Free Physician Assistant Cardiovascular System Disorders Questions and Answers — Questions and Answers
Question 1: A 68-year-old male with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden-onset 'tearing' chest pain that radiates to his back. On examination, his blood pressure is 190/110 mmHg in the right arm and 155/90 mmHg in the left arm. A new diastolic murmur is auscultated at the right sternal border. Which of the following is the most likely diagnosis?
- Acute myocardial infarction
- Pulmonary embolism
- Aortic dissection (Correct answer)
- Pericarditis
Correct answer: Aortic dissection
The classic presentation of a sudden-onset 'tearing' or 'ripping' chest pain radiating to the interscapular area of the back, accompanied by a significant blood pressure differential between the upper extremities (>20 mmHg systolic), and a new diastolic murmur of aortic regurgitation strongly suggests an acute aortic dissection.
Question 2: A 75-year-old female is being treated for heart failure with reduced ejection fraction (HFrEF). Which of the following medication classes has been shown to improve mortality in patients with HFrEF and should be considered a cornerstone of therapy?
- Loop diuretics
- Beta-blockers (Correct answer)
- Digoxin
- Calcium channel blockers
Correct answer: Beta-blockers
Beta-blockers (e.g., carvedilol, metoprolol succinate, bisoprolol) are one of the primary classes of medications, along with ACE inhibitors/ARBs/ARNIs, that have been proven to reduce mortality and hospitalizations in patients with HFrEF. Loop diuretics manage symptoms but do not improve mortality. Digoxin can reduce hospitalizations but does not have a mortality benefit. Most calcium channel blockers are not recommended in HFrEF.
Question 3: A 24-year-old female presents for a routine physical exam. On cardiac auscultation, a mid-systolic click followed by a late systolic murmur is heard best at the apex. The murmur is accentuated when she stands up from a squatting position. What is the most likely valvular abnormality?
- Aortic stenosis
- Mitral regurgitation
- Mitral valve prolapse (Correct answer)
- Tricuspid regurgitation
Correct answer: Mitral valve prolapse
A mid-systolic click is the pathognomonic finding for mitral valve prolapse. The click is caused by the sudden tensing of the chordae tendineae as the valve leaflets prolapse into the left atrium during systole. Maneuvers that decrease venous return and left ventricular volume, such as standing, cause the click and murmur to occur earlier in systole and become more prominent.
Question 4: A 55-year-old male with a history of poorly controlled hypertension presents with a headache and confusion. His blood pressure is measured at 220/130 mmHg. Fundoscopic examination reveals papilledema. Which of the following is the most appropriate immediate step in management?
- Administer oral clonidine and discharge home with follow-up
- Admit to the ICU and initiate an intravenous antihypertensive infusion (Correct answer)
- Prescribe a high-dose oral diuretic and recheck blood pressure in 24 hours
- Schedule an outpatient cardiology consultation for the following week
Correct answer: Admit to the ICU and initiate an intravenous antihypertensive infusion
This patient is presenting with a hypertensive emergency, defined as severely elevated blood pressure (typically >180/120 mmHg) with evidence of end-organ damage (in this case, papilledema indicating hypertensive encephalopathy). The standard of care is immediate admission to an ICU for continuous monitoring and a controlled reduction of blood pressure using an intravenous antihypertensive agent like nicardipine or labetalol.
Question 5: Which of the following electrocardiogram (ECG) findings is most characteristic of acute pericarditis?
- ST-segment elevation in a localized coronary distribution
- Development of pathologic Q waves
- Diffuse ST-segment elevation and PR-segment depression (Correct answer)
- Deep, symmetric T-wave inversions
Correct answer: Diffuse ST-segment elevation and PR-segment depression
The classic ECG finding in acute pericarditis is diffuse, concave-up ST-segment elevation across multiple limb and precordial leads, which does not conform to a specific coronary artery territory. This is often accompanied by PR-segment depression, particularly in lead II. Localized ST elevation and Q waves are more indicative of a myocardial infarction.
Question 6: A 45-year-old patient is diagnosed with hypertrophic cardiomyopathy (HCM). Which of the following should be strongly advised against for this patient?
- Participation in competitive, high-intensity sports (Correct answer)
- Treatment with beta-blockers for symptomatic relief
- Annual screening with echocardiography
- Genetic counseling for first-degree relatives
Correct answer: Participation in competitive, high-intensity sports
Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death in young athletes. The dynamic left ventricular outflow tract obstruction can worsen with intense physical exertion and dehydration. Therefore, patients with HCM are typically restricted from competitive, high-intensity sports to reduce this risk. Beta-blockers are a first-line treatment, and regular screening and genetic counseling are standard parts of management.
Free Physician Assistant Cardiovascular System Disorders Questions and Answers
A 68-year-old male with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden-onset 'tearing' chest pain that radiates to his back.
On examination, his blood pressure is 190/110 mmHg in the right arm and 155/90 mmHg in the left arm.
A new diastolic murmur is auscultated at the right sternal border.
Which of the following is the most likely diagnosis?