1. A 58-year-old woman with a history of hyperlipidemia presents with progressive exercise intolerance and shortness of breath. An echocardiogram reveals severe aortic stenosis. Which of the following is the most likely underlying mechanism for this patient’s aortic stenosis?
A. Calcific degeneration of the aortic valve
B. Rheumatic heart disease
C. Congenital bicuspid aortic valve
D. Infective endocarditis
E. Radiation-induced valvular disease
2. A 65-year-old man with a history of type 2 diabetes and hypertension presents with intermittent claudication in his lower extremities. Ankle-brachial index (ABI) testing reveals a value of 0.6 in the right lower extremity. Which of the following is the most appropriate next step in management?
A. Initiate aspirin and statin therapy
B. Refer for endovascular revascularization
C. Refer for surgical revascularization
D. Initiate anticoagulation therapy
E. Initiate a supervised exercise program
3. A 72-year-old man with a history of coronary artery disease and carotid artery stenosis presents with sudden onset of left-sided hemiparesis. Neuroimaging reveals an acute ischemic stroke. Which of the following is the most likely mechanism of this patient’s stroke?
A. Cardioembolic
B. Large-artery atherosclerosis
C. Small-vessel occlusion
D. Dissection
E. Lacunar infarction
4. A 55-year-old man with a history of hyperlipidemia undergoes a screening coronary artery calcium (CAC) scan, which reveals a score of 400. Which of the following is the most appropriate next step in management?
A. Initiate high-intensity statin therapy
B. Refer for coronary angiography
C. Perform a stress test
D. Initiate aspirin therapy
E. Reassure the patient and repeat the CAC scan in 5 years
5. A 60-year-old man with a history of peripheral artery disease presents with rest pain in his right lower extremity. Angiography reveals a long segment of stenosis in the superficial femoral artery. Which of the following is the most appropriate treatment?
A. Endovascular revascularization with angioplasty and stenting
B. Surgical revascularization with endarterectomy
C. Initiate anticoagulation therapy
D. Initiate a supervised exercise program
E. Initiate a trial of vasodilator therapy
6. A 72-year-old woman with a history of coronary artery disease and chronic kidney disease presents with worsening dyspnea and peripheral edema. Echocardiography reveals a severely reduced left ventricular ejection fraction of 25%. Which of the following is the most appropriate medication to initiate?
A. Angiotensin-converting enzyme (ACE) inhibitor
B. Angiotensin II receptor blocker (ARB)
C. Diuretic
D. Beta-blocker
E. Calcium channel blocker
7. A 55-year-old man with a history of type 2 diabetes and hypertension undergoes a carotid duplex ultrasound, which reveals a 70% stenosis of the right internal carotid artery. Which of the following is the most appropriate next step in management?
A. Initiate antiplatelet therapy
B. Refer for carotid endarterectomy
C. Refer for carotid artery stenting
D. Initiate high-intensity statin therapy
E. Recommend lifestyle modifications and risk factor control
8. A 65-year-old man with a history of peripheral artery disease presents with a non-healing ulcer on his right foot. Angiography reveals extensive occlusive disease in the tibial and peroneal arteries. Which of the following is the most appropriate treatment?
A. Endovascular revascularization with angioplasty and stenting
B. Surgical revascularization with bypass grafting
C. Initiate anticoagulation therapy
D. Initiate a trial of prostanoid therapy
E. Recommend amputation
9. A 60-year-old man with a history of coronary artery disease and chronic kidney disease presents with worsening angina and dyspnea. A cardiac catheterization reveals severe triple-vessel coronary artery disease. Which of the following is the most appropriate treatment?
A. Percutaneous coronary intervention with drug-eluting stents
B. Coronary artery bypass grafting
C. Initiate medical therapy with antiplatelet and statin
D. Refer for cardiac transplantation
E. Recommend palliative care
10. A 70-year-old man with a history of hypertension and hyperlipidemia presents with sudden-onset chest pain and shortness of breath. Computed tomography (CT) angiography of the chest reveals an aortic dissection involving the ascending aorta. Which of the following is the most appropriate initial management?
A. Immediate surgical repair
B. Initiate antihypertensive therapy
C. Initiate anticoagulation therapy
D. Perform coronary angiography
E. Recommend palliative care
11. A 55-year-old woman with a history of type 2 diabetes and obesity presents with progressive exertional dyspnea and lower extremity edema. Echocardiography reveals a restrictive pattern of diastolic dysfunction. Which of the following is the most likely underlying mechanism for this patient’s heart failure?
A. Myocardial infarction
B. Hypertensive heart disease
C. Diabetic cardiomyopathy
D. Valvular heart disease
E. Pericardial disease
12. A 60-year-old man with a history of peripheral artery disease undergoes endovascular revascularization of his superficial femoral artery. Which of the following is the most common complication of this procedure?
A. Bleeding
B. Restenosis
C. Distal embolization
D. Acute limb ischemia
E. Arterial dissection
13. A 65-year-old man with a history of coronary artery disease and chronic kidney disease presents with sudden-onset left-sided hemiparesis. Neuroimaging reveals an acute ischemic stroke in the right middle cerebral artery territory. Which of the following is the most appropriate antiplatelet therapy to initiate?
A. Aspirin
B. Clopidogrel
C. Ticagrelor
D. Prasugrel
E. Dual antiplatelet therapy with aspirin and clopidogrel
14. A 50-year-old man with a history of hypertension and hyperlipidemia undergoes a carotid duplex ultrasound, which reveals a 60% stenosis of the left internal carotid artery. Which of the following is the most appropriate next step in management?
A. Initiate antiplatelet therapy
B. Refer for carotid endarterectomy
C. Refer for carotid artery stenting
D. Initiate high-intensity statin therapy
E. Recommend lifestyle modifications and risk factor control
15. A 70-year-old woman with a history of peripheral artery disease presents with worsening claudication and rest pain. Angiography reveals extensive occlusive disease in the superficial femoral and popliteal arteries. Which of the following is the most appropriate treatment?
A. Endovascular revascularization with angioplasty and stenting
B. Surgical revascularization with bypass grafting
C. Initiate anticoagulation therapy
D. Initiate a trial of prostanoid therapy
E. Recommend amputation