Test your basic knowledge |

USMLE Step3 Cardiovascular

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. when should you stop aspirin before procedure that has bleeding risk?
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Primordial prevention is the prevention of risk factors; action undertaken before onset of disease- primary prevention; action halts progression of disease-secondary; disease advanced - action taken to limit impairment and disabilities.
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady

2. What is the most effective way to treat multivessel coronary artery blockade?
Normally jvp falls with inspiration due to reduced pressure in the expanding thoracic cavity and expansion of right ventricle duing diastole. in pericardial tamponade - impaired filling of ventricle leads to backflow of blood into venous system leadi
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
CABG not angioplasty

3. torsade and unresponsive
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Development of AF. after ETOH - develop AF---sudden cardia arrest
Defibrillation
Duplex doppleer us if renal function impaired. if normal renal function - MR angio

4. EKG shows ST elevation and suggest occlusion of major coronary artery.
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
When it is symptomatic. asso with dec cardiac output resulting hypotension

5. What is kussmaul sign
Elderly people with MI
Flecainamide
Normally jvp falls with inspiration due to reduced pressure in the expanding thoracic cavity and expansion of right ventricle duing diastole. in pericardial tamponade - impaired filling of ventricle leads to backflow of blood into venous system leadi
Increases the risk of MI - thromboembolism - breast cancer - dementia

6. when 24 hour holter monitoring and admission recommended?
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Without AF; INR 2-3; with AF: 2.5-3.5
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Unexplained synocope - dizziness - near syncope - recurrent palpitation

7. cocaine induced vasospasm leading to myocardial ischemia - initial tx?
Persistent brady after MI which is refractory to atropine tx
Scoliosis and pes planus
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing

8. location of VSD/MR mumur
Holocystolic murmur loudest at lower left sternal border
Transvenous pacemaker
VSD; can be asymptomatic to large with significant L to R shunt
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability

9. ehlers danlos
Scoliosis and pes planus
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
When it is symptomatic. asso with dec cardiac output resulting hypotension
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.

10. s/s carotid dissection
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Within 24 hours
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio

11. complication of HRT
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
Increases the risk of MI - thromboembolism - breast cancer - dementia
Defibrillation

12. How to treat a a patient with tCA overdose
Lidcaine drip
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Primordial prevention is the prevention of risk factors; action undertaken before onset of disease- primary prevention; action halts progression of disease-secondary; disease advanced - action taken to limit impairment and disabilities.
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

13. how amiodarone affects on warfarin
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
The dose should be adjusted such that TS H below 0.35
Scoliosis and pes planus
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%

14. When to treat sinus brady after acute MI
When it is symptomatic. asso with dec cardiac output resulting hypotension
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Without AF; INR 2-3; with AF: 2.5-3.5
Elderly people with MI

15. What is PEA? How do you treat?
Primordial prevention is the prevention of risk factors; action undertaken before onset of disease- primary prevention; action halts progression of disease-secondary; disease advanced - action taken to limit impairment and disabilities.
AF episode-- relieved with Diltiazem. ..then patient is asymptomatic but pulse irregularly irregular. recurrent episode of AF. treat with amiodarone. this is also best drug if AF is due to structural HD. eg CAD - CCF due to cardiomyo - HTN with LVH -
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.

16. sinus bradycardia after inf wall MI
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Development of AF. after ETOH - develop AF---sudden cardia arrest
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Weight loss

17. what medication cause pulmonary edema?
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
PPAR gamma receptor agonist pioglitazone.PPAR
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.

18. INR for mechanical prosthetic valve
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Persistent brady after MI which is refractory to atropine tx
Monitor EF after cardiotoxic chemo - bypass surgery
2.5-3.5

19. When to use anticoag or aspiring in AF
Scoliosis and pes planus
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
Coronary angio - identify blockage and tx with stent/bypass

20. When to start thrombolytic therapry in MI
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
Coronary angio - identify blockage and tx with stent/bypass

21. What drugs precipitate digoxin toxicity?
Increases the risk of MI - thromboembolism - breast cancer - dementia
Transvenous pacemaker
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady

22. Why nitroprusside cannot be used alone in aortic dissection
VSD; can be asymptomatic to large with significant L to R shunt
No...except posterior or dorsal MI
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation

23. How to dx SVT? tx?
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
Post wall MI - occlusion of right coronary artery. tx with atropine
VSD; can be asymptomatic to large with significant L to R shunt
No p wave - narrow qrs; first line of tx-adenosine

24. When rhythm control strategy is suprior than rate control in the Tx of AF
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
No p wave - narrow qrs; first line of tx-adenosine
Weight loss
2.5-3.5

25. Difference between cardioversion and defibrillation
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
AF episode-- relieved with Diltiazem. ..then patient is asymptomatic but pulse irregularly irregular. recurrent episode of AF. treat with amiodarone. this is also best drug if AF is due to structural HD. eg CAD - CCF due to cardiomyo - HTN with LVH -
Cardioversion is a synchonized shock of an unorganized tachyarrythmia AF or PSVT. defibrillation is to stop heart momentarily so unorganized activity such as ventricular fibillation is stopped. there will be a brief period of asystole and then normal
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS

26. what MI cause sinus brady?
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Elderly people with MI
Post wall MI - occlusion of right coronary artery. tx with atropine
Do cardiact stress test; 50-75% of CHF have coronary disease etiology

27. patient with unstable angina - chest pain - ekg changes but card enzymes normal - next step
Primordial prevention is the prevention of risk factors; action undertaken before onset of disease- primary prevention; action halts progression of disease-secondary; disease advanced - action taken to limit impairment and disabilities.
Elderly people with MI
Cardioversion is a synchonized shock of an unorganized tachyarrythmia AF or PSVT. defibrillation is to stop heart momentarily so unorganized activity such as ventricular fibillation is stopped. there will be a brief period of asystole and then normal
Coronary angio - identify blockage and tx with stent/bypass

28. what causes non sustained ventricular tachy (>3 or more consecutive beat >120/m)?
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Transvenous pacemaker

29. bradycardia after MI with hypotension. what would you do?
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
CABG not angioplasty
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure

30. spontaneous papillary muscle rupture
The dose should be adjusted such that TS H below 0.35
Scoliosis and pes planus
Persistent brady after MI which is refractory to atropine tx
Elderly people with MI

31. Most important predictor for future cardiovascular events
Defibrillation
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
Scoliosis and pes planus
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect

32. How long it takes for digoxin to have significant effect on rate control
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
The dose should be adjusted such that TS H below 0.35
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;

33. Indication of gemfibrozil?
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Reduce hypertriglyceridemia; in liver
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin

34. most effective non pharmacologic measure to decease blood pressure?
Defibrillation
Without AF; INR 2-3; with AF: 2.5-3.5
Go for coronary angio. high likelyhood of severe coronary artery disease
Weight loss

35. INR goal for bileaflet mechnial valve
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
Without AF; INR 2-3; with AF: 2.5-3.5
Holocystolic murmur loudest at lower left sternal border

36. paroxysmal AF with structural HD
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
Amiodarone;
VSD; can be asymptomatic to large with significant L to R shunt
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker

37. How do you diagnose multifocal atrial tachy?
Look for predisposing condition: hypoxia - COPD - hypokalemia - hypomagnesemia - CAD - medications like theophyline - aminophylline - isoproterenol; look at EKG: p wave of 3 different morphologies - narrow qrs. tx underlying cause.
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

38. When to use transvenous pacing?
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Persistent brady after MI which is refractory to atropine tx
Without AF; INR 2-3; with AF: 2.5-3.5
Amiodarone;

39. When to use dobutamine?
VSD; can be asymptomatic to large with significant L to R shunt
Pt with cardiogenic shock
2.5-3.5
Normally jvp falls with inspiration due to reduced pressure in the expanding thoracic cavity and expansion of right ventricle duing diastole. in pericardial tamponade - impaired filling of ventricle leads to backflow of blood into venous system leadi

40. wpw syndrome
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
The dose should be adjusted such that TS H below 0.35

41. sudden onset of HTN. How do you manage
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
2.5-3.5
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Elderly people with MI

42. patient with new onset CHF - What is next best step?
Amiodarone;
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

43. when we say QT prolonged?
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Holocystolic murmur loudest at lower left sternal border
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure

44. When to replace aortic valve
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
No...except posterior or dorsal MI
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
R/o IHD which is the most common causes of CHF. stress test if indicated or angio

45. when NSTEMI without comorbidiites should get PCI?
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Within 24 hours
Go for coronary angio. high likelyhood of severe coronary artery disease
Weight loss

46. treatment mobitz type 2 block (loss of QRS every 2nd /3rd beat)?
Reduce hypertriglyceridemia; in liver
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
Cardioversion is a synchonized shock of an unorganized tachyarrythmia AF or PSVT. defibrillation is to stop heart momentarily so unorganized activity such as ventricular fibillation is stopped. there will be a brief period of asystole and then normal
Defibrillation

47. paroxysmal AF without structural HD
Holocystolic murmur loudest at lower left sternal border
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Flecainamide

48. how rhematic feber - thyrotoxicosis - marfans - ehler danlos complicate cardiovascular systme
Coronary angio - identify blockage and tx with stent/bypass
No p wave - narrow qrs; first line of tx-adenosine
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
VSD; can be asymptomatic to large with significant L to R shunt

49. common complications of ca antagonists?
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
TCA inhibit fast Na channel in His-purkinje system- -slow av conduction---reentrant arrythmia---VT or VF. tx with sodium bicarb drip and lidocaine drip
Lidcaine drip
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

50. indication of radionuclide ventriculography
Monitor EF after cardiotoxic chemo - bypass surgery
VSD; can be asymptomatic to large with significant L to R shunt
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Within 24 hours