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. ehlers danlos
Scoliosis and pes planus
Development of AF. after ETOH - develop AF---sudden cardia arrest
Weight loss
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure

2. cocaine induced vasospasm leading to myocardial ischemia - initial tx?
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
The dose should be adjusted such that TS H below 0.35
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio

3. In cocaine induced vasospasm - if angio shows any thrombus - 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.
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Post wall MI - occlusion of right coronary artery. tx with atropine
Streptokinase

4. drugs increases the effect of warfarin
Pt with cardiogenic shock
Scoliosis and pes planus
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;

5. indication of radionuclide ventriculography
Go for coronary angio. high likelyhood of severe coronary artery disease
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
Monitor EF after cardiotoxic chemo - bypass surgery

6. who should get coronary intervention after MI
Coronary angio - identify blockage and tx with stent/bypass
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.

7. sudden onset of HTN. How do you manage
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Streptokinase
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Reduce hypertriglyceridemia; in liver

8. INR goal for bileaflet mechnial valve
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
No p wave - narrow qrs; first line of tx-adenosine
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

9. paroxysmal AF with structural HD
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
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.
Reduce hypertriglyceridemia; in liver
Amiodarone;

10. how rhematic feber - thyrotoxicosis - marfans - ehler danlos complicate cardiovascular systme
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture

11. How to dx SVT? tx?
No p wave - narrow qrs; first line of tx-adenosine
No...except posterior or dorsal MI
Post wall MI - occlusion of right coronary artery. tx with atropine
Do cardiact stress test; 50-75% of CHF have coronary disease etiology

12. complication of HRT
No...except posterior or dorsal MI
Increases the risk of MI - thromboembolism - breast cancer - dementia
Post wall MI - occlusion of right coronary artery. tx with atropine
Coronary angio - identify blockage and tx with stent/bypass

13. When to start thrombolytic therapry in MI
Streptokinase
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
Increases the risk of MI - thromboembolism - breast cancer - dementia
Post wall MI - occlusion of right coronary artery. tx with atropine

14. bradycardia with type 2 heart block
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Transvenous pacemaker
Coronary angio - identify blockage and tx with stent/bypass
Amiodarone;

15. When rhythm control strategy is suprior than rate control in the Tx of AF
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
VSD; can be asymptomatic to large with significant L to R shunt
Increases the risk of MI - thromboembolism - breast cancer - dementia
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.

16. location of VSD/MR mumur
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Defibrillation
Monitor EF after cardiotoxic chemo - bypass surgery
Holocystolic murmur loudest at lower left sternal border

17. Indication of gemfibrozil?
Reduce hypertriglyceridemia; in liver
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion

18. the dose levothyroxine in thyroid cancer remission
Unexplained synocope - dizziness - near syncope - recurrent palpitation
The dose should be adjusted such that TS H below 0.35
When it is symptomatic. asso with dec cardiac output resulting hypotension
High suspicion of MI. LAD occlusion leading to LBBB - next step angio

19. baloon valvulotomy for AS
If patient is started on rifampin or phenobarbital; they increases its metabolism
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm

20. how amiodarone affects on warfarin
Holocystolic murmur loudest at lower left sternal border
PPAR gamma receptor agonist pioglitazone.PPAR
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%

21. torsade and unresponsive
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Defibrillation

22. what causes non sustained ventricular tachy (>3 or more consecutive beat >120/m)?
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Flecainamide
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker

23. when NSTEMI without comorbidiites should get PCI?
Within 24 hours
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Defibrillation

24. paroxysmal AF without structural HD
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Flecainamide
Development of AF. after ETOH - develop AF---sudden cardia arrest
Do cardiact stress test; 50-75% of CHF have coronary disease etiology

25. When to treat sinus brady after acute MI
When it is symptomatic. asso with dec cardiac output resulting hypotension
Transvenous pacemaker
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

26. EKG shows ST elevation and suggest occlusion of major coronary artery.
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
Scoliosis and pes planus
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)

27. new onset LBBB - What is the next step
CABG not angioplasty
No...except posterior or dorsal MI
The dose should be adjusted such that TS H below 0.35
High suspicion of MI. LAD occlusion leading to LBBB - next step angio

28. patient with new onset CHF - What is next best step?
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
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
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used

29. patient with secondary htn - What is next step
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Holocystolic murmur loudest at lower left sternal border
PPAR gamma receptor agonist pioglitazone.PPAR
Duplex doppleer us if renal function impaired. if normal renal function - MR angio

30. What drugs precipitate digoxin toxicity?
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
No...except posterior or dorsal MI
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation

31. What is most congenital heart malformation?
Defibrillation
Transvenous pacemaker
VSD; can be asymptomatic to large with significant L to R shunt
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

32. What is PEA? How do you treat?
Within 24 hours
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Streptokinase

33. When to increase warfarin dose?
If patient is started on rifampin or phenobarbital; they increases its metabolism
Amiodarone;
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Development of AF. after ETOH - develop AF---sudden cardia arrest

34. What is paroxysmal AF? How do you treat?
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
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 -

35. s/s carotid dissection
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect

36. stable angina with heart failure
Go for coronary angio. high likelyhood of severe coronary artery disease
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Within 24 hours
Elderly people with MI

37. What is mech of TCA overdose
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.
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
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.

38. Why nitroprusside cannot be used alone in aortic dissection
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Holocystolic murmur loudest at lower left sternal border
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Monitor EF after cardiotoxic chemo - bypass surgery

39. when should you stop aspirin before procedure that has bleeding risk?
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Monitor EF after cardiotoxic chemo - bypass surgery
Lidcaine drip
7 days. coz aspirin cause platelet dysfunction that can last more than a week.

40. most effective non pharmacologic measure to decease blood pressure?
Weight loss
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 -
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
No p wave - narrow qrs; first line of tx-adenosine

41. when 24 hour holter monitoring and admission recommended?
If patient is started on rifampin or phenobarbital; they increases its metabolism
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
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Coronary angio - identify blockage and tx with stent/bypass

42. what medication cause pulmonary edema?
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.
Reduce hypertriglyceridemia; in liver
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
PPAR gamma receptor agonist pioglitazone.PPAR

43. patient with unstable angina - chest pain - ekg changes but card enzymes normal - next step
Weight loss
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Coronary angio - identify blockage and tx with stent/bypass

44. When to use dobutamine?
Reduce hypertriglyceridemia; in liver
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Pt with cardiogenic shock
Unexplained synocope - dizziness - near syncope - recurrent palpitation

45. sinus bradycardia after inf wall MI
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Persistent brady after MI which is refractory to atropine tx
Holocystolic murmur loudest at lower left sternal border

46. 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
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Within 24 hours
CABG not angioplasty

47. treatment mobitz type 2 block (loss of QRS every 2nd /3rd beat)?
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
VSD; can be asymptomatic to large with significant L to R shunt

48. How long it takes for digoxin to have significant effect on rate control
PPAR gamma receptor agonist pioglitazone.PPAR
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
If patient is started on rifampin or phenobarbital; they increases its metabolism

49. patient pw with new onset of heart failure and AF
CABG not angioplasty
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat

50. What is beck's triad?
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
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
Without AF; INR 2-3; with AF: 2.5-3.5
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.