PANCE Cardiovascular System 2

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?

Accepted Answer

Beta-blocker

Answer

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?

Accepted Answer

Amyl nitrite inhalation

Answer

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?

Accepted Answer

Pulmonary regurgitation

Answer

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?

Accepted Answer

Right ventricular diastolic collapse

Answer

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?

Accepted Answer

Furosemide plus metolazone

Answer

Furosemide plus metolazone provides sequential nephron blockade, overcoming diuretic resistance common in advanced heart failure with low GFR.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Cardiovascular System 2