MKSAP 19 – CARDIOLOGY EXAM COMPLETE
QUESTIONS AND ANSWERS 2025
Chest pain at night or at rest or use of illicit substances (methamphetamines,
cocaine), 5-FU
Coronary vasospasm
A tall, thin person with long arms with tearing acute chest and back pain
Marfan syndrome and aortic dissection
A patient with sharp or pleuritic chest pain, dyspnea, and risk factors for VTE
PE
A tall, thin young man who smokes with sudden pleuritic chest pain and
dyspnea
Spontaneous pneumothorax
A postmenopausal woman with STEMI following severe emotional/physical
stress and normal coronary angiography
Stress-induced (takotsubo) cardiomyopathy; look for characteristic apical
ballooning on ventriculogram
Forceful vomiting followed by chest pain
Esophageal rupture and mediastinitis
Chest pain during the peripartum period
Spontaneous coronary artery dissection
Sharp anterior chest pain, pleuritic, worse when supine
Acute pericarditis
Unstable angina
Normal cardiac biomarkers
May have nonspecific ECG changes, ST-segment depression, or T-wave
inversion
,NSTEMI
Positive biomarkers without ST elevations or ST-elevation equivalents
May have nonspecific ECG changes, ST-segment depression, and T-wave
inversion
STEMI
ST-segment elevation of ≥1 mm in ≥2 contiguous limb or chest leads, although
ST-segment elevation in leads V2 and V3 must be ≥2 mm in men and ≥1.5 mm
in women
ST-elevation equivalents include new LBBB or posterior MI (tall R waves and
ST depressions in V1-V4)
A 69-year-old man has a 3-month history of burning retrosternal discomfort
related to exertion that is relieved by rest. Physical examination is
unremarkable, and the resting ECG is normal.
Answer: For treatment, choose aspirin, sublingual nitroglycerin, and a β-
blocker, and follow up with an exercise stress test.
HFrEF is defined by
an LVEF of ≤40%
HFpEF is commonly defined by
an LVEF of ≥50%
Symptoms and signs that increase the likelihood of HF include:
paroxysmal nocturnal dyspnea (>2-fold likelihood)
an S3 (11-fold likelihood)
The likelihood of HF is decreased 50% by:
absence of dyspnea on exertion
absence of crackles on pulmonary auscultation
unusual causes of HF, including
hemochromatosis, multiple myeloma, amyloidosis, and myocarditis, should not
be performed.
,What conditions change BNP
Kidney failure, older age, and female sex all increase BNP; obesity reduces
BNP.
Under what conditions is VAlsartan-sacubitril used
Initiate or substitute for an ACE inhibitor or ARB in HFrEF (NYHA class II-IV
and EF <40%)
In what conditions is Hydralzine plus nitrates given
Given in addition to standard therapy for NYHA class III-IV and EF <40% in
select patients (low output syndrome, hypertension) to reduce mortality
For patients who cannot tolerate ACE inhibitors or ARBs
Aldosterone antagonist (spironolactone or eplerenone) given in NYHA class
For NYHA class III-IV HF to reduce mortality
In what conditions is a ICD used
For ischemic and nonischemic cardiomyopathy in patients with an EF ≤35%
and NYHA functional class II-III or with an EF ≤30% and NYHA functional
class I to improve survival
When is cardiac resynchronization therapy used
For NYHA class II-IV, LVEF ≤35%, LBBB with QRS duration >150 ms, and
sinus rhythm to improve LVEF and reduce symptoms and mortality
Do not begin β-blocker therapy in patients with
decompensated HF.
Continuous IV infusion of furosemide provides no advantage vs.
bolus therapy in decompensated HF.
Do not prescribe or continue NSAIDs or thiazolidinediones because
because they worsen HF.
Nondihydropyridine calcium channel blockers (diltiazem or verapamil) may be
harmful
may be harmful to patients with HFrEF.
, Do not implant ICD until
guideline-directed medical therapy has been administered for 3 months (or 40
days after MI) to assess potential recovery of LVEF.
A 64-year-old woman with previously stable HF now has increasing orthopnea.
Medications are lisinopril 10 mg/d and furosemide 20 mg/d. BP is 140/68 mm
Hg, and HR is 102/min. Pulmonary crackles and increased JVD are present.
Answer: For treatment, increase the furosemide and lisinopril dosages and add a
β-blocker when the patient is stable.
Strategies to prevent CHF readmission include:
Treatment of reversible causes of HF exacerbation
Euvolemia achieved with diuresis
Medication reconciliation
Discharge with medications that reduce mortality and morbidity
Patient education on HF physiology
Home nurse follow-up (or phone call within 48 h) soon after discharge
Follow-up appointment (within 7 days)
In patients with chronic HF who experience a change in clinical symptoms,
follow-up echocardiography is recommended.
SGLT2 inhibitors can decrease CV mortality and HF exacerbations in
HFpEF.
Diagnose HFpEF when signs and symptoms of HF are present but the
echocardiogram reveals
EF >50% and significant valvular abnormalities are absent.
Dilated cardiomyopathy is characterized by
dilation and reduced function of one or both ventricles manifesting as HF,
arrhythmias, and sudden death.
The most common cause of Dilated cardiomyopathy
is idiopathic dilated cardiomyopathy (50%),
Differential Diagnoses of Nonischemic Dilated Cardiomyopathy
QUESTIONS AND ANSWERS 2025
Chest pain at night or at rest or use of illicit substances (methamphetamines,
cocaine), 5-FU
Coronary vasospasm
A tall, thin person with long arms with tearing acute chest and back pain
Marfan syndrome and aortic dissection
A patient with sharp or pleuritic chest pain, dyspnea, and risk factors for VTE
PE
A tall, thin young man who smokes with sudden pleuritic chest pain and
dyspnea
Spontaneous pneumothorax
A postmenopausal woman with STEMI following severe emotional/physical
stress and normal coronary angiography
Stress-induced (takotsubo) cardiomyopathy; look for characteristic apical
ballooning on ventriculogram
Forceful vomiting followed by chest pain
Esophageal rupture and mediastinitis
Chest pain during the peripartum period
Spontaneous coronary artery dissection
Sharp anterior chest pain, pleuritic, worse when supine
Acute pericarditis
Unstable angina
Normal cardiac biomarkers
May have nonspecific ECG changes, ST-segment depression, or T-wave
inversion
,NSTEMI
Positive biomarkers without ST elevations or ST-elevation equivalents
May have nonspecific ECG changes, ST-segment depression, and T-wave
inversion
STEMI
ST-segment elevation of ≥1 mm in ≥2 contiguous limb or chest leads, although
ST-segment elevation in leads V2 and V3 must be ≥2 mm in men and ≥1.5 mm
in women
ST-elevation equivalents include new LBBB or posterior MI (tall R waves and
ST depressions in V1-V4)
A 69-year-old man has a 3-month history of burning retrosternal discomfort
related to exertion that is relieved by rest. Physical examination is
unremarkable, and the resting ECG is normal.
Answer: For treatment, choose aspirin, sublingual nitroglycerin, and a β-
blocker, and follow up with an exercise stress test.
HFrEF is defined by
an LVEF of ≤40%
HFpEF is commonly defined by
an LVEF of ≥50%
Symptoms and signs that increase the likelihood of HF include:
paroxysmal nocturnal dyspnea (>2-fold likelihood)
an S3 (11-fold likelihood)
The likelihood of HF is decreased 50% by:
absence of dyspnea on exertion
absence of crackles on pulmonary auscultation
unusual causes of HF, including
hemochromatosis, multiple myeloma, amyloidosis, and myocarditis, should not
be performed.
,What conditions change BNP
Kidney failure, older age, and female sex all increase BNP; obesity reduces
BNP.
Under what conditions is VAlsartan-sacubitril used
Initiate or substitute for an ACE inhibitor or ARB in HFrEF (NYHA class II-IV
and EF <40%)
In what conditions is Hydralzine plus nitrates given
Given in addition to standard therapy for NYHA class III-IV and EF <40% in
select patients (low output syndrome, hypertension) to reduce mortality
For patients who cannot tolerate ACE inhibitors or ARBs
Aldosterone antagonist (spironolactone or eplerenone) given in NYHA class
For NYHA class III-IV HF to reduce mortality
In what conditions is a ICD used
For ischemic and nonischemic cardiomyopathy in patients with an EF ≤35%
and NYHA functional class II-III or with an EF ≤30% and NYHA functional
class I to improve survival
When is cardiac resynchronization therapy used
For NYHA class II-IV, LVEF ≤35%, LBBB with QRS duration >150 ms, and
sinus rhythm to improve LVEF and reduce symptoms and mortality
Do not begin β-blocker therapy in patients with
decompensated HF.
Continuous IV infusion of furosemide provides no advantage vs.
bolus therapy in decompensated HF.
Do not prescribe or continue NSAIDs or thiazolidinediones because
because they worsen HF.
Nondihydropyridine calcium channel blockers (diltiazem or verapamil) may be
harmful
may be harmful to patients with HFrEF.
, Do not implant ICD until
guideline-directed medical therapy has been administered for 3 months (or 40
days after MI) to assess potential recovery of LVEF.
A 64-year-old woman with previously stable HF now has increasing orthopnea.
Medications are lisinopril 10 mg/d and furosemide 20 mg/d. BP is 140/68 mm
Hg, and HR is 102/min. Pulmonary crackles and increased JVD are present.
Answer: For treatment, increase the furosemide and lisinopril dosages and add a
β-blocker when the patient is stable.
Strategies to prevent CHF readmission include:
Treatment of reversible causes of HF exacerbation
Euvolemia achieved with diuresis
Medication reconciliation
Discharge with medications that reduce mortality and morbidity
Patient education on HF physiology
Home nurse follow-up (or phone call within 48 h) soon after discharge
Follow-up appointment (within 7 days)
In patients with chronic HF who experience a change in clinical symptoms,
follow-up echocardiography is recommended.
SGLT2 inhibitors can decrease CV mortality and HF exacerbations in
HFpEF.
Diagnose HFpEF when signs and symptoms of HF are present but the
echocardiogram reveals
EF >50% and significant valvular abnormalities are absent.
Dilated cardiomyopathy is characterized by
dilation and reduced function of one or both ventricles manifesting as HF,
arrhythmias, and sudden death.
The most common cause of Dilated cardiomyopathy
is idiopathic dilated cardiomyopathy (50%),
Differential Diagnoses of Nonischemic Dilated Cardiomyopathy
