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USMLE Step3 Cardiovascular

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
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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. bradycardia after MI with hypotension. what would you do?
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
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
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.
Development of AF. after ETOH - develop AF---sudden cardia arrest

2. When to use digoxin in AF
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
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
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
If there is evidence of heart failure

3. In cocaine induced vasospasm - if angio shows any thrombus - next step?
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
Streptokinase

4. how rhematic feber - thyrotoxicosis - marfans - ehler danlos complicate cardiovascular systme
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
Pt with cardiogenic shock
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
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. When rhythm control strategy is suprior than rate control in the Tx of AF
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
Weight loss
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
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 -

6. when should you stop aspirin before procedure that has bleeding risk?
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Within 24 hours
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
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.

7. stable angina with heart failure
VSD; can be asymptomatic to large with significant L to R shunt
Go for coronary angio. high likelyhood of severe coronary artery disease
Unexplained synocope - dizziness - near syncope - recurrent palpitation
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect

8. How to treat a a patient with tCA overdose
No p wave - narrow qrs; first line of tx-adenosine
Lidcaine drip
Without AF; INR 2-3; with AF: 2.5-3.5
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability

9. complication of HRT
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Increases the risk of MI - thromboembolism - breast cancer - dementia
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
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

10. patient with unstable angina - chest pain - ekg changes but card enzymes normal - next step
No p wave - narrow qrs; first line of tx-adenosine
Streptokinase
Coronary angio - identify blockage and tx with stent/bypass
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used

11. treatment mobitz type 2 block (loss of QRS every 2nd /3rd beat)?
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
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.

12. what medication cause pulmonary edema?
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.
PPAR gamma receptor agonist pioglitazone.PPAR
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;

13. s/s carotid dissection
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.
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture

14. what MI cause sinus brady?
Transvenous pacemaker
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
Post wall MI - occlusion of right coronary artery. tx with atropine

15. 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
When it is symptomatic. asso with dec cardiac output resulting hypotension
CABG not angioplasty
Coronary angio - identify blockage and tx with stent/bypass

16. primordial prevention vs primary/secondary/tertiary prevention
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
Lidcaine 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.

17. INR goal for bileaflet mechnial valve
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
VSD; can be asymptomatic to large with significant L to R shunt
Amiodarone;
Without AF; INR 2-3; with AF: 2.5-3.5

18. indication of radionuclide ventriculography
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Monitor EF after cardiotoxic chemo - bypass surgery
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.
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;

19. drugs increases the effect of warfarin
If patient is started on rifampin or phenobarbital; they increases its metabolism
Holocystolic murmur loudest at lower left sternal border
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;

20. What is PEA? How do you treat?
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Increases the risk of MI - thromboembolism - breast cancer - dementia
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation

21. ehlers danlos
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Scoliosis and pes planus
Go for coronary angio. high likelyhood of severe coronary artery disease

22. What is mech of TCA overdose
If there is evidence of heart failure
Defibrillation
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
PPAR gamma receptor agonist pioglitazone.PPAR

23. bradycardia with type 2 heart block
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Monitor EF after cardiotoxic chemo - bypass surgery
If there is evidence of heart failure
Transvenous pacemaker

24. cocaine induced vasospasm leading to myocardial ischemia - initial tx?
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
No p wave - narrow qrs; first line of tx-adenosine
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation

25. What is poor R wave progression?
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 -
No p wave - narrow qrs; first line of tx-adenosine
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.

26. Most important predictor for future cardiovascular events
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.
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
When it is symptomatic. asso with dec cardiac output resulting hypotension

27. How to dx SVT? tx?
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
No p wave - narrow qrs; first line of tx-adenosine
VSD; can be asymptomatic to large with significant L to R shunt

28. problem of WPW?
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.
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
Development of AF. after ETOH - develop AF---sudden cardia arrest
Monitor EF after cardiotoxic chemo - bypass surgery

29. What is beck's triad?
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
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

30. paroxysmal AF without structural HD
Flecainamide
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
High suspicion of MI. LAD occlusion leading to LBBB - next step angio

31. common complications of ca antagonists?
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
No p wave - narrow qrs; first line of tx-adenosine
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
If patient is started on rifampin or phenobarbital; they increases its metabolism

32. 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
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
If patient is started on rifampin or phenobarbital; they increases its metabolism

33. 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
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
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.
PPAR gamma receptor agonist pioglitazone.PPAR

34. Why nitroprusside cannot be used alone in aortic dissection
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Duplex doppleer us if renal function impaired. if normal renal function - MR angio

35. Difference between cardioversion and defibrillation
Holocystolic murmur loudest at lower left sternal border
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
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

36. torsade and unresponsive
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Defibrillation
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.

37. When to start thrombolytic therapry in MI
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
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%

38. patient pw with new onset of heart failure and AF
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.
Defibrillation
Pt with cardiogenic shock

39. when NSTEMI without comorbidiites should get PCI?
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
Development of AF. after ETOH - develop AF---sudden cardia arrest
Within 24 hours

40. What is most congenital heart malformation?
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
VSD; can be asymptomatic to large with significant L to R shunt
Amiodarone;
High suspicion of MI. LAD occlusion leading to LBBB - next step angio

41. the dose levothyroxine in thyroid cancer remission
The dose should be adjusted such that TS H below 0.35
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
PPAR gamma receptor agonist pioglitazone.PPAR
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

42. when 24 hour holter monitoring and admission recommended?
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Persistent brady after MI which is refractory to atropine tx
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used

43. Indication of gemfibrozil?
Reduce hypertriglyceridemia; in liver
The dose should be adjusted such that TS H below 0.35
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
Holocystolic murmur loudest at lower left sternal border

44. who should get coronary intervention after MI
Go for coronary angio. high likelyhood of severe coronary artery disease
Scoliosis and pes planus
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.

45. When to increase warfarin dose?
If patient is started on rifampin or phenobarbital; they increases its metabolism
Holocystolic murmur loudest at lower left sternal border
Pt with cardiogenic shock
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

46. location of VSD/MR mumur
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Holocystolic murmur loudest at lower left sternal border
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
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?
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
CABG not angioplasty
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
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

48. patient with secondary htn - What is next step
Defibrillation
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Coronary angio - identify blockage and tx with stent/bypass
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation

49. spontaneous papillary muscle rupture
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Elderly people with MI
Post wall MI - occlusion of right coronary artery. tx with atropine
Without AF; INR 2-3; with AF: 2.5-3.5

50. When to treat sinus brady after acute MI
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
When it is symptomatic. asso with dec cardiac output resulting hypotension
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.