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

7 cards from real CSC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 72-year-old man with DM and CKD (eGFR 28) presents for elective PCI. He is on metformin. How should his metformin be managed peri-procedurally?

    Answer: Hold metformin 48 hours before contrast and restart only after reassessing renal function

    Metformin should be withheld 48 hours before contrast administration and restarted only after confirming stable renal function due to risk of lactic acidosis.

  2. A 50-year-old man presents with progressive exertional dyspnea. Echo shows severe mitral stenosis with MVA 0.9 cm², mean gradient 14 mmHg, pliable non-calcified leaflets, and mild MR. Wilkins score is 7. What is the treatment of choice?

    Answer: Percutaneous mitral balloon valvotomy (PMBV)

    A Wilkins score ≤8 with favorable anatomy (pliable leaflets, minimal MR, no significant calcification) makes PMBV the preferred intervention for severe MS.

  3. A 66-year-old woman with AF and CHA₂DS₂-VASc score of 5 is on warfarin. She requires elective hip replacement. Her cardiologist considers bridging therapy. What is the current recommendation?

    Answer: Stop warfarin 5 days before; no bridging needed

    The BRIDGE trial showed that forgoing heparin bridging in AF patients on warfarin undergoing elective surgery did not increase thromboembolism risk and reduced bleeding.

  4. A 34-year-old pregnant woman (28 weeks) with known severe MS and worsening pulmonary edema despite diuretics is evaluated. Echo confirms MVA 0.8 cm². What is the safest definitive intervention?

    Answer: Percutaneous mitral balloon valvotomy with radiation shielding

    PMBV is preferred for pregnant women with severe symptomatic MS refractory to medical therapy, with abdominal shielding to minimize fetal radiation exposure.

  5. A 78-year-old man with severe HFrEF (EF 20%) on optimal GDMT presents with worsening dyspnea at rest and recurrent hospitalizations. He is not a transplant candidate. What device therapy should be considered?

    Answer: Destination therapy LVAD

    Destination therapy LVAD is indicated for advanced HFrEF patients ineligible for transplant who remain severely symptomatic on optimal medical therapy.

  6. A 60-year-old man has an EF of 30% and LBBB with QRS 155 ms despite maximal GDMT. He has NYHA class III symptoms. What intervention is most likely to improve his outcomes?

    Answer: Cardiac resynchronization therapy (CRT) with or without defibrillator

    CRT is strongly indicated (Class I) in patients with EF ≤35%, LBBB morphology, QRS ≥150 ms, and NYHA class II–IV symptoms on GDMT.

  7. A 55-year-old woman undergoes elective TAVR and develops complete heart block immediately after valve deployment. What is the appropriate next step?

    Answer: Place a temporary transvenous pacemaker and evaluate for permanent pacemaker need

    Complete heart block post-TAVR requires immediate temporary pacing, with permanent pacemaker implantation if conduction does not recover, typically within 24–72 hours.