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Test your basic knowledge |
USMLE Step3 Cardiovascular
Start Test
Study First
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. location of VSD/MR mumur
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
Holocystolic murmur loudest at lower left sternal border
Unexplained synocope - dizziness - near syncope - recurrent palpitation
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 -
2. EKG shows ST elevation and suggest occlusion of major coronary artery.
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Lidcaine drip
3. when NSTEMI without comorbidiites should get PCI?
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
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.
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Within 24 hours
4. bradycardia with type 2 heart block
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
Transvenous pacemaker
Holocystolic murmur loudest at lower left sternal border
5. what MI cause sinus brady?
Post wall MI - occlusion of right coronary artery. tx with atropine
Holocystolic murmur loudest at lower left sternal border
2.5-3.5
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
6. baloon valvulotomy for AS
Transvenous pacemaker
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
7. torsade and unresponsive
Go for coronary angio. high likelyhood of severe coronary artery disease
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
Defibrillation
Without AF; INR 2-3; with AF: 2.5-3.5
8. INR goal for bileaflet mechnial valve
The dose should be adjusted such that TS H below 0.35
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 it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Without AF; INR 2-3; with AF: 2.5-3.5
9. When to use dobutamine?
When it is symptomatic. asso with dec cardiac output resulting hypotension
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Pt with cardiogenic shock
VSD; can be asymptomatic to large with significant L to R shunt
10. primordial prevention vs primary/secondary/tertiary prevention
Holocystolic murmur loudest at lower left sternal border
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.
No p wave - narrow qrs; first line of tx-adenosine
Scoliosis and pes planus
11. sinus bradycardia after inf wall MI
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Weight loss
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
Defibrillation
12. common complications of ca antagonists?
Reduce hypertriglyceridemia; in liver
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
13. problem of WPW?
Streptokinase
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Development of AF. after ETOH - develop AF---sudden cardia arrest
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
14. patient with secondary htn - What is next step
Scoliosis and pes planus
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
15. treatment mobitz type 2 block (loss of QRS every 2nd /3rd beat)?
If symptomatic (hypotension - hx of syncope) place 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
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
Transvenous pacemaker
16. 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
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
Transvenous pacemaker
17. paroxysmal AF with structural HD
No p wave - narrow qrs; first line of tx-adenosine
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
Post wall MI - occlusion of right coronary artery. tx with atropine
Amiodarone;
18. what causes non sustained ventricular tachy (>3 or more consecutive beat >120/m)?
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Reduce hypertriglyceridemia; in liver
19. cocaine induced vasospasm leading to myocardial ischemia - initial tx?
Defibrillation
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Lidcaine drip
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
20. when we say QT prolonged?
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
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Reduce hypertriglyceridemia; in liver
21. When rhythm control strategy is suprior than rate control in the Tx of AF
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
Increases the risk of MI - thromboembolism - breast cancer - dementia
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.
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
22. s/s carotid dissection
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
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
23. what medication cause pulmonary edema?
Within 24 hours
PPAR gamma receptor agonist pioglitazone.PPAR
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
24. patient pw with new onset of heart failure and AF
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
Flecainamide
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
25. patient with unstable angina - chest pain - ekg changes but card enzymes normal - next step
When it is symptomatic. asso with dec cardiac output resulting hypotension
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Coronary angio - identify blockage and tx with stent/bypass
Persistent brady after MI which is refractory to atropine tx
26. When to replace aortic valve
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
When it is symptomatic. asso with dec cardiac output resulting hypotension
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
27. Indication of gemfibrozil?
Amiodarone;
VSD; can be asymptomatic to large with significant L to R shunt
Reduce hypertriglyceridemia; in liver
Defibrillation
28. When to use digoxin in AF
The dose should be adjusted such that TS H below 0.35
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
Weight loss
If there is evidence of heart failure
29. drugs increases the effect of warfarin
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
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
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
30. most effective non pharmacologic measure to decease blood pressure?
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.
Reduce hypertriglyceridemia; in liver
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
Weight loss
31. the dose levothyroxine in thyroid cancer remission
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
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
The dose should be adjusted such that TS H below 0.35
32. complication of HRT
PPAR gamma receptor agonist pioglitazone.PPAR
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
Increases the risk of MI - thromboembolism - breast cancer - dementia
33. When to use anticoag or aspiring in AF
Reduce hypertriglyceridemia; in liver
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
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
34. What is paroxysmal AF? How do you treat?
Within 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
Increases the risk of MI - thromboembolism - breast cancer - dementia
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. What is PEA? How do you treat?
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
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
Amiodarone;
36. INR for mechanical prosthetic valve
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
Coronary angio - identify blockage and tx with stent/bypass
2.5-3.5
37. When to use transvenous pacing?
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
Within 24 hours
Persistent brady after MI which is refractory to atropine tx
PPAR gamma receptor agonist pioglitazone.PPAR
38. What is poor R wave progression?
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
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
Post wall MI - occlusion of right coronary artery. tx with atropine
39. How to treat a a patient with tCA overdose
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Lidcaine drip
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
40. What is most congenital heart malformation?
VSD; can be asymptomatic to large with significant L to R shunt
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Coronary angio - identify blockage and tx with stent/bypass
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
41. how amiodarone affects on warfarin
Streptokinase
Go for coronary angio. high likelyhood of severe coronary artery disease
Within 24 hours
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
42. how rhematic feber - thyrotoxicosis - marfans - ehler danlos complicate cardiovascular systme
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
Pt with cardiogenic shock
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
43. What is mech of TCA overdose
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
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
44. bradycardia after MI with hypotension. what would you do?
VSD; can be asymptomatic to large with significant L to R shunt
If R wave in lead v1 to V4 are in the same size. cause: LVH - RVH - copd - anterior infarcion - conduction defects - cardiomyopat
Urgent transvenous pacing or IV atropine.. must be treated. even mild brady
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
45. spontaneous papillary muscle 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
Elderly people with MI
VSD; can be asymptomatic to large with significant L to R shunt
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
46. stable angina with heart failure
Go for coronary angio. high likelyhood of severe coronary artery disease
The dose should be adjusted such that TS H below 0.35
It slows metabolism and increases warfarin level. the dose needs to be decreased by 25%
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
47. indication of radionuclide ventriculography
Monitor EF after cardiotoxic chemo - bypass surgery
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Only AF with no other comorbidity- aspirin. AF with heart failure - CAD - HTN - Dm - >75 give warfarin
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
48. When to increase warfarin dose?
Monitor EF after cardiotoxic chemo - bypass surgery
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
If patient is started on rifampin or phenobarbital; they increases its metabolism
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
49. What is kussmaul sign
Go for coronary angio. high likelyhood of severe coronary artery disease
Persistent brady after MI which is refractory to atropine tx
No p wave - narrow qrs; first line of tx-adenosine
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
50. When to treat sinus brady after acute MI
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
If patient is started on rifampin or phenobarbital; they increases its metabolism
When it is symptomatic. asso with dec cardiac output resulting hypotension
Lidcaine drip