Internal Medicine Exam Cardiovascular Disease Management 5

Question 1

A 70-year-old man with HFrEF (EF 28%) has persistent LBBB with QRS duration of 160 ms despite optimal medical therapy. His NYHA class is III. What device therapy is indicated?

Accepted Answer

Cardiac resynchronization therapy with defibrillator (CRT-D)

Answer

ICD alone

Answer

Permanent pacemaker alone

Answer

No device therapy until EF <20%

Question 2

A 45-year-old marathon runner collapses during a race. ECG shows right bundle branch block with ST elevation in V1–V3 and a family history of sudden cardiac death. What is the most likely diagnosis?

Accepted Answer

Brugada syndrome

Answer

Hypertrophic cardiomyopathy

Answer

Long QT syndrome type 1

Answer

Arrhythmogenic right ventricular cardiomyopathy

Question 3

A 60-year-old woman with mitral stenosis (MVA 0.9 cm²) presents with increasing dyspnea. She has no mitral regurgitation and favorable valve morphology (Wilkins score 6). What is the preferred intervention?

Accepted Answer

Percutaneous mitral balloon commissurotomy (PMBC)

Answer

Mitral valve replacement with mechanical prosthesis

Answer

Mitral valve repair

Answer

Medical therapy with diuretics indefinitely

Question 4

A 55-year-old man is started on warfarin for mechanical mitral valve replacement. What is the target INR range?

Accepted Answer

2.5–3.5

Answer

1.5–2.0

Answer

2.0–3.0

Answer

3.5–4.5

Question 5

A 48-year-old woman with no prior cardiac history presents with chest pain and is found to have ST elevation in leads II, III, and aVF. Coronary angiography shows no obstructive disease but a spiral dissection in the right coronary artery. What is the most likely diagnosis?

Accepted Answer

Spontaneous coronary artery dissection (SCAD)

Answer

Coronary artery vasospasm

Answer

Takayasu arteritis

Answer

Cocaine-induced coronary spasm

Question 6

A 72-year-old man with chronic kidney disease (eGFR 20) and a recent STEMI requires anticoagulation for concurrent atrial fibrillation. Which DOAC dose adjustment is most critical?

Accepted Answer

Apixaban 2.5 mg twice daily if criteria met; avoid dabigatran

Answer

Rivaroxaban 20 mg daily without adjustment

Answer

Dabigatran 150 mg twice daily

Answer

No dose adjustment needed for any DOAC

Question 7

A 67-year-old man develops hypotension, JVD, clear lung fields, and ST elevation in V1 and right-sided leads after inferior STEMI. What is the most appropriate fluid management?

Accepted Answer

Aggressive IV fluid resuscitation with normal saline

Answer

IV furosemide to reduce preload

Answer

Dobutamine infusion only without fluids

Answer

Immediate diuresis and nitroglycerin