ITE Cardiovascular Disease 2

Question 1

A 58-year-old man with hypertension presents with sudden-onset tearing chest pain radiating to the back. BP is 180/100 in the right arm and 150/85 in the left arm. Which imaging study is most appropriate?

Accepted Answer

CT angiography of the chest

Answer

CT angiography is the gold standard for diagnosing aortic dissection, which is suggested by the tearing pain and blood pressure differential between arms.

Question 2

A patient with known mitral stenosis develops sudden onset palpitations. ECG shows no P waves and irregularly irregular rhythm. What is the immediate concern?

Accepted Answer

Systemic thromboembolism

Answer

Atrial fibrillation in mitral stenosis significantly increases the risk of left atrial thrombus formation and systemic embolism, including stroke.

Question 3

Which medication class is the preferred initial treatment for heart failure with reduced ejection fraction (HFrEF) to reduce mortality?

Accepted Answer

Beta-blockers and ACE inhibitors

Answer

Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) and ACE inhibitors/ARBs are proven to reduce mortality in HFrEF and are the cornerstone of therapy.

Question 4

A 65-year-old woman presents with exertional dyspnea and a harsh systolic crescendo-decrescendo murmur at the right upper sternal border radiating to the carotids. Echocardiogram shows an AVA of 0.7 cm². What is the next step?

Accepted Answer

Referral for aortic valve replacement

Answer

An AVA <0.8 cm² with symptoms defines severe symptomatic aortic stenosis, which requires valve replacement as definitive treatment.

Question 5

A 70-year-old man is found to have a 5.6 cm infrarenal abdominal aortic aneurysm on ultrasound during screening. He is asymptomatic. What is the recommended management?

Accepted Answer

Elective surgical repair

Answer

AAAs ≥5.5 cm in men carry high rupture risk and warrant elective repair; this patient's 5.6 cm aneurysm meets the threshold.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Cardiovascular Disease 2