Practice Test GeeksCSC - Cardiac Subspecialty Certification Exam Practice Test
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Case Studies & Practical Application Flashcards

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  1. A 58-year-old man presents with exertional chest pain and dyspnea. Echo shows LVEF 35%, moderate MR, and dilated LV. Coronary angiography reveals 3-vessel disease. What is the most appropriate next step?

    Answer: Perform CABG with concurrent mitral annuloplasty

    In patients with ischemic cardiomyopathy and moderate functional MR, CABG combined with mitral annuloplasty is preferred when revascularization is planned.

  2. A 45-year-old woman with known bicuspid aortic valve is found to have an ascending aorta measuring 4.8 cm on surveillance imaging. She is asymptomatic. What is the recommended management?

    Answer: Elective surgical repair is indicated at this size for bicuspid AV

    Guidelines recommend surgical repair of the ascending aorta at ≥4.5–5.0 cm in patients with bicuspid aortic valve, lower than the threshold for tricuspid valves.

  3. A 70-year-old man with hypertension presents with acute-onset tearing back pain. CT shows a Stanford Type B aortic dissection without malperfusion. BP is 160/90 mmHg. What is the initial treatment?

    Answer: IV labetalol to achieve SBP <120 mmHg and HR <60 bpm

    Uncomplicated Stanford Type B dissections are managed medically with aggressive blood pressure and heart rate control as the primary intervention.

  4. A 62-year-old woman presents with progressive dyspnea. Echo reveals severe aortic stenosis with AVA 0.7 cm², mean gradient 52 mmHg, and LVEF 60%. She has COPD and prior stroke. STS score is 8%. What is preferred treatment?

    Answer: TAVR via transfemoral approach

    TAVR is preferred for high-surgical-risk patients with severe symptomatic AS, and transfemoral TAVR is the default approach when anatomy permits.

  5. A 55-year-old man with HFrEF (EF 30%) on optimal medical therapy develops symptomatic ventricular tachycardia. He previously declined ICD. Amiodarone has been ineffective. What is the next best step?

    Answer: Catheter ablation of VT

    Catheter ablation is recommended for recurrent, drug-refractory VT in patients with structural heart disease.

  6. A 48-year-old competitive athlete presents with syncope during exercise. ECG shows epsilon waves and T-wave inversions in V1–V3. MRI reveals fatty infiltration of the RV free wall. What is the diagnosis and priority management?

    Answer: ARVC; disqualify from competitive sports and refer for ICD

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) carries high risk of sudden death with exercise; competitive sports are contraindicated and ICD implantation is typically indicated.

  7. A 65-year-old woman post-MI 6 weeks ago presents with pleuritic chest pain, friction rub, and new diffuse ST elevation. Echo shows a small pericardial effusion. What is the best treatment?

    Answer: High-dose aspirin and colchicine

    Dressler syndrome (post-MI pericarditis) is treated with aspirin as the preferred NSAID and colchicine to reduce recurrence risk.