100+ Free HKCP Intermediate Practice Questions

Explanation: According to STEMI guidelines, if the time from first medical contact to primary PCI is expected to exceed 120 minutes, fibrinolytic therapy should be administered immediately (within 30 minutes of presentation) if there are no contraindications. Since the estimated transfer and PCI time is 140 minutes, immediate fibrinolytic therapy is the class I recommendation.

Explanation: For Stanford Type B aortic dissection, initial medical management focuses on heart rate and blood pressure control. Intravenous beta-blockers, specifically labetalol or esmolol, are first-line. Labetalol reduces both heart rate and blood pressure, lowering the shear stress (dP/dt) on the aortic wall. The target heart rate is < 60 bpm and systolic blood pressure is 100-120 mmHg.

Explanation: SGLT2 inhibitors, such as dapagliflozin or empagliflozin, are now class I recommended therapies for all patients with HFrEF (LVEF <= 40%) regardless of the presence of diabetes. They reduce cardiovascular mortality and heart failure hospitalizations. Given her eGFR is 45 (which is above the threshold for initiation), adding dapagliflozin is the next logical step. Mineralocorticoid receptor antagonists (MRAs) like spironolactone are also indicated, but SGLT2 inhibitors have shown rapid benefits and are highly recommended.

Explanation: This patient has Hypertrophic Cardiomyopathy (HCM) with a high risk of sudden cardiac death (SCD). A maximum LV wall thickness >= 30 mm is an independent major risk factor for SCD. Along with the family history of SCD in a young first-degree relative, an ICD is strongly indicated for primary prevention of SCD.

Explanation: The patient has infective endocarditis complicated by acute heart failure (pulmonary edema) due to aortic regurgitation. Heart failure is the strongest indication for urgent surgery in infective endocarditis, overriding other criteria such as vegetation size. Delaying surgery carries a very high mortality risk.

Explanation: In patients with severe symptomatic aortic stenosis who are at high surgical risk (STS score > 8% or age > 75), transcatheter aortic valve implantation (TAVI) is preferred over surgical aortic valve replacement (SAVR) as it is associated with lower periprocedural mortality and faster recovery.

Explanation: For patients with severe primary mitral regurgitation, surgery is indicated even in asymptomatic patients if there is evidence of early LV dysfunction, defined as LVEF <= 60% or LVESD >= 40 mm (Class I recommendation). Mitral valve repair is preferred over replacement when feasible.

Explanation: The patient's CHA2DS2-VASc score is 4 (Age = 1, Female = 1, Hypertension = 1, Diabetes = 1). For patients with atrial fibrillation and a CHA2DS2-VASc score >= 2 in men or >= 3 in women, oral anticoagulation is strongly indicated to reduce the risk of stroke. Direct oral anticoagulants (DOACs) are preferred over warfarin unless contraindicated.

Explanation: Beta-blockers, particularly nadolol or propranolol, are the cornerstone of therapy for congenital Long QT Syndrome (LQTS). They reduce the frequency of cardiac events by blunting sympathetic surges. Propranolol or nadolol are preferred for LQT1 and LQT2. Amiodarone is contraindicated as it prolongs the QT interval further.

Explanation: Hemodynamic differentiation between constrictive pericarditis and restrictive cardiomyopathy is critical. Constrictive pericarditis is characterized by ventricular discordance (during inspiration, LV peak systolic pressure decreases while RV peak systolic pressure increases due to ventricular interaction within a fixed pericardial space). Restrictive cardiomyopathy shows ventricular concordance (both decrease or remain unchanged in tandem).