ITE Cardiovascular Disease 5

Question 1

A 55-year-old woman with class II obesity presents for cardiovascular risk assessment. Her 10-year ASCVD risk is 8%. LDL is 125 mg/dL. What is the most appropriate initial intervention?

Accepted Answer

Lifestyle modification with shared decision-making about statin therapy

Answer

A 10-year ASCVD risk of 7.5–10% is considered borderline; guidelines recommend shared decision-making about statin initiation after lifestyle modification counseling.

Question 2

A 60-year-old man is admitted for acute decompensated heart failure. He is volume-overloaded with creatinine 1.4 mg/dL. IV furosemide is started. What laboratory finding would indicate adequate diuresis response?

Accepted Answer

Urine output >0.5 mL/kg/hr and weight loss of 0.5–1 kg/day

Answer

Adequate decongestion is monitored by urine output and daily weight loss of 0.5–1 kg/day, balancing diuresis against worsening renal function.

Question 3

A 38-year-old woman presents with dyspnea and is found to have a systolic BP of 160/90 in both arms and diastolic murmur over the back. CXR shows rib notching. What is the diagnosis?

Accepted Answer

Coarctation of the aorta

Answer

Coarctation of the aorta presents with upper extremity hypertension, a diastolic murmur over the back from collaterals, and rib notching from intercostal artery enlargement.

Question 4

A 67-year-old man with known CAD presents with inferior ST-segment elevation. He has no contraindications. The nearest PCI-capable hospital is 3 hours away. What is the most appropriate reperfusion strategy?

Accepted Answer

Fibrinolytic therapy within 30 minutes, then transfer

Answer

When PCI cannot be performed within 120 minutes of first medical contact, fibrinolytic therapy should be given within 30 minutes followed by transfer for angiography.

Question 5

Which finding would most support a diagnosis of pulmonary arterial hypertension (PAH) rather than pulmonary hypertension due to left heart disease?

Accepted Answer

Mean PAP >25 mmHg with PCWP ≤15 mmHg

Answer

PAH is defined as mean PAP >25 mmHg with a normal wedge pressure (PCWP ≤15 mmHg), distinguishing it from pulmonary hypertension driven by elevated left-sided filling pressures.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Cardiovascular Disease 5