Eidgenössisches Examen Humanmedizin Practice Questions - Eidgenössische Prüfung in Humanmedizin Examen fédéral en médecine humaine Exam - Eidgenössisches Examen Humanmedizin Practice Questions - Eidgenössische Prüfung in Humanmedizin Examen fédéral en médecine humaine Exam

Question 1

A 58-year-old male presents to the emergency department with acute, crushing substernal chest pain radiating to his left arm and jaw that started 45 minutes ago. He is diaphoresis and dyspneic. His 12-lead ECG demonstrates 3 mm ST-segment elevations in leads V1–V4 with reciprocal ST depressions in leads II, III, and aVF. Blood pressure is 135/85 mmHg, heart rate is 88 bpm, and SpO2 is 97% on room air. According to European Society of Cardiology (ESC) guidelines, what is the most appropriate immediate reperfusion and pharmacological strategy?

Immediate transfer for primary percutaneous coronary intervention (PCI) with target wire-crossing <90 minutes, loading with aspirin, a potent P2Y12 inhibitor (ticagrelor or prasugrel), and unfractionated heparin Immediate IV fibrinolysis with tenecteplase in the emergency department followed by routine elective coronary angiography within 48 to 72 hours Immediate administration of high-dose intravenous nitroglycerin, beta-blocker, and fondaparinux, delaying catheterization until high-sensitivity troponin levels peak Immediate transfer for emergent coronary artery bypass grafting (CABG) as first-line revascularization for all anterior ST-segment elevation myocardial infarctions

Correct Answer:

Question 2

A 64-year-old female with ischemic cardiomyopathy presents for outpatient follow-up. Transthoracic echocardiography reveals a left ventricular ejection fraction (LVEF) of 28% with global hypokinesia. She reports dyspnea when walking up one flight of stairs (NYHA Class II). Her current medications are bisoprolol 5 mg daily and ramipril 5 mg daily. Blood pressure is 122/74 mmHg, heart rate is 68 bpm, eGFR is 62 mL/min/1.73m², and serum potassium is 4.3 mmol/L. According to ESC Heart Failure guidelines, which medical regimen constitutes optimal quadruple guideline-directed medical therapy (GDMT)?

Continue bisoprolol and ramipril, and add digoxin and ivabradine Switch ramipril to an ARNI (sacubitril/valsartan), maintain bisoprolol, add a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and add an SGLT2 inhibitor (dapagliflozin or empagliflozin) Discontinue bisoprolol, increase ramipril to maximum tolerated dose, and initiate hydralazine plus isosorbide dinitrate monotherapy Add amiodarone and furosemide while maintaining current doses of bisoprolol and ramipril without further neurohormonal blockade

Correct Answer:

Switch ramipril to an ARNI (sacubitril/valsartan), maintain bisoprolol, add a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and add an SGLT2 inhibitor (dapagliflozin or empagliflozin)

Question 3

A 71-year-old male with a history of hypertension and type 2 diabetes mellitus presents with palpitations. An ECG confirms newly diagnosed atrial fibrillation with a ventricular response of 115 bpm. He has no prior history of stroke, TIA, or vascular disease. Echocardiography shows preserved left ventricular systolic function and no significant valvular disease. Blood pressure is 138/82 mmHg. What is his CHA2DS2-VASc score, and what is the recommended long-term antithrombotic management?

CHA2DS2-VASc = 1; prescribe low-dose aspirin 100 mg daily CHA2DS2-VASc = 2; dual antiplatelet therapy with aspirin and clopidogrel for 12 months CHA2DS2-VASc = 3; oral anticoagulation with a direct oral anticoagulant (DOAC, e.g., apixaban, edoxaban, or rivaroxaban) as preferred first-line therapy CHA2DS2-VASc = 4; therapeutic intravenous unfractionated heparin bridging followed by lifelong vitamin K antagonist (warfarin/phenprocoumon) with target INR 3.0–4.0

Correct Answer:

CHA2DS2-VASc = 3; oral anticoagulation with a direct oral anticoagulant (DOAC, e.g., apixaban, edoxaban, or rivaroxaban) as preferred first-line therapy

Question 4

A 52-year-old male presents with a 4-week history of low-grade fever, night sweats, fatigue, and weight loss. On examination, a new 3/6 holosystolic murmur is heard loudest at the cardiac apex. Fundoscopic exam reveals retinal flame hemorrhages with pale centers (Roth spots), and splinter hemorrhages are visible under the fingernails. What is the most crucial initial diagnostic step before initiating antimicrobial therapy?

Immediate administration of empiric IV vancomycin plus gentamicin followed by a single set of blood cultures 6 hours later Transesophageal echocardiography followed by therapeutic pericardiocentesis Urgent cardiac MRI and serum troponin T measurement Drawing at least three separate sets of blood cultures from different venipuncture sites spaced at least 30 to 60 minutes apart, followed by prompt transthoracic echocardiography (TTE)

Correct Answer:

Drawing at least three separate sets of blood cultures from different venipuncture sites spaced at least 30 to 60 minutes apart, followed by prompt transthoracic echocardiography (TTE)

Question 5

A 78-year-old woman presents with progressive exertional dyspnea and two recent episodes of presyncope while walking uphill. Cardiac auscultation reveals a harsh, crescendo-decrescendo systolic ejection murmur at the right upper sternal border radiating to the carotids, accompanied by a delayed and diminished carotid pulse (pulsus parvus et tardus) and a single soft second heart sound (S2). Transthoracic echocardiography shows a calcified trileaflet aortic valve with a peak transvalvular jet velocity of 4.4 m/s, mean pressure gradient of 48 mmHg, and an aortic valve area (AVA) of 0.7 cm². What is the definitive management of choice?

Aortic valve replacement (transcatheter aortic valve implantation [TAVI] or surgical aortic valve replacement [SAVR]) after Heart Team evaluation Long-term medical therapy with high-dose loop diuretics and ACE inhibitors without procedural intervention Percutaneous balloon aortic valvuloplasty as definitive lifelong corrective therapy Prescription of beta-blockers and reassurance with repeat echocardiography in 12 months

Correct Answer:

Aortic valve replacement (transcatheter aortic valve implantation [TAVI] or surgical aortic valve replacement [SAVR]) after Heart Team evaluation

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Eidgenössisches Examen Humanmedizin Practice Questions - Eidgenössische Prüfung in Humanmedizin Examen fédéral en médecine humaine Exam

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