PANCE Cardiovascular System 5 — Questions and Answers
Question 1: A 70-year-old man with history of MI 10 years ago presents with a pulsatile abdominal mass. Ultrasound shows infrarenal aortic diameter of 6 cm. What is the recommended management?
- Watchful waiting with repeat ultrasound in 1 year
- Beta-blocker therapy
- Elective surgical or endovascular repair (Correct answer)
- Emergency surgery only if symptomatic
Correct answer: Elective surgical or endovascular repair
Abdominal aortic aneurysms ≥5.5 cm in men warrant elective repair due to high rupture risk; endovascular repair (EVAR) is preferred if anatomy allows.
Question 2: A neonate is diagnosed with transposition of the great arteries. Which immediate intervention maintains cardiac output prior to surgical correction?
- IV furosemide
- Prostaglandin E1 infusion (Correct answer)
- Digoxin
- Atropine
Correct answer: Prostaglandin E1 infusion
Prostaglandin E1 keeps the ductus arteriosus patent, allowing mixing of oxygenated and deoxygenated blood until definitive arterial switch operation.
Question 3: A 48-year-old man is found to have a total cholesterol of 280, LDL 190, HDL 38, and triglycerides 250. He has no cardiovascular disease. What is the primary treatment target?
- Raise HDL with niacin
- Lower triglycerides with fibrate
- Lower LDL with high-intensity statin (Correct answer)
- Lower total cholesterol with bile acid sequestrant
Correct answer: Lower LDL with high-intensity statin
High-intensity statin therapy targeting LDL reduction is the primary intervention for primary prevention in patients with LDL ≥190 mg/dL per ACC/AHA guidelines.
Question 4: A 63-year-old woman with known CAD presents 30 minutes after onset of crushing chest pain. EKG shows 3 mm ST elevation in leads II, III, aVF. Door-to-balloon time capability is 45 minutes. Best treatment?
- Thrombolytics (tPA)
- Primary percutaneous coronary intervention (PCI) (Correct answer)
- Heparin drip alone
- Urgent CABG
Correct answer: Primary percutaneous coronary intervention (PCI)
Primary PCI is the preferred reperfusion strategy for STEMI when door-to-balloon time is ≤90 minutes, offering superior outcomes over thrombolytics.
Question 5: A patient with chronic atrial flutter is found to have a ventricular rate of 150 bpm with a sawtooth pattern at 300 bpm. Which medication would most reliably convert this to sinus rhythm?
- Metoprolol
- Digoxin
- Ibutilide (Correct answer)
- Verapamil
Correct answer: Ibutilide
Ibutilide, a class III antiarrhythmic, is highly effective for chemical cardioversion of atrial flutter, with conversion rates of approximately 60-70%.
Question 6: A 55-year-old man presents with claudication. Doppler shows ABI of 0.72 at rest, dropping to 0.45 post-exercise. What is the first-line treatment?
- Immediate revascularization
- Supervised exercise therapy and cilostazol (Correct answer)
- Warfarin anticoagulation
- Compression stockings
Correct answer: Supervised exercise therapy and cilostazol
Supervised exercise rehabilitation plus cilostazol (a phosphodiesterase inhibitor) is first-line for claudication from PAD, improving walking distance and quality of life.
Question 7: A patient with end-stage renal disease on dialysis develops hypotension with distended neck veins and muffled heart sounds. CXR shows enlarged cardiac silhouette. Immediate management is:
- IV fluid bolus
- Emergent dialysis
- Pericardiocentesis (Correct answer)
- IV furosemide
Correct answer: Pericardiocentesis
Beck's triad (hypotension, JVD, muffled heart sounds) indicates cardiac tamponade, which requires immediate pericardiocentesis to relieve life-threatening pericardial pressure.
PANCE Cardiovascular System 5
A 70-year-old man with history of MI 10 years ago presents with a pulsatile abdominal mass.
Ultrasound shows infrarenal aortic diameter of 6 cm.
What is the recommended management?