PANCE Cardiovascular System 2 — Questions and Answers
Question 1: A 68-year-old man presents with exertional chest pain relieved by rest. EKG shows ST depression during a stress test. Which medication is first-line for symptom management?
- Sublingual nitroglycerin
- Beta-blocker (Correct answer)
- Calcium channel blocker
- Long-acting nitrate
Correct answer: Beta-blocker
Beta-blockers are first-line for stable angina as they reduce myocardial oxygen demand by decreasing heart rate and contractility.
Question 2: A patient with hypertrophic obstructive cardiomyopathy (HOCM) experiences syncope. Which intervention would WORSEN outflow obstruction?
- Beta-blocker administration
- Leg elevation
- IV fluid bolus
- Amyl nitrite inhalation (Correct answer)
Correct answer: Amyl nitrite inhalation
Amyl nitrite causes vasodilation and decreases preload and afterload, which worsens HOCM outflow obstruction by allowing greater septal apposition to the anterior mitral leaflet.
Question 3: A 55-year-old woman is found to have a diastolic murmur at the left sternal border that increases with inspiration. What is the most likely diagnosis?
- Aortic regurgitation
- Mitral stenosis
- Pulmonary regurgitation (Correct answer)
- Tricuspid stenosis
Correct answer: Pulmonary regurgitation
Pulmonary regurgitation produces a diastolic murmur at the left sternal border that increases with inspiration (Carvallo sign) due to increased right-sided flow.
Question 4: Which finding on transthoracic echocardiogram is most consistent with cardiac tamponade?
- Left ventricular hypertrophy
- Right ventricular diastolic collapse (Correct answer)
- Mitral valve prolapse
- Septal hypokinesis
Correct answer: Right ventricular diastolic collapse
Right ventricular diastolic collapse is the classic echocardiographic finding in cardiac tamponade due to elevated pericardial pressure exceeding low RV diastolic pressure.
Question 5: A 72-year-old man with heart failure has a BNP of 1,200 pg/mL. His ejection fraction is 30%. Which diuretic combination is preferred for decongestion?
- Furosemide alone
- Hydrochlorothiazide alone
- Furosemide plus metolazone (Correct answer)
- Spironolactone alone
Correct answer: Furosemide plus metolazone
Furosemide plus metolazone provides sequential nephron blockade, overcoming diuretic resistance common in advanced heart failure with low GFR.
Question 6: A patient presents with sudden-onset tearing chest pain radiating to the back. CT angiography confirms a Stanford Type B aortic dissection. Initial management should include:
- Emergency surgical repair
- IV labetalol and nicardipine (Correct answer)
- Thrombolytic therapy
- Emergent pericardiocentesis
Correct answer: IV labetalol and nicardipine
Uncomplicated Type B dissections (descending aorta) are managed medically with IV beta-blockers to reduce heart rate and blood pressure, limiting propagation.
Question 7: A 45-year-old man has prolonged QT on EKG (QTc 510 ms) and is prescribed an antibiotic. Which is SAFEST to use?
- Azithromycin
- Moxifloxacin
- Amoxicillin (Correct answer)
- Erythromycin
Correct answer: Amoxicillin
Amoxicillin does not prolong the QT interval, making it safe in patients with prolonged QTc, unlike macrolides and fluoroquinolones.
PANCE Cardiovascular System 2
A 68-year-old man presents with exertional chest pain relieved by rest.
EKG shows ST depression during a stress test.
Which medication is first-line for symptom management?