CCS Patient Care & Risk Management 2 — Questions and Answers
Question 1: A patient with stable angina is found to have a Framingham 10-year cardiovascular risk of 22%. According to ACC/AHA guidelines, this patient falls into which risk category?
- Low risk (<5%)
- Borderline risk (5–7.5%)
- Intermediate risk (7.5–20%)
- High risk (>20%) (Correct answer)
Correct answer: High risk (>20%)
A 10-year ASCVD risk ≥20% places the patient in the high-risk category per ACC/AHA 2019 guidelines.
Question 2: Which action is MOST appropriate when a patient with heart failure reports a 3-lb weight gain over two days?
- Schedule a routine follow-up in two weeks
- Advise the patient to increase diuretic dose per a pre-established sick-day plan (Correct answer)
- Recommend restricting all fluid intake to 500 mL/day
- Immediately discontinue ACE inhibitor therapy
Correct answer: Advise the patient to increase diuretic dose per a pre-established sick-day plan
Rapid weight gain in heart failure signals fluid retention; a pre-established sick-day plan allowing self-adjustment of diuretics prevents hospitalization.
Question 3: A cardiovascular specialist is counseling a post-MI patient on secondary prevention. Which lifestyle modification has the strongest evidence for reducing recurrent cardiac events?
- Switching to a gluten-free diet
- Smoking cessation (Correct answer)
- Eliminating all dietary fat
- Taking daily vitamin E supplements
Correct answer: Smoking cessation
Smoking cessation is the single most effective lifestyle intervention for reducing recurrent cardiovascular events after MI.
Question 4: When performing a cardiovascular risk assessment, which tool is specifically validated for estimating 10-year ASCVD risk in primary prevention patients aged 40–79?
- TIMI Risk Score
- GRACE Score
- Pooled Cohort Equations (Correct answer)
- HAS-BLED Score
Correct answer: Pooled Cohort Equations
The Pooled Cohort Equations (PCE), endorsed by ACC/AHA, calculate 10-year ASCVD risk for primary prevention in patients aged 40–79.
Question 5: A patient with hypertension, type 2 diabetes, and stage 3 CKD presents for cardiovascular risk reduction counseling. Which blood pressure target is MOST appropriate?
- <150/90 mmHg
- <140/90 mmHg
- <130/80 mmHg (Correct answer)
- <120/70 mmHg
Correct answer: <130/80 mmHg
ACC/AHA and ADA guidelines recommend a BP target of <130/80 mmHg in patients with diabetes and CKD to reduce cardiovascular and renal events.
Question 6: A 68-year-old woman with atrial fibrillation has a CHA₂DS₂-VASc score of 3. What is the MOST appropriate anticoagulation recommendation?
- Anticoagulation is optional at this score
- Antiplatelet therapy with aspirin alone is preferred
- Oral anticoagulation is recommended (Correct answer)
- Anticoagulation is contraindicated unless she has prior stroke
Correct answer: Oral anticoagulation is recommended
A CHA₂DS₂-VASc score ≥2 in females (or ≥2 overall) indicates oral anticoagulation is recommended to reduce stroke risk.
Question 7: During cardiac rehabilitation, a patient develops chest tightness and ST depression at a heart rate of 130 bpm. What is the correct immediate action?
- Continue exercise but reduce intensity by 10%
- Stop exercise, assess vital signs, and obtain a 12-lead ECG (Correct answer)
- Administer sublingual nitroglycerin and continue monitoring
- Increase the exercise load to determine ischemic threshold
Correct answer: Stop exercise, assess vital signs, and obtain a 12-lead ECG
Exercise-induced ST depression and symptoms require immediate cessation of activity, vital sign assessment, and a 12-lead ECG to evaluate for ischemia.
CCS Patient Care & Risk Management 2
A patient with stable angina is found to have a Framingham 10-year cardiovascular risk of 22%.
According to ACC/AHA guidelines, this patient falls into which risk category?