Internal Medicine Exam Cardiovascular Disease 5

Question 1

A 52-year-old man with diabetes presents 90 minutes after onset of crushing chest pain. ECG shows 3 mm ST elevation in V1-V4. Which reperfusion strategy is preferred?

Accepted Answer

Primary percutaneous coronary intervention (PCI)

Answer

Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed within 90 minutes of first medical contact (door-to-balloon time), as it is superior to fibrinolysis.

Question 2

A 44-year-old woman presents with sudden onset of pulmonary edema. Echo reveals severe mitral regurgitation with a flail posterior leaflet. Her blood pressure is 85/60 mmHg. What is the most appropriate immediate intervention?

Accepted Answer

Intra-aortic balloon pump followed by urgent surgery

Answer

Acute severe MR causing cardiogenic shock requires hemodynamic stabilization with an intra-aortic balloon pump (reduces afterload, increases coronary perfusion) as a bridge to urgent surgical repair.

Question 3

Which clinical scenario best describes Dressler syndrome?

Accepted Answer

Fever, pleuritic chest pain, and pericarditis occurring weeks after MI or cardiac surgery

Answer

Dressler syndrome is an autoimmune pericarditis that occurs weeks to months after MI or cardiac surgery, presenting with fever, pleurisy, and pericardial inflammation.

Question 4

A 66-year-old man with known HFrEF (EF 30%) develops worsening renal function after ACE inhibitor dose uptitration. Creatinine rose from 1.2 to 1.8 mg/dL. What is the most appropriate action?

Accepted Answer

Continue ACE inhibitor if creatinine rise is ≤30% above baseline

Answer

A creatinine rise of up to 30-50% above baseline is acceptable when starting or uptitrating ACE inhibitors in HFrEF, as these agents provide mortality benefit that outweighs the modest GFR reduction.

Question 5

A 58-year-old woman with poorly controlled hypertension develops a new murmur. Echo shows aortic regurgitation with LV end-systolic diameter of 52 mm and EF of 48%. She is mildly symptomatic. What is the best management?

Accepted Answer

Aortic valve replacement

Answer

Symptomatic severe AR with EF <50% or LVESD >50 mm is a class I indication for aortic valve replacement, as these thresholds predict irreversible LV dysfunction if surgery is further delayed.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Cardiovascular Disease 5