MCCQE Cardiovascular Disease Management 2 — Questions and Answers
Question 1: A 65-year-old man with STEMI undergoes primary PCI. Which antiplatelet regimen is recommended post-procedure?
- Aspirin alone for 12 months
- Aspirin plus clopidogrel for 12 months
- Aspirin plus ticagrelor for 12 months (Correct answer)
- Clopidogrel alone for 6 months
Correct answer: Aspirin plus ticagrelor for 12 months
Dual antiplatelet therapy with aspirin and ticagrelor (or prasugrel) for 12 months is recommended after PCI for ACS due to superior outcomes over clopidogrel.
Question 2: A patient with HFrEF (EF 30%) remains symptomatic on maximally tolerated ACE inhibitor and beta-blocker. What is the next best step?
- Add digoxin
- Add sacubitril/valsartan replacing ACE inhibitor (Correct answer)
- Add aldosterone antagonist
- Refer for cardiac transplant evaluation
Correct answer: Add sacubitril/valsartan replacing ACE inhibitor
Sacubitril/valsartan (ARNI) replaces ACE inhibitor in symptomatic HFrEF patients and reduces mortality and hospitalizations (PARADIGM-HF trial).
Question 3: Which ECG finding is most specific for right ventricular strain in acute pulmonary embolism?
- Sinus tachycardia
- S1Q3T3 pattern (Correct answer)
- New right bundle branch block
- ST elevation in V1
Correct answer: S1Q3T3 pattern
The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is the classic though not highly sensitive ECG finding for acute RV strain in PE.
Question 4: A 58-year-old woman with hypertension has a blood pressure of 170/100 mmHg. She has bilateral renal artery stenosis. Which antihypertensive is contraindicated?
- Amlodipine
- ACE inhibitor (Correct answer)
- Beta-blocker
- Thiazide diuretic
Correct answer: ACE inhibitor
ACE inhibitors are contraindicated in bilateral renal artery stenosis because they reduce efferent arteriolar tone, precipitating acute renal failure.
Question 5: A patient presents with wide-complex tachycardia at 180 bpm. He is hemodynamically stable. Which drug is appropriate for acute management if VT is suspected?
- Adenosine IV
- Amiodarone IV (Correct answer)
- Verapamil IV
- Digoxin IV
Correct answer: Amiodarone IV
IV amiodarone is first-line for hemodynamically stable monomorphic VT when the diagnosis is confirmed or strongly suspected.
Question 6: In a patient with non-valvular atrial fibrillation and CHA₂DS₂-VASc score of 3, what is the most appropriate anticoagulation strategy?
- Aspirin 81 mg daily
- Warfarin with INR target 2.0–3.0
- A direct oral anticoagulant (DOAC) (Correct answer)
- No anticoagulation needed
Correct answer: A direct oral anticoagulant (DOAC)
DOACs (e.g., rivaroxaban, apixaban) are preferred over warfarin for non-valvular AF with CHA₂DS₂-VASc ≥2 due to better efficacy and safety profile.
Question 7: A 70-year-old man has aortic stenosis with valve area 0.8 cm², mean gradient 55 mmHg, and EF 60%. He is asymptomatic. What is the recommended management?
- Immediate aortic valve replacement
- Watchful waiting with annual echocardiography (Correct answer)
- Start ACE inhibitor to reduce afterload
- Balloon aortic valvuloplasty
Correct answer: Watchful waiting with annual echocardiography
Asymptomatic severe AS with preserved EF is managed with watchful waiting and serial echocardiography every 6–12 months; surgery is triggered by symptoms or EF decline.
MCCQE Cardiovascular Disease Management 2
A 65-year-old man with STEMI undergoes primary PCI.
Which antiplatelet regimen is recommended post-procedure?