ITE Cardiovascular Medicine 5

Question 1

A 65-year-old woman with HFpEF (EF 60%) presents with recurrent hospitalizations for fluid overload. Her BNP is 450 pg/mL. Which treatment has the strongest evidence for reducing HFpEF hospitalizations?

Accepted Answer

SGLT2 inhibitor (empagliflozin)

Answer

SGLT2 inhibitors (empagliflozin, dapagliflozin) are the first drug class to demonstrate significant reduction in cardiovascular death and worsening HF hospitalizations in HFpEF.

Question 2

A 50-year-old man undergoes a nuclear stress test. Imaging shows a fixed perfusion defect in the inferior wall and a transient ischemic dilation of the LV cavity. What does transient ischemic dilation indicate?

Accepted Answer

Severe, extensive coronary artery disease with stress-induced LV dysfunction

Answer

Transient ischemic dilation (TID) of the LV during stress reflects subendocardial ischemia causing apparent cavity enlargement and is a marker of severe, multivessel CAD.

Question 3

A 58-year-old man with no prior cardiac history is found to have a calcium score of 320 Agatston units. His 10-year ASCVD risk is 12%. What is the most appropriate action?

Accepted Answer

Start high-intensity statin therapy

Answer

A coronary artery calcium score ≥300 reclassifies the patient to high risk and supports initiation of high-intensity statin therapy regardless of calculated ASCVD risk.

Question 4

A 74-year-old woman with a mechanical mitral valve on warfarin requires elective knee replacement surgery. What is the appropriate perioperative anticoagulation strategy?

Accepted Answer

Stop warfarin 5 days before surgery with UFH bridging; restart warfarin post-op

Answer

Mechanical mitral valves carry high thromboembolic risk, requiring bridging with unfractionated or low-molecular-weight heparin when warfarin is held perioperatively.

Question 5

A 29-year-old woman with Marfan syndrome is found to have an aortic root diameter of 4.8 cm. She wishes to become pregnant. What counseling is most appropriate?

Accepted Answer

Prophylactic aortic root repair is recommended before pregnancy given high dissection risk at this diameter

Answer

In Marfan syndrome, prophylactic aortic root repair is recommended before pregnancy when the aortic root is ≥4.5 cm, given the substantial risk of dissection during pregnancy and delivery.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Cardiovascular Medicine 5