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. sudden onset of HTN. How do you manage
No p wave - narrow qrs; first line of tx-adenosine
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Scoliosis and pes planus

2. the dose levothyroxine in thyroid cancer remission
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
The dose should be adjusted such that TS H below 0.35

3. should we give thrombolytic in ST depression?
Development of AF. after ETOH - develop AF---sudden cardia arrest
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
No...except posterior or dorsal MI

4. Indication of gemfibrozil?
Reduce hypertriglyceridemia; in liver
If there is evidence of heart failure
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Go for coronary angio. high likelyhood of severe coronary artery disease

5. when we say QT prolonged?
Reduce hypertriglyceridemia; in liver
VSD; can be asymptomatic to large with significant L to R shunt
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure

6. When to replace aortic valve
Without AF; INR 2-3; with AF: 2.5-3.5
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Monitor EF after cardiotoxic chemo - bypass surgery

7. torsade and unresponsive
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Defibrillation
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

8. INR goal for bileaflet mechnial valve
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Without AF; INR 2-3; with AF: 2.5-3.5
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect

9. What is poor R wave progression?
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation

10. When rhythm control strategy is suprior than rate control in the Tx of AF
Transvenous pacemaker
Elderly people with MI
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
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

11. what causes non sustained ventricular tachy (>3 or more consecutive beat >120/m)?
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
Transvenous pacemaker
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Do cardiact stress test; 50-75% of CHF have coronary disease etiology

12. how amiodarone affects on warfarin
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
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
The dose should be adjusted such that TS H below 0.35
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;

13. EKG shows ST elevation and suggest occlusion of major coronary artery.
Transvenous pacemaker
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
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

14. Difference between cardioversion and defibrillation
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
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
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.

15. When to use digoxin in AF
If there is evidence of heart failure
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
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Development of AF. after ETOH - develop AF---sudden cardia arrest

16. patient with new onset CHF - What is next best step?
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
R/o IHD which is the most common causes of CHF. stress test if indicated or 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

17. How to treat a a patient with tCA overdose
Lidcaine drip
CABG not angioplasty
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Elderly people with MI

18. Most important predictor for future cardiovascular events
VSD; can be asymptomatic to large with significant L to R shunt
The dose should be adjusted such that TS H below 0.35
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect

19. drugs increases the effect of warfarin
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Without AF; INR 2-3; with AF: 2.5-3.5
CABG not angioplasty

20. who should get coronary intervention after MI
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Coronary angio - identify blockage and tx with stent/bypass
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
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

21. When to use transvenous pacing?
Lidcaine drip
Post wall MI - occlusion of right coronary artery. tx with atropine
Persistent brady after MI which is refractory to atropine tx
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

22. 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
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Monitor EF after cardiotoxic chemo - bypass surgery

23. wpw syndrome
Pt with cardiogenic shock
Weight loss
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS

24. most effective non pharmacologic measure to decease blood pressure?
Weight loss
No...except posterior or dorsal MI
Scoliosis and pes planus
Development of AF. after ETOH - develop AF---sudden cardia arrest

25. When to start thrombolytic therapry in MI
When it is symptomatic. asso with dec cardiac output resulting hypotension
Unexplained synocope - dizziness - near syncope - recurrent palpitation
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
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

26. What is kussmaul sign
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
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Streptokinase
Increases the risk of MI - thromboembolism - breast cancer - dementia

27. s/s carotid dissection
Without AF; INR 2-3; with AF: 2.5-3.5
Monitor EF after cardiotoxic chemo - bypass surgery
VSD; can be asymptomatic to large with significant L to R shunt
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation

28. treatment mobitz type 2 block (loss of QRS every 2nd /3rd beat)?
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
Amiodarone;
When it is symptomatic. asso with dec cardiac output resulting hypotension
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm

29. INR for mechanical prosthetic valve
Coronary angio - identify blockage and tx with stent/bypass
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
No...except posterior or dorsal MI
2.5-3.5

30. When to use dobutamine?
Pt with cardiogenic shock
Unexplained synocope - dizziness - near syncope - recurrent palpitation
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
Transvenous pacemaker

31. How to dx SVT? tx?
Streptokinase
When it is symptomatic. asso with dec cardiac output resulting hypotension
No p wave - narrow qrs; first line of tx-adenosine
High suspicion of MI. LAD occlusion leading to LBBB - next step angio

32. When to treat sinus brady after acute MI
PPAR gamma receptor agonist pioglitazone.PPAR
When it is symptomatic. asso with dec cardiac output resulting hypotension
Monitor EF after cardiotoxic chemo - bypass surgery
Streptokinase

33. how rhematic feber - thyrotoxicosis - marfans - ehler danlos complicate cardiovascular systme
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Transvenous pacemaker

34. ehlers danlos
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
Scoliosis and pes planus
If there is evidence of heart failure

35. What is paroxysmal AF? How do you treat?
Defibrillation
Weight loss
Pt with cardiogenic shock
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 -

36. problem of WPW?
Development of AF. after ETOH - develop AF---sudden cardia arrest
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Post wall MI - occlusion of right coronary artery. tx with atropine
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.

37. location of VSD/MR mumur
Holocystolic murmur loudest at lower left sternal border
Elderly people with MI
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
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.

38. when should you stop aspirin before procedure that has bleeding risk?
No p wave - narrow qrs; first line of tx-adenosine
No...except posterior or dorsal MI
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Defibrillation

39. What is beck's triad?
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
CABG not angioplasty
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.

40. when NSTEMI without comorbidiites should get PCI?
PPAR gamma receptor agonist pioglitazone.PPAR
Persistent brady after MI which is refractory to atropine tx
Scoliosis and pes planus
Within 24 hours

41. common complications of ca antagonists?
Within 24 hours
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

42. bradycardia with type 2 heart block
Transvenous pacemaker
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Defibrillation
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability

43. sinus bradycardia after inf wall MI
Reduce hypertriglyceridemia; in liver
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
No...except posterior or dorsal MI
Amiodarone;

44. patient with unstable angina - chest pain - ekg changes but card enzymes normal - next step
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Coronary angio - identify blockage and tx with stent/bypass
CABG not angioplasty
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

45. paroxysmal AF without structural HD
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
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
Reduce hypertriglyceridemia; in liver

46. Why nitroprusside cannot be used alone in aortic dissection
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
The dose should be adjusted such that TS H below 0.35
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady

47. What is the most effective way to treat multivessel coronary artery blockade?
Persistent brady after MI which is refractory to atropine tx
CABG not angioplasty
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
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.

48. complication of HRT
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Post wall MI - occlusion of right coronary artery. tx with atropine
Increases the risk of MI - thromboembolism - breast cancer - dementia
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

49. stable angina with heart failure
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
If patient is started on rifampin or phenobarbital; they increases its metabolism
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
Go for coronary angio. high likelyhood of severe coronary artery disease

50. paroxysmal AF with structural HD
Transvenous pacemaker
Amiodarone;
Elderly people with MI
Duplex doppleer us if renal function impaired. if normal renal function - MR angio