CMC Risk Assessment & Management 5

Question 1

A patient with stable angina has a fractional flow reserve (FFR) of 0.78 during coronary angiography. What is the clinical implication?

Accepted Answer

Hemodynamically significant ischemia; revascularization is indicated

Answer

An FFR ≤ 0.80 indicates hemodynamically significant ischemia, and revascularization has been shown to improve outcomes compared to medical therapy alone.

Question 2

Which lipid parameter, beyond LDL-C, is most useful for residual cardiovascular risk assessment in a patient with elevated triglycerides and low HDL?

Accepted Answer

Non-HDL cholesterol

Answer

Non-HDL cholesterol (total cholesterol minus HDL-C) captures all atherogenic lipoproteins including VLDL remnants and is superior to LDL-C alone in hypertriglyceridemia.

Question 3

In a patient with aortic stenosis being evaluated for transcatheter aortic valve replacement (TAVR), the STS-PROM score is 8%. How is this risk categorized?

Accepted Answer

High surgical risk (> 8% STS-PROM)

Answer

An STS-PROM of > 8% is classified as high surgical risk, supporting TAVR over SAVR in eligible patients with severe symptomatic aortic stenosis.

Question 4

Which medication class, when added to maximally tolerated statin therapy in patients with atherosclerotic cardiovascular disease and LDL > 70 mg/dL, has demonstrated reduction in cardiovascular events?

Accepted Answer

PCSK9 inhibitors (evolocumab or alirocumab)

Answer

PCSK9 inhibitors reduce LDL-C by 50–60% and have demonstrated significant reductions in cardiovascular events in patients with established ASCVD on maximally tolerated statins (FOURIER and ODYSSEY OUTCOMES trials).

Question 5

A patient with a mechanical mitral valve replacement has an INR of 1.8. What is the most appropriate next step?

Accepted Answer

Increase warfarin dose; target INR is 2.5–3.5 for mechanical mitral valves

Answer

Mechanical mitral valves require a higher INR target of 2.5–3.5 due to higher thrombogenicity; an INR of 1.8 is subtherapeutic and warfarin dose should be increased.

CMC - Cardiac Medicine Certification Practice Test

CMC - Cardiac Medicine Certification Practice Test

CMC Risk Assessment & Management 5