CSC CSC 2

Question 1

A patient with acute decompensated heart failure has a pulmonary capillary wedge pressure (PCWP) of 28 mmHg and a cardiac index of 1.8 L/min/m². Which hemodynamic profile best describes this patient?

Accepted Answer

Cold and wet

Answer

A low cardiac index (<2.2) with elevated filling pressures (PCWP >18 mmHg) defines the 'cold and wet' profile, indicating low perfusion and congestion.

Question 2

Which echocardiographic finding is most consistent with cardiac tamponade physiology?

Accepted Answer

Diastolic collapse of the right atrium and right ventricle

Answer

Diastolic collapse of the right atrium (>1/3 of systole) and right ventricle are hallmark echo findings of tamponade physiology due to elevated pericardial pressure.

Question 3

A 58-year-old man presents with exertional chest pain. Coronary angiography shows 60% stenosis of the LAD. Which test best determines the hemodynamic significance of this lesion?

Accepted Answer

Fractional flow reserve (FFR)

Answer

FFR ≤0.80 identifies a physiologically significant stenosis and guides revascularization decisions more accurately than anatomic severity alone.

Question 4

Which antiarrhythmic drug is contraindicated in patients with Wolff-Parkinson-White (WPW) syndrome presenting with atrial fibrillation?

Accepted Answer

Digoxin

Answer

Digoxin (and other AV nodal blockers like verapamil and adenosine) can accelerate conduction through the accessory pathway in WPW, potentially precipitating ventricular fibrillation.

Question 5

A patient with hypertrophic obstructive cardiomyopathy (HOCM) develops worsening dyspnea despite maximum medical therapy. The LVOT gradient is 65 mmHg at rest. What is the next best intervention?

Accepted Answer

Septal reduction therapy (myectomy or alcohol ablation)

Answer

Septal reduction therapy (surgical myectomy or alcohol septal ablation) is indicated for symptomatic HOCM with resting LVOT gradient ≥50 mmHg refractory to medical therapy.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC CSC 2