Internal Medicine Exam Cardiovascular Disease Management 2

Question 1

A 58-year-old man with stable angina is found to have a left main coronary artery stenosis of 70% on angiography. What is the preferred management?

Accepted Answer

Coronary artery bypass grafting (CABG)

Answer

Left main coronary artery stenosis ≥50% with suitable anatomy is a Class I indication for CABG due to superior long-term survival outcomes compared to PCI.

Question 2

A 65-year-old woman with HFrEF (EF 30%) is already on maximally tolerated ACE inhibitor and beta-blocker. Her NT-proBNP remains elevated. Which medication should be added next?

Accepted Answer

Sacubitril/valsartan replacing the ACE inhibitor

Answer

Sacubitril/valsartan (ARNI) reduces mortality and hospitalization in HFrEF and should replace ACE inhibitor therapy in eligible patients with persistently symptomatic disease.

Question 3

A 72-year-old man presents with a blood pressure of 185/110 mmHg and acute pulmonary edema. What is the immediate pharmacologic priority?

Accepted Answer

IV nitrates and IV furosemide

Answer

Hypertensive emergency with pulmonary edema requires rapid BP reduction with IV nitrates (venodilators) and diuresis with IV furosemide to reduce preload and congestion.

Question 4

A 50-year-old woman with atrial fibrillation has a CHA₂DS₂-VASc score of 3. She has no contraindications to anticoagulation. Which therapy is most appropriate?

Accepted Answer

Direct oral anticoagulant (DOAC)

Answer

A CHA₂DS₂-VASc score ≥2 in women (≥3 in this case) is a Class I indication for oral anticoagulation; DOACs are preferred over warfarin due to superior safety profile.

Question 5

Which finding on echocardiography is most consistent with cardiac tamponade?

Accepted Answer

Diastolic collapse of the right ventricle

Answer

Diastolic RV collapse due to external pericardial pressure is the hallmark echocardiographic finding of cardiac tamponade.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Cardiovascular Disease Management 2