Physician Assistant Cardiovascular System Disorders 4 — Questions and Answers
Question 1: Which finding is MOST characteristic of constrictive pericarditis on physical exam?
- Loud S1 heart sound
- Kussmaul's sign (JVD increasing with inspiration) (Correct answer)
- Pulsus alternans
- Friction rub that disappears with leaning forward
Correct answer: Kussmaul's sign (JVD increasing with inspiration)
Kussmaul's sign — paradoxical rise in JVP during inspiration — is a classic finding in constrictive pericarditis.
Question 2: A 30-year-old athlete collapses during a basketball game. ECG shows asymmetric septal hypertrophy. What is the most likely diagnosis?
- Dilated cardiomyopathy
- Hypertrophic obstructive cardiomyopathy (Correct answer)
- Arrhythmogenic right ventricular cardiomyopathy
- Myocarditis
Correct answer: Hypertrophic obstructive cardiomyopathy
HOCM is the most common cause of sudden cardiac death in young athletes and presents with asymmetric septal hypertrophy.
Question 3: Which statement about the management of STEMI is correct?
- Fibrinolysis is preferred over PCI when door-to-balloon time is under 90 minutes
- Primary PCI is preferred when door-to-balloon time is under 120 minutes (Correct answer)
- Anticoagulation is not required if PCI is performed
- Aspirin should be withheld until after revascularization
Correct answer: Primary PCI is preferred when door-to-balloon time is under 120 minutes
Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed within 90-120 minutes of first medical contact.
Question 4: A patient's ECG shows a prolonged PR interval, but all P waves are conducted. What rhythm is this?
- Second-degree AV block Mobitz I
- Second-degree AV block Mobitz II
- First-degree AV block (Correct answer)
- Third-degree AV block
Correct answer: First-degree AV block
First-degree AV block is defined by a PR interval >200 ms with all P waves conducted to the ventricles.
Question 5: A patient with peripheral artery disease has an ABI of 0.55. What does this indicate?
- Normal arterial perfusion
- Mild PAD
- Moderate-to-severe PAD (Correct answer)
- Non-compressible vessels (calcification)
Correct answer: Moderate-to-severe PAD
An ABI of 0.41–0.70 indicates moderate-to-severe peripheral arterial disease with significant hemodynamic compromise.
Question 6: Which medication class is first-line for long-term rate control in atrial fibrillation in a patient with heart failure with reduced ejection fraction?
- Non-dihydropyridine calcium channel blockers
- Digoxin alone
- Beta-blockers (Correct answer)
- Class IC antiarrhythmics
Correct answer: Beta-blockers
Beta-blockers (e.g., carvedilol, metoprolol succinate) are first-line for rate control in AF with HFrEF and provide mortality benefit.
Question 7: A 50-year-old woman presents with dyspnea and a loud S2 with fixed splitting. What is the most likely diagnosis?
- Ventricular septal defect
- Atrial septal defect (Correct answer)
- Patent ductus arteriosus
- Pulmonary stenosis
Correct answer: Atrial septal defect
Fixed wide splitting of S2 that does not vary with respiration is pathognomonic for an atrial septal defect.
Physician Assistant Cardiovascular System Disorders 4
Which finding is MOST characteristic of constrictive pericarditis on physical exam?