Cardiovascular Disease Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Cardiovascular Disease flashcards as text
A 58-year-old man with hypertension and diabetes presents with exertional chest pain. Stress testing shows ST depression in leads V4-V6. What is the most appropriate next step?
Answer: Coronary angiography
Significant ST depression on stress testing (≥2 mm) in a high-risk patient warrants coronary angiography to define anatomy and guide revascularization.
Which finding on echocardiography is most consistent with cardiac tamponade?
Answer: Right ventricular diastolic collapse
Right ventricular diastolic collapse on echocardiography is the classic finding of cardiac tamponade due to elevated pericardial pressure compressing the low-pressure right heart.
A 45-year-old woman is found to have a QTc of 520 ms on routine ECG. She is asymptomatic. Which medication should be avoided?
Answer: Ondansetron
Ondansetron is a 5-HT3 antagonist that prolongs the QT interval and can precipitate torsades de pointes in patients with baseline QT prolongation.
A patient with known heart failure with reduced ejection fraction (HFrEF) has a resting heart rate of 82 bpm despite maximum tolerated beta-blocker therapy. Which additional agent is indicated?
Answer: Ivabradine
Ivabradine is indicated in HFrEF patients in sinus rhythm with heart rate ≥70 bpm on maximally tolerated beta-blocker to further reduce hospitalizations.
A 70-year-old man with atrial fibrillation and CKD stage 3 (eGFR 40) needs anticoagulation. His CHA₂DS₂-VASc score is 4. Which anticoagulant is most appropriate?
Answer: Apixaban
Apixaban is preferred in moderate CKD as it has the least renal clearance (~27%) among DOACs and requires minimal dose adjustment down to eGFR 25.
Which hemodynamic pattern is most consistent with constrictive pericarditis on right heart catheterization?
Answer: Equalization of diastolic pressures
Equalization of diastolic pressures (RVEDP = LVEDP = mean RA = mean PCWP within 5 mmHg) is the hallmark hemodynamic finding of constrictive pericarditis.
A 55-year-old woman with hypertension presents with a blood pressure of 220/120 mmHg and new-onset confusion. Creatinine is 2.8 mg/dL (baseline 1.0). What is the target blood pressure reduction in the first hour?
Answer: Reduce mean arterial pressure by no more than 25%
In hypertensive emergency, the MAP should be reduced by no more than 25% in the first hour to avoid ischemia from loss of cerebral autoregulation.