MOC Questions

Cardiology Review® Online, December 2007, Volume 24, Issue 12

Preparing for the American Board of Internal Medicine Maintenance of Certification

The following questions can assist candidates for the Maintenance of Certification Exam in Cardiovascular Disease prepare for this test. We hope you find this helpful and welcome your feedback.


  1. Which of the following is not true regarding the pathophysiology of rheumatic aortic stenosis? Heart block can be caused by calcification in the region of the membranous septum. Calcification is most prominent at the commissures. It is usually an isolated process. The majority of patients will not have a previous history of rheumatic fever.
  2. Which of the following statements is true regarding the natural history of aortic stenosis? Average survival is 5 years after the onset of symptoms. Sudden cardiac death is uncommon in asymptomatic patients. When heart failure develops, it is usually the result of increased afterload. All of the above.
  3. A 70-year-old male with 3-vessel disease and preserved ejection fraction is referred for coronary artery bypass graft (CABG) because of angina, despite optimal medical management. At the time of catheterization, he is noted to have a mean aortic gradient of 30 mm Hg and a calculated valve area of 1.0 cm2. His echo shows a mildly calcified aortic valve. The most optimal therapy for this patient would include: CABG only. CABG and aortic valve replacement. Continue medical therapy until the aortic valve area is <1.0 cm2. CABG and aortic valve debridement.
  4. In patients with severe aortic stenosis being referred for aortic valve replacement, indications for preoperative cardiac catheterization include: Symptoms of angina. Adult onset diabetes mellitus. Family history of coronary artery disease. Age >50 years. All of the above. A and C only
  5. A 45-year-old female has significant mitral stenosis and atrial fibrillation. She hopes to avoid surgery and wishes to have a percutaneous balloon valvuloplasty. Contraindication to this technique includes: Moderate to severe mitral regurgitation. Presence of atrial fibrillation. Presence of left atrial thrombus. Calcium in the mitral leaflets. All of the above. A and C only.
  6. Which of the following is true for mitral valve repair surgery? Mitral valve repair is indicated in asymptomatic patients with chronic severe mitral regurgitation (MR) and preserved left ventricular function in whom the likelihood of a successful repair is greater than 90%. Most residual regurgitation and need for reoperation occurs late after surgery. Mitral valve repair is superior to replacement in patients with severe ischemic MR. The most common cause of death after mitral valve repair is thromboembolism. All of the above.
  7. Which of the following is not an absolute indication for surgery for aortic valve endocarditis? Fungal endocarditis. Congestive heart failure. Systemic emboli during antibiotic therapy. Size of the vegetation.
  8. A 78-year-old male is found to have an aneurysm of the descending thoracic aorta on routine chest X-ray. On computed tomography (CT) scan it measures 4.5 cm and is located in the midthoracic aorta. The best treatment for this aneurysm is: Open repair of the aneurysm on an elective basis. Endovascular repair of the aneurysm on an elective basis. Immediate repair of the aneurysm by either open or endovascular technique. Serial CT scans on a 6-12 month basis and control of hypertension.
  9. Current limitations of the 64-slice CT scans to evaluate coronary artery disease include: Atrial arrhythmias. Need to achieve resting heart rates ≤ 70. Presence of severe coronary calcification. Increased radiation requirements. All of the above.
  10. A 70-year-old male with severely reduced ejection fraction of ≤ 25% and multivessel coronary disease is referred for CABG surgery. Determinants of operative mortality include: Quality of target vessels. Presence or absence of mitral regurgitation. Extent of viable myocardium. Age. All of the above. A, B, C. C only.


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