1. (23) A 60 yo man presented to the cardiovascukar clinic for consultation.

He
described typical angina climbing one flight of stairs. Symptomps was
improved with ISDN 5mg SL. He was smoker and had history of hypertension
for 5 yrs wich was controlled with amlodipine 5 mg od. Resting ECG was
normal. Which of the following statementsabout the case is correct?
a. Coronary angiography is indicated because high risk patient
b. Coronary angiography is inappropriate because the patientis stable and
well controlled with medicamentosa
c. Coronary angiography is appropriate for the patient without prior
noninvasive stress test
d. Risk statfication with noninvasive stress testhas to be done before refers
the patient to cath lab for coronary angiography
2. (24) A 78 yo diabetic male is referred to your clinic for preoperativeevaluation
priorto left knee replacement. He currently can only walk 1 -2 blocks before
shopping, but he is limited by knee pain and deries angina or shortness of
breath. He has an adenosine sestamibi stress test that demonstrates a small
area of ischemia at the apex. Hje didintany discomfort during the test. He is
currently on 81 mg aspirin daily and has adequate beta blocker with
metoprolol. His vital are:HR 62bpm, BP 118/70mmHg, LDL 68mg/Dl, HDL 45
mg/Dl, TG 98 mg/Dl
Your next step is:
a. Proceed to coronary angiogram to perform PCI on the LAD
b. Increase aspirin to 325 mg daily and continue beta blocker
c. Tell patient that nothing further evaluation is needed at this time
d. Advice patient to postpone surgery for further diagnostic testing
e. Proceed to aconary angiogram to define the anatomy
3. (25) according to the ACCF/ AHA 2009 Focused update of the 2005 guidelines
for the diagnostic and management of heart failure in adults which of the
following is a class I recommendation for the prevention of chronic HF in
patients at high risk of developing HF?
a. Beta blocker can be usefull to prevent HF in patient at high risk for
developingHF who have a history of atherosclerotic vascular disease,
diabetic mellitus, or hypertension with associated cardiovascular risk
factors.
b. Angiotensin II receptor blockers can be usefull to prevent HF in patients at
high risk developing HF who have history of atherosclerotic vascular
disease, diabetic mellitus, or hypertension with associated cardiovascular
risk factors.
c. Routine uise of nutritional supplements to prevent the development of
structural heart disease is recommended
d. Angiotensin-converting enzyme inhibitors can be useful to prevent HF in
patient at high risk for developingHF who have a history of atherosclerotic
vascular disease, diabetic mellitus, or hypertension with associated
cardiovascular risk factors.
e. Thyroid disorders should be treated in accordance with contemporary
guidelines

4. (26) A 42-years old male nurse in a rural emergency room

develompscrushinh chest pain 30 minutes after he smoked a cigarette during
a break in his shift. An ECG is performed
What is the most appropriate intervention?
a. Treat with intravenous metoprolol 5mg three times
b. Initiate fibrinolytic therapy with reseplase with adjunctive treatment with
aspirin and intravenous heparin
c. Treat with intravenous verapamil for vasospasm
d. Load with cpg 600mg and initiate heparin for a diagnosis of NSTEMI ACS
e. Load with prasugrel 60mgonce daily and transfer for primary PCI to a
laboratory 4 hours away
5. (27) Which of the following statements is true concerning the comparison of
primary PCI and thrombolysis in the treatment of AMI?
a. Success rates of rescue PCI fter failed thrombolysis are similar to those of
primary PCI
b. Survival with PCI in an 74-years old diabetic female who presents 2 hrs
after the onset og MI with cardiogenic shock is likelyto better than with
aggres-sve medical treatment including thrombolysis
c. Survival benefit with primary PCI compared to thrombolysis is confined to
anterior MI
d. Successful PCI and survival benefit with primary PCI is not associatedwith
operator volume
e. Survival is higher among eldery patients if treated with thrombolytic
agents rather than primary PCI
6. (28) A 63 years old woman present to the clinic after episode of sudden
transient left sided vision loss. Symptomps lasted about 15minutes with
spontaneous resolution. Her past medical historyis significant for ananterior
MI 3 weeksago treated with PCI with bore metal stent (BMS) to the left
anterior descending artery (LAD). Other medical conditions include
hypertension, type-2 diabetesmelitus, and hyperlipidemia. Current
medications are aspirin. Prasugrel, atorvastatin, metformin, and metoprolol.
Physicalexamination is normal. There are no carotid bruits. Ophthalmologic
examination is within normal limits. An ECG reveals sinus rhythm with
persisten ST elevations in V2 to V4.
What is the next step in management?
a. Left heart catheterization
b. MRI of the brain with contrast
c. Transthoracic echocardiogram
d. Carotid ultrasound
e. Exercise stress test eith nuclear imaging
7. (40) AN 85 yo man presnts with increasing internsity of his typical angina
pain associated with shortness of breath. His ECG isunchanged from prior
tracings. He has a history of established coronary artery disease and has
previously refused revascularization. A decision is made to mangae him
conservatively. Which of the following interventions woulb be considered
inappropriate?

a. Continue treatment with aspirin

b. Initiation of anticoagulation with fondaparinux
c. Treatment with cpg 300 mg followed by 75 mg daily
d. Initiate treatment with prasugrel bolus 60mg followed by 5 mg once daily
e. Increase the dosage of prior beta blocker therapy
8. (35) A 70 yo farmer presents with 3 days of intermittent chest pressure and
dyspepnea with minimal exertion. He had one episode of nocturnal
dyspepnea 3 days prior. He is currently asymptomatic. His past medical
history includes HTN and hyperlipidemia. He is currently medicated with
metoprolol 25 mg twice daily and aspirin 325 mg daily. On physical
examination his BP is 140/35 mmHg and his HR is 76 bpm and regular. His JVP
is normal. His carotid upstrokes are normal and without bruits. His lungs are
clear to auscultation. His heart has a regular rate and rhythm. The apical
impulse is in the normal location and of normal quality. The first and second
heart sounds are normal. There ae no murmurs or gallops appreciated. The
abdomen is soft with no masses or bruits. The extremiteshave no clubbing,
cyanosis, or edema, and the peripheral pulse are normal. The ECG shows
nonspecific ST-T wave changes without frank elevation or depression. The
chest x-ray is interpreted as normal. CBC, electrolytes and cardiac biomarker
are all negative. The best step is:
a. Increase beta blocker and add nitrates,followed by noninvasive stress
testing
b. Pharmacologic stress testing
c. Start therapy with trofban 0,1 mcg/kg/min
d. Diagnostic coronary angiography with possible percutaneous
revascularization
e. Either A or B