ITE Cardiovascular Medicine 4

Question 1

A 60-year-old man with known CAD is prescribed ranolazine for refractory angina. Which mechanism of action explains its antianginal effect?

Accepted Answer

Inhibition of late sodium current reducing myocardial oxygen demand

Answer

Ranolazine inhibits the late inward sodium current (I_Na late), which reduces intracellular calcium overload and myocardial oxygen demand without significantly affecting heart rate or blood pressure.

Question 2

An 80-year-old woman with severe symptomatic aortic stenosis is deemed high surgical risk. Which factor most strongly favors TAVR over surgical AVR?

Accepted Answer

Predicted operative mortality >8% using STS score

Answer

High surgical risk (STS mortality score ≥8%) is the primary indication favoring TAVR, which has demonstrated non-inferior or superior outcomes in this population.

Question 3

A 44-year-old woman has recurrent syncopal episodes during emotional stress. ECG shows a prolonged QTc of 520ms. She is started on nadolol. Which additional measure is most important for preventing sudden death?

Accepted Answer

Avoidance of all QT-prolonging medications

Answer

Avoidance of QT-prolonging drugs (antiarrhythmics, antibiotics, antiemetics, antipsychotics) is critical in congenital long QT syndrome to prevent torsades de pointes.

Question 4

A 67-year-old man undergoes coronary angiography and is found to have a 50% left main stenosis. FFR measurement yields 0.79. What is the most appropriate management?

Accepted Answer

PCI of the left main lesion

Answer

An FFR of 0.79 (≤0.80) indicates hemodynamically significant ischemia; left main disease with positive FFR warrants revascularization, with CABG preferred over PCI for left main.

Question 5

A 38-year-old man presents with fever, new murmur, and positive blood cultures for Streptococcus viridans. Echocardiography shows a 12mm vegetation on the mitral valve. Which finding would prompt urgent surgical consultation?

Accepted Answer

Heart failure due to severe mitral regurgitation

Answer

Heart failure secondary to valve dysfunction from endocarditis is the most common indication for urgent surgery, as it significantly increases mortality without intervention.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Cardiovascular Medicine 4