CSC Risk Assessment & Management 4

Question 1

A patient on dual antiplatelet therapy (DAPT) after drug-eluting stent placement requires urgent non-cardiac surgery at 2 months post-stent. What is the recommended management?

Accepted Answer

Continue aspirin alone and hold the P2Y12 inhibitor perioperatively

Answer

When surgery cannot be deferred beyond 30 days post-DES, continuing aspirin while holding the P2Y12 inhibitor minimizes both bleeding and stent thrombosis risk.

Question 2

Which non-invasive stress test has the highest sensitivity for detecting significant coronary artery disease in patients with known left bundle branch block (LBBB)?

Accepted Answer

Adenosine stress myocardial perfusion imaging (MPI)

Answer

Vasodilator pharmacologic stress (adenosine or regadenoson) MPI is preferred in LBBB because exercise and dobutamine can cause false-positive septal defects.

Question 3

The EuroSCORE II is primarily designed to predict which outcome in cardiac surgical patients?

Accepted Answer

In-hospital or 30-day operative mortality

Answer

EuroSCORE II predicts in-hospital or 30-day operative mortality risk in patients undergoing cardiac surgery.

Question 4

In a patient with stable ischemic heart disease, which finding on coronary CT angiography (CCTA) most increases the risk of future MACE beyond luminal stenosis assessment?

Accepted Answer

Positive remodeling with low-attenuation plaque (vulnerable plaque features)

Answer

Positive arterial remodeling combined with low-attenuation (lipid-rich) plaque on CCTA identifies high-risk 'vulnerable' plaques associated with future acute coronary events.

Question 5

Which variable is NOT included in the MAGGIC risk calculator for heart failure prognosis?

Accepted Answer

6-minute walk distance

Answer

The MAGGIC score incorporates clinical and laboratory variables including age, EF, BMI, creatinine, NYHA class, and serum sodium, but not 6-minute walk distance.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Risk Assessment & Management 4