PANRE Cardiology 3 — Questions and Answers
Question 1: A patient presents with sharp pleuritic chest pain, friction rub, and diffuse ST elevation with PR depression on EKG. What is the diagnosis?
- STEMI
- Acute pericarditis (Correct answer)
- Pulmonary embolism
- Aortic dissection
Correct answer: Acute pericarditis
Diffuse ST elevation with PR depression and friction rub are hallmark features of acute pericarditis.
Question 2: A 55-year-old man with an EF of 30% is on optimal medical therapy. His QRS is 160 ms with LBBB morphology. Which device is indicated?
- Implantable cardioverter-defibrillator (ICD) alone
- Cardiac resynchronization therapy with defibrillator (CRT-D) (Correct answer)
- Permanent pacemaker
- Left ventricular assist device (LVAD)
Correct answer: Cardiac resynchronization therapy with defibrillator (CRT-D)
CRT-D is indicated for symptomatic HFrEF with EF ≤35%, QRS ≥150 ms (especially LBBB), on optimal medical therapy.
Question 3: Which physical exam finding is most characteristic of aortic regurgitation?
- Opening snap followed by diastolic rumble
- Pulsus paradoxus
- Water-hammer pulse (bounding pulse) (Correct answer)
- Fixed split S2
Correct answer: Water-hammer pulse (bounding pulse)
The water-hammer (Corrigan's) pulse reflects the wide pulse pressure caused by rapid diastolic runoff in aortic regurgitation.
Question 4: A 45-year-old woman is found to have a serum LDL of 210 mg/dL with no cardiovascular risk factors. Initial management should include:
- High-intensity statin and aspirin
- Lifestyle modification for 3 months, then reassess (Correct answer)
- Immediate coronary calcium scoring
- Ezetimibe monotherapy
Correct answer: Lifestyle modification for 3 months, then reassess
In primary prevention with elevated LDL but no other risk factors, lifestyle modification is the initial step before pharmacotherapy.
Question 5: A patient with known heart failure presents with worsening dyspnea, orthopnea, and bilateral crackles. BNP is 1,200 pg/mL. Which medication provides the most immediate symptomatic relief?
- Oral metoprolol
- IV furosemide (Correct answer)
- Spironolactone
- Sacubitril/valsartan
Correct answer: IV furosemide
IV loop diuretics rapidly reduce preload and relieve pulmonary congestion in acute decompensated heart failure.
Question 6: Which electrocardiographic finding is most suggestive of right heart strain in acute pulmonary embolism?
- Diffuse ST depression with T-wave inversions in V4-V6
- S1Q3T3 pattern (Correct answer)
- ST elevation in leads II, III, and aVF
- Left axis deviation with RBBB
Correct answer: S1Q3T3 pattern
The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is classic for acute right heart strain in PE.
Question 7: A 72-year-old man has a murmur that decreases with standing and increases with squatting. Which diagnosis is most consistent?
- Mitral valve prolapse
- Hypertrophic obstructive cardiomyopathy (Correct answer)
- Aortic stenosis
- Tricuspid regurgitation
Correct answer: Hypertrophic obstructive cardiomyopathy
HOCM murmur increases with maneuvers that decrease preload (standing, Valsalva) and decreases with increased preload (squatting).
PANRE Cardiology 3
A patient presents with sharp pleuritic chest pain, friction rub, and diffuse ST elevation with PR depression on EKG.
What is the diagnosis?