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

CRT-D is a Class I indication for HFrEF with LBBB morphology, QRS ≥150 ms, and NYHA class II–III on optimal medical therapy, reducing mortality and improving EF.

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

The spontaneous Type 1 Brugada pattern (coved ST elevation in V1–V3 with RBBB morphology) combined with family history of SCD is diagnostic of Brugada syndrome.

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

Symptomatic severe MS (MVA ≤1.0 cm²) with favorable valve morphology (Wilkins score ≤8, no significant MR) is best treated with PMBC, which is less invasive than surgery with similar outcomes.

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

Mechanical mitral valve prostheses require a higher INR target of 2.5–3.5 due to greater thrombogenicity compared to aortic mechanical valves (target 2.0–3.0).

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

SCAD predominantly affects young women without traditional cardiac risk factors and presents as ACS with angiographic spiral dissection; conservative management is preferred over PCI.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Cardiovascular Disease Management 5