ITE Cardiovascular Disease Questions and Answers

Question 1

A 68-year-old male with a history of hypertension and type 2 diabetes presents with a 2-month history of exertional chest pain.
An exercise stress test is positive for ischemia.
Coronary angiography reveals three-vessel coronary artery disease with 80% stenosis in the left main coronary artery.
His left ventricular ejection fraction is 45%.
According to the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization, which of the following is the most appropriate next step in management?

Accepted Answer

Coronary artery bypass grafting (CABG)

Answer

Percutaneous coronary intervention (PCI) with a drug-eluting stent

Answer

Continue optimal medical therapy alone

Answer

Initiate ranolazine for symptom control

Question 2

A 62-year-old female presents to the emergency department with an acute onset of shortness of breath. Her medical history is significant for hypertension. On examination, her blood pressure is 155/95 mmHg, heart rate is 105 bpm, and respiratory rate is 24 breaths/min. She has bilateral crackles on lung auscultation and 2+ pitting edema in her lower extremities. A B-type natriuretic peptide (BNP) level is markedly elevated. Transthoracic echocardiogram reveals a left ventricular ejection fraction of 35%. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure, which of the following medication classes should be initiated in this patient, in addition to a diuretic, once she is hemodynamically stable?

Accepted Answer

All of the above

Answer

An SGLT2 inhibitor

Answer

A beta-blocker

Answer

An angiotensin receptor-neprilysin inhibitor (ARNI)

Question 3

A 75-year-old asymptomatic female is found to have a harsh, crescendo-decrescendo systolic murmur at the right upper sternal border that radiates to the carotid arteries during a routine physical exam. A transthoracic echocardiogram confirms severe aortic stenosis with a valve area of 0.8 cm², a mean gradient of 50 mmHg, and a left ventricular ejection fraction of 60%. According to the 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease, which of the following is the most appropriate recommendation?

Accepted Answer

Referral for aortic valve replacement

Answer

Annual follow-up with echocardiography

Answer

Initiation of an ACE inhibitor for afterload reduction

Answer

A beta-blocker to reduce myocardial oxygen demand

Question 4

According to the 2023 AHA/ACC Guideline for the Management of Patients With Chronic Coronary Disease, which of the following statements regarding the long-term use of beta-blockers is correct?

Accepted Answer

Their long-term use is not recommended to improve outcomes in patients with CCD without a history of MI in the past year or an LVEF ≤50%.

Answer

They are recommended for all patients with a history of myocardial infarction, regardless of timing or LV function.

Answer

They should be continued indefinitely to improve outcomes in all patients with CCD.

Answer

They are contraindicated in patients with chronic coronary disease and stable angina.

Question 5

A 45-year-old woman presents to the clinic for a follow-up visit. Her blood pressure today is 148/92 mmHg. A reading last month was 145/90 mmHg. She has no other medical problems. According to the JNC 8 guidelines, what is the recommended initial treatment for her hypertension?

Accepted Answer

Hydrochlorothiazide

Answer

Amlodipine

Answer

Lisinopril

Answer

Losartan

Question 6

A 35-year-old female presents to the emergency department with pleuritic chest pain and shortness of breath that began yesterday. She has no significant past medical history but reports using oral contraceptive pills. Her vital signs are: heart rate 95 bpm, blood pressure 120/80 mmHg, respiratory rate 18, and oxygen saturation 98% on room air. There is no unilateral leg swelling. The physician has a low clinical suspicion for pulmonary embolism (PE). Which of the following would allow the physician to use the Pulmonary Embolism Rule-out Criteria (PERC) to safely exclude PE without further testing?

Accepted Answer

The patient meeting all eight PERC criteria

Answer

A negative D-dimer test

Answer

A Wells score of 1.5

Answer

A normal chest X-ray