Cardiology boards ABIM LATEST 2023-2024
ACTUAL EXAM 400 QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
What is a positive stress test - CORRECT ANSWER Flat or Down sloping St-
segment depression >1 mm occurring 80 msec after j point
When to stop a stress test - CORRECT ANSWER St segment depression > 2 mm,
ventricular tachycardia, drop in SBP > 15, chest pain, dyspnea, lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - CORRECT ANSWER
Myocardial perfusion imaging with adenosine,NOT exercising!
Know the algorithm for stress testing - CORRECT ANSWER See page 5-3,figure 5-
1
When to not use doutamine for stress - CORRECT ANSWER History of VT, severe
HTN, Low BP, poor echo images
When to not use adenosine for stress - CORRECT ANSWER Bronchospasm,
severe valvular dysfunction, severe carotid stenosis, 2nd degree heart block,
theophylline dependent
,Normals for PA catheter pressures - CORRECT ANSWER RA <7, RV 30/7, PCWP 3-
11
PA cath findings in tamponade or restrictive pericarditis - CORRECT ANSWER
Diastolic pressures elevated and equalized in all chambers, low BP
PA cath findings with RV AMI - CORRECT ANSWER Elevated RA and PA pressures,
decreased or nl PCWP, hypotension, and inferior MI. R side is decompensated,
cannot fill L side of the heart
PA cath findings in cardiogenic shock - CORRECT ANSWER Elevated PCWP, RA
pressure, and decreased SBP/cardiac output
PA cath findings in mitral stenosis with RV failure - CORRECT ANSWER Elevated
RA, PA (very elevated), PCWP, nl SBP
PA cath findings in pulmonary HTN - CORRECT ANSWER Elevated PA, RA
pressures, nl PCWP, SBP
Pulsus paradoxus - CORRECT ANSWER 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
What conditions give you pulsus paradoxus? - CORRECT ANSWER Constrictive or
restrictive pericarditis, asthma, tension pneumothorax
,What gives you pulsus bisferiens (two systolic peaks per cycle) - CORRECT
ANSWER Aortic regurgitation, HOCM
What causes pulsus alternans - CORRECT ANSWER Severe LV dysfunction
What causes pulsus tardus - CORRECT ANSWER Aortic stenosis
How do positional maneuvers affect blood flow and murmurs - CORRECT
ANSWER -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
What causes a physiologic split S2 - CORRECT ANSWER Increased blood volume
in the RV prolongs systole and delays pulmonary valve closure
What causes a fixed split S2 - CORRECT ANSWER Pulmonary stenosis, PE, LV
pacer, RBBB, MR (early AV closure), ASD, RV failue
What causes a paradoxic split S2 - CORRECT ANSWER LBBB, RV pacing, HOCM
What causes an S3? - CORRECT ANSWER Rapid LV filling - acute ventricular
decompensation, severe AR or MR
KNOW - S3 with LV dysfunction is a poor prognostic factor - CORRECT ANSWER ...
, What causes a S4? - CORRECT ANSWER Decreased ventricular compliance during
atrial contraction - ischemic heart dz, AS, MR, HOCM, hypertrophic or diabetic
cardiomyopathy, HTN heart dz, concentric LVH
Can you have a S4 with atrial fibrillation? - CORRECT ANSWER No - no atrial
contraction
What are the parts of the venous waveform? - CORRECT ANSWER 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
What gives elevated a and v waves - CORRECT ANSWER Pulmonary HTN, RV
infarction
Large r side v waves - CORRECT ANSWER Septal rupture
Large v waves - CORRECT ANSWER TR (right), MR (left)
Rapid x and y descent - CORRECT ANSWER Constrictive pericarditis, restrictive
cardiomyopathy, tamponade (x descent only, loss of y descent)
Large a waves - CORRECT ANSWER TS,severe RVH (on right), MS
ACTUAL EXAM 400 QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
What is a positive stress test - CORRECT ANSWER Flat or Down sloping St-
segment depression >1 mm occurring 80 msec after j point
When to stop a stress test - CORRECT ANSWER St segment depression > 2 mm,
ventricular tachycardia, drop in SBP > 15, chest pain, dyspnea, lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - CORRECT ANSWER
Myocardial perfusion imaging with adenosine,NOT exercising!
Know the algorithm for stress testing - CORRECT ANSWER See page 5-3,figure 5-
1
When to not use doutamine for stress - CORRECT ANSWER History of VT, severe
HTN, Low BP, poor echo images
When to not use adenosine for stress - CORRECT ANSWER Bronchospasm,
severe valvular dysfunction, severe carotid stenosis, 2nd degree heart block,
theophylline dependent
,Normals for PA catheter pressures - CORRECT ANSWER RA <7, RV 30/7, PCWP 3-
11
PA cath findings in tamponade or restrictive pericarditis - CORRECT ANSWER
Diastolic pressures elevated and equalized in all chambers, low BP
PA cath findings with RV AMI - CORRECT ANSWER Elevated RA and PA pressures,
decreased or nl PCWP, hypotension, and inferior MI. R side is decompensated,
cannot fill L side of the heart
PA cath findings in cardiogenic shock - CORRECT ANSWER Elevated PCWP, RA
pressure, and decreased SBP/cardiac output
PA cath findings in mitral stenosis with RV failure - CORRECT ANSWER Elevated
RA, PA (very elevated), PCWP, nl SBP
PA cath findings in pulmonary HTN - CORRECT ANSWER Elevated PA, RA
pressures, nl PCWP, SBP
Pulsus paradoxus - CORRECT ANSWER 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
What conditions give you pulsus paradoxus? - CORRECT ANSWER Constrictive or
restrictive pericarditis, asthma, tension pneumothorax
,What gives you pulsus bisferiens (two systolic peaks per cycle) - CORRECT
ANSWER Aortic regurgitation, HOCM
What causes pulsus alternans - CORRECT ANSWER Severe LV dysfunction
What causes pulsus tardus - CORRECT ANSWER Aortic stenosis
How do positional maneuvers affect blood flow and murmurs - CORRECT
ANSWER -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
What causes a physiologic split S2 - CORRECT ANSWER Increased blood volume
in the RV prolongs systole and delays pulmonary valve closure
What causes a fixed split S2 - CORRECT ANSWER Pulmonary stenosis, PE, LV
pacer, RBBB, MR (early AV closure), ASD, RV failue
What causes a paradoxic split S2 - CORRECT ANSWER LBBB, RV pacing, HOCM
What causes an S3? - CORRECT ANSWER Rapid LV filling - acute ventricular
decompensation, severe AR or MR
KNOW - S3 with LV dysfunction is a poor prognostic factor - CORRECT ANSWER ...
, What causes a S4? - CORRECT ANSWER Decreased ventricular compliance during
atrial contraction - ischemic heart dz, AS, MR, HOCM, hypertrophic or diabetic
cardiomyopathy, HTN heart dz, concentric LVH
Can you have a S4 with atrial fibrillation? - CORRECT ANSWER No - no atrial
contraction
What are the parts of the venous waveform? - CORRECT ANSWER 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
What gives elevated a and v waves - CORRECT ANSWER Pulmonary HTN, RV
infarction
Large r side v waves - CORRECT ANSWER Septal rupture
Large v waves - CORRECT ANSWER TR (right), MR (left)
Rapid x and y descent - CORRECT ANSWER Constrictive pericarditis, restrictive
cardiomyopathy, tamponade (x descent only, loss of y descent)
Large a waves - CORRECT ANSWER TS,severe RVH (on right), MS
