ECS2019-Certificates – Medgress Submission Portal

CASE-BASED QUESTIONS

The following questions are designed to help you and the faculty gauge current understanding of concepts in cardiovascular care that were addressed in the course. Individual scores are not provided to the faculty. Responses are confidential and only reported in aggregate.

A 67 year old man presents for recommendations regarding lipid management. He has a history of PCI of the RCA following NSTEMI 2 years ago. He has known diabetes and hypertension. He is tolerating therapy with atorvastatin 80 mg daily. His current lipid panel shows: Total cholesterol: 151 mg/dL, HDL cholesterol: 40 mg/dL, LDL cholesterol: 68 mg/dL, Triglycerides: 217 mg/dL. Based on the results of the REDUCE-IT trial, which ONE of the following is CORRECT regarding the expectations for this patient with the addition of icosapent ethyl to statin therapy?*

The addition of icosapent ethyl should be avoided due to an increased risk of major bleeding.
The addition of icosapent ethyl is associated with a relative risk reduction of 21% for new onset atrial fibrillation.
The addition of icosapent ethyl is associated with 25% reduction in CV death, MI, stroke, revascularization, and unstable angina.
The addition of icosapent ethyl should be avoided due to an increased risk of worsening glycemic control in patients with diabetes.

Which of the following electrocardiographic criteria has the highest sensitivity and specificity to determine if a wide complex tachycardia is most likely ventricular tachycardia?*

Absence of an RS complex in all precordial leads
A-V dissociation
Longest R to S interval > 100ms in any precordial lead
Presence of an initial r or q wave > 40 ms in aVR
R wave peak time > 50 ms in lead DII

According to the 2019 ACC/AHA Primary Prevention Guidelines, which ONE of the following is CORRECT regarding the use of aspirin?*

Aspirin 325 mg daily should be considered for patients with 10-year ASCVD risk of >7.5 to 19.9% who are not at increased risk of bleeding.
Aspirin 75-100 mg daily might be considered among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk.
Aspirin 75-100 mg daily should be administered for the primary prevention of stroke among adults >70 years of age.
Low-dose aspirin (75-100 mg orally daily) is not associated with an increased bleeding risk when compared to full dose aspirin (325 mg daily) for the primary prevention of ASCVD.

Regarding the end diameter of systole as a surgical indicator in asymptomatic aortic regurgitation:*

The 55mm cut-off point is the most robust mortality indicator
The 25 mm / m2 cut-off point is the most robust mortality indicator
The 50mm cut-off point is the most robust mortality indicator
The 20 mm / m2 cut-off point is the most robust mortality indicator

A 70-year-old woman presents to your clinic for evaluation of her progressive lower extremity edema and dyspnea on exertion. Her medical history includes hypertension, diabetes, and chronic kidney disease. She is on lisinopril, hydrochlorothiazide, and insulin. Transthoracic echo reveals left ventricular (LV) ejection fraction of 65%, moderate concentric LV hypertrophy, normal valvular function, pulmonary artery systolic pressure of 45 mm Hg, and E/e' ratio of 18. Which the following therapies have been proven effective to reduce her mortality from her heart failure with preserved ejection fraction (HFpEF)?*

A 60-year-old man with a history of Type 2 IDDM, hypertension, and hyperlipidemia presents to emergency department 2 hours after onset of typical chest pain and dyspnea. The patient appears diaphoretic, pale and anxious. On initial evaluation BP: 80/60, HR: 120bpm, and RR: 24. The EKG shows ST segment elevation in the anterior leads. The patient is taken to the catheterization lab for an emergent PCI. Which of the following statements regarding hemodynamic support for this patient is correct according to the ACC/AHA guidelines?*

IABP counter-pulsation is recommended in every STEMI case
IABP counter-pulsation is recommended in every STEMI case complicated with cardiogenic shock
Percutaneous LV support devices are recommended in every STEMI case complicated with shock
IABP counter-pulsation is recommended for patients with STEMI complicated by cardiogenic shock who do not quickly stabilize with pharmacological therapy.
Percutaneous LV support devices are recommended for patients with STEMI complicated by cardiogenic shock who do not quickly stabilize with pharmacological therapy.

You are advising your patient with HFrEF and atrial fibrillation regarding the choice between atrial fibrillation ablation versus medical therapy. Based on CASTLE-AF data, and the 2019 ACC Atrial Fibrillation Guideline, you will inform them that AF ablation is a reasonable option that may:*

Reduce their risk of stroke and death.
Reduce their risk of inappropriate ICD shocks and death.
Reduce their risk of death and hospitalization for heart failure.
Reduce their risk of stroke and hospitalization for heart failure.

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CASE-BASED QUESTIONS

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