Practice Test GeeksCSC - Cardiac Subspecialty Certification Exam Practice Test
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CSC Flashcards

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  1. A patient with acute decompensated heart failure has a pulmonary capillary wedge pressure (PCWP) of 28 mmHg and a cardiac index of 1.8 L/min/m². Which hemodynamic profile best describes this patient?

    Answer: Cold and wet

    A low cardiac index (18 mmHg) defines the 'cold and wet' profile, indicating low perfusion and congestion.

  2. Which echocardiographic finding is most consistent with cardiac tamponade physiology?

    Answer: Diastolic collapse of the right atrium and right ventricle

    Diastolic collapse of the right atrium (>1/3 of systole) and right ventricle are hallmark echo findings of tamponade physiology due to elevated pericardial pressure.

  3. A 58-year-old man presents with exertional chest pain. Coronary angiography shows 60% stenosis of the LAD. Which test best determines the hemodynamic significance of this lesion?

    Answer: Fractional flow reserve (FFR)

    FFR ≤0.80 identifies a physiologically significant stenosis and guides revascularization decisions more accurately than anatomic severity alone.

  4. Which antiarrhythmic drug is contraindicated in patients with Wolff-Parkinson-White (WPW) syndrome presenting with atrial fibrillation?

    Answer: Digoxin

    Digoxin (and other AV nodal blockers like verapamil and adenosine) can accelerate conduction through the accessory pathway in WPW, potentially precipitating ventricular fibrillation.

  5. A patient with hypertrophic obstructive cardiomyopathy (HOCM) develops worsening dyspnea despite maximum medical therapy. The LVOT gradient is 65 mmHg at rest. What is the next best intervention?

    Answer: Septal reduction therapy (myectomy or alcohol ablation)

    Septal reduction therapy (surgical myectomy or alcohol septal ablation) is indicated for symptomatic HOCM with resting LVOT gradient ≥50 mmHg refractory to medical therapy.

  6. Which ECG finding is pathognomonic for hyperkalemia at dangerous levels (K⁺ >7.0 mEq/L)?

    Answer: Sine wave pattern with widened QRS

    Severe hyperkalemia produces a sine wave pattern from merging of widened QRS with T waves, signaling imminent ventricular fibrillation.

  7. In a patient with New York Heart Association Class III heart failure with reduced ejection fraction (HFrEF, EF 28%), which device therapy has been shown to reduce all-cause mortality?

    Answer: Cardiac resynchronization therapy (CRT) in appropriate candidates

    CRT reduces mortality and improves symptoms in HFrEF patients with LBBB and QRS duration ≥150 ms who remain symptomatic on optimal medical therapy.