ITE Cardiovascular Disease 4

Question 1

A 62-year-old man presents with exertional chest pain. Stress test shows 2 mm ST depression in leads V4–V6 at 85% of maximum heart rate. He has diabetes and hypertension. What is the most appropriate next step?

Accepted Answer

Coronary angiography

Answer

A strongly positive stress test (≥2 mm ST depression at submaximal heart rate) in a high-risk patient warrants coronary angiography to define anatomy and guide revascularization.

Question 2

Which lipoprotein pattern is most associated with premature atherosclerotic cardiovascular disease?

Accepted Answer

Elevated LDL-C with small dense LDL particles

Answer

Small dense LDL particles are more atherogenic because they penetrate the endothelium more easily and are more susceptible to oxidation, driving plaque formation.

Question 3

A 50-year-old woman with systemic lupus erythematosus presents with dyspnea, elevated JVP, and an echocardiogram showing a thickened pericardium with respiratory variation in mitral inflow >25%. What is the diagnosis?

Accepted Answer

Constrictive pericarditis

Answer

Constrictive pericarditis presents with elevated JVP, Kussmaul's sign, and exaggerated respiratory variation in Doppler inflow velocities, and is a known complication of SLE.

Question 4

A 48-year-old male smoker with hyperlipidemia and hypertension has a resting ECG showing Q waves in leads II, III, and aVF. He has no chest pain history. What is the most likely explanation?

Accepted Answer

Prior inferior myocardial infarction

Answer

Pathological Q waves in the inferior leads (II, III, aVF) in the setting of multiple cardiovascular risk factors most likely represent a prior silent inferior MI.

Question 5

A 66-year-old woman with atrial fibrillation and a CHA₂DS₂-VASc score of 4 is started on apixaban. She asks about dietary restrictions. What is the most accurate counseling?

Accepted Answer

No significant dietary restrictions required

Answer

Unlike warfarin, apixaban (a direct oral anticoagulant) does not require dietary vitamin K restriction or routine INR monitoring.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Cardiovascular Disease 4