CMC Risk Assessment & Management 2 — Questions and Answers
Question 1: A 62-year-old man with hypertension and dyslipidemia presents for cardiovascular risk evaluation. His 10-year ASCVD risk is 9.5%. Which management step is most appropriate?
- Initiate high-intensity statin therapy immediately
- Engage in a risk discussion and consider statin therapy with moderate intensity (Correct answer)
- Reassure patient and recheck in 5 years
- Refer immediately to cardiology
Correct answer: Engage in a risk discussion and consider statin therapy with moderate intensity
A 10-year ASCVD risk of 7.5–10% is in the borderline risk zone, warranting a clinician–patient risk discussion before initiating moderate-intensity statin therapy.
Question 2: Which of the following 'risk-enhancing factors' can shift a borderline-risk patient toward initiating statin therapy per 2018 AHA/ACC guidelines?
- Family history of colon cancer
- hsCRP ≥ 2 mg/L (Correct answer)
- BMI of 27 kg/m²
- Serum ferritin > 300 ng/mL
Correct answer: hsCRP ≥ 2 mg/L
An hsCRP ≥ 2 mg/L is a recognized risk-enhancing factor that supports initiation of statin therapy in borderline-risk patients.
Question 3: In the revised GRACE 2.0 ACS risk score, which variable contributes most to predicting 6-month mortality after hospitalization for ACS?
- Serum sodium
- Age (Correct answer)
- Total cholesterol
- Ejection fraction at discharge
Correct answer: Age
Age is the single most heavily weighted variable in the GRACE score, reflecting the strong age-dependent increase in post-ACS mortality.
Question 4: A patient's coronary artery calcium (CAC) score returns at 0. How does this result affect statin decision-making in a borderline-risk patient?
- It mandates immediate statin initiation
- It supports withholding statin therapy and repeating in 5–10 years (Correct answer)
- It is irrelevant to statin decisions
- It indicates obstructive CAD requiring catheterization
Correct answer: It supports withholding statin therapy and repeating in 5–10 years
A CAC score of 0 in a borderline-risk patient supports a decision to withhold statin therapy, as it indicates very low near-term atherosclerotic event risk.
Question 5: Which cardiac biomarker, when elevated in a stable outpatient with heart failure, is most strongly associated with increased mortality risk?
- Troponin I (high-sensitivity) (Correct answer)
- CK-MB
- Myoglobin
- Lactate dehydrogenase
Correct answer: Troponin I (high-sensitivity)
Elevated high-sensitivity troponin I in stable heart failure patients identifies subclinical myocardial injury and is independently associated with increased mortality.
Question 6: According to the HAS-BLED score, which of the following increases bleeding risk in a patient on anticoagulation for atrial fibrillation?
- Age < 65 years
- History of major bleeding or predisposition (Correct answer)
- Female sex
- LDL > 130 mg/dL
Correct answer: History of major bleeding or predisposition
History of major bleeding or a bleeding predisposition is one of the components of HAS-BLED that adds 1 point and increases estimated bleeding risk.
Question 7: A patient with NSTEMI has a TIMI risk score of 5. What does this score indicate regarding management?
- Low risk; discharge with aspirin only
- Intermediate risk; conservative medical management preferred
- High risk; early invasive strategy is recommended (Correct answer)
- Very low risk; outpatient stress testing only
Correct answer: High risk; early invasive strategy is recommended
A TIMI score of 5 (out of 7) indicates high risk, where early invasive strategy (angiography within 24–48 hours) is recommended to reduce adverse outcomes.
CMC Risk Assessment & Management 2
A 62-year-old man with hypertension and dyslipidemia presents for cardiovascular risk evaluation.
His 10-year ASCVD risk is 9.5%.
Which management step is most appropriate?