PANCE Cardiovascular System 5

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?

Accepted Answer

Elective surgical or endovascular repair

Answer

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?

Accepted Answer

Prostaglandin E1 infusion

Answer

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?

Accepted Answer

Lower LDL with high-intensity statin

Answer

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?

Accepted Answer

Primary percutaneous coronary intervention (PCI)

Answer

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?

Accepted Answer

Ibutilide

Answer

Ibutilide, a class III antiarrhythmic, is highly effective for chemical cardioversion of atrial flutter, with conversion rates of approximately 60-70%.

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PANCE Cardiovascular System 5