USMLE Step 3, Cardiology(A+ Guaranteed Answers)
most dangerous factor for CAD is correct answersdiabetes
ddx of pleuritic chest pain correct answersPE, pneumonia, pleuritis, pericarditis, pneumothorax
ddx of positional pain correct answerspericarditis
MCC of chest pain not cardiac in etiology is correct answersGERD
patient comes to the ED with CP, pain also occurs in epigastric area and is asso with sore throat,
metallic taste in the mouth and a cough, what do you recommend? correct answersPPI
an alcoholic patient comes to the ED with CP, nausea and vomiting and epigastric tenderness;
what do you recommend? correct answerscheck amylase and lipase levels
S3 vs S4 correct answersdilated LV vs LVH
mechanism of an S3 gallop correct answersrapid ventricular filling during diastole
mechanism of an s4 gallop correct answerssound of atrial systole into a stiff or noncompliant left
ventricle
best accurate test for cardiac ischemic disease correct answersCK-MB and troponin levels
main diff between CK-MB and troponin correct answersboth rise at 3-6 hrs after chest pain;
CKMB stays elevated 1-2 days while troponin stays elevated for 1-2 weeks
best test to detect a reinfarction a few days after the initial infarction correct answersCK MB
testing
troponin C correct answersbinds to calcium to activate actin-myosin interaction
troponin T correct answersbinds to tropomyosis
troponin I correct answersblocks or inhibits actin-myosin interaction
which cardiac marker will rise first? correct answersmyoglobin (rises 1-4 hrs after start of chest
pain)
when do you obtain exercise thallium testing or stress echocardiography correct answerswhen
EKG is unreadable for ischemia due to LBBB, digoxin use, pacemaker, LVH, or any baseline
abnormality of the ST segment of the EKG
, when do you obtain dipyridamole or adenosine thallium stress test or dobutamine echo? correct
answerspatients who cannot exercise: COPD, amputation, reconditioning, lower extremity ulcer,
dementia, obesity
in what pts do you use sestamibi nuclear stress testing? correct answersobese pts and those with
large breasts bc of the greater ability of this radioisotope to penetrate tissue
which is more dangerous on a stress test? reversible ischemia or fixed defect? correct
answersreversible; fixed means that it is a scar from a previous infarction
mechanism of thallium in cardiac testing? correct answersnuclear isotopes are picked up by the
Na/K ATPase of normal myocardium; if cardiac tissue is alive and perfused, it will pick up the
nuclear isotope
do nitrates and morphine lower mortality in ACS? correct answersNO
what ACS meds are added to everyone getting angioplasy and stent? correct answersprasugrel,
clopidogrel or ticagrelor to inhibit platelet aggregation by inhibiting ADP activation of platelets
What has the single greatest efficacy in lower mortality in STEMI? correct answersurgent
angioplasty (percutaneous coronary intervention) within 90 minutes of ED arrival
when are thrombolytics indicated? correct answerswhen patient has chest pain < 12 hours and
has ST elevation in 2 or more leads or a new LBBB;
when should you give thrombolytics correct answerswithin 30 minutes of a patient's arrival in
the ED with chest pain
mechanism of thrombolytics correct answersactivate plasminogen into plasmin which chops up
fresh or newly formed fibrin strands into D-dimers
ACE inhibitors or ARBs only lower mortality if what? correct answersthere is LV dysfunction or
systolic dysfunction (i.e. ejection fraction is low)
do beta blockers lower mortality? correct answersyes but it is not dependent on how soon patient
receives it
therapies that always decrease mortality correct answersaspirin, thrombolytics, primary
angioplasty, metoprolol, statins, clopidogrel, prasugrel or ticagrelor
do calcium channel blockers or amiodarone lower mortality? correct answersNO
praasugrel has greater efficacy than clopidogrel but causes correct answersmore bleeding
clopidogrel or ticagrelor is used when correct answerspt has aspirin allergy, pt will have
angioplasty and stenting, acute mI
most dangerous factor for CAD is correct answersdiabetes
ddx of pleuritic chest pain correct answersPE, pneumonia, pleuritis, pericarditis, pneumothorax
ddx of positional pain correct answerspericarditis
MCC of chest pain not cardiac in etiology is correct answersGERD
patient comes to the ED with CP, pain also occurs in epigastric area and is asso with sore throat,
metallic taste in the mouth and a cough, what do you recommend? correct answersPPI
an alcoholic patient comes to the ED with CP, nausea and vomiting and epigastric tenderness;
what do you recommend? correct answerscheck amylase and lipase levels
S3 vs S4 correct answersdilated LV vs LVH
mechanism of an S3 gallop correct answersrapid ventricular filling during diastole
mechanism of an s4 gallop correct answerssound of atrial systole into a stiff or noncompliant left
ventricle
best accurate test for cardiac ischemic disease correct answersCK-MB and troponin levels
main diff between CK-MB and troponin correct answersboth rise at 3-6 hrs after chest pain;
CKMB stays elevated 1-2 days while troponin stays elevated for 1-2 weeks
best test to detect a reinfarction a few days after the initial infarction correct answersCK MB
testing
troponin C correct answersbinds to calcium to activate actin-myosin interaction
troponin T correct answersbinds to tropomyosis
troponin I correct answersblocks or inhibits actin-myosin interaction
which cardiac marker will rise first? correct answersmyoglobin (rises 1-4 hrs after start of chest
pain)
when do you obtain exercise thallium testing or stress echocardiography correct answerswhen
EKG is unreadable for ischemia due to LBBB, digoxin use, pacemaker, LVH, or any baseline
abnormality of the ST segment of the EKG
, when do you obtain dipyridamole or adenosine thallium stress test or dobutamine echo? correct
answerspatients who cannot exercise: COPD, amputation, reconditioning, lower extremity ulcer,
dementia, obesity
in what pts do you use sestamibi nuclear stress testing? correct answersobese pts and those with
large breasts bc of the greater ability of this radioisotope to penetrate tissue
which is more dangerous on a stress test? reversible ischemia or fixed defect? correct
answersreversible; fixed means that it is a scar from a previous infarction
mechanism of thallium in cardiac testing? correct answersnuclear isotopes are picked up by the
Na/K ATPase of normal myocardium; if cardiac tissue is alive and perfused, it will pick up the
nuclear isotope
do nitrates and morphine lower mortality in ACS? correct answersNO
what ACS meds are added to everyone getting angioplasy and stent? correct answersprasugrel,
clopidogrel or ticagrelor to inhibit platelet aggregation by inhibiting ADP activation of platelets
What has the single greatest efficacy in lower mortality in STEMI? correct answersurgent
angioplasty (percutaneous coronary intervention) within 90 minutes of ED arrival
when are thrombolytics indicated? correct answerswhen patient has chest pain < 12 hours and
has ST elevation in 2 or more leads or a new LBBB;
when should you give thrombolytics correct answerswithin 30 minutes of a patient's arrival in
the ED with chest pain
mechanism of thrombolytics correct answersactivate plasminogen into plasmin which chops up
fresh or newly formed fibrin strands into D-dimers
ACE inhibitors or ARBs only lower mortality if what? correct answersthere is LV dysfunction or
systolic dysfunction (i.e. ejection fraction is low)
do beta blockers lower mortality? correct answersyes but it is not dependent on how soon patient
receives it
therapies that always decrease mortality correct answersaspirin, thrombolytics, primary
angioplasty, metoprolol, statins, clopidogrel, prasugrel or ticagrelor
do calcium channel blockers or amiodarone lower mortality? correct answersNO
praasugrel has greater efficacy than clopidogrel but causes correct answersmore bleeding
clopidogrel or ticagrelor is used when correct answerspt has aspirin allergy, pt will have
angioplasty and stenting, acute mI
