Infective Endocarditis (IE), HLD, Cardiac Tumors

Infective endocarditis is best described as an infection of which cardiac structure?

Which of the following patient populations is at the highest risk for developing infective endocarditis?

Intravenous drug abuse is most closely associated with infective endocarditis affecting which heart valve?

Which of the following is the most common initial symptom observed in patients with infective endocarditis?

A patient with suspected infective endocarditis develops painful, subcutaneous nodules on the fingertips and toes. These lesions are most consistent with:

Painless, erythematous macules on the palms and soles observed in a patient with suspected infective endocarditis are known as:

Linear, dark red streaks observed under the nailbeds in a patient with fever and a new heart murmur are most likely:

Fundoscopic examination in a patient with suspected infective endocarditis reveals retinal hemorrhages with pale centers. These findings are known as:

A new or changing regurgitant heart murmur in a patient with fever should raise suspicion for:

Which heart valves are most commonly affected by infective endocarditis in the general population?

The Osler triad, a less common presentation of infective endocarditis, consists of endocarditis, meningitis, and:

The initial diagnostic test of choice for suspected infective endocarditis is:

Why is it recommended to obtain blood cultures from different venipuncture sites rather than from an existing intravenous line when evaluating for infective endocarditis?

Which type of echocardiogram is generally more sensitive for detecting vegetations in infective endocarditis?

According to the modified Duke criteria, which of the following is considered a major criterion for the diagnosis of infective endocarditis?

Which of the following bacterial genera is NOT typically associated with causing infective endocarditis as part of the HACEK group?

Vegetations detected on echocardiography are considered a:

Which of the following is considered a minor Duke criterion for infective endocarditis?

Streptococcus viridans is most commonly associated with infective endocarditis of:

Staphylococcus aureus is the most frequent cause of infective endocarditis in which patient population?

Which of the following organisms is most commonly implicated in prosthetic valve endocarditis, particularly in the early postoperative period?

The typical duration of intravenous antibiotic therapy for infective endocarditis is:

Which antibiotic combination is commonly used for empiric treatment of infective endocarditis?

Surgical intervention is often considered in infective endocarditis for patients with:

What is the most frequent cause of death in patients with infective endocarditis despite antibiotic treatment?

Prior to the antibiotic era, the prognosis for infective endocarditis was:

The current mortality rate for infective endocarditis is approximately:

Prophylactic antibiotics are recommended for patients at high risk of infective endocarditis undergoing certain procedures. Which of the following conditions is NOT routinely considered a high-risk condition for IE prophylaxis?

Which antibiotic is typically recommended for oral prophylaxis against infective endocarditis in adults?

For a patient with a penicillin allergy requiring infective endocarditis prophylaxis and who can take oral medication, which of the following is an appropriate alternative?

Infective endocarditis prophylaxis is recommended for dental procedures that involve:

Which of the following procedures typically requires infective endocarditis prophylaxis in high-risk patients?

A patient with a prosthetic heart valve is scheduled for a tooth extraction. Which prophylactic antibiotic regimen is most appropriate if they can take oral medications and are not allergic to penicillin?

Which of the following is a neurological complication associated with infective endocarditis?

A patient with infective endocarditis develops persistent fever despite appropriate antibiotic therapy. This may suggest the presence of:

Which of the following is NOT a typical sign or symptom of infective endocarditis?

Splenomegaly is found in approximately what percentage of patients with infective endocarditis who have been ill for months?

Which of the following is the MOST important step in the management of a patient suspected of having infective endocarditis?

A patient with known prosthetic valve endocarditis develops a sudden onset of right-sided weakness and speech difficulty. This is most likely due to:

For patients unable to take oral medications and requiring infective endocarditis prophylaxis, which of the following intravenous or intramuscular agents is recommended as an alternative to amoxicillin?

According to current guidelines, at what age should universal cholesterol screening begin in individuals without specific risk factors?

Which of the following lipid panel components is considered 'good cholesterol' due to its protective effects against coronary heart disease?

A persistently elevated triglyceride level is defined as what value?

Which of the following biomarkers, when elevated, is considered a risk-enhancing factor for ASCVD, especially in individuals with a family history of premature ASCVD?

A patient's lipid panel reveals elevated triglycerides. Using the Friedewald equation, which of the following conditions would invalidate the calculation of LDL-C?

A patient with known cardiovascular disease has a coronary artery calcium (CAC) score of 350. How would you interpret this result?

Which of the following lifestyle modifications is MOST critical for all patients with hyperlipidemia, regardless of their calculated ASCVD risk?

Which of the following best describes the primary mechanism of action of HMG-CoA reductase inhibitors (statins)?

Which of the following is a common, reversible side effect associated with statin medications?

A patient with severe renal impairment requires statin therapy. Which statin would be MOST appropriate to initiate, given its safety profile in this population?

A patient is prescribed simvastatin 40mg daily for hyperlipidemia. Which of the following medications, if initiated concurrently, would warrant a reduction in the simvastatin dose to a maximum of 20mg daily due to increased risk of myopathy?

Which of the following statins is generally considered to provide the greatest reduction in LDL-C levels at commonly prescribed doses?

According to current guidelines, which of the following represents a high-intensity statin therapy?

A patient with persistent hypercholesterolemia despite maximally tolerated statin therapy requires additional LDL-C lowering. Which of the following medications works by blocking the re-uptake of cholesterol in the small intestine?

A patient with ASCVD and persistent hypercholesterolemia despite statin and ezetimibe therapy is being considered for a PCSK9 inhibitor. What is the primary mechanism of action of PCSK9 inhibitors?

A patient asks about a relatively new injectable medication for hyperlipidemia that their friend is taking. Which of the following describes the mechanism of action of inclisiran (Leqvio)?

A patient with significantly elevated triglycerides (>500 mg/dL) is at increased risk for which of the following conditions?

Which of the following lipid-lowering medications carries the highest risk of myopathy when used in combination with statins?

Niacin is known to affect lipid profiles in several ways. Which of the following is niacin NOT shown to do?

What is the primary mechanism by which bile acid sequestrants lower LDL-C?

According to the 2018 AHA/ACC/AACVPR guidelines, what is the initial step in managing blood cholesterol in all individuals, regardless of their ASCVD risk?

Which of the following is considered part of the definition of clinical ASCVD?

A 68-year-old patient with a history of myocardial infarction is considered to have clinical ASCVD. According to guidelines, what intensity of statin therapy is generally recommended as the initial treatment?

Which of the following conditions, in addition to established ASCVD, would classify a patient as 'very high risk' according to current cholesterol management guidelines?

In a patient WITHOUT clinical ASCVD, what LDL-C level would automatically trigger consideration for statin therapy, regardless of other risk factors?

A 55-year-old patient with diabetes mellitus and an LDL-C of 85 mg/dL, but WITHOUT clinical ASCVD, should be started on what intensity of statin therapy according to current guidelines?

In adults aged 40-75 years being evaluated for PRIMARY ASCVD prevention, what assessment should be done before initiating statin therapy?

Regardless of the presence of clinical ASCVD, at what LDL level would a patient be recommended to be placed on a high intensity statin?

A patient is found to have an ABI < 0.9. Which of the following statements best describes this?

A patient has an LDL of 200 and is started on a high intensity statin. After a few months, their LDL is 110. What medication could be added next?

A patient with familial hypercholesterolemia has been on high-intensity statin therapy and ezetimibe, with a persistent LDL-C above goal. Which medication should be considered next?

A patient with known cardiovascular disease has a moderate ASCVD risk and a LDL level of 100 mg/dL. According to current guidelines, what is the target LDL level for this patient?

A cardiologist recommends measuring ApoB in a patient's lipid panel. What is a relative indication for its measurement?

A patient with ASCVD has been on a high intensity statin and ezetimibe, but their LDL level is still above goal. What is the most appropriate next step in management?

A patient with diabetes has been on multiple lipid-lowering agents, including a statin, ezetimibe, and a PCSK9 inhibitor, yet their LDL-C remains stubbornly high at 120 mg/dL. They are already on the maximally tolerated doses of these medications. Assuming cost is not a factor, what is the most appropriate next step?

A patient with a history of statin-induced myopathy develops severe hypertriglyceridemia (800 mg/dL). Knowing that fibrates are generally avoided in statin-intolerant patients due to the increased risk of myopathy, which of the following would be the safest initial agent to add to therapy?

According to the US Preventive Services Task Force, at what age is it generally recommended to begin routine cholesterol screening in adults without specific risk factors?

A patient's lipid panel reveals an HDL-C level of 55 mg/dL. Which of the following statements best describes the role of HDL-C in cardiovascular health?

A 62-year-old male with a history of myocardial infarction is being managed for secondary prevention of ASCVD. According to current guidelines, which of the following represents high-intensity statin therapy aimed at reducing LDL-C by ≥50%?

A 58-year-old patient with established coronary artery disease and type 2 diabetes mellitus is currently managed with high-intensity statin therapy and ezetimibe. Despite this regimen, his LDL-C remains elevated at 95 mg/dL (2.46 mmol/L). Which of the following would be the MOST appropriate next step in managing his hyperlipidemia according to guideline-directed therapy?

A 45-year-old woman with no known cardiovascular disease or diabetes presents for a routine health check. Her lipid panel reveals a total cholesterol of 220 mg/dL and LDL-C of 150 mg/dL. She reports a family history of premature coronary artery disease in her father, who had a myocardial infarction at age 52. Which of the following additional tests would be MOST useful in further refining her ASCVD risk assessment and guiding decisions regarding statin therapy?

What percentage of tumors affecting the heart are primary tumors, as indicated by autopsy series data?

Most primary cardiac tumors share which characteristic?

Which of the following factors contributes most significantly to the poor prognosis associated with most malignant primary and metastatic cardiac lesions?

Which of the following is the most common location within the heart for myxomas to develop?

A 'tumor flop' sound is most characteristic of which cardiac tumor?

A patient presents with syncope that occurs primarily when bending over. Which type of cardiac tumor should you suspect?

Which symptom is least likely to be associated with a cardiac myxoma?

A patient is diagnosed with a cardiac angiosarcoma. This tumor is best classified as:

Considering primary cardiac tumors, which of the following does NOT belong to the benign classification?

What is the primary treatment goal for malignant cardiac sarcomas and metastatic lesions?

What clinical manifestation would most strongly suggest a positional component related to gravity affecting a cardiac mass?

Which statement accurately reflects the treatment approach for primary cardiac tumors?

Which of the following is the most common presenting symptom of a benign cardiac myxoma?

What is the typical behavior of malignant primary cardiac tumors and metastatic lesions regarding treatment response?

What percentage range accurately represents the incidence of primary cardiac tumors found during autopsy series?

In the context of primary cardiac tumors, which of the following is typically associated with a poor long-term survival rate?

Which cardiac tumor is most likely to cause constitutional symptoms such as fever and weight loss?

A patient presents with symptoms suggestive of a cardiac tumor. If the tumor is causing intermittent obstruction of the mitral valve, where is the most probable location of the mass?

What is a key difference in management between a benign cardiac tumor and a malignant cardiac tumor?

A previously healthy 35-year-old male experiences sudden onset of syncope, particularly when transitioning from a lying to standing position. Transthoracic echocardiography reveals a mobile mass in the left atrium. Given the patient's presentation and imaging findings, which of the following is the MOST likely diagnosis?

Which of the following are secondary causes of hyperlipidemia (click all that apply)?

22 year-old black male with total cholesterol 440mg/dL, HDL 35mg/dL, LDL 200mg/dL, systolic BP 130mmHg, not a diabetic, non smoker. What is recommended?

A 55 year-old male is discharged from the hospital after a MI. Which of the following medications should he take?

A 67 year-old female has peripheral arterial disease. Her LDL is 100. Which of the following is the best option?

A 70 year-old male has stable angina. Which of the following is the best option?

A 60 year-old male received Percutaneous intervention (PCI) with 2 Drug eluding stents (DES): 1 to the RCA and 1 to the PDA. Which of the following is the best option?

Which patient should get a high intensity statin? (click all that apply)

A 56 year-old male with CAD and a history of multiple MI's on Atorvastatin 80mg daily and Ezetimibe 10mg daily. His current LDL is 107 mg/dL. Which of the following would be the best option to add to this patient's regime?

Which of the following would be best for a patient who has isolated hypertriglyceridemia of 700mg/dL (click all that apply)?

22 year-old black male with total cholesterol 440mg/dL, HDL 35mg/dL, LDL 200mg/dL, systolic BP 130mmHg, not a diabetic, non smoker is started on Atorvastatin (Lipitor) 80mg daily. His repeat LDL is 120 mg/dL. What medication is recommended next to add to Atorvastatin?

42 year-old African American male, total cholesterol 180 mg/dL, HDL 40mg/dL, LDL 120mg/dL, BP 140/84 mm Hg, not taking antihypertensive medication, not on a statin, not on aspirin, not diabetic, + current smoker. Calculate his 10 year ASCVD risk https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/. What is recommended?

57 year-old white male with total cholesterol of 255, HDL 45mg/dL, LDL 144 mg/dL, systolic BP 110/70 mm Hg, not taking antihypertensive medication, not on a statin, not taking aspirin, not diabetic, + former smoker (quit 3 years ago). Calculate his 10 year-ASCVD risk: https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/. What is recommended?

48 year-old African American female with Diabetes, total cholesterol 180 mg/dL, HDL 55 mg/dL, LDL 89 mg/dL, systolic BP 130/80 mm Hg, taking antihypertensive medication, taking aspirin, taking Simvastatin 20mg daily. + diabetic, + smoker. Calculate the 10 year ASCVD risk https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/. What is recommended?

42 year-old white man with total cholesterol 250mg/dL, HDL 40mg/dL, LDL 154mg/dL, Blood pressure is 130/90mm Hg, not a diabetic, + smoker, & does not take any prescription or over the counter medications. Calculated 10-year risk of CHD or stroke is 9%. Calculate his 10-year ASCVD risk https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/. What is recommended?

Which of the following pharmacotherapies can favorable modify lipid levels and improve patient outcomes?

For patients who are not meeting low-density lipoprotein cholesterol (LDL-C) goals using maximally-tolerated statin therapy alone, clinicians should consider adding ezetimibe to treatment

A 28 year-old female with DM type I has an LDL of 130. Which of the following is recommended?

A 28-year-old patient with a strong family history of early MI is found to have LDL-C levels of 220 mg/dL despite a healthy lifestyle. Achilles tendon thickening is noted on exam. What is the most likely diagnosis?

Which of the following statins is safest in a patient with chronic liver disease who is abstinent from alcohol?

A 61-year-old man with a history of aortic valve replacement presents with fever, fatigue, and a new murmur. What is the most appropriate next step?

A 40-year-old IV drug user presents with fever, petechiae, and a new systolic murmur. Which valve is most likely involved?

Which of the following is a major Duke criterion for the diagnosis of infective endocarditis?

A 68-year-old woman presents with fever, weight loss, and anemia. She reports presyncopal episodes when bending over. What is the most likely diagnosis?

A patient is found to have a large left atrial mass that causes symptoms when changing position in bed. Which of the following best describes the expected finding on physical exam?

What is the most common primary cardiac tumor in adults?

A patient with a history of valve replacement is scheduled for dental extraction. Which of the following is the correct antibiotic prophylaxis?

A 73-year-old male with a prosthetic valve and suspected IE has 2 positive blood cultures and a new regurgitant murmur. Which of the following fulfills Duke criteria?

A 54-year-old man on simvastatin and amlodipine presents with myalgias and dark urine. Which of the following best explains the cause?

Which of the following agents would be most appropriate for a statin-intolerant patient with severe primary hypercholesterolemia (LDL ≥ 190 mg/dL)?

A 67-year-old patient presents with infective endocarditis due to Enterococcus. He has no allergies. What is the best empiric antibiotic regimen?

A patient with infective endocarditis has negative blood cultures, despite prolonged fever and murmur. What organism class is most likely?

A 32-year-old male has a painful subcutaneous nodule on his palm and retinal hemorrhages. What diagnosis do these findings support?

A patient with left atrial myxoma presents with dyspnea and presyncope when changing position. Which of the following is the most likely murmur?

A 49-year-old man has LDL-C 190 mg/dL. After 6 months of lifestyle change and atorvastatin 80 mg, LDL is still 140 mg/dL. What's the next best step?