USMLE STEP 2 CARDIOLOGY EXAM UPDATED QUESTIONS
AND ACCURATE ANSWERS
HOCM pathology - CORRECT ANSWER✅✅✅-Autosomal dom, Af Amer
-diastolic dysfunction, stiff hypertrophied ventricle, high diastolic filling P - P inc with: inc HR,
contractility or dec LV filling
-outflow obstruction, from asymm hypertrophy interventricular septum
HOCM treatment - CORRECT ANSWER✅✅✅-avoid strenuous exercies
-symp: B-Blockers (HR dec, improve diastolic filling)
--CCB, diuretics
--surgery (myomectomy, MV replacement)
HOCM murmurs - CORRECT ANSWER✅✅✅-loud S4
-- best heard Left lower sternal border
- rapid carotid pulse with 2 upstrokes
- sys ejection murmur: ↑ murmur w/ ↓ preload
--*inc w/ valsalva*, standing (↓ LV size --> ↓ LV filling)
--↓ with squatting, lying down, straightleg raise (d/t ↑ LV filling)
-- ↓ w/ sustained handgrip (↑ sys resistance so ↓gradient across aortic valve)
Murmur effects: Standing, Valsalva, leg raise - CORRECT ANSWER✅✅✅- ↓left
ventricular volume, *decreases preload*
-↓intensity all mumurs EXCEPT mitral valve prolapse &HOCM
Murmur effects: squatting - CORRECT ANSWER✅✅✅-*increases preload*
-↑ intensity of all murmurs EXCEPT MVP, HCM
,Murmur effects: sustained handgrip - CORRECT ANSWER✅✅✅-↑ systemic resistance,
*increases afterload*
-↑ intensity of MVP, Aortic regurgitation
-↓ intensity of HOCM
*Affects of Handgrip, Valsalva and squatting on Aortic Regurgitation* - CORRECT
ANSWER✅✅✅Handgrip: inc afterload--> inc intensity AS
Valsalva: dec preload--> dec intensity AS
Squatting: inc preload--> inc intensity of AS
Premature atrial complexes (causes and tx) - CORRECT ANSWER✅✅✅-early P wave from
atria, not sinus node
-caused by adrenergic excess, drugs, alcohol, tobacco...
-not signficant in normal heart, OR precursor of ischemia in ds heart
-usually aymp: no tx
-if symptomtic (palpitations): B-Blockers
A Flutter tx - CORRECT ANSWER✅✅✅-rate 250-350 bpm, ECG saw tooth inf leads (II,
III, aVF)
-causes: COPD (MC association), heart ds, ASD
-tx like A fib:
1. rate control
2. rhythm control
3. asses need for anticoagulation
PSVT vs VTachy - CORRECT ANSWER✅✅✅PSVT: narrow QRS complex
--responds to carotid massage, Valsalva, IV adenosine
VT: wide QRS complex
,--no response to vagal maneuvers or adenosine
Torsades de Pointes (associations, tx) - CORRECT ANSWER✅✅✅-rapid polymorphic V
tachy, can lead to Vfib
-a/w prolong QT (congential QT syn, TCAs, anticholinergicsm, ischemia, electrolyte abnorm)
-*IV magnesium,* for cardiac stabalization
-tx underlying cause
HTN causes - CORRECT ANSWER✅✅✅-essential HTN - 95%
-secondary HTN: MCC*renal artery stenosis
--birthcontrol pills MCC* young women
--cushings, pheo, hyperthyroid, acromegaly, OCP, estrogen, TCAs, NSAIDs, coarc aorta,
stimulants, sleep apnea
thiazide diuretics AEs - CORRECT ANSWER✅✅✅-Hypokalemia
-hyperuricemia, hyperglycemia, ↑ chol and TGs, metab alk, hypomagnesia
digoxin toxicity symptoms - CORRECT ANSWER✅✅✅GI: nausea, vomit, anorexia
Cardiac: *PSVT* and *AV block*, Atrial tachy
CNS: visual disturbances, disorientation
High output Heart Failure (pathophys, CO, LVEDV, PR) - CORRECT ANSWER✅✅✅-↑
CO needed for requirements of peripheral tissues for O2
-*normal CO;
↑ LVEDV/LVEDP;
*↓ total peripheral resistance
Congestive heart failure pathophysiology CO, LVEDV - CORRECT ANSWER✅✅✅-*
↓CO --> activate RAAS and sympathetic NS--> systemic vasoconstriction, volume retention-->
, -↑ venous return --> ↑ preload (try to maintain CO)-->
-↑ LVEDV causes ↑LVEDP, which goes to pulm veins, and pulm congestion
Rheumatic fever diagnosis - CORRECT ANSWER✅✅✅-Requires two major criteria OR
one major, two minor
Major:
-migratory polyarthritis, erythema marginatum, cardiac involvement, chorea, subcutaneous
nodules
Minor:
-fever, inc ESR, polysrthralgias, prior h/o rheum fever, prologed PR interval, evidence of strep
infxn
Native valve endocarditis organisms - CORRECT ANSWER✅✅✅-MC: Strep viridans;
other staph sp (S aureus> S epidermidis), enterococci
-HACEK organisms:
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
prosthetic valve endocarditis organisms - CORRECT ANSWER✅✅✅-Staphylococci w/in
60 d of surgery (S. epidermidis> S aureus)
-Streptococci AFTER 60 d of surgery (late onset)
endocarditis in IV drug users organisms - CORRECT ANSWER✅✅✅-*right-sided*
endocarditis
-MCC Staph aureus
-others: enterococci and strep> fungi (candida) and gram - rods (Pseudomonas)
Infective endocarditis diagnosis - CORRECT ANSWER✅✅✅Dukes criteria: 2major; 1
major + 3 minor; or 5 minor
AND ACCURATE ANSWERS
HOCM pathology - CORRECT ANSWER✅✅✅-Autosomal dom, Af Amer
-diastolic dysfunction, stiff hypertrophied ventricle, high diastolic filling P - P inc with: inc HR,
contractility or dec LV filling
-outflow obstruction, from asymm hypertrophy interventricular septum
HOCM treatment - CORRECT ANSWER✅✅✅-avoid strenuous exercies
-symp: B-Blockers (HR dec, improve diastolic filling)
--CCB, diuretics
--surgery (myomectomy, MV replacement)
HOCM murmurs - CORRECT ANSWER✅✅✅-loud S4
-- best heard Left lower sternal border
- rapid carotid pulse with 2 upstrokes
- sys ejection murmur: ↑ murmur w/ ↓ preload
--*inc w/ valsalva*, standing (↓ LV size --> ↓ LV filling)
--↓ with squatting, lying down, straightleg raise (d/t ↑ LV filling)
-- ↓ w/ sustained handgrip (↑ sys resistance so ↓gradient across aortic valve)
Murmur effects: Standing, Valsalva, leg raise - CORRECT ANSWER✅✅✅- ↓left
ventricular volume, *decreases preload*
-↓intensity all mumurs EXCEPT mitral valve prolapse &HOCM
Murmur effects: squatting - CORRECT ANSWER✅✅✅-*increases preload*
-↑ intensity of all murmurs EXCEPT MVP, HCM
,Murmur effects: sustained handgrip - CORRECT ANSWER✅✅✅-↑ systemic resistance,
*increases afterload*
-↑ intensity of MVP, Aortic regurgitation
-↓ intensity of HOCM
*Affects of Handgrip, Valsalva and squatting on Aortic Regurgitation* - CORRECT
ANSWER✅✅✅Handgrip: inc afterload--> inc intensity AS
Valsalva: dec preload--> dec intensity AS
Squatting: inc preload--> inc intensity of AS
Premature atrial complexes (causes and tx) - CORRECT ANSWER✅✅✅-early P wave from
atria, not sinus node
-caused by adrenergic excess, drugs, alcohol, tobacco...
-not signficant in normal heart, OR precursor of ischemia in ds heart
-usually aymp: no tx
-if symptomtic (palpitations): B-Blockers
A Flutter tx - CORRECT ANSWER✅✅✅-rate 250-350 bpm, ECG saw tooth inf leads (II,
III, aVF)
-causes: COPD (MC association), heart ds, ASD
-tx like A fib:
1. rate control
2. rhythm control
3. asses need for anticoagulation
PSVT vs VTachy - CORRECT ANSWER✅✅✅PSVT: narrow QRS complex
--responds to carotid massage, Valsalva, IV adenosine
VT: wide QRS complex
,--no response to vagal maneuvers or adenosine
Torsades de Pointes (associations, tx) - CORRECT ANSWER✅✅✅-rapid polymorphic V
tachy, can lead to Vfib
-a/w prolong QT (congential QT syn, TCAs, anticholinergicsm, ischemia, electrolyte abnorm)
-*IV magnesium,* for cardiac stabalization
-tx underlying cause
HTN causes - CORRECT ANSWER✅✅✅-essential HTN - 95%
-secondary HTN: MCC*renal artery stenosis
--birthcontrol pills MCC* young women
--cushings, pheo, hyperthyroid, acromegaly, OCP, estrogen, TCAs, NSAIDs, coarc aorta,
stimulants, sleep apnea
thiazide diuretics AEs - CORRECT ANSWER✅✅✅-Hypokalemia
-hyperuricemia, hyperglycemia, ↑ chol and TGs, metab alk, hypomagnesia
digoxin toxicity symptoms - CORRECT ANSWER✅✅✅GI: nausea, vomit, anorexia
Cardiac: *PSVT* and *AV block*, Atrial tachy
CNS: visual disturbances, disorientation
High output Heart Failure (pathophys, CO, LVEDV, PR) - CORRECT ANSWER✅✅✅-↑
CO needed for requirements of peripheral tissues for O2
-*normal CO;
↑ LVEDV/LVEDP;
*↓ total peripheral resistance
Congestive heart failure pathophysiology CO, LVEDV - CORRECT ANSWER✅✅✅-*
↓CO --> activate RAAS and sympathetic NS--> systemic vasoconstriction, volume retention-->
, -↑ venous return --> ↑ preload (try to maintain CO)-->
-↑ LVEDV causes ↑LVEDP, which goes to pulm veins, and pulm congestion
Rheumatic fever diagnosis - CORRECT ANSWER✅✅✅-Requires two major criteria OR
one major, two minor
Major:
-migratory polyarthritis, erythema marginatum, cardiac involvement, chorea, subcutaneous
nodules
Minor:
-fever, inc ESR, polysrthralgias, prior h/o rheum fever, prologed PR interval, evidence of strep
infxn
Native valve endocarditis organisms - CORRECT ANSWER✅✅✅-MC: Strep viridans;
other staph sp (S aureus> S epidermidis), enterococci
-HACEK organisms:
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
prosthetic valve endocarditis organisms - CORRECT ANSWER✅✅✅-Staphylococci w/in
60 d of surgery (S. epidermidis> S aureus)
-Streptococci AFTER 60 d of surgery (late onset)
endocarditis in IV drug users organisms - CORRECT ANSWER✅✅✅-*right-sided*
endocarditis
-MCC Staph aureus
-others: enterococci and strep> fungi (candida) and gram - rods (Pseudomonas)
Infective endocarditis diagnosis - CORRECT ANSWER✅✅✅Dukes criteria: 2major; 1
major + 3 minor; or 5 minor
