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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. what medication cause pulmonary edema?
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
PPAR gamma receptor agonist pioglitazone.PPAR
Elderly people with MI

2. INR goal for bileaflet mechnial valve
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.
Without AF; INR 2-3; with AF: 2.5-3.5
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
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.

3. the dose levothyroxine in thyroid cancer remission
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
The dose should be adjusted such that TS H below 0.35
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

4. should we give thrombolytic in ST depression?
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
No...except posterior or dorsal MI
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
7 days. coz aspirin cause platelet dysfunction that can last more than a week.

5. How to dx SVT? tx?
No p wave - narrow qrs; first line of tx-adenosine
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.
Coronary angio - identify blockage and tx with stent/bypass
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours

6. 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
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
PPAR gamma receptor agonist pioglitazone.PPAR
CABG not angioplasty

7. In cocaine induced vasospasm - if angio shows any thrombus - next step?
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
Streptokinase
Scoliosis and pes planus
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

8. ehlers danlos
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Increases the risk of MI - thromboembolism - breast cancer - dementia
Scoliosis and pes planus

9. What is poor R wave progression?
When it is symptomatic. asso with dec cardiac output resulting hypotension
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Reduce hypertriglyceridemia; in liver

10. patient with secondary htn - What is next step
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
The dose should be adjusted such that TS H below 0.35
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.

11. paroxysmal AF without structural HD
Weight loss
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
Flecainamide

12. How do you diagnose multifocal atrial tachy?
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 -
Transvenous pacemaker
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.
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

13. cocaine induced vasospasm leading to myocardial ischemia - initial tx?
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Without AF; INR 2-3; with AF: 2.5-3.5
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
Flecainamide

14. paroxysmal AF with structural HD
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Amiodarone;
Weight loss
If patient is started on rifampin or phenobarbital; they increases its metabolism

15. Indication of gemfibrozil?
2.5-3.5
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Reduce hypertriglyceridemia; in liver

16. When rhythm control strategy is suprior than rate control in the Tx of AF
Transvenous pacemaker
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
Go for coronary angio. high likelyhood of severe coronary artery disease
Monitor EF after cardiotoxic chemo - bypass surgery

17. patient with new onset CHF - What is next best step?
No p wave - narrow qrs; first line of tx-adenosine
Elderly people with MI
Scoliosis and pes planus
R/o IHD which is the most common causes of CHF. stress test if indicated or angio

18. when NSTEMI without comorbidiites should get PCI?
Pt with cardiogenic shock
Development of AF. after ETOH - develop AF---sudden cardia arrest
Within 24 hours
Coronary angio - identify blockage and tx with stent/bypass

19. patient with unstable angina - chest pain - ekg changes but card enzymes normal - next step
VSD; can be asymptomatic to large with significant L to R shunt
Coronary angio - identify blockage and tx with stent/bypass
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.
High suspicion of MI. LAD occlusion leading to LBBB - next step angio

20. What drugs precipitate digoxin toxicity?
No...except posterior or dorsal MI
Defibrillation
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
If there is evidence of heart failure

21. How to treat a a patient with tCA overdose
Transvenous pacemaker
Scoliosis and pes planus
Lidcaine drip
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

22. how rhematic feber - thyrotoxicosis - marfans - ehler danlos complicate cardiovascular systme
Go for coronary angio. high likelyhood of severe coronary artery disease
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
Reduce hypertriglyceridemia; in liver
When it is symptomatic. asso with dec cardiac output resulting hypotension

23. treatment mobitz type 2 block (loss of QRS every 2nd /3rd beat)?
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
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
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.

24. most effective non pharmacologic measure to decease blood pressure?
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Weight loss
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS

25. when 24 hour holter monitoring and admission recommended?
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Amiodarone;
Unexplained synocope - dizziness - near syncope - recurrent palpitation
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used

26. problem of WPW?
Development of AF. after ETOH - develop AF---sudden cardia arrest
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Weight loss
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.

27. torsade and unresponsive
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Defibrillation
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
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

28. new onset LBBB - What is the next step
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
Monitor EF after cardiotoxic chemo - bypass surgery
Pt with cardiogenic shock
PPAR gamma receptor agonist pioglitazone.PPAR

29. Difference between cardioversion and defibrillation
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
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.
VSD; can be asymptomatic to large with significant L to R shunt
If there is evidence of heart failure

30. spontaneous papillary muscle rupture
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
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.
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Elderly people with MI

31. primordial prevention vs primary/secondary/tertiary prevention
Increases the risk of MI - thromboembolism - breast cancer - dementia
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.
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.

32. how amiodarone affects on warfarin
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
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 -
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%

33. wpw syndrome
Within 24 hours
Defibrillation
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat

34. Why nitroprusside cannot be used alone in aortic dissection
Post wall MI - occlusion of right coronary artery. tx with atropine
The dose should be adjusted such that TS H below 0.35
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation

35. When to use transvenous pacing?
Persistent brady after MI which is refractory to atropine tx
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Monitor EF after cardiotoxic chemo - bypass surgery

36. what MI cause sinus brady?
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Post wall MI - occlusion of right coronary artery. tx with atropine
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Elderly people with MI

37. What is paroxysmal AF? How do you treat?
Increases the risk of MI - thromboembolism - breast cancer - dementia
PPAR gamma receptor agonist pioglitazone.PPAR
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 -
Without AF; INR 2-3; with AF: 2.5-3.5

38. complication of HRT
Coronary angio - identify blockage and tx with stent/bypass
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.
Increases the risk of MI - thromboembolism - breast cancer - dementia
Transvenous pacemaker

39. indication of radionuclide ventriculography
Lidcaine drip
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
Monitor EF after cardiotoxic chemo - bypass surgery
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.

40. What is most congenital heart malformation?
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
VSD; can be asymptomatic to large with significant L to R shunt
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin

41. drugs increases the effect of warfarin
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

42. What is mech of TCA overdose
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
Streptokinase
Lidcaine drip
CABG not angioplasty

43. When to start thrombolytic therapry in MI
If patient is started on rifampin or phenobarbital; they increases its metabolism
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours

44. INR for mechanical prosthetic valve
2.5-3.5
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Flecainamide
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

45. When to treat sinus brady after acute MI
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
When it is symptomatic. asso with dec cardiac output resulting hypotension
Without AF; INR 2-3; with AF: 2.5-3.5

46. When to increase warfarin dose?
Development of AF. after ETOH - develop AF---sudden cardia arrest
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.
If patient is started on rifampin or phenobarbital; they increases its metabolism
Without AF; INR 2-3; with AF: 2.5-3.5

47. location of VSD/MR mumur
Holocystolic murmur loudest at lower left sternal border
Development of AF. after ETOH - develop AF---sudden cardia arrest
No p wave - narrow qrs; first line of tx-adenosine
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

48. When to replace aortic valve
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
7 days. coz aspirin cause platelet dysfunction that can last more than a week.

49. sudden onset of HTN. How do you manage
Amiodarone;
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Coronary angio - identify blockage and tx with stent/bypass
Transvenous pacemaker

50. s/s carotid dissection
If there is evidence of heart failure
Holocystolic murmur loudest at lower left sternal border
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
PPAR gamma receptor agonist pioglitazone.PPAR