PANRE Cardiology 4 — Questions and Answers
Question 1: A 60-year-old woman with no prior cardiac history develops new onset palpitations. EKG shows absent P waves, irregularly irregular rhythm, and rate of 130 bpm. She is hemodynamically stable. What is the first-line rate control agent?
- Adenosine IV
- Digoxin IV
- Metoprolol IV (Correct answer)
- Amiodarone IV
Correct answer: Metoprolol IV
IV metoprolol (a beta-blocker) is first-line for rate control in hemodynamically stable atrial fibrillation.
Question 2: Which lipid abnormality pattern is most associated with metabolic syndrome?
- Elevated LDL with normal triglycerides
- Low HDL with elevated triglycerides (Correct answer)
- Elevated LDL with low triglycerides
- Isolated elevated HDL
Correct answer: Low HDL with elevated triglycerides
Metabolic syndrome characteristically presents with hypertriglyceridemia and low HDL cholesterol, along with insulin resistance.
Question 3: A patient develops acute ST depression in V4-V6 during a stress test at 6 METs with chest pain and 20 mmHg drop in systolic BP. What is the appropriate next step?
- Continue the test to achieve target heart rate
- Stop the test and schedule elective angiography
- Stop the test immediately and arrange urgent evaluation (Correct answer)
- Administer nitroglycerin and resume testing
Correct answer: Stop the test immediately and arrange urgent evaluation
ST depression with hypotension and chest pain at low workload indicates high-risk findings, requiring immediate test termination and urgent cardiac evaluation.
Question 4: Which medication has been shown to reduce mortality in patients with stable chronic heart failure with reduced ejection fraction (HFrEF)?
- Amlodipine
- Furosemide
- Carvedilol (Correct answer)
- Digoxin
Correct answer: Carvedilol
Carvedilol, a non-selective beta-blocker, is one of the three beta-blockers proven to reduce mortality in HFrEF (along with metoprolol succinate and bisoprolol).
Question 5: A 50-year-old man presents with tearing chest pain radiating to the back, unequal arm blood pressures, and a widened mediastinum on CXR. Which is the most appropriate immediate next step?
- Administer IV heparin and urgent cath
- CT angiography of the chest (Correct answer)
- Transthoracic echocardiogram
- Start thrombolytics
Correct answer: CT angiography of the chest
CT angiography of the chest is the preferred imaging modality to rapidly confirm aortic dissection and define its extent.
Question 6: Which valve lesion most commonly causes dysphagia due to left atrial enlargement compressing the esophagus?
- Aortic stenosis
- Mitral stenosis (Correct answer)
- Tricuspid regurgitation
- Pulmonary stenosis
Correct answer: Mitral stenosis
Mitral stenosis causes progressive left atrial enlargement; the enlarged LA can compress the esophagus, causing dysphagia.
Question 7: A 68-year-old diabetic woman presents with fatigue, nausea, and diaphoresis for 2 hours. EKG shows new ST elevation in V1-V4. Which vessels is most likely occluded?
- Right coronary artery
- Left circumflex artery
- Left anterior descending artery (Correct answer)
- Obtuse marginal branch
Correct answer: Left anterior descending artery
Anterior STEMI (V1-V4) results from occlusion of the left anterior descending (LAD) artery.
PANRE Cardiology 4
A 60-year-old woman with no prior cardiac history develops new onset palpitations.
EKG shows absent P waves, irregularly irregular rhythm, and rate of 130 bpm.
She is hemodynamically stable.
What is the first-line rate control agent?