ITE Cardiovascular Medicine 2

Question 1

A 58-year-old man presents with exertional chest pain. Stress testing shows 2mm ST depression in leads V4-V6 at 5 METs. What is the most appropriate next step?

Accepted Answer

Refer for coronary angiography

Answer

High-risk stress test findings (≥2mm ST depression, low exercise capacity <5 METs) warrant prompt coronary angiography for definitive evaluation.

Question 2

A 72-year-old woman with atrial fibrillation and a CHA₂DS₂-VASc score of 5 is started on apixaban. Which monitoring parameter is most important at follow-up?

Accepted Answer

Renal function annually or with clinical changes

Answer

DOACs like apixaban are renally cleared, so renal function should be monitored at least annually (or more frequently if declining) to guide dose adjustments.

Question 3

Which finding on transthoracic echocardiography best distinguishes cardiac tamponade from constrictive pericarditis?

Accepted Answer

Pericardial effusion with right atrial collapse in systole

Answer

Right atrial collapse during systole (and right ventricular diastolic collapse) are hallmarks of cardiac tamponade physiology due to elevated pericardial pressure.

Question 4

A 45-year-old with hypertrophic obstructive cardiomyopathy (HOCM) has persistent symptoms despite medical therapy. Which intervention is most appropriate?

Accepted Answer

Septal reduction therapy (surgical myectomy or alcohol ablation)

Answer

Septal reduction therapy — either surgical myectomy or alcohol septal ablation — is indicated for HOCM patients with persistent NYHA Class III-IV symptoms despite optimal medical therapy.

Question 5

A patient with known coronary artery disease develops hypotension and pulmonary edema 3 days after an anterior MI. Echo shows a new VSD. What is the definitive treatment?

Accepted Answer

Emergency surgical repair of the VSD

Answer

Post-MI VSD with cardiogenic shock carries very high mortality and requires emergency surgical repair, often with mechanical circulatory support as a bridge.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Cardiovascular Medicine 2