General Board Simulation Questions – Part 1 1

Question 1
A 58-year-old man develops exertional chest pain and is referred for an exercise test with
adjunctive nuclear imaging. The exercise test is terminated at 8 minutes due to chest pain,
which is associated with 1 mm ST depression in leads 2, 3, and aVF on the exercise ECG, and a
reversible abnormality in the inferior wall on perfusion imaging. His resting LV function is
normal, and you decide to manage him medically. He reports that he has had severe wheezing
with aspirin on several occasions in the past.
Which of the following is the most appropriate antiplatelet agent for this patient?
A. Dipyridamole 75 mg TID.
B. Clopidogrel 75 mg QD.
C. Ticlopidine 150 mg BID.
D. Aspirin 81 mg QD, with close observation for recurrent wheezing.

Question 2
Long-term postoperative survival after pericardiectomy is poorest for which of the following
etiologies of constrictive pericarditis?
A. Idiopathic with extensive calcification.
B. Post-cardiac surgery.
C. Radiation-induced.
D. Idiopathic with minimal calcification.
E. Post-blunt chest wall trauma.

Question 3
A 56-year-old man complains of cramping in the left calf after walking one block. The discomfort
subsides when he stops walking. His BP is 154/88 mm Hg. The right ankle-brachial index is 1.10
and the left ankle-brachial index is 0.82. Which of the following drug treatments is indicated to
improve his symptoms?
A. Clopidogrel.
B. Metoprolol.
C. Cilostazol.
D. Ramipril.

Question 4A
A 32-year-old overweight woman presents to a general medicine office for an employment
physical. She has no past history of any medical problems except for two prior episodes of
pancreatitis and is taking no medications. Her only relative that developed CHD was her mom, who
died of a stroke at age 70. She has no known allergies. She has smoked one pack of cigarettes per
day for the past 13 years. She denies alcohol use and has been trying to improve her dietary
habits. Her BP is 135/85 mm Hg. A recent lipid panel shows total cholesterol 315 mg/dl, LDL-C 140
mg/dl, triglycerides 372 mg/dl, and HDL-C 51 mg/dl.
Based on the Framingham risk equation, which of the following is this woman’s 10-year risk of
CV disease?
A. Low (<10%).
B. Intermediate (10-20%).
C. High (>20%).
D. Cannot be determined from the information provided.

Question 4B
If her lipid values do not improve significantly with lifestyle modification, which medication
would probably be most useful given the above lipid profile? (Refer to question 4A.)
A. Cholestyramine.
B. Fenofibrate.
C. Atorvastatin.
D. Niaspan.

Question 5
A stress imaging procedure is recommended over a standard exercise test as the initial
noninvasive testing modality in which of the following?
A. A patient whose resting ECG shows RBBB.
B. A patient whose resting ECG shows pre-excitation (Wolff-Parkinson-White pattern).
C. A patient 4 days after acute inferior wall MI whose resting ECG shows Q waves and inverted
T wave in the inferior leads.
D. A patient taking a beta-blocker who cannot safely discontinue this medication 48 hours prior
to the test.