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. What is the most effective way to treat multivessel coronary artery blockade?
VSD; can be asymptomatic to large with significant L to R shunt
Holocystolic murmur loudest at lower left sternal border
CABG not angioplasty
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. INR for mechanical prosthetic valve
Flecainamide
Elderly people with MI
Persistent brady after MI which is refractory to atropine tx
2.5-3.5

3. drugs increases the effect of warfarin
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Amiodarone;
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm

4. Why nitroprusside cannot be used alone in aortic dissection
Cephalosporin - ciprofloxacin - erythromycin - fluconzol - amiodarone;
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
The dose should be adjusted such that TS H below 0.35

5. When to use dobutamine?
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
Pt with cardiogenic shock
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture

6. How to dx SVT? tx?
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
If patient is started on rifampin or phenobarbital; they increases its metabolism
No p wave - narrow qrs; first line of tx-adenosine
2.5-3.5

7. What is most congenital heart malformation?
Defibrillation
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
VSD; can be asymptomatic to large with significant L to R shunt

8. Most important predictor for future cardiovascular events
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker

9. spontaneous papillary muscle rupture
Elderly people with MI
Reduce hypertriglyceridemia; in liver
CABG not angioplasty
Within 24 hours

10. What is paroxysmal AF? How do you treat?
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 -
Pt with cardiogenic shock
The dose should be adjusted such that TS H below 0.35
Increases the risk of MI - thromboembolism - breast cancer - dementia

11. torsade and unresponsive
Defibrillation
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
2.5-3.5
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio

12. when should you stop aspirin before procedure that has bleeding risk?
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
7 days. coz aspirin cause platelet dysfunction that can last more than a week.
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Flecainamide

13. patient with secondary htn - What is next step
Coronary angio - identify blockage and tx with stent/bypass
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Development of AF. after ETOH - develop AF---sudden cardia arrest
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 -

14. When rhythm control strategy is suprior than rate control in the Tx of AF
Defibrillation
Lidcaine drip
Pt with marked palpitaion - diszzines - dyspnoea - or hemodynamic instability.
The dose should be adjusted such that TS H below 0.35

15. when 24 hour holter monitoring and admission recommended?
Unexplained synocope - dizziness - near syncope - recurrent palpitation
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
Persistent brady after MI which is refractory to atropine tx
Monitor EF after cardiotoxic chemo - bypass surgery

16. What drugs precipitate digoxin toxicity?
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
Monitor EF after cardiotoxic chemo - bypass surgery
Persistent brady after MI which is refractory to atropine tx

17. baloon valvulotomy for AS
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Flecainamide
VSD; can be asymptomatic to large with significant L to R shunt
High procedural morbidity and transient efficacy; considered only in selected clinical settings eg patient with hemodynamic instability

18. How do you diagnose multifocal atrial tachy?
Do cardiact stress test; 50-75% of CHF have coronary disease etiology
Unexplained synocope - dizziness - near syncope - recurrent palpitation
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 symptomatic (hypotension - hx of syncope) place transvenous pacemaker

19. primordial prevention vs primary/secondary/tertiary prevention
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
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
Elderly people with MI

20. When to increase warfarin dose?
Reduce hypertriglyceridemia; in liver
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
Duplex doppleer us if renal function impaired. if normal renal function - MR angio

21. What is PEA? How do you treat?
Pulseless electrical activity. ekg shows cardiac rhythm but no cardiac output. no measurable pusle/BP.
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
PPAR gamma receptor agonist pioglitazone.PPAR
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture

22. what MI cause sinus brady?
Development of AF. after ETOH - develop AF---sudden cardia arrest
Increases the risk of MI - thromboembolism - breast cancer - dementia
Post wall MI - occlusion of right coronary artery. tx with atropine
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.

23. What is beck's triad?
Post wall MI - occlusion of right coronary artery. tx with atropine
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Flecainamide

24. location of VSD/MR mumur
Weight loss
Flecainamide
Holocystolic murmur loudest at lower left sternal border
Post wall MI - occlusion of right coronary artery. tx with atropine

25. When to start thrombolytic therapry in MI
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.
Persistent brady after MI which is refractory to atropine tx
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.

26. 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
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Pt with cardiogenic shock
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.

27. How long it takes for digoxin to have significant effect on rate control
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation
5.5 hours. thats Why not preferred in acute setting; diltiazen or beta blockers esmolol - metoprolol - propranolol should be used
Scoliosis and pes planus
Weight loss

28. sudden onset of HTN. How do you manage
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 -
Defibrillation
Most likely secondary. if young rule out renal cause. look at BUN/Cr; then look for pheocromo - cushing. then look for renovascular cause
Weight loss

29. bradycardia after MI with hypotension. what would you do?
Lidcaine drip
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
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

30. common complications of ca antagonists?
The dose should be adjusted such that TS H below 0.35
If patient has >1mm st elevation in two contiguous leads and presents within 12 /24 hours
Persistent brady after MI which is refractory to atropine tx
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.

31. new onset LBBB - What is the next step
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
Increases the risk of MI - thromboembolism - breast cancer - dementia

32. In cocaine induced vasospasm - if angio shows any thrombus - next step?
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
Streptokinase
If patient is started on rifampin or phenobarbital; they increases its metabolism
PPAR gamma receptor agonist pioglitazone.PPAR

33. When to use transvenous pacing?
PPAR gamma receptor agonist pioglitazone.PPAR
Persistent brady after MI which is refractory to atropine tx
VSD; can be asymptomatic to large with significant L to R shunt
Defibrillation

34. who should get coronary intervention after MI
STEMI - NSTEMI with high risk e.g. heart failure - angina - persistent arrythmia.
Persistent brady after MI which is refractory to atropine tx
Flecainamide
No...except posterior or dorsal MI

35. wpw syndrome
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS
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
Nitrate/ca channel blocker - aspirin - benzo; if no improvement angio
Within 24 hours

36. When to replace aortic valve
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
Cause reflex sympathetic activation - increases heart rate and ventricular contractility which worsen the situation
2.5-3.5
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm

37. When to use digoxin in AF
If symptomatic (hypotension - hx of syncope) place transvenous pacemaker
Monitor EF after cardiotoxic chemo - bypass surgery
Bilat dependent edema. mechanisms not known. arterial dilatation may cause this.
If there is evidence of heart failure

38. most effective non pharmacologic measure to decease blood pressure?
Coronary angio - identify blockage and tx with stent/bypass
Weight loss
High suspicion of MI. LAD occlusion leading to LBBB - next step angio
Unilateral headache - horner syndrom (miosis - ptosis and anhidrosis) dx MRA if it is unclear do catheter angio tx anticoagulation

39. patient with new onset CHF - What is next best step?
When it is symptomatic. asso with dec cardiac output resulting hypotension
No p wave - narrow qrs; first line of tx-adenosine
R/o IHD which is the most common causes of CHF. stress test if indicated or angio
CABG not angioplasty

40. stable angina with heart failure
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
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.

41. problem of WPW?
Medical emergency. go for PCI without measuring card enzumes which will take several hours to be elevated.
1. MI/CAD 2. LVH 3. dilated cardiomyo 4. MVR; tx order EKG - cardiac enzymes - Echo (most common in ward)
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect
Development of AF. after ETOH - develop AF---sudden cardia arrest

42. what medication cause pulmonary edema?
PPAR gamma receptor agonist pioglitazone.PPAR
Without AF; INR 2-3; with AF: 2.5-3.5
Transient resolves in 24-48h. no tx or atropine; if pulmonary edema - rales or other signs of CHF - transvenous pacing
Unexplained synocope - dizziness - near syncope - recurrent palpitation

43. ehlers danlos
Transvenous pacemaker
Scoliosis and pes planus
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

44. Indication of gemfibrozil?
No...except posterior or dorsal MI
Reduce hypertriglyceridemia; in liver
VAQ verapamil - amiodarone and quinidine; they inhibits renal tubula secretion of digoxin; patient presents with n/v/visual disturbance/confusion
DM. equivalent to CAD. any additional risk factors such as hypertension and smoking has synergistic effect

45. when we say QT prolonged?
Streptokinase
When valve area is <0.7 - patient is sympotmatic - LVH >15 mm
If it is more than half of the RR interval - cause: antiarrythmic drugs - TCA - hypokalemia - stroke - seizure
Holocystolic murmur loudest at lower left sternal border

46. the dose levothyroxine in thyroid cancer remission
The dose should be adjusted such that TS H below 0.35
Coronary angio - identify blockage and tx with stent/bypass
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture
Increases the risk of MI - thromboembolism - breast cancer - dementia

47. Difference between cardioversion and defibrillation
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
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.
No...except posterior or dorsal MI

48. paroxysmal AF without structural HD
Post wall MI - occlusion of right coronary artery. tx with atropine
Flecainamide
Elderly people with MI
Extra conduction pathway connects atria and ventricles. impulses run faster in accessory pathway than AV node. ventricles excited prematurely - shorter pr interval - slurred QRS

49. indication of radionuclide ventriculography
Duplex doppleer us if renal function impaired. if normal renal function - MR angio
Monitor EF after cardiotoxic chemo - bypass surgery
2.5-3.5
Rheumatic causes MR; thyrotoxicosis presents with high output failure; marfans-chronic - progressive MR; Ehlers-acute MR due to rupture of chorda tendenie.....ehlers---rupture

50. How to treat a a patient with tCA overdose
Hypotension - distant heart sound - Inc jugular venous pressure suggestive of pericardial tamponade.
Lidcaine drip
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.