Physician Assistant Cardiovascular System Disorders 5 — Questions and Answers
Question 1: A patient with new-onset heart failure has an ejection fraction of 35%. Which combination of medications has been shown to reduce mortality?
- Digoxin + furosemide
- ACE inhibitor + beta-blocker + aldosterone antagonist (Correct answer)
- ARB + calcium channel blocker
- Nitrates + hydralazine alone
Correct answer: ACE inhibitor + beta-blocker + aldosterone antagonist
The combination of ACE inhibitor (or ARB/ARNI), beta-blocker, and aldosterone antagonist forms the evidence-based cornerstone of HFrEF therapy.
Question 2: Which type of shock is characterized by low PCWP, low SVR, and high cardiac output?
- Cardiogenic shock
- Hypovolemic shock
- Distributive (septic) shock (Correct answer)
- Obstructive shock
Correct answer: Distributive (septic) shock
Distributive shock (e.g., sepsis) features vasodilation causing low SVR and compensatory high CO with low filling pressures.
Question 3: A 62-year-old man with a history of MI presents with palpitations. ECG shows a wide complex tachycardia at 160 bpm. What is the most important initial step?
- Adenosine 6 mg IV push
- Verapamil IV
- Assume VT and treat accordingly until proven otherwise (Correct answer)
- Synchronized cardioversion only if unstable
Correct answer: Assume VT and treat accordingly until proven otherwise
Wide complex tachycardia in a patient with structural heart disease should be presumed ventricular tachycardia until proven otherwise.
Question 4: Which physical exam maneuver increases the intensity of the murmur of hypertrophic obstructive cardiomyopathy?
- Squatting
- Passive leg raise
- Valsalva maneuver (Correct answer)
- Handgrip
Correct answer: Valsalva maneuver
Valsalva decreases preload and venous return, reducing LV size and worsening outflow obstruction in HOCM, increasing the murmur.
Question 5: A patient on warfarin for AF has an INR of 8.5 with active major bleeding. What is the most appropriate immediate treatment?
- Hold warfarin and recheck INR tomorrow
- Vitamin K 10 mg IV only
- 4-factor prothrombin complex concentrate (4F-PCC) plus IV vitamin K (Correct answer)
- Fresh frozen plasma alone
Correct answer: 4-factor prothrombin complex concentrate (4F-PCC) plus IV vitamin K
Life-threatening warfarin-related bleeding requires rapid reversal with 4F-PCC for immediate effect plus IV vitamin K for sustained reversal.
Question 6: What is the most common cause of right heart failure in the United States?
- Primary pulmonary hypertension
- Left heart failure (Correct answer)
- Pulmonary embolism
- Tricuspid stenosis
Correct answer: Left heart failure
Left heart failure is the most common cause of right heart failure due to elevated pulmonary pressures transmitted to the right ventricle.
Question 7: A 55-year-old woman with systemic lupus erythematosus develops pericarditis. Which anti-inflammatory agent is typically added to NSAIDs to reduce recurrence?
- Prednisone high-dose
- Colchicine (Correct answer)
- Methotrexate
- Hydroxychloroquine
Correct answer: Colchicine
Colchicine added to NSAIDs significantly reduces the risk of recurrent pericarditis and is now standard first-line adjunct therapy.
Physician Assistant Cardiovascular System Disorders 5
A patient with new-onset heart failure has an ejection fraction of 35%.
Which combination of medications has been shown to reduce mortality?