Classifying the risk of major adverse cardiovascular events (MACE)

c. Determining the need for invasive angiography

d. Identifying metabolic disturbances

14. Which non-invasive test is commonly used to assess myocardial ischemia in stable angina?

a. Echocardiography

b. Coronary angiography

c. Nuclear myocardial perfusion test

d. Chest X-ray

15. What is the high-risk criteria for ischemia on an ECG exercise test?

a. DUKE score > 11

b. CV mortality between 1-3% per year

c. Ischemic volume > 10% of LV on SPECT

d. Occurring at low exercise threshold

16. What imaging test is used to assess ischemic volume on stress echo?

a. Coronary angio-CT

b. Nuclear myocardial perfusion test

c. Stress echocardiography

d. ECG exercise testing

17. What does FFR stand for in the context of invasive tests for chronic coronary syndromes?

a. Fractional Flow Rate

b. Free Fatty Acid Ratio

c. Functional Flow Reserve

d. Forceful Flow Reduction

18. Which drug class is considered part of optimal medical therapy (OMT) for chronic coronary
syndromes?

a. Antibiotics

b. Antidepressants

c. Anticoagulants

d. Beta-blockers

19. What is the main metabolic therapy aimed at increasing glucose use in the myocardium?

a. Ranolazine

b. Nicorandil

c. Statins

d. Calcium channel blockers

20. What is the primary goal of revascularization in chronic coronary syndromes?

a. Reduce cholesterol levels

b. Improve symptoms and quality of life

c. Increase blood pressure

d. Decrease heart rate

21. When is coronary artery bypass grafting (CABG) preferred over percutaneous coronary
intervention (PCI) in chronic coronary syndromes?

a. Single-vessel disease

b. Proximal LAD stenosis

c. Three-vessel disease

d. Low Syntax score

22. What is the purpose of the Syntax score in deciding between PCI and CABG?

a. Assessing myocardial ischemia severity

b. Evaluating left ventricular ejection fraction

c. Classifying the risk of major adverse cardiovascular events (MACE)

d. Quantifying coronary artery disease complexity

23. Which of the following is a high-risk criteria for coronary angiography in stable myocardial
ischemia?

a. Occurring at low exercise threshold

b. Marked ST segment changes

c. Ischemic volume > 10% of LV on SPECT

d. DUKE score > 11

24. What lifestyle changes are considered necessary in the management of chronic coronary
syndromes?

a. Smoking cessation

b. Reduced physical activity

c. Increased alcohol consumption

d. High-fat diet

25. What is the primary purpose of stress angio-CT in assessing chronic coronary syndromes?

a. Calcium scoring

b. Coronary anatomy

c. Fractional flow reserve (FFR)

d. Myocardial viability

26. What is the main focus of optimal medical therapy (OMT) in chronic coronary syndromes?

a. Revascularization

b. Symptomatic relief

c. Lifestyle changes

d. Metabolic therapy

27. Which drug class is commonly used for symptom relief in chronic coronary syndromes?

a. Statins

b. Calcium channel blockers

c. Beta-blockers

d. ACE inhibitors

28. What does LV stand for in the context of ischemic volume assessment on SPECT?

a. Left ventricle

b. Low volume

c. Lumen volume

d. Lumbar vertebrae

29. What is the main mechanism targeted by metabolic therapy in chronic coronary syndromes?

a. Increase in free fatty acid oxidation

b. Enhancement of glucose oxidation

c. Reduction of anaerobic glycolysis

d. Decrease in lactate production

30. What is the primary purpose of coronary angiography in stable myocardial ischemia?

a. Assessing metabolic risk factors

b. Evaluating left ventricular ejection fraction

c. Identifying significant stenoses

d. Quantifying coronary artery disease complexity

31. What is the primary goal of revascularization in chronic coronary syndromes?

a. To reduce cholesterol levels

b. To improve symptoms and quality of life

c. To increase blood pressure

d. To decrease heart rate

32. When is coronary artery bypass grafting (CABG) preferred over percutaneous coronary
intervention (PCI) in chronic coronary syndromes?

a. Single-vessel disease

b. Proximal LAD stenosis

c. Three-vessel disease

d. Low Syntax score

33. What is the purpose of the Syntax score in deciding between PCI and CABG?

a. Assessing myocardial ischemia severity

b. Evaluating left ventricular ejection fraction

c. Classifying the risk of major adverse cardiovascular events (MACE)

d. Quantifying coronary artery disease complexity

34. Which of the following is a high-risk criteria for coronary angiography in stable myocardial
ischemia?

a. Occurring at low exercise threshold

b. Marked ST segment changes

c. Ischemic volume > 10% of LV on SPECT

d. DUKE score > 11

35. What lifestyle changes are considered necessary in the management of chronic coronary
syndromes?

a. Smoking cessation

b. Reduced physical activity

c. Increased alcohol consumption

d. High-fat diet

36. What is the primary purpose of stress angio-CT in assessing chronic coronary syndromes?

a. Calcium scoring

b. Coronary anatomy

c. Fractional flow reserve (FFR)

d. Myocardial viability

37. What is the main focus of optimal medical therapy (OMT) in chronic coronary syndromes?

a. Revascularization

b. Symptomatic relief

c. Lifestyle changes

d. Metabolic therapy

38. Which drug class is commonly used for symptom relief in chronic coronary syndromes?

a. Statins

b. Calcium channel blockers

c. Beta-blockers

d. ACE inhibitors

39. What does LV stand for in the context of ischemic volume assessment on SPECT?

a. Left ventricle

b. Low volume

c. Lumen volume

d. Lumbar vertebrae

40. What is the main mechanism targeted by metabolic therapy in chronic coronary syndromes?

a. Increase in free fatty acid oxidation

b. Enhancement of glucose oxidation

c. Reduction of anaerobic glycolysis

d. Decrease in lactate production