, Question 1
Which hemodynamic profile best distinguishes cardiogenic shock from
distributive (septic) shock in a patient with acute decompensated heart failure?
A. Cardiac index <2.2 L/min/m² with elevated SVR; septic shock shows
elevated CI with low SVR
B. Elevated CVP with low SVR in both; differentiation requires lactate
clearance only
C. Low PAOP with high SVR in cardiogenic; high PAOP with low SVR
in septic
D. Mixed venous oxygen saturation >75% in cardiogenic; <50% in septic
Correct Answer: A - Cardiac index <2.2 L/min/m² with elevated
SVR; septic shock shows elevated CI with low SVR
RATIONALE
Cardiogenic shock is a low-output state (CI <2.2) with compensatory
vasoconstriction (high SVR), whereas septic shock is a high-output,
vasodilated state (high CI, low SVR). Option C reverses PAOP and
SVR values, and option D misstates SvO2 patterns, which are
typically low in both due to inadequate delivery or extraction.
Question 2
A patient with nonvalvular atrial fibrillation and a CHADS-VASc score of 4
has normal renal function. Which anticoagulation strategy reflects current
guideline-concordant practice?
A. Aspirin 81 mg daily indefinitely
B. Apixaban 5 mg twice daily
C. Warfarin with target INR 1.5-2.0
D. Dual antiplatelet therapy with aspirin and clopidogrel
Correct Answer: B - Apixaban 5 mg twice daily
Page 2
, RATIONALE
For a CHADS-VASc score 2, direct oral anticoagulants such as
apixaban are first-line for stroke prevention in nonvalvular AF.
Aspirin and dual antiplatelet therapy are inadequate for stroke
prophylaxis, and a warfarin INR target of 1.5-2.0 is subtherapeutic
(goal 2.0-3.0).
Question 3
Which ECG finding most reliably indicates a true posterior myocardial
infarction rather than anterior ST-elevation myocardial infarction?
A. ST elevation in V1-V2 with tall R waves and upright T waves
B. ST depression in V1-V3 with tall R waves and upright T waves
C. ST elevation in V3-V4 with reciprocal depression in II, III, aVF
D. New left bundle branch block with concordant ST changes
Correct Answer: B - ST depression in V1-V3 with tall R waves
and upright T waves
RATIONALE
True posterior MI presents with reciprocal ST depression in V1-V3,
dominant R waves, and upright T waves (the mirror image of posterior
injury). Anterior STEMI shows ST elevation in precordial leads, and
new LBBB is a separate high-risk finding, not the posterior pattern.
Question 4
Which mechanism best explains why low-dose aspirin is continued indefinitely
after coronary artery bypass grafting while dual antiplatelet therapy is typically
reserved for acute coronary syndrome or PCI?
A. Aspirin irreversibly inhibits platelet COX-1, providing durable graft
patency benefit; DAPT adds bleeding risk without proven benefit in
stable post-CABG patients
B. Aspirin's antithrombotic effect is reversible, allowing safer
perioperative management
Page 3
Which hemodynamic profile best distinguishes cardiogenic shock from
distributive (septic) shock in a patient with acute decompensated heart failure?
A. Cardiac index <2.2 L/min/m² with elevated SVR; septic shock shows
elevated CI with low SVR
B. Elevated CVP with low SVR in both; differentiation requires lactate
clearance only
C. Low PAOP with high SVR in cardiogenic; high PAOP with low SVR
in septic
D. Mixed venous oxygen saturation >75% in cardiogenic; <50% in septic
Correct Answer: A - Cardiac index <2.2 L/min/m² with elevated
SVR; septic shock shows elevated CI with low SVR
RATIONALE
Cardiogenic shock is a low-output state (CI <2.2) with compensatory
vasoconstriction (high SVR), whereas septic shock is a high-output,
vasodilated state (high CI, low SVR). Option C reverses PAOP and
SVR values, and option D misstates SvO2 patterns, which are
typically low in both due to inadequate delivery or extraction.
Question 2
A patient with nonvalvular atrial fibrillation and a CHADS-VASc score of 4
has normal renal function. Which anticoagulation strategy reflects current
guideline-concordant practice?
A. Aspirin 81 mg daily indefinitely
B. Apixaban 5 mg twice daily
C. Warfarin with target INR 1.5-2.0
D. Dual antiplatelet therapy with aspirin and clopidogrel
Correct Answer: B - Apixaban 5 mg twice daily
Page 2
, RATIONALE
For a CHADS-VASc score 2, direct oral anticoagulants such as
apixaban are first-line for stroke prevention in nonvalvular AF.
Aspirin and dual antiplatelet therapy are inadequate for stroke
prophylaxis, and a warfarin INR target of 1.5-2.0 is subtherapeutic
(goal 2.0-3.0).
Question 3
Which ECG finding most reliably indicates a true posterior myocardial
infarction rather than anterior ST-elevation myocardial infarction?
A. ST elevation in V1-V2 with tall R waves and upright T waves
B. ST depression in V1-V3 with tall R waves and upright T waves
C. ST elevation in V3-V4 with reciprocal depression in II, III, aVF
D. New left bundle branch block with concordant ST changes
Correct Answer: B - ST depression in V1-V3 with tall R waves
and upright T waves
RATIONALE
True posterior MI presents with reciprocal ST depression in V1-V3,
dominant R waves, and upright T waves (the mirror image of posterior
injury). Anterior STEMI shows ST elevation in precordial leads, and
new LBBB is a separate high-risk finding, not the posterior pattern.
Question 4
Which mechanism best explains why low-dose aspirin is continued indefinitely
after coronary artery bypass grafting while dual antiplatelet therapy is typically
reserved for acute coronary syndrome or PCI?
A. Aspirin irreversibly inhibits platelet COX-1, providing durable graft
patency benefit; DAPT adds bleeding risk without proven benefit in
stable post-CABG patients
B. Aspirin's antithrombotic effect is reversible, allowing safer
perioperative management
Page 3
