CMC Certification Cardio Vascular 2 — Questions and Answers
Question 1: A patient with ST-elevation in leads II, III, and aVF most likely has occlusion of which coronary artery?
- Left anterior descending artery
- Right coronary artery (Correct answer)
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
Inferior ST-elevation (II, III, aVF) is classically caused by right coronary artery (RCA) occlusion, which supplies the inferior wall in most patients.
Question 2: Which hemodynamic parameter is most elevated in cardiogenic shock compared to distributive shock?
- Cardiac output
- Systemic vascular resistance
- Mixed venous oxygen saturation
- Pulmonary artery wedge pressure (Correct answer)
Correct answer: Pulmonary artery wedge pressure
Cardiogenic shock is characterized by elevated pulmonary artery wedge pressure (PAWP) reflecting left heart failure, whereas distributive shock has low SVR.
Question 3: What is the target INR range for a patient with a mechanical mitral valve replacement?
- 1.5–2.0
- 2.0–2.5
- 2.5–3.5 (Correct answer)
- 3.5–4.5
Correct answer: 2.5–3.5
Mechanical mitral valves carry higher thromboembolic risk and require a therapeutic INR of 2.5–3.5 per ACC/AHA guidelines.
Question 4: During treadmill stress testing, which finding is considered a high-risk marker requiring urgent intervention?
- Heart rate increase of 20 bpm in stage 1
- ST depression ≥2 mm at low workload with hypotension (Correct answer)
- Premature atrial contractions at peak exercise
- Normal blood pressure response with 1 mm ST depression
Correct answer: ST depression ≥2 mm at low workload with hypotension
ST depression ≥2 mm at low workload accompanied by hypotension indicates severe ischemia and high-risk disease requiring urgent catheterization.
Question 5: A 68-year-old presents with exertional dyspnea and a harsh systolic ejection murmur at the right upper sternal border radiating to the carotids. Which finding on echocardiography confirms severe aortic stenosis?
- Mean gradient >20 mmHg
- Aortic valve area >1.5 cm²
- Peak velocity >4 m/s (Correct answer)
- Left ventricular ejection fraction <40%
Correct answer: Peak velocity >4 m/s
A peak aortic jet velocity >4 m/s corresponds to a severe pressure gradient and is a primary criterion for severe aortic stenosis by echocardiography.
Question 6: Which medication class is the cornerstone of long-term therapy to reduce mortality after acute MI in patients with reduced LVEF?
- Calcium channel blockers
- Beta-blockers (Correct answer)
- Long-acting nitrates
- Digoxin
Correct answer: Beta-blockers
Beta-blockers have robust evidence reducing mortality, sudden cardiac death, and re-infarction in post-MI patients with reduced ejection fraction.
Question 7: Which finding on right heart catheterization is diagnostic of constrictive pericarditis versus restrictive cardiomyopathy?
- Elevated right atrial pressure
- Pulmonary artery systolic pressure >50 mmHg
- Ventricular interdependence with discordant RV/LV pressure variation (Correct answer)
- Equalization of diastolic pressures
Correct answer: Ventricular interdependence with discordant RV/LV pressure variation
Ventricular interdependence with discordant RV and LV pressure changes during respiration is the hemodynamic hallmark that distinguishes constrictive pericarditis from restrictive cardiomyopathy.
CMC Certification Cardio Vascular 2
A patient with ST-elevation in leads II, III, and aVF most likely has occlusion of which coronary artery?