Internal Medicine Exam Cardiovascular Disease Management 3

Question 1

A 45-year-old man presents with acute pericarditis. He is hemodynamically stable with no fever. What is the first-line treatment?

Accepted Answer

Aspirin plus colchicine

Answer

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?

Accepted Answer

Aortic valve replacement (surgical or TAVR)

Answer

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?

Accepted Answer

Short PR interval with delta wave and wide QRS

Answer

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?

Accepted Answer

SGLT2 inhibitor (empagliflozin or dapagliflozin)

Answer

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?

Accepted Answer

Emergency surgical repair or percutaneous closure with hemodynamic support

Answer

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.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Cardiovascular Disease Management 3