PANRE Cardiology 2 — Questions and Answers
Question 1: A 58-year-old man with hypertension presents with exertional chest pain relieved by rest. EKG at rest is normal. Which is the most appropriate next step?
- Start isosorbide mononitrate
- Order exercise stress test (Correct answer)
- Perform coronary angiography
- Prescribe sublingual nitroglycerin and discharge
Correct answer: Order exercise stress test
An exercise stress test is the standard initial evaluation for stable angina with a normal resting EKG.
Question 2: Which finding on echocardiogram is most consistent with cardiac tamponade?
- Left ventricular hypertrophy
- Right ventricular diastolic collapse (Correct answer)
- Mitral valve prolapse
- Aortic valve stenosis with reduced leaflet excursion
Correct answer: Right ventricular diastolic collapse
Right ventricular diastolic collapse on echo is a classic sign of cardiac tamponade due to elevated pericardial pressure.
Question 3: A patient on warfarin for atrial fibrillation has an INR of 8.5 with no active bleeding. What is the most appropriate management?
- Administer IV vitamin K 10 mg
- Hold warfarin and administer oral vitamin K 2.5 mg (Correct answer)
- Administer fresh frozen plasma
- Continue warfarin and recheck INR in 24 hours
Correct answer: Hold warfarin and administer oral vitamin K 2.5 mg
For INR >8 without bleeding, holding warfarin and giving low-dose oral vitamin K is the recommended approach.
Question 4: A 70-year-old woman develops hypotension, bradycardia, and cool extremities after an inferior MI. Which territory is most likely involved?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
The right coronary artery supplies the inferior wall and the AV node, making RCA occlusion the likely cause of inferior MI with bradycardia.
Question 5: Which medication is CONTRAINDICATED in a patient with hypertrophic obstructive cardiomyopathy (HOCM) who presents with symptoms?
- Metoprolol
- Verapamil
- Nitroglycerin (Correct answer)
- Disopyramide
Correct answer: Nitroglycerin
Nitroglycerin reduces preload, worsening LVOT obstruction in HOCM and is contraindicated.
Question 6: A 65-year-old man has an EKG showing delta waves, short PR interval, and wide QRS. He develops rapid atrial fibrillation. Which drug should be AVOIDED?
- Procainamide
- Ibutilide
- Digoxin (Correct answer)
- Amiodarone (IV initial use is controversial but not first-line contraindicated)
Correct answer: Digoxin
In WPW with AF, digoxin can enhance conduction through the accessory pathway, potentially causing ventricular fibrillation.
Question 7: Which class of antihypertensive is preferred as first-line therapy in a Black patient without diabetes or heart failure?
- ACE inhibitors
- Beta-blockers
- Thiazide diuretics or calcium channel blockers (Correct answer)
- ARBs alone
Correct answer: Thiazide diuretics or calcium channel blockers
JNC and ACC/AHA guidelines recommend thiazide diuretics or calcium channel blockers as first-line therapy in Black patients due to superior efficacy.
PANRE Cardiology 2
A 58-year-old man with hypertension presents with exertional chest pain relieved by rest.
EKG at rest is normal.
Which is the most appropriate next step?