Cardiology boards ABIM exam 2023 with 100%
correct answers
1). What is a positive stress test
Ans: Flat or Down sloping St-segment depression >1 mm occurring 80 msec after j
point
2). When to stop a stress test
Ans: St segment depression > 2 mm, ventricular tachycardia, drop in SBP > 15, chest
pain, dyspnea, lightheadedness
3). Stress test of choice with a lbbb or ventricular pacing?
Ans: Myocardial perfusion imaging with adenosine,NOT exercising!
4). Know the algorithm for stress testing
Ans: See page 5-3,figure 5-1
5). When to not use doutamine for stress
Ans: History of VT, severe HTN, Low BP, poor echo images
6). When to not use adenosine for stress
Ans: Bronchospasm, severe valvular dysfunction, severe carotid stenosis, 2nd degree
heart block, theophylline dependent
7). Normals for pa catheter pressures
Ans: RA <7, RV 30/7, PCWP 3-11
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, 8). Pa cath findings in tamponade or restrictive pericarditis
Ans: Diastolic pressures elevated and equalized in all chambers, low BP
9). Pa cath findings with rv ami
Ans: Elevated RA and PA pressures, decreased or nl PCWP, hypotension, and inferior
MI. R side is decompensated, cannot fill L side of the heart
10). Pa cath findings in cardiogenic shock
Ans: Elevated PCWP, RA pressure, and decreased SBP/cardiac output
11). Pa cath findings in mitral stenosis with rv failure
Ans: Elevated RA, PA (very elevated), PCWP, nl SBP
12). Pa cath findings in pulmonary htn
Ans: Elevated PA, RA pressures, nl PCWP, SBP
13). Pulsus paradoxus
Ans: decrease in systolic BP of more than 10mmHg with normal inspiration; palpated
as weakened pulse with inspiration along with more heart contractions to pulse beats
14). What conditions give you pulsus paradoxus?
Ans: Constrictive or restrictive pericarditis, asthma, tension pneumothorax
15). What gives you pulsus bisferiens (two systolic peaks per cycle)
Ans: Aortic regurgitation, HOCM
16). What causes pulsus alternans
Ans: Severe LV dysfunction
17). What causes pulsus tardus
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, Ans: Aortic stenosis
18). How do positional maneuvers affect blood flow and murmurs
Ans: -standing/valsalva - decreased cardiac filling, decreases most murmurs except
MVP and HOCM
-squatting/ lying down - increase cardiac volume, increased murmurs except MVP,
HOCM
-sustained handgrip - increases systemic resistance, decreases murmur in HOCM, AS
19). What causes a physiologic split s2
Ans: Increased blood volume in the RV prolongs systole and delays pulmonary valve
closure
20). What causes a fixed split s2
Ans: Pulmonary stenosis, PE, LV pacer, RBBB, MR (early AV closure), ASD, RV failue
21). What causes a paradoxic split s2
Ans: LBBB, RV pacing, HOCM
22). What causes an s3?
Ans: Rapid LV filling - acute ventricular decompensation, severe AR or MR
23). Know - s3 with lv dysfunction is a poor prognostic factor
Ans: ...
24). What causes a s4?
Ans: Decreased ventricular compliance during atrial contraction - ischemic heart dz,
AS, MR, HOCM, hypertrophic or diabetic cardiomyopathy, HTN heart dz, concentric LVH
25). Can you have a s4 with atrial fibrillation?
Ans: No - no atrial contraction
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, 26). What are the parts of the venous waveform?
Ans: A wave - atrial contraction
X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens, passive emptying into ventricle
27). What gives elevated a and v waves
Ans: Pulmonary HTN, RV infarction
28). Large r side v waves
Ans: Septal rupture
29). Large v waves
Ans: TR (right), MR (left)
30). Rapid x and y descent
Ans: Constrictive pericarditis, restrictive cardiomyopathy, tamponade (x descent only,
loss of y descent)
31). Large a waves
Ans: TS,severe RVH (on right), MS
32). Cannon a waves
Ans: AV disassociation - complete heart block, ventricular pacing
33). Slow y descent
Ans: Delayed atrial emptying - TS
34). Most important prognostic factor with cad
Ans: Degree of LV dysfunction
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correct answers
1). What is a positive stress test
Ans: Flat or Down sloping St-segment depression >1 mm occurring 80 msec after j
point
2). When to stop a stress test
Ans: St segment depression > 2 mm, ventricular tachycardia, drop in SBP > 15, chest
pain, dyspnea, lightheadedness
3). Stress test of choice with a lbbb or ventricular pacing?
Ans: Myocardial perfusion imaging with adenosine,NOT exercising!
4). Know the algorithm for stress testing
Ans: See page 5-3,figure 5-1
5). When to not use doutamine for stress
Ans: History of VT, severe HTN, Low BP, poor echo images
6). When to not use adenosine for stress
Ans: Bronchospasm, severe valvular dysfunction, severe carotid stenosis, 2nd degree
heart block, theophylline dependent
7). Normals for pa catheter pressures
Ans: RA <7, RV 30/7, PCWP 3-11
PaperStoc.com Page 1 of 32
, 8). Pa cath findings in tamponade or restrictive pericarditis
Ans: Diastolic pressures elevated and equalized in all chambers, low BP
9). Pa cath findings with rv ami
Ans: Elevated RA and PA pressures, decreased or nl PCWP, hypotension, and inferior
MI. R side is decompensated, cannot fill L side of the heart
10). Pa cath findings in cardiogenic shock
Ans: Elevated PCWP, RA pressure, and decreased SBP/cardiac output
11). Pa cath findings in mitral stenosis with rv failure
Ans: Elevated RA, PA (very elevated), PCWP, nl SBP
12). Pa cath findings in pulmonary htn
Ans: Elevated PA, RA pressures, nl PCWP, SBP
13). Pulsus paradoxus
Ans: decrease in systolic BP of more than 10mmHg with normal inspiration; palpated
as weakened pulse with inspiration along with more heart contractions to pulse beats
14). What conditions give you pulsus paradoxus?
Ans: Constrictive or restrictive pericarditis, asthma, tension pneumothorax
15). What gives you pulsus bisferiens (two systolic peaks per cycle)
Ans: Aortic regurgitation, HOCM
16). What causes pulsus alternans
Ans: Severe LV dysfunction
17). What causes pulsus tardus
PaperStoc.com Page 2 of 32
, Ans: Aortic stenosis
18). How do positional maneuvers affect blood flow and murmurs
Ans: -standing/valsalva - decreased cardiac filling, decreases most murmurs except
MVP and HOCM
-squatting/ lying down - increase cardiac volume, increased murmurs except MVP,
HOCM
-sustained handgrip - increases systemic resistance, decreases murmur in HOCM, AS
19). What causes a physiologic split s2
Ans: Increased blood volume in the RV prolongs systole and delays pulmonary valve
closure
20). What causes a fixed split s2
Ans: Pulmonary stenosis, PE, LV pacer, RBBB, MR (early AV closure), ASD, RV failue
21). What causes a paradoxic split s2
Ans: LBBB, RV pacing, HOCM
22). What causes an s3?
Ans: Rapid LV filling - acute ventricular decompensation, severe AR or MR
23). Know - s3 with lv dysfunction is a poor prognostic factor
Ans: ...
24). What causes a s4?
Ans: Decreased ventricular compliance during atrial contraction - ischemic heart dz,
AS, MR, HOCM, hypertrophic or diabetic cardiomyopathy, HTN heart dz, concentric LVH
25). Can you have a s4 with atrial fibrillation?
Ans: No - no atrial contraction
PaperStoc.com Page 3 of 32
, 26). What are the parts of the venous waveform?
Ans: A wave - atrial contraction
X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens, passive emptying into ventricle
27). What gives elevated a and v waves
Ans: Pulmonary HTN, RV infarction
28). Large r side v waves
Ans: Septal rupture
29). Large v waves
Ans: TR (right), MR (left)
30). Rapid x and y descent
Ans: Constrictive pericarditis, restrictive cardiomyopathy, tamponade (x descent only,
loss of y descent)
31). Large a waves
Ans: TS,severe RVH (on right), MS
32). Cannon a waves
Ans: AV disassociation - complete heart block, ventricular pacing
33). Slow y descent
Ans: Delayed atrial emptying - TS
34). Most important prognostic factor with cad
Ans: Degree of LV dysfunction
PaperStoc.com Page 4 of 32
