FMCLA Cardiovascular and Pulmonary Medicine 2 — Questions and Answers
Question 1: Which finding distinguishes cardiac asthma from primary asthma in a patient with wheezing and dyspnea?
- Nocturnal symptoms
- Elevated BNP and orthopnea (Correct answer)
- Response to bronchodilators
- Eosinophilia on CBC
Correct answer: Elevated BNP and orthopnea
Elevated BNP and orthopnea indicate a cardiac cause of wheezing (pulmonary edema), distinguishing it from primary asthma.
Question 2: A patient on ACE inhibitor therapy develops a dry, persistent cough. What is the most appropriate management?
- Add an antihistamine
- Switch to an ARB (Correct answer)
- Continue therapy and reassure
- Add a short-acting bronchodilator
Correct answer: Switch to an ARB
ACE inhibitor-induced cough is a class effect due to bradykinin accumulation; switching to an ARB eliminates the cough while maintaining cardiovascular benefit.
Question 3: Which auscultatory finding is most characteristic of aortic stenosis?
- Holosystolic murmur at the apex
- Crescendo-decrescendo systolic murmur at the right upper sternal border (Correct answer)
- Diastolic murmur at the left sternal border
- Fixed split S2
Correct answer: Crescendo-decrescendo systolic murmur at the right upper sternal border
Aortic stenosis produces a harsh crescendo-decrescendo systolic ejection murmur best heard at the right upper sternal border with radiation to the carotids.
Question 4: A patient with asthma requires step-up therapy. They are currently on a low-dose ICS alone. What is the preferred next step per GINA guidelines?
- Add a LAMA
- Add a LABA to the ICS (Correct answer)
- Switch to oral corticosteroids
- Add a leukotriene receptor antagonist alone
Correct answer: Add a LABA to the ICS
GINA guidelines recommend adding a long-acting beta-agonist (LABA) to inhaled corticosteroids (ICS) as the preferred step-up approach.
Question 5: Which electrocardiogram finding is most consistent with right heart strain seen in massive pulmonary embolism?
- Prolonged PR interval
- S1Q3T3 pattern (Correct answer)
- Delta wave
- Osborn J waves
Correct answer: S1Q3T3 pattern
The S1Q3T3 pattern (deep S in I, Q wave and T inversion in III) is a classic but non-specific ECG finding associated with acute right heart strain in PE.
Question 6: In a patient with stable ischemic heart disease, which medication has demonstrated mortality benefit beyond symptom control?
- Long-acting nitrates
- Aspirin and statin therapy (Correct answer)
- Calcium channel blockers
- Short-acting nitrates
Correct answer: Aspirin and statin therapy
Antiplatelet therapy (aspirin) and high-intensity statin therapy are proven to reduce mortality and cardiovascular events in stable ischemic heart disease.
FMCLA Cardiovascular and Pulmonary Medicine 2
Which finding distinguishes cardiac asthma from primary asthma in a patient with wheezing and dyspnea?