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ABFM HEART DISEASE QUESTIONS WITH CORRECTBANSWERS GRADED A.pdf

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ABFM HEART DISEASE QUESTIONS WITH CORRECTBANSWERS GRADED A.pdf

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ABFM HEART DISEASE QUESTIONS WITH
CORRECTBANSWERS GRADED A+ FOR 2025-
2026 ASSURED EXCEL!!

Af65-year-
oldffemalefwhofhasfheartffailurefwithfanfejectionffractionfoff35%fisffoundftofhavefafTSHflevelfoff13.8f
µU/mLf(Nf0.3-
4.82).fHerfT3fandfT4flevelsfarefnormal,fandfherfthyroidfglandfisfnormalftofpalpation.fYoufcheckfherfle
velsfagainfinf2fmonthsfandftheyfarefunchanged.fYoufadvisefherfthat



hypothyroidismfdecreasesfherfmetabolicfrate,fwhichfreducesfthefstressfonfherfheart

hypothyroidismfisfdetrimentalftofherfheartfonlyfiffshefdevelopsfhypothyroidfsymptoms

subclinicalfhypothyroidismfhasfnegativefeffectsfonfheartffailurefandftreatmentfshouldfbefconsidere
d

treatmentfoffsubclinicalfhypothyroidismfwouldfraisefherfLDL-cholesterolflevelf-
ffCORRECTfANSWERSC




Clinicalfhypothyroidismfhasflongfbeenfassociatedfwithfcardiacfdysfunction.fItfhasfalsofbeenfshownft
hatfsubclinicalfhypothyroidismf(TSHf>4fµU/mLfwithfnormalforfborderlineflowfthyroidfhormonefleve
ls)fcanfcausefleftfventricularfsystolicfandfdiastolicfdysfunction,fwhichfimprovesfwithfthyroidfreplace
mentftherapy.fPatientsfwithfovertforfsubclinicalfhypothyroidismfshouldfbeftreatedfwithflevothyroxi
neftofimproveftheirfcardiovascularffunctionfandfdecreasefthefpotentialfriskfoffheartffailure.fThyroxi
nefinfexcessfcanfexacerbatefcoronaryfarteryfdisease,fandfshouldfbefstartedfatflowfdosesfandfincreas
edfslowlyfinfpatientsfwithfpossiblefunderlyingfcoronaryfarteryfdisease.fResultsfoffmeta-
analysesfindicatefthatftherapyfwillflower,fnotfraise,fserumfLDL-cholesterolflevels.



Af58-year-
oldfmalefisfhospitalizedfwithfseverefdecompensatedfheartffailurefrefractoryftofintravenousfinotropi
cftherapyfandfguideline-
directedfmedicalftherapy.fYoufarefconsideringfreferralftofaftertiaryfcarefhospitalfforfmechanicalfcirc
ulatoryfsupportftofbridgeftoftransplantation.Whichfonefofftheffollowingfisftruefregardingfmechanic
alfcirculatoryfsupportfbridgeftherapy?

,Itfshouldfbeflimitedftofpatientsfwhofmeetfthefcriteriafforfheartftransplantation

Itfshouldfonlyfbefusedfinfpatientsfwithfbiventricularfheartffailure

Itfgenerallyfimprovesfqualityfofflifefwhilefwaitingfforftransplantation

Itfgreatlyfreducesfqualityfofflifefwhilefwaitingfforftransplantationf-ffCORRECTfANSWERSc



Mechanicalfcirculatoryfsupportf(MCS)fwithfafventricularfassistfdevicefhasfcontinuedftofevolvefandfh
asfemergedfasfafviableftherapeuticfoptionfforfpatientsfwithfadvancedfstagefDfheartffailurefwithfredu
cedfejectionffractionfrefractoryftofguideline-
directedfmedicalftherapyfandfcardiacfdevicefintervention.fAfvarietyfoffventricularfassistfdevicesfaref
nowfavailable.fThesefdevicesfmayfbefeitherfintracorporealforfextracorporeal,fandfmayfbefdesignedf
tofassistfthefleftfventricle,frightfventricle,forfboth.Bridgeftherapyfrefersftofthefusefoffleftfventricularf
assistfdevicesftofhelpfafpatientfsurvivefuntilfafdonorfheartfbecomesfavailablefforftransplantation.fSe
veralfdevicesfarefavailable,fsomefoffwhichfarefimplantablefandfallowfpatientsftofbefdischargedftofth
eirfhomes.fThesefdevicesfcanfincreasefpatientfactivityflevelsfandfqualityfofflife.fComplicationsfcanfo
ccur,fincludingfstroke,finfection,fandfdeath,fbutfthesefdevicesfcanfbeflifesavingfinfpatientsfwithfrefra
ctoryfheartffailure.ThefdataffromfthefInteragencyfRegistryfforfMechanicallyfAssistedfCirculatoryfSup
portfindicatesfthatfcardiogenicfshock,fadvancedfage,fandfseverefrightfheartffailuref(manifestedfasfa
scitesforfincreasedfbilirubin)farefmajorfriskffactorsfforfdeathfafterfMCS.fThisfledftofafrecommendatio
nfthatfreferralfforfMCSfbefconsideredfbeforefseverefrightfventricularffailurefdevelops.fPossiblefindic
ationsfforfafbridge-to-
candidacyfventricularfassistfdevicefincludefobesity,ftobaccofuse,fandfseverefpulmonaryfhypertensi
onfinfpatientsfwhofmightfotherwisefbefcandidatesfforftransplantation.



Anfactivef66-year-
oldffemalefpresentsfwithfintermittentfchestfpainfandfdyspnea.fShefisfcurrentlyfpainffree.fAfrestingfE
KGfisfnormal.Ifffoundfonfthefhistoryfandfexamination,fwhichfonefofftheffollowingfsymptomsfisfmostfl
ikelyftofbefassociatedfwithfmyocardialfischemiafasfthefcausefoffchestfpain?



Anfepisodefoffdiaphoresisfassociatedfwithfthefchestfpain

Painfreproducedfbyfchestfwallfpalpationfonfthefleftfsidefoffthefchest

Painfthatfcomesfandfgoesfwithfandfwithoutfexertion

,Intermittentfpleuritic-typefpainfandfdyspneaf-ffCORRECTfANSWERSA



Cardiacfischemiafisfclassicallyfdefinedfasfdeep,fpoorlyflocalizedfchestforfarmfdiscomfortfreproducibl
yfassociatedfwithfexertionforfemotionalfstress.fItfisfrelievedfwithfrestfandfnitroglycerin.fItfcanfpresen
tfinfanfatypicalffashion,fandfthefdiscomfortfcanflocalizeforfradiateftofthefneck,flowerfjaw,fthroat,fsho
ulder,fepigastrium,fhands,forfupperfback.fItfmayfbefentirelyfabsentfinfsomefcases.fInfolderfpatientsf
withoutfchestfpain,fnew-
onsetforfunexplainedfexertionalfdyspneafisfthefmostfcommonfanginalfequivalent,fevenfwithfafnorm
alfrestingfEKG.Althoughftheyfmayfbefpresent,fpleuritic-
typefpain,fpainfreproducedfwithfmovementforfpalpationfoffthefchestfwallforfarm,fandfsharpforfstab
bingfpainfarefnotfcharacteristicffeaturesfoffmyocardialfischemia.fVeryfbrieffepisodesfoffpain,flastingf
affewfsecondsforfless,farefalsofnotfcharacteristicfoffmyocardialfischemia.fInfafmeta-
analysisfoffsymptomsfusefulfinfdiagnosingfacutefcoronaryfsyndromefinfaflow-
riskfsetting,fdiaphoresisfwasffoundftofbefthefstrongestfpredictorfoffmyocardialfinfarctionf(MI)f(likeli
hoodfratiof[LR]f=f2.44),fandfthefpresencefoffchestfwallftendernessfsignificantlyfreducedfthefpossibili
tyfoffMIf(LRf=f0.23).fAfcompletelyfnormalfEKGfdoesfnotfexcludefthefpossibilityfoffacutefcoronaryfsyn
dromefbecausef1%-
6%foffsuchfpatientsfeventuallyfareffoundftofhavefanfacutefmyocardialfinfarctionf(non-ST-
segmentfelevationfbyfdefinition)fandfatfleastf4%fhavefunstablefangina.



Af69-year-
oldffemalefwithfafhistoryfoffchronicfhypertensionfandfafpreviousfmyocardialfinfarctionfseesfyoufforff
ollow-
upf6fweeksfafterfbeingfhospitalizedfforfchestfpain.fDuringfherfhospitalizationfshefunderwentfcardia
cfcatheterization,fwhichfshowedfonlyfaflesionfinfthefcircumflexfthatfwasflessfthanf50%foccluded.fAnf
EKGfrevealedfsinusfbradycardiafoff52fbeats/min,fmultifocalfPVCs,fandfafQRSfintervalfoff0.10fsec.fEch
ocardiographyfrevealedfafleftfventricularfejectionffractionfoff32%.Althoughfthefpatientffeelsfcomfo
rtablefatfrestfshefreportsfthatfshefhasfdifficultyfwalkingfupfafsinglefflightfoffstairs.fHerfcurrentfmedic
ationsfincludefatorvastatinf(Lipitor),f40fmgfdaily;flisinoprilf(Prinivil,fZestril),f20fmgfdaily;fmetoprololf
succinatef(Toprol-
XL),f100fmgfdaily;ffurosemidef(Lasix),f40fmgfdaily;fandfaspirin,f81fmgfdaily.Onfexaminationfthefpatie
ntfisfnotfinfacutefdistress.fHerfbloodfpressurefisf132/78fmmfHgfandfherfpulsefratef-
ffCORRECTfANSWERSD

, Aldosteronefantagonistsfarefimportantfinfthefmanagementfoffseverefheartffailure.fThefadditionfoffa
nfaldosteronefantagonistftofafβ-
blockerfandfanfACEfinhibitorfwasfshownfinfthefRandomizedfAldactonefEvaluationfStudyftofreducefra
tesfoffdeathfandfhospitalfreadmissionsfinfselectedfpatientsfwithfmoderateftofseverefsymptomsfoffh
eartffailurefandfafreducedfleftfventricularfejectionffractionf(LVEF)f(SORfB).fMorefrecently,fthefEMPH
ASIS-
HFftrialf(EplerenonefinfMildfPatientsfHospitalizationfandfSurvivalfStudyfinfHeartfFailureftrial)ffoundft
hatfthefadditionfoffeplerenonefinfheartffailurefpatientsfwithfmildfsymptomsfconsistentfwithfNewfYo
rkfHeartfAssociationf(NYHA)fclassfIIfheartffailurefandfafmeanfLVEFfoff26%fresultedfinfafreductionfinfb
othfhospitalizationsfandfdeaths.fCurrentfAmericanfHeartfAssociationfguidelinesfrecommendfthefad
ditionfoffanfaldosteronefantagonistftofanfACEfinhibitorfandfafβ-
blockerfinfselectedfpatientsfwithfmoderatelyfsevereftofseverefsymptomsfoffheartffailurefandfafredu
cedfLVEF.Althoughfthefadditionfoffdigoxinfcanfbefoffbenefitfinfselectedfheartffailurefpatientsfbyfredu
cingfthefriskfforfhospitalization,fitfhasfnotfbeenfshownftofreducefmortalityf(SORfB).fAccordingftofrec
entfguidelines,fpatientsfarefconsideredfcandidatesfforfcardiacfresynchronizationftherapyfifftheyfhav
efNYHAfclassfII-
IVfheartffailure,fafleftfventricularfejectionffractionf≤35%,fandfafQRSfdurationf>130fmsfonfanfEKG.fHo
wever,f30%-
35%foffpatientsfwhofmeetfthesefcriteriafarefnonrespondersfwithfnofsymptomaticfimprovementforfr
eversefleftfventricularfremodeling.fLeftfbundlefbranchfblockfmorphology,fafQRSfdurationf≥150fms,fa
ndfadequatefcoronaryfsinusfanatomyfhavefbeenfmostfcloselyfassociatedfwithfaffavorablefresponse.f
Mitralfvalvefregurgitation,frightfventricularfdysfunction,fandfatrialffibrillationfhavefbeenfshownftofh
avefafnegativefimpactfonfpatientfr



Youfadmitfafpatientfwithfacutefcoronaryfsyndromeftofthefhospital.fWhichfonefofftheffollowingfisftru
efregardingfthefdifferencesfbetweenflowfmolecularfweightfheparinf(LMWH)fandfunfractionatedfhe
parinf(UFH)finfthisfsituation?



ThefusefoffglycoproteinfIIb/IIIafinhibitorsfdoesfnotfrequirefafchangefinfthefdosagefoffUFH

Thefdosagefoffbothfshouldfbeftitratedftofachievefafpartialfthromboplastinftimefoff1.5-
2.5ftimesfcontrol

Plateletfactivationfisfthefsamefforfboth

ThefincidencefoffthrombocytopeniafisflowerfwithfLMWH

UFHfhasfhigherfbioavailabilityfbecausefitfisfgivenfintravenouslyf-ffCORRECTfANSWERSD
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