Internal Medicine Exam Cardiovascular Disease Management 3 — Questions and Answers
Question 1: A 45-year-old man presents with acute pericarditis. He is hemodynamically stable with no fever. What is the first-line treatment?
- Aspirin plus colchicine (Correct answer)
- Prednisone
- IV methylprednisolone
- NSAIDs alone without colchicine
Correct answer: Aspirin plus colchicine
Current guidelines recommend aspirin (or NSAIDs) combined with colchicine as first-line therapy for acute pericarditis to reduce recurrence risk.
Question 2: A 70-year-old man with known aortic stenosis presents with syncope on exertion. His echocardiogram shows a mean gradient of 48 mmHg and AVA of 0.7 cm². What is the next step?
- Aortic valve replacement (surgical or TAVR) (Correct answer)
- Balloon aortic valvuloplasty as definitive therapy
- Medical management with diuretics
- Exercise stress testing to confirm severity
Correct answer: Aortic valve replacement (surgical or TAVR)
Symptomatic severe aortic stenosis (syncope, angina, or HF) is a Class I indication for aortic valve replacement; exercise stress testing is contraindicated in symptomatic severe AS.
Question 3: Which electrocardiographic pattern is characteristic of Wolff-Parkinson-White (WPW) syndrome during sinus rhythm?
- Short PR interval with delta wave and wide QRS (Correct answer)
- Long PR interval with narrow QRS
- Short PR interval with normal QRS
- Prolonged QT interval with U waves
Correct answer: Short PR interval with delta wave and wide QRS
WPW syndrome manifests during sinus rhythm as a short PR interval (<120 ms), slurred upstroke (delta wave), and widened QRS due to ventricular pre-excitation via an accessory pathway.
Question 4: A 55-year-old woman with HFpEF (EF 60%) presents with dyspnea and leg edema. Which intervention has the strongest evidence for improving outcomes in HFpEF?
- SGLT2 inhibitor (empagliflozin or dapagliflozin) (Correct answer)
- ACE inhibitor
- Beta-blocker
- Aldosterone antagonist
Correct answer: SGLT2 inhibitor (empagliflozin or dapagliflozin)
SGLT2 inhibitors have demonstrated significant reduction in heart failure hospitalizations and cardiovascular death in HFpEF in landmark trials (EMPEROR-Preserved, DELIVER).
Question 5: A 62-year-old man develops new bundle branch block and cardiogenic shock 6 hours after anterior STEMI. Echocardiography shows a ventricular septal defect. What is the definitive treatment?
- Emergency surgical repair or percutaneous closure with hemodynamic support (Correct answer)
- Intra-aortic balloon pump alone
- IV dobutamine and watchful waiting
- Thrombolytic therapy
Correct answer: Emergency surgical repair or percutaneous closure with hemodynamic support
Post-MI ventricular septal rupture causing cardiogenic shock requires urgent mechanical repair (surgical or percutaneous) along with hemodynamic support; medical therapy alone has very high mortality.
Question 6: A 48-year-old man is found to have a 4.2 cm ascending aortic aneurysm incidentally. He is asymptomatic with no connective tissue disorder. What is the recommended management?
- Surveillance imaging every 6–12 months and aggressive blood pressure control (Correct answer)
- Immediate surgical repair
- Endovascular stent grafting
- Beta-blockers and repeat imaging in 5 years
Correct answer: Surveillance imaging every 6–12 months and aggressive blood pressure control
Asymptomatic ascending aortic aneurysms <5.0–5.5 cm (without high-risk features) are managed with surveillance imaging and risk factor modification including BP control.
Question 7: A 66-year-old woman is started on amiodarone for atrial fibrillation. Which baseline workup is most important before initiating therapy?
- Thyroid function tests, liver function tests, pulmonary function tests, and ophthalmologic exam (Correct answer)
- Renal function tests and urinalysis only
- Complete blood count and ESR
- Echocardiogram and stress test only
Correct answer: Thyroid function tests, liver function tests, pulmonary function tests, and ophthalmologic exam
Amiodarone affects thyroid, liver, lung, cornea, and skin; baseline TFTs, LFTs, PFTs, chest X-ray, and eye exam are essential to detect organ toxicity.
Internal Medicine Exam Cardiovascular Disease Management 3
A 45-year-old man presents with acute pericarditis.
He is hemodynamically stable with no fever.
What is the first-line treatment?