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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 causes non sustained ventricular tachy (>3 or more consecutive beat >120/m)?
PPAR gamma receptor agonist pioglitazone.PPAR
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
CABG not angioplasty
Pt with cardiogenic shock

2. How to treat a a patient with tCA overdose
Lidcaine drip
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion

3. when NSTEMI without comorbidiites should get PCI?
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Within 24 hours
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
The dose should be adjusted such that TS H below 0.35

4. s/s carotid dissection
Amiodarone;
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
Persistent brady after MI which is refractory to atropine tx

5. how rhematic feber - thyrotoxicosis - marfans - ehler danlos complicate cardiovascular systme
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
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
Post wall MI - occlusion of right coronary artery. tx with atropine
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure

6. when should you stop aspirin before procedure that has bleeding risk?
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
No...except posterior or dorsal MI
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation

7. What is the most effective way to treat multivessel coronary artery blockade?
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
CABG not angioplasty
Defibrillation
PPAR gamma receptor agonist pioglitazone.PPAR

8. What is beck's triad?
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
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.
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.

9. 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.
If patient is started on rifampin or phenobarbital; they increases its metabolism
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)

10. How long it takes for digoxin to have significant effect on rate control
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
CABG not angioplasty
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours

11. most effective non pharmacologic measure to decease blood pressure?
Streptokinase
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Weight loss

12. indication of radionuclide ventriculography
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
VSD; can be asymptomatic to large with significant L to R shunt
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.
Monitor EF after cardiotoxic chemo - bypass surgery

13. When to start thrombolytic therapry in MI
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
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.
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.

14. What is kussmaul sign
Reduce hypertriglyceridemia; in liver
Within 24 hours
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
Holocystolic murmur loudest at lower left sternal border

15. cocaine induced vasospasm leading to myocardial ischemia - initial tx?
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio

16. ehlers danlos
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.
Scoliosis and pes planus
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

17. torsade and unresponsive
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
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
Defibrillation

18. paroxysmal AF with structural HD
Amiodarone;
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
Increases the risk of MI - thromboembolism - breast cancer - dementia
VSD; can be asymptomatic to large with significant L to R shunt

19. complication of HRT
Increases the risk of MI - thromboembolism - breast cancer - dementia
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
Duplex doppleer us if renal function impaired. if normal renal function - MR angio

20. spontaneous papillary muscle rupture
Elderly people with MI
Increases the risk of MI - thromboembolism - breast cancer - dementia
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

21. should we give thrombolytic in ST depression?
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Pt with cardiogenic shock
Within 24 hours
No...except posterior or dorsal MI

22. paroxysmal AF without structural HD
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Flecainamide
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)

23. INR for mechanical prosthetic valve
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
2.5-3.5
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

24. new onset LBBB - What is the next step
No...except posterior or dorsal MI
Lidcaine drip
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
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

25. When to use dobutamine?
Pt with cardiogenic shock
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
No...except posterior or dorsal MI
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

26. sinus bradycardia after inf wall MI
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
VSD; can be asymptomatic to large with significant L to R shunt
Amiodarone;

27. patient with secondary htn - What is next step
PPAR gamma receptor agonist pioglitazone.PPAR
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
If patient is started on rifampin or phenobarbital; they increases its metabolism
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.

28. What drugs precipitate digoxin toxicity?
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Go for coronary angio. high likelyhood of severe coronary artery disease
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion

29. who should get coronary intervention after MI
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Pt with cardiogenic shock
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation

30. Why nitroprusside cannot be used alone in aortic dissection
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
Post wall MI - occlusion of right coronary artery. tx with atropine

31. INR goal for bileaflet mechnial valve
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
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
Monitor EF after cardiotoxic chemo - bypass surgery

32. What is poor R wave progression?
Persistent brady after MI which is refractory to atropine tx
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
Scoliosis and pes planus

33. Indication of gemfibrozil?
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Reduce hypertriglyceridemia; in liver
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

34. primordial prevention vs primary/secondary/tertiary prevention
Reduce hypertriglyceridemia; in liver
VSD; can be asymptomatic to large with significant L to R shunt
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
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.

35. stable angina with heart failure
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
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
PPAR gamma receptor agonist pioglitazone.PPAR

36. What is most congenital heart malformation?
No...except posterior or dorsal MI
VSD; can be asymptomatic to large with significant L to R shunt
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture

37. patient with unstable angina - chest pain - ekg changes but card enzymes normal - next step
Coronary angio - identify blockage and tx with stent/bypass
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
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

38. How to dx SVT? tx?
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Flecainamide
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

39. When to treat sinus brady after acute MI
Post wall MI - occlusion of right coronary artery. tx with atropine
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
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.

40. Difference between cardioversion and defibrillation
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
If patient is started on rifampin or phenobarbital; they increases its metabolism
Pt with cardiogenic shock
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

41. When rhythm control strategy is suprior than rate control in the Tx of AF
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.

42. what MI cause sinus brady?
Lidcaine drip
Post wall MI - occlusion of right coronary artery. tx with atropine
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
Coronary angio - identify blockage and tx with stent/bypass

43. location of VSD/MR mumur
Post wall MI - occlusion of right coronary artery. tx with atropine
Holocystolic murmur loudest at lower left sternal border
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
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

44. bradycardia with type 2 heart block
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
Transvenous pacemaker
Pt with cardiogenic shock
Duplex doppleer us if renal function impaired. if normal renal function - MR angio

45. patient with new onset CHF - What is next best 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
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
PPAR gamma receptor agonist pioglitazone.PPAR

46. common complications of ca antagonists?
Reduce hypertriglyceridemia; in liver
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.
Streptokinase
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

47. what medication cause pulmonary edema?
Coronary angio - identify blockage and tx with stent/bypass
Reduce hypertriglyceridemia; in liver
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
PPAR gamma receptor agonist pioglitazone.PPAR

48. Most important predictor for future cardiovascular events
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Post wall MI - occlusion of right coronary artery. tx with atropine

49. 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
Within 24 hours
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

50. When to replace aortic valve
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Coronary angio - identify blockage and tx with stent/bypass
Unexplained synocope - dizziness - near syncope - recurrent palpitation