PANCE Cardiovascular System 4

Question 1

A 65-year-old man with hypertension and diabetes presents with exertional dyspnea and preserved ejection fraction (60%). BNP is elevated. What is the most likely diagnosis?

Accepted Answer

Heart failure with preserved ejection fraction (HFpEF)

Answer

HFpEF is characterized by symptoms of heart failure with EF ≥50%, commonly seen in elderly patients with hypertension and diabetes who have impaired diastolic relaxation.

Question 2

A 40-year-old woman presents with exertional dyspnea and a loud S1 with an opening snap. Echocardiogram shows a mitral valve area of 1.2 cm². What is the preferred intervention?

Accepted Answer

Percutaneous mitral balloon valvuloplasty

Answer

Percutaneous mitral balloon valvuloplasty is the procedure of choice for symptomatic severe mitral stenosis with favorable valve morphology (pliable, non-calcified leaflets).

Question 3

A 30-year-old marathon runner collapses during a race. His ECG shows deep T-wave inversions in V1-V4 and epsilon waves. What is the most likely diagnosis?

Accepted Answer

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

Answer

ARVC is characterized by epsilon waves, T-wave inversions in right precordial leads, and fatty replacement of the right ventricular myocardium, causing ventricular arrhythmias.

Question 4

A patient post-MI develops a new harsh holosystolic murmur at the left sternal border with a thrill. Echo shows a step-up in oxygen saturation from right atrium to right ventricle. What is the diagnosis?

Accepted Answer

Ventricular septal defect

Answer

Post-MI ventricular septal defect causes a left-to-right shunt with oxygen step-up from RA to RV and presents with a harsh holosystolic murmur and thrill.

Question 5

A 58-year-old man with peripheral artery disease has an ankle-brachial index (ABI) of 0.55. He has rest pain. Next best step?

Accepted Answer

Referral for revascularization

Answer

An ABI <0.6 with rest pain indicates critical limb ischemia (CLI), which requires urgent revascularization to prevent limb loss.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Cardiovascular System 4