Here is your combined prompt for Ischaemic Heart Disease + Heart Failure — 50 MCQs total, weighted equally. --- Prompt (Copy & Paste) ```text You are a Hong Kong medical examiner. Generate 50 high-yield MCQs for HK-MLE preparation covering Ischaemic Heart Disease and Heart Failure TOGETHER. Use clinical vignettes. Cover ALL subtopics from BOTH topics: ISCHAEMIC HEART DISEASE (50% of questions): - Stable angina (CCS classification, investigation, medical management) - Unstable angina / NSTEMI (TIMI/GRACE scores, timing of angiography, anticoagulation) - STEMI (ECG localization, reperfusion — primary PCI vs thrombolysis, pharmacoinvasive strategy) - Complications of MI (VSD, papillary muscle rupture, free wall rupture, Dressler syndrome, LV aneurysm, arrhythmias, cardiogenic shock) - Investigations (ECG changes — hyperacute T, ST elevation, Q waves; biomarkers — troponin, CK-MB, myoglobin; imaging — echo, CXR) - Management (MONA, DAPT, anticoagulation, beta-blockers, ACEi/ARB, statins, PCI, CABG) HEART FAILURE (50% of questions): - HFrEF vs HFpEF vs HFmrEF (definitions, epidemiology) - Pathophysiology (neurohormonal activation, remodelling, Frank-Starling) - Clinical features (DO POP for left HF, JALE for right HF, NYHA/ACC staging) - Investigations (BNP/NT-proBNP cut-offs, CXR ABCDE, echocardiography) - GDMT (BAMS — Beta-blocker, ACEi/ARNI, MRA, SGLT2i) + ARNI superiority (PARADIGM-HF) - Acute decompensated HF (LMNOP mnemonic, CPAP/BiPAP, vasopressors vs inotropes) - High-output heart failure (causes — HATPAB) - Device therapy (CRT, ICD indications) - Notable trials (PARADIGM-HF, DAPA-HF, EMPEROR-Reduced, DELIVER) For each question provide: 1. Correct answer 2. One-sentence explanation why correct 3. One-sentence explanation for each distractor Weight equally: 50% IHD, 50% Heart Failure. Include HKMLE trap answers (e.g., morphine in APO, atropine in Mobitz II, IABP for CS without evidence, routine post-arrest PCI without STEMI, beta-blockers in acute decompensated HF). Base on Davidson's + 2024-2025 ESC/AHA guidelines. Format: Q#. [Clinical vignette] A) B) C) D) E) Answer: X — [one-sentence explanation why correct] Distractors: A) [one-sentence explanation why wrong] B) [one-sentence explanation why wrong] C) [one-sentence explanation why wrong] D) [one-sentence explanation why wrong] E) [one-sentence explanation why wrong] End with a summary table showing question numbers per subtopic (IHD vs Heart Failure). Now generate the 50 MCQs. ``` --- What This Will Generate Subtopic Approx. Questions Ischaemic Heart Disease (all subtopics) 25 Heart Failure (all subtopics) 25 Total 50 --- Example Question It Will Produce Q1. A 65-year-old man presents with crushing chest pain for 2 hours. ECG shows 3mm ST elevation in V1-V4. BP 130/80 mmHg. He arrives at a hospital without PCI capability. Door-to-balloon time to nearest PCI centre is 150 minutes. What is the most appropriate reperfusion strategy? A) Transfer for primary PCI B) Immediate thrombolysis with tenecteplase C) Conservative management with heparin only D) Immediate thrombolysis followed by transfer for angiography within 3-24 hours E) Emergency CABG Answer: D — Immediate thrombolysis followed by pharmacoinvasive angiography (within 3-24 hours) is indicated when primary PCI cannot be performed within 120 minutes of first medical contact. Distractors: A) Transfer for primary PCI with a 150-minute delay exceeds the 120-minute window and would result in worse outcomes than immediate thrombolysis. B) Thrombolysis alone without planned angiography is incomplete management; pharmacoinvasive strategy requires transfer for angiography within 24 hours. C) Conservative management without reperfusion in a 2-hour STEMI results in large infarcts and high mortality. E) Emergency CABG is reserved for failed PCI, cardiogenic shock with unfavourable anatomy, or mechanical complications. --- Summary Table (Example) Subtopic Question Numbers Ischaemic Heart Disease (IHD) 1-25 Heart Failure (HF) 26-50 --- One-Line Message 50 MCQs. 25 IHD + 25 Heart Failure. Clinical vignettes. Trap answers. Guideline-based. Ready for HKMLE.