ITE Cardiovascular Medicine 3

Question 1

A 55-year-old man with diabetes and hypertension has a resting ECG showing left bundle branch block. He presents with 2 hours of chest pain. Which statement is correct regarding diagnosis?

Accepted Answer

New or presumably new LBBB with ischemic symptoms should be treated as STEMI equivalent

Answer

Per Sgarbossa criteria and current guidelines, new or presumably new LBBB with ischemic symptoms should be managed as a STEMI equivalent with emergent reperfusion therapy.

Question 2

A patient with long-standing hypertension presents with an aortic dissection beginning just distal to the left subclavian artery (Type B). Blood pressure is 165/95 mmHg and he is pain-free. What is the preferred initial management?

Accepted Answer

Medical management with IV beta-blockers targeting HR <60 and SBP 100-120 mmHg

Answer

Uncomplicated Type B (Stanford) aortic dissections are initially managed medically with heart rate and blood pressure control using IV beta-blockers.

Question 3

Which of the following is the most common cause of sudden cardiac death in athletes under 35 years of age in the United States?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in young US athletes, typically from ventricular arrhythmias during intense exertion.

Question 4

A 62-year-old woman with heart failure with reduced ejection fraction (HFrEF, EF 30%) is on optimal medical therapy. QRS duration is 155ms with LBBB morphology. Which intervention improves mortality?

Accepted Answer

Cardiac resynchronization therapy with defibrillator (CRT-D)

Answer

CRT-D is indicated in HFrEF patients with LBBB and QRS ≥150ms on GDMT, reducing mortality and hospitalization by resynchronizing ventricular contraction.

Question 5

A 48-year-old man is found to have an LDL of 310 mg/dL despite high-intensity statin therapy. Genetic testing confirms heterozygous familial hypercholesterolemia. What is the most appropriate add-on therapy?

Accepted Answer

Ezetimibe plus a PCSK9 inhibitor

Answer

Ezetimibe plus a PCSK9 inhibitor (evolocumab or alirocumab) provides additive LDL lowering and is recommended for FH patients not at goal on maximally tolerated statins.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Cardiovascular Medicine 3