MCCQE Cardiovascular Disease Management 2

Question 1

A 65-year-old man with STEMI undergoes primary PCI. Which antiplatelet regimen is recommended post-procedure?

Accepted Answer

Aspirin plus ticagrelor for 12 months

Answer

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?

Accepted Answer

Add sacubitril/valsartan replacing ACE inhibitor

Answer

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?

Accepted Answer

S1Q3T3 pattern

Answer

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?

Accepted Answer

ACE inhibitor

Answer

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?

Accepted Answer

Amiodarone IV

Answer

IV amiodarone is first-line for hemodynamically stable monomorphic VT when the diagnosis is confirmed or strongly suspected.

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

MCCQE Cardiovascular Disease Management 2