Internal Medicine Exam Cardiovascular Disease 4

Question 1

A 50-year-old man with no cardiac history presents with palpitations. ECG shows a short PR interval, delta waves, and wide QRS complexes. He develops rapid atrial fibrillation. Which drug is contraindicated?

Accepted Answer

Adenosine

Answer

Adenosine (and AV nodal blocking agents like digoxin and verapamil) are contraindicated in WPW with AF because blocking the AV node can accelerate conduction down the accessory pathway, potentially causing ventricular fibrillation.

Question 2

A 55-year-old man with hypertension presents with progressive dyspnea. Echo shows EF 30%, LV dilation, and no significant valvular disease. Coronary angiography shows normal coronaries. What is the diagnosis?

Accepted Answer

Dilated cardiomyopathy

Answer

Dilated cardiomyopathy is characterized by LV dilation, reduced EF (<40%), and systolic dysfunction in the absence of coronary artery disease or abnormal loading conditions.

Question 3

A 48-year-old woman presents with dyspnea, peripheral edema, and a JVP that rises with inspiration (Kussmaul's sign). Echo shows preserved EF with septal bounce. What is the most likely diagnosis?

Accepted Answer

Constrictive pericarditis

Answer

Kussmaul's sign (JVP rise with inspiration) combined with septal bounce and preserved EF on echo points to constrictive pericarditis, where inspiration cannot augment RV filling.

Question 4

A 35-year-old athlete collapses during a basketball game. ECG shows asymmetric septal hypertrophy and dynamic LVOT obstruction of 50 mmHg. Which medication is most appropriate for symptom management?

Accepted Answer

Metoprolol succinate

Answer

Beta-blockers like metoprolol are first-line therapy for symptomatic hypertrophic obstructive cardiomyopathy as they reduce heart rate, decrease LV contractility, and lessen dynamic outflow obstruction.

Question 5

A 65-year-old woman presents with worsening dyspnea and is found to have severe aortic stenosis (AVA 0.7 cm², mean gradient 52 mmHg). She has severe COPD with FEV1 40% predicted and is deemed high surgical risk. What is the preferred intervention?

Accepted Answer

Transcatheter aortic valve replacement (TAVR)

Answer

TAVR is preferred over SAVR in patients with severe symptomatic aortic stenosis who are at high or prohibitive surgical risk, as shown in the PARTNER trials.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Cardiovascular Disease 4