FMCLA Cardiovascular and Pulmonary Medicine 1 — Questions and Answers
Question 1: Which finding on spirometry is most consistent with obstructive lung disease?
- Reduced FVC with normal FEV1/FVC ratio
- FEV1/FVC ratio less than 0.70 (Correct answer)
- Increased TLC with elevated DLCO
- Reduced TLC with normal FEV1/FVC ratio
Correct answer: FEV1/FVC ratio less than 0.70
An FEV1/FVC ratio below 0.70 post-bronchodilator is the diagnostic criterion for obstructive lung disease per GOLD guidelines.
Question 2: A 60-year-old male smoker presents with progressive dyspnea and chronic cough. Spirometry shows FEV1/FVC of 0.58. What is the diagnosis?
- Asthma
- Pulmonary fibrosis
- COPD (Correct answer)
- Congestive heart failure
Correct answer: COPD
COPD is confirmed by post-bronchodilator FEV1/FVC <0.70 in a patient with relevant exposure history and symptoms.
Question 3: Which medication is first-line for rate control in a patient with atrial fibrillation with rapid ventricular response?
- Amiodarone
- Digoxin
- Metoprolol (Correct answer)
- Flecainide
Correct answer: Metoprolol
Beta-blockers such as metoprolol or calcium channel blockers (diltiazem) are first-line for ventricular rate control in atrial fibrillation.
Question 4: What is the CHA2DS2-VASc score used to determine in patients with atrial fibrillation?
- Rate vs. rhythm control strategy
- Risk of stroke and need for anticoagulation (Correct answer)
- Appropriate antiarrhythmic drug selection
- Need for cardioversion
Correct answer: Risk of stroke and need for anticoagulation
The CHA2DS2-VASc score estimates thromboembolic stroke risk in AF patients and guides the decision to initiate anticoagulation.
Question 5: Which drug class is considered first-line for reducing cardiovascular mortality in patients with reduced ejection fraction heart failure?
- Loop diuretics
- Beta-blockers (Correct answer)
- Calcium channel blockers
- Nitrates
Correct answer: Beta-blockers
Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) have demonstrated robust mortality reduction in HFrEF in multiple large trials.
Question 6: A patient with an ejection fraction of 35% and NYHA Class II symptoms is started on an ARNI. Which medication is this?
- Lisinopril
- Losartan
- Sacubitril/valsartan (Correct answer)
- Spironolactone
Correct answer: Sacubitril/valsartan
Sacubitril/valsartan (Entresto) is an ARNI (angiotensin receptor-neprilysin inhibitor) shown to reduce cardiovascular death in HFrEF compared to enalapril.
FMCLA Cardiovascular and Pulmonary Medicine 1
Which finding on spirometry is most consistent with obstructive lung disease?