Internal Medicine Exam Cardiovascular Disease 2

Question 1

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?

Accepted Answer

Coronary angiography

Answer

Significant ST depression on stress testing (≥2 mm) in a high-risk patient warrants coronary angiography to define anatomy and guide revascularization.

Question 2

Which finding on echocardiography is most consistent with cardiac tamponade?

Accepted Answer

Right ventricular diastolic collapse

Answer

Right ventricular diastolic collapse on echocardiography is the classic finding of cardiac tamponade due to elevated pericardial pressure compressing the low-pressure right heart.

Question 3

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?

Accepted Answer

Ondansetron

Answer

Ondansetron is a 5-HT3 antagonist that prolongs the QT interval and can precipitate torsades de pointes in patients with baseline QT prolongation.

Question 4

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?

Accepted Answer

Ivabradine

Answer

Ivabradine is indicated in HFrEF patients in sinus rhythm with heart rate ≥70 bpm on maximally tolerated beta-blocker to further reduce hospitalizations.

Question 5

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?

Accepted Answer

Apixaban

Answer

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.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Cardiovascular Disease 2