ITE Cardiovascular Disease 3

Question 1

A 45-year-old woman with no cardiac history presents with sharp pleuritic chest pain and a pericardial friction rub 2 weeks after a viral URI. ECG shows diffuse ST elevation with PR depression. What is the first-line treatment?

Accepted Answer

NSAIDs plus colchicine

Answer

Acute viral pericarditis is treated with NSAIDs plus colchicine, which reduces recurrence; steroids are reserved for refractory cases.

Question 2

Which drug interaction is most clinically significant in a patient taking warfarin who is newly prescribed amiodarone?

Accepted Answer

Amiodarone inhibits CYP2C9, increasing warfarin effect

Answer

Amiodarone inhibits CYP2C9 (and CYP3A4), significantly reducing warfarin metabolism and increasing anticoagulant effect, requiring close INR monitoring and dose reduction.

Question 3

A 55-year-old man with STEMI is treated with primary PCI. Two days later he develops new hypotension, elevated JVP, and a new holosystolic murmur at the left lower sternal border. What is the most likely diagnosis?

Accepted Answer

Ventricular septal defect (VSD)

Answer

Post-MI VSD typically occurs 2–5 days after infarction, presenting with a new harsh holosystolic murmur, right heart failure signs, and hemodynamic compromise.

Question 4

A 68-year-old man with stable angina has a 70% stenosis of the left anterior descending artery on coronary angiography. His symptoms are well-controlled on medical therapy. What is the preferred management?

Accepted Answer

Continue optimal medical therapy

Answer

In stable ischemic heart disease, PCI does not reduce MI or mortality compared to optimal medical therapy (COURAGE trial), making medical management preferred for stable symptoms.

Question 5

Which physical examination finding is most specific for cardiac tamponade?

Accepted Answer

Pulsus paradoxus >10 mmHg

Answer

Pulsus paradoxus (>10 mmHg drop in systolic BP during inspiration) is the most specific physical finding for cardiac tamponade.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Cardiovascular Disease 3