MCCQE Cardiovascular Disease Management 3

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?

Accepted Answer

NSTEMI

Answer

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?

Accepted Answer

Right ventricular diastolic collapse

Answer

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?

Accepted Answer

SGLT2 inhibitor (empagliflozin)

Answer

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?

Accepted Answer

Digoxin

Answer

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?

Accepted Answer

Cardiac resynchronization therapy (CRT)

Answer

CRT is indicated in HFrEF with LVEF ≤35%, LBBB, and QRS ≥150 ms on optimal medical therapy to improve symptoms and reduce mortality.

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

MCCQE Cardiovascular Disease Management 3