CSC Cardiac Subspecialty Certification 2

Question 1

A patient with hypertrophic obstructive cardiomyopathy (HOCM) presents with worsening dyspnea. Which maneuver would INCREASE the outflow tract gradient?

Accepted Answer

Valsalva maneuver

Answer

The Valsalva maneuver decreases preload and venous return, reducing LV cavity size and worsening HOCM obstruction.

Question 2

On right heart catheterization, a patient has a pulmonary capillary wedge pressure (PCWP) of 28 mmHg, cardiac output of 3.2 L/min, and pulmonary artery pressure of 50/28 mmHg. What is the transpulmonary gradient?

Accepted Answer

22 mmHg

Answer

Transpulmonary gradient = mean PAP minus PCWP; mean PAP ≈ (50+2×28)/3 ≈ 35.3 mmHg, so TPG ≈ 35 − 28 = ~7; actually mean PAP here is 35 mmHg minus PCWP 28 = 7, but with diastolic PAP 28 and PCWP 28, TPG using mean: mean PAP = (50+56)/3 = 35, TPG = 35−28 = 7; selecting closest: the TPG = mean PAP − PCWP = 35 − 28 = 7 mmHg, but the listed answer 22 uses systolic−PCWP = 50−28.

Question 3

Which echocardiographic finding is MOST consistent with cardiac tamponade physiology?

Accepted Answer

Right ventricular diastolic collapse

Answer

Right ventricular diastolic collapse is the most specific echocardiographic sign of cardiac tamponade.

Question 4

A 60-year-old man with atrial fibrillation has a CHA₂DS₂-VASc score of 3. He has a history of a GI bleed 6 months ago. What is the most appropriate anticoagulation strategy?

Accepted Answer

Direct oral anticoagulant therapy

Answer

A CHA₂DS₂-VASc ≥2 warrants anticoagulation; prior GI bleed increases bleeding risk but does not contraindicate DOACs, which have lower intracranial bleeding rates than warfarin.

Question 5

Which finding on coronary angiography would be MOST likely to prompt fractional flow reserve (FFR) measurement rather than immediate intervention?

Accepted Answer

Intermediate lesion with 50–70% stenosis in the LAD

Answer

FFR is most useful for intermediate stenoses (40–70%) where angiographic severity does not reliably predict functional significance.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Cardiac Subspecialty Certification 2