CMC Certification Cardio Vascular 5 — Questions and Answers
Question 1: Which imaging modality is considered the gold standard for quantifying myocardial viability before revascularization in ischemic cardiomyopathy?
- Dobutamine stress echocardiography
- Cardiac MRI with gadolinium late enhancement (Correct answer)
- Nuclear perfusion imaging (SPECT)
- PET with FDG
Correct answer: Cardiac MRI with gadolinium late enhancement
Cardiac MRI with late gadolinium enhancement precisely quantifies transmural scar extent; myocardium with <50% LGE transmurality predicts functional recovery after revascularization.
Question 2: A patient with known peripheral artery disease and hypertension requires an antihypertensive. Which class should be avoided due to risk of worsening claudication?
- ACE inhibitors
- Dihydropyridine calcium channel blockers
- Non-selective beta-blockers (Correct answer)
- Thiazide diuretics
Correct answer: Non-selective beta-blockers
Non-selective beta-blockers can worsen peripheral artery disease symptoms by blocking beta-2-mediated vasodilation and leaving alpha-mediated vasoconstriction unopposed.
Question 3: Which finding on invasive coronary angiography defines a fractional flow reserve (FFR) measurement indicating a hemodynamically significant lesion?
- FFR ≤0.90
- FFR ≤0.85
- FFR ≤0.80 (Correct answer)
- FFR ≤0.75
Correct answer: FFR ≤0.80
An FFR ≤0.80 measured during maximal hyperemia with adenosine is the validated threshold for hemodynamically significant coronary stenosis warranting revascularization.
Question 4: A patient with aortic regurgitation has a widened pulse pressure of 80 mmHg. Which physical exam finding is directly caused by the wide pulse pressure?
- Austin Flint murmur
- Duroziez sign (femoral artery bruit)
- Water-hammer (Corrigan) pulse (Correct answer)
- S3 gallop
Correct answer: Water-hammer (Corrigan) pulse
The Corrigan or water-hammer pulse is a bounding, rapid-rise and collapse peripheral pulse directly caused by the wide pulse pressure of significant aortic regurgitation.
Question 5: In a patient with known long QT syndrome type 2 (LQT2), which trigger most commonly precipitates life-threatening arrhythmias?
- Physical exercise
- Sudden auditory stimuli (e.g., alarm clock) (Correct answer)
- Sleep or rest
- Emotional stress alone
Correct answer: Sudden auditory stimuli (e.g., alarm clock)
LQT2 is caused by KCNH2 mutations affecting the IKr channel; sudden auditory stimuli are the classic trigger for torsades de pointes in this genotype.
Question 6: Which scoring system is used to predict 30-day mortality risk in patients presenting with acute decompensated heart failure?
- GRACE score
- TIMI risk score
- MAGGIC score
- ADHERE risk model (Correct answer)
Correct answer: ADHERE risk model
The ADHERE (Acute Decompensated Heart Failure National Registry) risk model stratifies in-hospital mortality for ADHF using BUN, creatinine, and systolic BP.
Question 7: Which intervention has demonstrated mortality benefit specifically in patients with HFpEF (ejection fraction ≥50%)?
- ACE inhibitors (CHARM-Preserved trial)
- Beta-blockers
- SGLT2 inhibitors (EMPEROR-Preserved trial) (Correct answer)
- Aldosterone antagonists (TOPCAT trial)
Correct answer: SGLT2 inhibitors (EMPEROR-Preserved trial)
Empagliflozin in EMPEROR-Preserved demonstrated reduced cardiovascular death and HF hospitalization in HFpEF, making SGLT2 inhibitors the first class with proven benefit in this population.
CMC Certification Cardio Vascular 5
Which imaging modality is considered the gold standard for quantifying myocardial viability before revascularization in ischemic cardiomyopathy?