ACCSAP Pearls Exam UPDATED
QUESTIONS AND CORRECT ANSWERS
Echo finding associated w/ Turner's Syndrome - CORRECT ANSWER Bicuspid aortic valve
and coarctation
Echo finding associated w/ Noonan syndrome - CORRECT ANSWER Pulmonary stenosis
Echo finding associated w/ Down's Syndrome - CORRECT ANSWER AV Canal Defects
Echo finding associated w/ Holt-Oram - CORRECT ANSWER ASDs
Echo finding associated w/ DiGeorge Syndrome - CORRECT ANSWER Tetralogy of Fallot
Echo finding associated w/ William syndrome - CORRECT ANSWER Supra aortic stenosis
How does Aspirin work? - CORRECT ANSWER inhibits cyclo-oxygenase-1 and prevents the
synthesis of thromboxane A2, a platelet aggregation stimulator
How does glycoprotein IIb/IIIa inhibitors work? - CORRECT ANSWER blocks the cross-
linking of platelets by inhibiting platelet binding to the dimeric fibrinogen molecule
How does ticagrelor work? - CORRECT ANSWER Inhibits ADP-induced platelet aggregation
How to address erythrocytosis in Eisenminger's patients - CORRECT ANSWER supplemental
oxygen therapy (if it increases arterial oxygen saturation), pulmonary vasodilator therapy, and iron
supplementation when iron deficiency is present
Risk factors for anthracycline toxicity - CORRECT ANSWER 1) total lifetime dose of
anthracycline; 2) intravenous bolus administration; 3) higher single doses; 4) history of prior
mediastinal irradiation; 5) use of other concomitant agents known to have cardiotoxic effects, such as
cyclophosphamide, trastuzumab, and paclitaxel; 6) female sex; 7) underlying cardiovascular disease;
, 8) extremes of patient age (both very young and old age); and 9) increased length of time since
anthracycline completion
How to manage asymptomatic pericardial effusion? - CORRECT ANSWER Tamponade or
bacterial/neoplastic then centesis; also get inflammatory biomarkers to guide tx w/ NSAID.
Medical treatment for preexcited AF - CORRECT ANSWER ibutilide or intravenous
procainamide
In addition to GDMT, which intervention reduced hospitalization in HF patients? - CORRECT
ANSWER Standard HF education
What are the indications for valve replacement in severe AR? - CORRECT ANSWER LV
systolic dysfunction defined by EF <0.55, LV is severely enlarged (end-systolic dimension >50 mm or
end-systolic dimension index >25 mm)
Hemodynamic tracing of constrictive pericarditis - CORRECT ANSWER "sqrt sign" with
interventricular dependence
HIV med interaction w/ lipid profile - CORRECT ANSWER Protease inhibitor drugs worsen
lipid profiles. Switching from a stable protease inhibitor regimen to an alternative regimen may be
associated with virologic breakthrough. Initiating medications, like statins and fish oil, which are
designed to improve lipids and triglycerides, is likely a better option for decreasing CV risk, rather
than changing antiretrovirals. Simvastatin and lovastatin are contraindicated for use with protease
inhibitors.
How long after PDE5 inhibitors is NTG contraindicated - CORRECT ANSWER within 24
hours of sildenafil or vardenafil use or within 48 hours of tadalafil use
What is an LV pseudoaneurysm? - CORRECT ANSWER ventricular free wall rupture but is
contained by localized pericardial adhesions. distinctively different from left ventricular aneurysms
(LVA) and notably have a narrow neck that communicates freely with the left ventricle
What is an LV aneurysm? - CORRECT ANSWER thin, scarred segment of the left ventricle and
is the result of a transmural myocardial infarction. It most commonly involves the apex or anterior
wall.
QUESTIONS AND CORRECT ANSWERS
Echo finding associated w/ Turner's Syndrome - CORRECT ANSWER Bicuspid aortic valve
and coarctation
Echo finding associated w/ Noonan syndrome - CORRECT ANSWER Pulmonary stenosis
Echo finding associated w/ Down's Syndrome - CORRECT ANSWER AV Canal Defects
Echo finding associated w/ Holt-Oram - CORRECT ANSWER ASDs
Echo finding associated w/ DiGeorge Syndrome - CORRECT ANSWER Tetralogy of Fallot
Echo finding associated w/ William syndrome - CORRECT ANSWER Supra aortic stenosis
How does Aspirin work? - CORRECT ANSWER inhibits cyclo-oxygenase-1 and prevents the
synthesis of thromboxane A2, a platelet aggregation stimulator
How does glycoprotein IIb/IIIa inhibitors work? - CORRECT ANSWER blocks the cross-
linking of platelets by inhibiting platelet binding to the dimeric fibrinogen molecule
How does ticagrelor work? - CORRECT ANSWER Inhibits ADP-induced platelet aggregation
How to address erythrocytosis in Eisenminger's patients - CORRECT ANSWER supplemental
oxygen therapy (if it increases arterial oxygen saturation), pulmonary vasodilator therapy, and iron
supplementation when iron deficiency is present
Risk factors for anthracycline toxicity - CORRECT ANSWER 1) total lifetime dose of
anthracycline; 2) intravenous bolus administration; 3) higher single doses; 4) history of prior
mediastinal irradiation; 5) use of other concomitant agents known to have cardiotoxic effects, such as
cyclophosphamide, trastuzumab, and paclitaxel; 6) female sex; 7) underlying cardiovascular disease;
, 8) extremes of patient age (both very young and old age); and 9) increased length of time since
anthracycline completion
How to manage asymptomatic pericardial effusion? - CORRECT ANSWER Tamponade or
bacterial/neoplastic then centesis; also get inflammatory biomarkers to guide tx w/ NSAID.
Medical treatment for preexcited AF - CORRECT ANSWER ibutilide or intravenous
procainamide
In addition to GDMT, which intervention reduced hospitalization in HF patients? - CORRECT
ANSWER Standard HF education
What are the indications for valve replacement in severe AR? - CORRECT ANSWER LV
systolic dysfunction defined by EF <0.55, LV is severely enlarged (end-systolic dimension >50 mm or
end-systolic dimension index >25 mm)
Hemodynamic tracing of constrictive pericarditis - CORRECT ANSWER "sqrt sign" with
interventricular dependence
HIV med interaction w/ lipid profile - CORRECT ANSWER Protease inhibitor drugs worsen
lipid profiles. Switching from a stable protease inhibitor regimen to an alternative regimen may be
associated with virologic breakthrough. Initiating medications, like statins and fish oil, which are
designed to improve lipids and triglycerides, is likely a better option for decreasing CV risk, rather
than changing antiretrovirals. Simvastatin and lovastatin are contraindicated for use with protease
inhibitors.
How long after PDE5 inhibitors is NTG contraindicated - CORRECT ANSWER within 24
hours of sildenafil or vardenafil use or within 48 hours of tadalafil use
What is an LV pseudoaneurysm? - CORRECT ANSWER ventricular free wall rupture but is
contained by localized pericardial adhesions. distinctively different from left ventricular aneurysms
(LVA) and notably have a narrow neck that communicates freely with the left ventricle
What is an LV aneurysm? - CORRECT ANSWER thin, scarred segment of the left ventricle and
is the result of a transmural myocardial infarction. It most commonly involves the apex or anterior
wall.
