PANCE Cardiovascular System 3

Question 1

A 60-year-old woman with atrial fibrillation has a CHA₂DS₂-VASc score of 4. She has no contraindications. Which anticoagulation is preferred?

Accepted Answer

Direct oral anticoagulant (DOAC)

Answer

DOACs are preferred over warfarin for non-valvular atrial fibrillation due to superior efficacy, safety, and convenience without routine INR monitoring.

Question 2

A patient develops hypotension, bradycardia, and diaphoresis minutes after inferior wall STEMI. Which artery is most likely occluded?

Accepted Answer

Right coronary artery

Answer

The right coronary artery supplies the inferior wall, SA node, and AV node; its occlusion causes inferior STEMI with bradycardia and hypotension.

Question 3

Which physical exam finding is pathognomonic for constrictive pericarditis?

Accepted Answer

Kussmaul sign

Answer

Kussmaul sign (paradoxical rise in JVP with inspiration) is the hallmark of constrictive pericarditis due to impaired right heart filling against a rigid pericardium.

Question 4

A 50-year-old man with dilated cardiomyopathy and EF of 25% is on optimal medical therapy. Which device therapy reduces mortality most significantly?

Accepted Answer

Implantable cardioverter-defibrillator (ICD)

Answer

ICD implantation reduces sudden cardiac death in patients with EF ≤35% and symptomatic heart failure on optimal medical therapy per MADIT-II and SCD-HeFT trials.

Question 5

A 35-year-old woman develops sudden-onset severe headache and is found to have markedly elevated blood pressure (240/130 mmHg) with papilledema. Which agent should be avoided?

Accepted Answer

Nitroprusside IV

Answer

Nitroprusside is metabolized to cyanide and can increase intracranial pressure, making it problematic in hypertensive emergency with neurologic involvement.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Cardiovascular System 3