Internal Medicine Cardiovascular Disease Questions and Answers

Question 1

A 68-year-old male with a history of stable ischemic heart disease underwent percutaneous coronary intervention (PCI) with a drug-eluting stent to the left anterior descending artery one year ago.
He has been asymptomatic on dual antiplatelet therapy (DAPT) with aspirin and clopidogrel.
He has a high bleeding risk (PRECISE-DAPT score of 30).
According to the most recent ACC/AHA guidelines, what is the most appropriate recommendation for his antiplatelet therapy at this time?

Accepted Answer

Discontinue clopidogrel and continue aspirin monotherapy.

Answer

Continue DAPT for at least another 12 months.

Answer

Discontinue aspirin and continue clopidogrel monotherapy.

Answer

Discontinue both aspirin and clopidogrel.

Question 2

A 76-year-old female with a history of hypertension and type 2 diabetes mellitus is diagnosed with non-valvular atrial fibrillation. Her CHA2DS2-VASc score is calculated to be 4. Which of the following is the most appropriate management for stroke prevention in this patient?

Accepted Answer

Oral anticoagulation with a direct oral anticoagulant (DOAC) or warfarin.

Answer

No antithrombotic therapy is needed.

Answer

Aspirin 81 mg daily.

Answer

Aspirin 325 mg and clopidogrel 75 mg daily.

Question 3

A 62-year-old male presents to the emergency department with 3 hours of substernal chest pressure. His ECG shows ST-segment depression in the lateral leads. Initial troponin levels are elevated. He is diagnosed with NSTE-ACS (Non-ST-Elevation Acute Coronary Syndrome). In addition to aspirin, nitrates, and a high-intensity statin, which of the following is a critical component of initial medical management?

Accepted Answer

Administration of a P2Y12 inhibitor and an anticoagulant.

Answer

Immediate administration of a thrombolytic agent.

Answer

Initiation of an ACE inhibitor within the first hour.

Answer

Urgent cardioversion.

Question 4

Which of the following medication classes has been shown in recent large clinical trials to reduce the composite risk of cardiovascular death or hospitalization for heart failure in patients with Heart Failure with preserved Ejection Fraction (HFpEF)?

Accepted Answer

Sodium-glucose cotransporter-2 (SGLT2) inhibitors

Answer

Beta-blockers

Answer

Angiotensin-converting enzyme (ACE) inhibitors

Answer

Loop diuretics

Question 5

A 55-year-old man is newly diagnosed with Stage 1 Hypertension with a blood pressure of 136/88 mmHg on multiple readings. He has no other medical problems, and his 10-year atherosclerotic cardiovascular disease (ASCVD) risk is calculated to be 6%. According to the 2025 ACC/AHA guidelines, what is the most appropriate initial management step?

Accepted Answer

Recommend a 3- to 6-month trial of lifestyle modifications.

Answer

Initiate therapy with a thiazide diuretic.

Answer

Start treatment with an ACE inhibitor.

Answer

Initiate combination therapy with an ARB and a calcium channel blocker.

Question 6

A 79-year-old male with known coronary artery disease, prior myocardial infarction, and systolic heart failure (LVEF 30%) presents with recurrent episodes of syncope. A 12-lead ECG shows sinus rhythm with a left bundle branch block and a QRS duration of 160 ms. He is on optimal guideline-directed medical therapy. Which of the following interventions is most likely to improve his symptoms and reduce mortality?

Accepted Answer

Implantation of a cardiac resynchronization therapy with defibrillator (CRT-D) device.

Answer

Ablation of the AV node and placement of a single-chamber pacemaker.

Answer

Implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD).

Answer

Coronary artery bypass grafting (CABG).