Physician Assistant Cardiovascular System Disorders 3 — Questions and Answers
Question 1: A 45-year-old man presents with sudden severe tearing chest pain radiating to the back. BP is 180/100 in the right arm and 140/80 in the left arm. What is the most likely diagnosis?
- Acute STEMI
- Pulmonary embolism
- Aortic dissection (Correct answer)
- Esophageal rupture
Correct answer: Aortic dissection
Asymmetric blood pressures combined with tearing back pain are classic for aortic dissection.
Question 2: Which medication is contraindicated in a patient with decompensated heart failure and an ejection fraction of 20%?
- Carvedilol initiated at low dose (Correct answer)
- IV furosemide
- Dobutamine infusion
- Nitrates for preload reduction
Correct answer: Carvedilol initiated at low dose
Beta-blockers should not be started during decompensated HF; they should only be initiated once the patient is stabilized.
Question 3: A patient with known HFrEF reports dizziness after starting a new medication. Potassium is 5.9 mEq/L and creatinine has risen. Which drug is most likely responsible?
- Metoprolol succinate
- Spironolactone (Correct answer)
- Digoxin
- Hydralazine
Correct answer: Spironolactone
Spironolactone, a potassium-sparing aldosterone antagonist, commonly causes hyperkalemia and can worsen renal function.
Question 4: Wolff-Parkinson-White syndrome involves which anatomical abnormality?
- Hypertrophied bundle of His
- Accessory conduction pathway (Bundle of Kent) bypassing the AV node (Correct answer)
- Dilated coronary sinus
- Abnormal SA node automaticity
Correct answer: Accessory conduction pathway (Bundle of Kent) bypassing the AV node
WPW is caused by an accessory pathway (Bundle of Kent) that bypasses the AV node, allowing pre-excitation of the ventricles.
Question 5: Which of the following ECG changes is MOST specific for hyperkalemia?
- ST depression in lateral leads
- Peaked T waves (Correct answer)
- Q waves in inferior leads
- Left bundle branch block
Correct answer: Peaked T waves
Peaked, narrow, symmetrical T waves are the earliest and most characteristic ECG finding in hyperkalemia.
Question 6: A patient with mitral stenosis is most at risk for which complication?
- Ventricular fibrillation
- Atrial fibrillation and systemic embolism (Correct answer)
- Complete heart block
- Ventricular tachycardia
Correct answer: Atrial fibrillation and systemic embolism
Mitral stenosis causes left atrial enlargement, predisposing to atrial fibrillation and thrombus formation with embolic risk.
Question 7: A 65-year-old woman with diabetes presents with fatigue and jaw pain during exertion but denies chest pain. Troponin is elevated. What is the most likely diagnosis?
- Musculoskeletal pain
- Anxiety disorder
- Acute coronary syndrome (Correct answer)
- GERD
Correct answer: Acute coronary syndrome
Diabetic patients often have atypical ACS presentations (jaw pain, fatigue) due to autonomic neuropathy masking classic chest pain.
Physician Assistant Cardiovascular System Disorders 3
A 45-year-old man presents with sudden severe tearing chest pain radiating to the back.
BP is 180/100 in the right arm and 140/80 in the left arm.
What is the most likely diagnosis?