CSC CSC 5

Question 1

A 68-year-old with chronic kidney disease and new-onset atrial fibrillation requires anticoagulation. His CrCl is 28 mL/min. Which DOAC requires the most significant dose adjustment?

Accepted Answer

Dabigatran

Answer

Dabigatran is 80% renally cleared and is contraindicated when CrCl <30 mL/min (FDA) or <15 mL/min (European guidelines), making renal function the critical determinant of dosing.

Question 2

Which hemodynamic change characteristically occurs with inspiration during cardiac tamponade?

Accepted Answer

Paradoxical pulse with ≥10 mmHg drop in systolic BP during inspiration

Answer

Pulsus paradoxus (≥10 mmHg inspiratory fall in SBP) occurs in tamponade because inspiratory RV filling competes with LV in the constrained pericardial space, reducing LV output.

Question 3

A patient is started on amiodarone for recurrent VT. Which side effect requires monitoring with annual pulmonary function tests and chest radiography?

Accepted Answer

Pulmonary toxicity

Answer

Amiodarone pulmonary toxicity (0.1–0.5%/year) is potentially fatal and requires surveillance with annual PFTs and CXR, including DLCO measurement.

Question 4

Which finding on cardiac MRI is most diagnostic of cardiac sarcoidosis?

Accepted Answer

Mid-wall or epicardial late gadolinium enhancement in a non-ischemic pattern

Answer

Cardiac sarcoidosis shows non-ischemic late gadolinium enhancement (mid-wall/epicardial, typically basal-septal or lateral), distinguishing it from ischemic cardiomyopathy's subendocardial pattern.

Question 5

A patient with HFrEF (EF 30%) develops worsening kidney function after starting an ACE inhibitor. Creatinine increases 25%. What is the appropriate management?

Accepted Answer

Continue ACE inhibitor if creatinine rise is ≤30% and potassium remains <5.5 mEq/L

Answer

A creatinine rise up to 30% above baseline after RAAS inhibitor initiation is acceptable and expected due to reduced efferent arteriolar tone; discontinuation is only needed for larger rises or hyperkalemia.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC CSC 5