Internal Medicine Exam Cardiovascular Disease Management 4

Question 1

A 75-year-old man with peripheral artery disease and claudication has an ABI of 0.6. He is a non-smoker on a statin and aspirin. What additional therapy improves walking distance?

Accepted Answer

Cilostazol

Answer

Cilostazol, a phosphodiesterase III inhibitor, is the only FDA-approved medication shown to improve claudication symptoms and walking distance in PAD.

Question 2

A 55-year-old man presents with sharp, positional chest pain that worsens when lying flat and improves when leaning forward. Temperature is 38.4°C. ECG shows diffuse ST elevation with PR depression. What is the most likely diagnosis?

Accepted Answer

Acute pericarditis

Answer

Diffuse (saddle-shaped) ST elevation with PR depression, pleuritic positional pain, and low-grade fever are classic findings of acute pericarditis.

Question 3

A 68-year-old woman with newly diagnosed atrial flutter undergoes successful cardioversion to sinus rhythm. How long should anticoagulation be continued after cardioversion?

Accepted Answer

At least 4 weeks post-cardioversion, then ongoing based on stroke risk score

Answer

Post-cardioversion anticoagulation for at least 4 weeks is mandatory (due to atrial stunning), followed by long-term anticoagulation guided by CHA₂DS₂-VASc score.

Question 4

A 52-year-old man with type 2 diabetes and established cardiovascular disease has an eGFR of 55 mL/min and is on metformin. Which additional agent has the most evidence for reducing cardiovascular mortality?

Accepted Answer

GLP-1 receptor agonist (e.g., liraglutide or semaglutide)

Answer

GLP-1 receptor agonists (LEADER, SUSTAIN-6 trials) have demonstrated significant reduction in MACE and cardiovascular mortality in patients with T2DM and established CVD.

Question 5

A patient in the ICU develops a wide-complex tachycardia at 180 bpm. She is hypotensive with BP of 78/50 mmHg. What is the immediate treatment?

Accepted Answer

Synchronized direct current cardioversion

Answer

Unstable wide-complex tachycardia with hemodynamic compromise requires immediate synchronized DC cardioversion regardless of the underlying rhythm.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Cardiovascular Disease Management 4