MCCQE UPDATED Exam Questions and CORRECT Answers

MCCQE UPDATED Exam Questions and
CORRECT Answers
Diagnosing adult asthma - CORRECT ANSWER - 1. Gold standard = PFTs showing
reduced FEV1/FEV and > 11% increase in FEV1 with SABA or ICS course


2. PEF (peak expiratory flow) - >20% improvement in PEF with SABA or ICS course


3. Positive challenge test - methacholine challenge or > 10% drop in FEV1 with exercise


Asthma medications - CORRECT ANSWER - All patients:
1. SABA (salbutamol) PRN
2. ICS


If insufficient control:
1. Increase ICS dose
2. Add LABA or leukotriene antagonist (LTRA)


For exacerbation: give PO steroids
-Kids: prednisone or dexamethasone
-Adults: prednisone
-Can also consider ipratroprium bromide or MgSO4


NYHA classes of functional capacity - CORRECT ANSWER - NYHA Class I: no
limitations
NYHA Class II: ordinary activity causes dyspnea, palpitations, fatigue
NYHA Class III: less than ordinary activity causes dyspnea, palpitations, fatigue
NYHA Class IV: dyspnea, palpitations, fatigue at rest

,Secondary management of ischemic heart disease - CORRECT ANSWER - 1. Cardiac
rehab
2. Anti-HTN: target BP < 140/90 or < 130/80 if diabetes or CKD
3. ASA: clopidogrel if cannot take ASA
4. ACEI: ramipril, perindopril, can use ARB as second-line (stop if hyperkalemia or rise in Cr >
30% above baseline)
5. Statin: max dose (target LDL-C <2 or >50% reduction)
6. BB: 3 months or long-term if HF or LV dysfunction, metoprolol, carvedilol, bisoprolol, use
CCB or nitrates if intolerant
7. Diabetes management HbA1C < 7%


Secondary management of ischemic heart disease with the following comorbidities:
1. Severe hepatic disease
2. CKD
3. COPD

4. Hx of PCI or stent - CORRECT ANSWER - For everyone:
1. Cardiac rehab
2. Anti-HTN
3. ASA
4. ACEI
5. Statin
6. BB


Comorbidities:
1. Severe hepatic disease = dose reduce metoprolol, carvedilol, some statins
2. CKD = reduce dose of ACEI, BB, diuretics if GFR < 50
3. COPD = cardioselective BB metoprolol
4. Hx of PCI or stent = clopidogrel x 1 year

,3 types of ACS: unstable angina vs. NSTEMI vs. STEMI - CORRECT ANSWER -
Unstable angina: decreased myocardial perfusion WITHOUT necrosis


NSTEMI: non Q-wave MI, partial myocardial necrosis


STEMI: Q-wave MI, transmural myocardial necrosis


Patient presents to ED or FP with typical or atypical CP - CORRECT ANSWER - ED =
Invx = ECG and troponin
FP = Invx = ECG - if abnormal send to ED


1. Unstable angina: normal ECG, possible ST changes
2. NSTEMI: >2mm ST depressions, troponin elevated by 9 hours after CP
3. STEMI: >20 minute ST elevation, troponin elevated by 9 hours after CP


Management of UA, NSTEMI, STEMI - CORRECT ANSWER - UA = pharmacotherapy,
stress testing, ECHO
NSTEMI = pharmacotherapy, angiography/revascularization
STEMI = immediate reperfusion


Immediate vs. long-term pharma management of ACS - CORRECT ANSWER - Acute:
1. Anti-platelet/anticoagulant (ASA chewed + clopidogrel +/- anti-coagulant)
2. BB (IV)
3. CCB (if cannot tolerate BB)
4. Statins
5. Nitrates (IV until CP resolves)


Long-term:
1. Anti-platelet/anticoagulant (ASA + clopidogrel +/- anticoagulant)

, 2. ACEI/ARB (telmisartan/valsartan/perindopril) - do NOT COMBINE
3. BB - metoprolol
4. CCB (if cannot tolerate BB)
5. Statins
6. Nitroglycerin spray PRN for CP


Monitoring for pharma for secondary ACS prevention:
1. Antiplatelets/anticoagulants
2. ACEI/ARB
3. BB
4. CCB
5. Statins

6. Nitroglycerine - CORRECT ANSWER - 1. Antiplatelets/anticoagulants
-Bleeding, D/C 5 days before surgery


2. ACEI/ARB
-Monitor K and Cr, do NOT combine - increased risk for MI


3. BB
-Monitor for hypotension, bradycardia, fatigue


4. CCB
-Monitor for AV block with dihydropyridine calcium channel blockers (i.e. verapamil, diltiazem)


5. Statins
-Monitor liver enzymes, CK, signs of rhabdo
-CYP3A4 interactions common