Physician Assistant Cardiovascular System Disorders 2 — Questions and Answers
Question 1: A 58-year-old man presents with exertional chest pain relieved by rest. ECG at rest is normal. What is the most appropriate next diagnostic step?
- Coronary angiography
- Exercise stress test (Correct answer)
- Echocardiogram
- Holter monitor
Correct answer: Exercise stress test
Exercise stress testing is the standard initial evaluation for stable angina when the resting ECG is normal.
Question 2: Which finding on echocardiography is most consistent with cardiac tamponade?
- Left ventricular hypertrophy
- Diastolic collapse of the right ventricle (Correct answer)
- Mitral valve prolapse
- Aortic stenosis gradient
Correct answer: Diastolic collapse of the right ventricle
Diastolic right ventricular collapse is the classic echocardiographic sign of cardiac tamponade due to elevated pericardial pressure.
Question 3: A patient with hypertension develops a blood pressure of 210/120 mmHg with headache and papilledema. How should this be managed?
- Oral labetalol and discharge
- IV nitroprusside with continuous BP monitoring (Correct answer)
- Sublingual nifedipine
- Furosemide IV bolus only
Correct answer: IV nitroprusside with continuous BP monitoring
Hypertensive emergency with end-organ damage requires IV antihypertensives with controlled, gradual BP reduction.
Question 4: What is the primary mechanism of action of digoxin in atrial fibrillation?
- Blocks sodium channels in atrial cells
- Enhances vagal tone to slow AV node conduction (Correct answer)
- Directly cardioverts AF to sinus rhythm
- Blocks potassium channels to prolong action potential
Correct answer: Enhances vagal tone to slow AV node conduction
Digoxin slows ventricular rate in AF primarily by increasing vagal tone and decreasing AV nodal conduction.
Question 5: A 70-year-old woman with dyspnea has an S3 gallop, bilateral crackles, and JVD. Which BNP level best supports acute decompensated heart failure?
- BNP 30 pg/mL
- BNP 120 pg/mL
- BNP 850 pg/mL (Correct answer)
- BNP 50 pg/mL
Correct answer: BNP 850 pg/mL
BNP >100 pg/mL strongly supports heart failure; levels above 400-500 pg/mL are highly specific for decompensated HF.
Question 6: Which valve disorder characteristically produces a mid-systolic click followed by a late systolic murmur?
- Aortic stenosis
- Mitral stenosis
- Mitral valve prolapse (Correct answer)
- Tricuspid regurgitation
Correct answer: Mitral valve prolapse
Mitral valve prolapse produces a mid-systolic click with a late systolic murmur heard best at the apex.
Question 7: A patient on amiodarone develops thyroid dysfunction. Which pattern is MOST common?
- Hyperthyroidism due to iodine excess only
- Hypothyroidism (Correct answer)
- Thyroid storm
- Euthyroid sick syndrome
Correct answer: Hypothyroidism
Amiodarone-induced hypothyroidism is the most common thyroid side effect, especially in iodine-sufficient populations.
Physician Assistant Cardiovascular System Disorders 2
A 58-year-old man presents with exertional chest pain relieved by rest.
ECG at rest is normal.
What is the most appropriate next diagnostic step?