MCCQE Cardiovascular Disease Management 3 — Questions and Answers
Question 1: A 55-year-old diabetic man presents with typical chest pain and troponin elevation. ECG shows no ST changes. Which diagnosis is most likely?
- Stable angina
- NSTEMI (Correct answer)
- Prinzmetal angina
- Pericarditis
Correct answer: NSTEMI
Troponin elevation with ischemic symptoms but no ST elevation is diagnostic of NSTEMI, distinguishing it from unstable angina (no troponin rise).
Question 2: Which finding on echocardiography is most consistent with cardiac tamponade?
- Left ventricular hypertrophy
- Right ventricular diastolic collapse (Correct answer)
- Mitral valve prolapse
- Aortic root dilation
Correct answer: Right ventricular diastolic collapse
Diastolic collapse of the right ventricle on echocardiography is the hallmark finding of cardiac tamponade due to external pericardial compression.
Question 3: A patient with HFpEF (EF 55%) presents with dyspnea. Which treatment has shown clear mortality benefit in HFpEF?
- ACE inhibitor
- Beta-blocker
- SGLT2 inhibitor (empagliflozin) (Correct answer)
- Aldosterone antagonist
Correct answer: SGLT2 inhibitor (empagliflozin)
Empagliflozin (EMPEROR-Preserved trial) demonstrated reduced cardiovascular death and heart failure hospitalization in HFpEF, the first therapy with clear benefit.
Question 4: A 60-year-old woman with Wolff-Parkinson-White syndrome develops AF. Which drug is contraindicated?
- Procainamide
- Amiodarone IV
- DC cardioversion
- Digoxin (Correct answer)
Correct answer: Digoxin
Digoxin (and verapamil, diltiazem) are contraindicated in WPW with AF because blocking the AV node increases conduction through the accessory pathway, risking VF.
Question 5: A 45-year-old man with dilated cardiomyopathy (EF 25%) on optimal medical therapy has LBBB with QRS 155 ms. What device therapy should be considered?
- Implantable loop recorder
- Permanent pacemaker
- Cardiac resynchronization therapy (CRT) (Correct answer)
- Implantable cardioverter-defibrillator alone
Correct answer: Cardiac resynchronization therapy (CRT)
CRT is indicated in HFrEF with LVEF ≤35%, LBBB, and QRS ≥150 ms on optimal medical therapy to improve symptoms and reduce mortality.
Question 6: A patient presents with chest pain that is worse when lying flat and relieved by leaning forward. ECG shows diffuse ST elevation with PR depression. What is the diagnosis?
- STEMI
- Aortic dissection
- Acute pericarditis (Correct answer)
- Myocarditis
Correct answer: Acute pericarditis
Diffuse ST elevation with PR depression, pleuritic positional chest pain relieved by leaning forward is the classic presentation of acute pericarditis.
Question 7: Which lipid-lowering drug class is most appropriate as first-line therapy for a patient with LDL 4.5 mmol/L and established atherosclerotic cardiovascular disease?
- Bile acid sequestrants
- Fibrates
- Niacin
- High-intensity statins (Correct answer)
Correct answer: High-intensity statins
High-intensity statins (e.g., atorvastatin 40–80 mg, rosuvastatin 20–40 mg) are first-line for secondary prevention, reducing LDL by ≥50% and lowering CV events.
MCCQE Cardiovascular Disease Management 3
A 55-year-old diabetic man presents with typical chest pain and troponin elevation.
ECG shows no ST changes.
Which diagnosis is most likely?