Family Practice Exam Family Practice Exam Cardiovascular Medicine 2 — Questions and Answers
Question 1: A patient presents with sudden palpitations, HR 158 bpm, and an irregularly irregular rhythm on exam. What is the most likely diagnosis?
- Sinus tachycardia
- Atrial fibrillation (Correct answer)
- Ventricular tachycardia
- Supraventricular tachycardia
Correct answer: Atrial fibrillation
An irregularly irregular rhythm at a rapid rate is the hallmark clinical finding of atrial fibrillation.
Question 2: Which physical exam finding is most specific for heart failure with reduced ejection fraction?
- Peripheral edema
- S3 gallop (Correct answer)
- Bilateral crackles
- Jugular venous distension
Correct answer: S3 gallop
An S3 gallop (third heart sound) is highly specific for ventricular volume overload and reduced ejection fraction in heart failure.
Question 3: What is the LDL goal for a patient with established atherosclerotic cardiovascular disease (ASCVD)?
- Less than 100 mg/dL
- Less than 70 mg/dL (Correct answer)
- Less than 130 mg/dL
- Less than 55 mg/dL
Correct answer: Less than 70 mg/dL
ACC/AHA guidelines recommend an LDL target of <70 mg/dL for patients with established ASCVD due to their very high cardiovascular risk.
Question 4: A patient with HFrEF on lisinopril develops a persistent dry cough. What is the best medication change?
- Switch to a different ACE inhibitor
- Add a beta-blocker
- Switch to an ARB (Correct answer)
- Discontinue all heart failure medications
Correct answer: Switch to an ARB
ARBs provide equivalent cardiovascular benefits to ACE inhibitors without causing bradykinin-mediated cough.
Question 5: Which valve lesion produces a harsh systolic ejection murmur best heard at the right upper sternal border radiating to the carotids?
- Mitral regurgitation
- Aortic stenosis (Correct answer)
- Tricuspid regurgitation
- Pulmonic stenosis
Correct answer: Aortic stenosis
Aortic stenosis classically produces a harsh crescendo-decrescendo systolic murmur at the right second intercostal space that radiates to the carotid arteries.
Question 6: What is the most common cause of secondary hypertension in adults under 40 years old?
- Primary aldosteronism
- Renovascular hypertension (Correct answer)
- Cushing syndrome
- Pheochromocytoma
Correct answer: Renovascular hypertension
Renovascular hypertension from renal artery stenosis (often fibromuscular dysplasia in young adults) is the most common cause of secondary hypertension in patients under 40.
Family Practice Exam Family Practice Exam Cardiovascular Medicine 2
A patient presents with sudden palpitations, HR 158 bpm, and an irregularly irregular rhythm on exam.
What is the most likely diagnosis?