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. complication of HRT
Flecainamide
Increases the risk of MI - thromboembolism - breast cancer - dementia
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS

2. Difference between cardioversion and defibrillation
Go for coronary angio. high likelyhood of severe coronary artery disease
Flecainamide
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
7 days. coz aspirin cause platelet dysfunction that can last more than a week.

3. what MI cause sinus brady?
Development of AF. after ETOH - develop AF---sudden cardia arrest
Post wall MI - occlusion of right coronary artery. tx with atropine
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Persistent brady after MI which is refractory to atropine tx

4. cocaine induced vasospasm leading to myocardial ischemia - initial tx?
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
Holocystolic murmur loudest at lower left sternal border

5. 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
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
When it is symptomatic. asso with dec cardiac output resulting hypotension

6. when should you stop aspirin before procedure that has bleeding risk?
Within 24 hours
Development of AF. after ETOH - develop AF---sudden cardia arrest
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
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

7. indication of radionuclide ventriculography
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
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Monitor EF after cardiotoxic chemo - bypass surgery
When it is symptomatic. asso with dec cardiac output resulting hypotension

8. 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
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
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady

9. bradycardia with type 2 heart block
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Transvenous pacemaker
Go for coronary angio. high likelyhood of severe coronary artery disease

10. How long it takes for digoxin to have significant effect on rate control
No p wave - narrow qrs; first line of tx-adenosine
If patient is started on rifampin or phenobarbital; they increases its metabolism
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker

11. baloon valvulotomy for AS
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
CABG not angioplasty
Without AF; INR 2-3; with AF: 2.5-3.5
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 -

12. What is the most effective way to treat multivessel coronary artery blockade?
CABG not angioplasty
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
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.

13. When to use digoxin in AF
The dose should be adjusted such that TS H below 0.35
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
If there is evidence of heart failure
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%

14. How to dx SVT? tx?
PPAR gamma receptor agonist pioglitazone.PPAR
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
No p wave - narrow qrs; first line of tx-adenosine
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

15. When to start thrombolytic therapry in MI
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Holocystolic murmur loudest at lower left sternal border
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours

16. What is most congenital heart malformation?
No p wave - narrow qrs; first line of tx-adenosine
Development of AF. after ETOH - develop AF---sudden cardia arrest
VSD; can be asymptomatic to large with significant L to R shunt
Elderly people with MI

17. drugs increases the effect of warfarin
When it is symptomatic. asso with dec cardiac output resulting hypotension
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;

18. sinus bradycardia after inf wall MI
If there is evidence of heart failure
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Elderly people with MI
Without AF; INR 2-3; with AF: 2.5-3.5

19. sudden onset of HTN. How do you manage
Persistent brady after MI which is refractory to atropine tx
Streptokinase
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

20. wpw syndrome
Coronary angio - identify blockage and tx with stent/bypass
When it is symptomatic. asso with dec cardiac output resulting hypotension
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS

21. bradycardia after MI with hypotension. what would you do?
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
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
Monitor EF after cardiotoxic chemo - bypass surgery
Holocystolic murmur loudest at lower left sternal border

22. What is mech of TCA overdose
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
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
Increases the risk of MI - thromboembolism - breast cancer - dementia

23. When to use anticoag or aspiring in AF
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
2.5-3.5
Increases the risk of MI - thromboembolism - breast cancer - dementia
Post wall MI - occlusion of right coronary artery. tx with atropine

24. ehlers danlos
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Scoliosis and pes planus
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect

25. spontaneous papillary muscle rupture
Elderly people with MI
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
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
Scoliosis and pes planus

26. When to use transvenous pacing?
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Persistent brady after MI which is refractory to atropine tx
Amiodarone;
No p wave - narrow qrs; first line of tx-adenosine

27. new onset LBBB - What is the next step
2.5-3.5
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 -
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
High suspicion of MI. LAD occlusion leading to LBBB - next step angio

28. What is PEA? How do you treat?
Defibrillation
Coronary angio - identify blockage and tx with stent/bypass
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
2.5-3.5

29. patient pw with new onset of heart failure and AF
Pt with cardiogenic shock
Coronary angio - identify blockage and tx with stent/bypass
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

30. common complications of ca antagonists?
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Streptokinase
Go for coronary angio. high likelyhood of severe coronary artery disease
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.

31. When rhythm control strategy is suprior than rate control in the Tx of AF
When it is symptomatic. asso with dec cardiac output resulting hypotension
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
No p wave - narrow qrs; first line of tx-adenosine

32. In cocaine induced vasospasm - if angio shows any thrombus - next step?
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
VSD; can be asymptomatic to large with significant L to R shunt
Streptokinase

33. When to increase warfarin dose?
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
Pt with cardiogenic shock
If patient is started on rifampin or phenobarbital; they increases its metabolism

34. treatment mobitz type 2 block (loss of QRS every 2nd /3rd beat)?
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
Monitor EF after cardiotoxic chemo - bypass surgery
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker

35. paroxysmal AF with structural HD
Coronary angio - identify blockage and tx with stent/bypass
Amiodarone;
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
High suspicion of MI. LAD occlusion leading to LBBB - next step angio

36. What is beck's triad?
Transvenous pacemaker
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
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
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.

37. the dose levothyroxine in thyroid cancer remission
The dose should be adjusted such that TS H below 0.35
Development of AF. after ETOH - develop AF---sudden cardia arrest
No p wave - narrow qrs; first line of tx-adenosine
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure

38. When to treat sinus brady after acute MI
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
When it is symptomatic. asso with dec cardiac output resulting hypotension
Increases the risk of MI - thromboembolism - breast cancer - dementia

39. what causes non sustained ventricular tachy (>3 or more consecutive beat >120/m)?
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
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion

40. What is poor R wave progression?
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause

41. What is paroxysmal AF? How do you treat?
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
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...except posterior or dorsal MI
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)

42. location of VSD/MR mumur
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Flecainamide
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Holocystolic murmur loudest at lower left sternal border

43. INR goal for bileaflet mechnial valve
Coronary angio - identify blockage and tx with stent/bypass
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Without AF; INR 2-3; with AF: 2.5-3.5

44. most effective non pharmacologic measure to decease blood pressure?
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
Weight loss
Within 24 hours
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)

45. When to replace aortic valve
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
Transvenous pacemaker
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm

46. patient with secondary htn - What is next step
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
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
R/o IHD which is the most common causes of CHF. stress test if indicated or angio

47. torsade and unresponsive
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Defibrillation
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Increases the risk of MI - thromboembolism - breast cancer - dementia

48. what medication cause pulmonary edema?
No p wave - narrow qrs; first line of tx-adenosine
PPAR gamma receptor agonist pioglitazone.PPAR
When it is symptomatic. asso with dec cardiac output resulting hypotension
Coronary angio - identify blockage and tx with stent/bypass

49. should we give thrombolytic in ST depression?
No...except posterior or dorsal MI
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Monitor EF after cardiotoxic chemo - bypass surgery

50. when we say QT prolonged?
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Holocystolic murmur loudest at lower left sternal border
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure