The resting electrocardiogram (ECG) is normal in what percentage of patients with stable coronary artery disease (CAD)?

1. About 10%
   
2. About 50%
   
3. About 75%
   
4. 100%

The occurrence of conduction disturbances such as left bundle branch block (LBBB) and left anterior fascicular block (LAFB) are associated with which of the following?

1. Good prognosis
   
2. Poor prognosis
   
3. Does not dictate prognosis
   
4. None of the above

The presence of LV hypertrophy on the resting ECG in a patient with stable CAD may be suggestive of which of the following?

1. Underlying hypertension
   
2. Aortic stenosis
   
3. Hypertrophic cardiomyopathy
   
4. All of the above
   
5. None of the above

In what percentage of patients does the resting ECG become abnormal in patients with stable CAD during an episode of angina?

1. 100%
   
2. 50%
   
3. 75%
   
4. 25%

What is the most common finding on the ECG in stable CAD patients during an episode of angina?

1. ST segment depression
   
2. ST segment elevation
   
3. Normalization of previous ST abnormalities (pseudonormalization)
   
4. None of the above

In a patient with chest pain and moderate probability of CAD and a normal resting ECG, what is the best test to order to evaluate for ischemia?

1. Exercise stress ECG
   
2. Exercise echo
   
3. Dobutamine stress echo
   
4. Stress nuclear

What is true of a negative stress ECG for a patient receiving anti-anginal medications when evaluating for ischemia?

1. Reduces the sensitivity as a screening tool
   
2. Does not have any effect on the test
   
3. Increases the sensitivity as a screening tool
   
4. None of the above

A stress nuclear test is helpful in which of the following situations?

1. Abnormal resting ECG changes
   
2. LBBB
   
3. LV hypertrophy
   
4. All of the above

A pharmacological stress test can be ordered to evaluate for CAD in which of the following situations?

1. Patients unable to exercise and achieve an adequate workload
   
2. Peripheral vascular disease
   
3. Patients with pulmonary disease
   
4. All of the above

Exercise testing in asymptomatic patients without known CAD may be appropriate in which situation?

1. Patients with diabetes mellitus
   
2. Severe coronary calcifications on electron beam computed tomography (CT)
   
3. Evidence of ischemia on ambulatory ECG
   
4. All of the above
   
5. None of the above

Which of the following is a true statement?

1. Stress test in females is associated with higher false-positive results compared with males
   
2. Stress test in females is associated with low rate of false-positive results compared with males
   
3. Stress test in females is associated with higher rates of false-negative results compared with males
   
4. Stress test in females is associated with low rates of false-negative results compared with males
   
5. The results are similar in both men and women when stratified appropriately

In a patient with angina, with an intermediate to high pretest probability, with LBBB on ECG and with moderate ability for physical exercise, what is a reasonable diagnostic test to perform?

1. Exercise stress ECG
   
2. Exercise stress echo
   
3. Coronary angiogram
   
4. Adenosine stress cardiovascular magnetic resonance (CMR)

In a patient with angina, with intermediate pretest probability and able to perform moderate ability to function physically, what would be a reasonable test to perform?

1. Coronary angiography
   
2. Exercise stress ECG
   
3. Exercise stress echo
   
4. Coronary CT angiography (CCTA)

In a patient with an intermediate to high pretest probability for CAD and who is incapable of at least moderate exertion, what are the recommended tests for the diagnosis of CAD?

1. Dobutamine stress echo
   
2. Adenosine stress single-photon emission CT (SPECT)
   
3. Dobutamine stress SPECT
   
4. None of the above
   
5. All of the above

A 40-year-old woman is referred for evaluation of angina. Her physical exam is normal. Based on her history she is at low pretest likelihood. She has severe knee pain and is unable to perform moderate physical activity. What is the best recommended diagnostic test to evaluate her angina?

1. Coronary angiogram
   
2. Adenosine stress CMR
   
3. CCTA
   
4. Dobutamine stress echo
   
5. B, C, and D

A 55-year-old male with a history of hypertension, diabetes, smoking, and family history of CAD is referred to you for evaluation of chest pain. He is unable to walk on the treadmill due to back pain. What is a reasonable diagnostic test to perform?

1. Coronary angiogram
   
2. Dipyridamole stress echo
   
3. Stress CMR
   
4. CCTA

A 65-year-old male is referred for evaluation of exercise-induced angina. He has a history of hypertension, diabetes mellitus, and hypercholesterolemia. He used to smoke one pack of cigarettes a day for 20 years and has quit recently. His father was diagnosed with CAD and underwent coronary artery bypass grafting (CABG) at age 68. He is on aspirin, amlodipine 10 mg daily, lisinopril 20 mg daily and Lipitor 40 mg qd. On exam his heart rate is 60 bpm, BP 120/75 mmHg, and is otherwise unremarkable. He used to walk 2 miles a day. He now has intractable angina and is not able to perform low-intensity exercise. His primary care physician had started him on long-acting nitrates without relief. What is the best test to evaluate this patient’s symptoms?

1. Exercise stress ECG
   
2. Exercise stress SPECT
   
3. Coronary angiogram
   
4. Dobutamine stress echo

A 63-year-old male with a history of hypertension, diabetes mellitus, hypercholesterolemia, and past history of smoking has complaints of angina. His primary care physician has optimized him on guideline-directed medical therapy and has referred him to you for further evaluation. An echocardiogram is ordered and resting LV ejection fraction (EF) is 30%. What is the best test to evaluate this patient?

1. Exercise SPECT
   
2. Adenosine SPECT
   
3. Coronary angiogram
   
4. Exercise treadmill

A 60-year-old female with cardiac risk factors is being evaluated for IHD. She has complaints of new-onset angina. She is on optimal medical therapy for hypertension, hypercholesterolemia and diabetes mellitus. She is unable to walk due to orthopedic limitations. She then has a dobutamine stress echocardiogram, wherein she achieves 70% of her age-predicted maximum heart rate at peak stress. What is the best approach in further evaluation of this patient?

1. Adenosine stress SPECT
   
2. Coronary angiogram
   
3. No further testing
   
4. Intensify medical therapy

A 69-year-old male has a history of hypertension, diabetes mellitus controlled on long-acting insulin therapy, hypercholesterolemia, and past history of smoking. He is on optimal medical therapy. He has new onset of exercise-induced angina of 1 month duration. His primary care physician ordered a stress test. His stress test was interpreted as negative. He is now referred to you for further evaluation. What is the best test to order?

1. No further testing
   
2. Stress nuclear imaging
   
3. Coronary angiogram
   
4. Adenosine stress CMR

A 59-year-old male patient with multiple cardiac risk factors and intractable angina was referred for a coronary angiogram. His coronary angiogram revealed a 60% stenosis in the mid LAD artery. What is the best approach in the treatment of this patient?

1. Percutaneous coronary intervention (PCI) of the 60% stenosis with a bare-metal stent
   
2. Fractional flow reserve (FFR)-guided PCI of the 60% stenosis
   
3. No further evaluation
   
4. PCI with a drug-eluting stent (DES)

A 71-year-old male underwent coronary angiogram to evaluate suspected IHD. His angiogram revealed 30% lesion in his mid right coronary artery (RCA), 40% lesion in left circumflex artery, and a 60% stenosis of his proximal LAD artery. FFR of the LAD artery lesion was 0.85. What is the best approach in managing this patient?

1. PCI with a DES to his proximal LAD stenosis
   
2. Intensify medical therapy
   
3. PCI of left circumflex and LAD stenosis
   
4. No further therapy

What is the US annual mortality rate in a middle-aged man with CAD?

1. 1.7–3%
   
2. 5–10%
   
3. 10–15%
   
4. None of the above

What is the US occurrence of major ischemic events in a middle-aged person with CAD?

1. 5–10%
   
2. 1.4–2.4%
   
3. 15–25%
   
4. None of the above

What is the 5-year survival in a patient with triple-vessel disease with an LV EF of 30% and on medical therapy?

1. 70%
   
2. 60%
   
3. 40%
   
4. 25%

There is an increased gradient of risk based on angiographic extent of disease. Which of the following options best describes this statement?

1. True
   
2. False
   
3. Not enough information is provided
   
4. None of the above

In a patient with symptomatic CAD, with three-vessel CAD on coronary angiography and an EF of 40%, what would the best approach be?

1. Multivessel PCI with DES
   
2. Multivessel PCI with bare metal stents
   
3. Coronary artery bypass grafting (CABG) including left internal mammary artery (LIMA) to LAD artery
   
4. Medical therapy only

According to the SYNTAX trial, what was a low SYNTAX score?

1. 23–32
   
2. ≤22
   
3. ≥33
   
4. 50

In the SYNTAX trial, the combined end point of death, myocardial infarction (MI), and stroke for CABG was described as what compared with DES at 5-year follow-up?

1. Equal
   
2. Lower
   
3. Higher
   
4. None of the above

In the SYNTAX trial, MI and repeat revascularization were described as what in the DES group compared with the CABG group?

1. Lower
   
2. Higher
   
3. Equal
   
4. None of the above

In the SYNTAX trial at 5-year follow-up, the occurrence of major adverse cardiac and cerebrovascular events (MACCEs) was described as what in the PCI group compared with the CABG group?

1. Equal
   
2. Lower
   
3. Higher
   
4. Do not know

What is the best approach for revascularization in a patient with 70% distal left main coronary disease?

1. PCI with DES
   
2. CABG
   
3. Medical therapy
   
4. Medical therapy plus CABG

A 65-year-old male patient has complaints of severe angina. His coronary angiogram reveals a 50% mid RCA stenosis, FFR of 0.85, and a 30% left circumflex lesion. What is the best approach in treating this patient?

1. DES to RCA stenosis only
   
2. DES to RCA and left circumflex arteries
   
3. CABG
   
4. Guideline-directed medical therapy

In the COURAGE trial, is it true or false that PCI with optimal medical therapy reduced the risk of death or MI compared with optimal medical therapy alone?

1. True
   
2. False

A 69-year-old male with hypertension and diabetes mellitus had a coronary angiogram for symptoms of angina. His resting echocardiogram showed an EF of 35%. He underwent PCI with a DES to the mid LAD artery. He is on aspirin, clopidogrel, metoprolol, and high-intensity atorvastatin. Prior to discharge, what other medication is indicated?

1. Hydrochlorothiazide
   
2. Angiotensin-converting inhibitor
   
3. Diltiazem
   
4. Angiotensin receptor blocker

In the patient mentioned in Question 10.35, what is the optimal duration of dual antiplatelet therapy?

1. 3 months
   
2. 6 months
   
3. 12 months
   
4. 6–12 months

A 54-year-old male with CAD has complained of angina which occurs two or three times per week. He is on aspirin, long-acting metoprolol, and atorvastatin. What is the next best step to add?

1. Nifedipine
   
2. Switch metoprolol to atenolol
   
3. Ranolazine
   
4. Long-acting nitrates

The patient in Question 10.37 is started on a long-acting nitrate. He comes back to your office for a follow-up. He indicates that his angina is not completely resolved. He also says that his BP at home is elevated 150/95 mmHg. What is the best course of action to take next?

1. Add nicardipine
   
2. Start ranolazine
   
3. No need to add anything at this time
   
4. Switch metoprolol to atenolol