Cardiology Board Exam Review Samples
Below you will find a sampling of cardiology board exam review
questions. Note the variety of formats. Some are short answer with a quick
response, while others require interpretation and synthesis of a variety of
sources of information with a longer answer. Many of the questions include
pearls of wisdom and links to clinical images that you should know for your
exam.
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1. A 34 Year Old with Flu-like symptoms and Chest Pain
A 34 year old woman is admitted for malaise, fatigue, subjective fevers and chest pains that are not exacerbated or lessened by any maneuver or changes in activity all over the past 2 days. Her personal and family medical history is unremarkable. She does not use any alcohol or drugs.
On Exam, she is febrile at 38.1 degress Celsius, BP is 112/78, HR is 121 bpm. She is alert and oriented. JVP is mildly increased. Cardiac exam reveals tachycardia, S1 S2 and an S3. Lungs were clear. Chest xray showed mild congestion and cardiomegaly. Her CBC, Chemistry, LFTs, TSH, ANA are all normal. Her troponin was mildly elevated. An echo shows an EF of 30% with mild MR and a trivial pericardial effusion. Her EKG is shown.
What's your next best step in management?
A. Add amiodarone.
B. Add captopril and carvidelol.
C. Give IV steroids.
D. Give tissue plasminogen activator.
E. Give ceftriaxone and vancomycin.
ANSWER: B.
This young patient has acute myocarditis, or even myo-pericarditis. With her EKG, symptoms, echo, and clinical findings, myocarditis is the only possibility. Occasionally, echos can show regional wall motion abnormalities mimicking acute MI, but the diffuse ST elevations, PR depression shown on the EKG indiciate myocarditis. Sometimes atrial dysrhythmias are seen
(atrial tachycardia, atrial flutter and atrial fibrillation). The treatment of choice in this case is supportive and treatment for heart failure.
Steroids have not shown improvement in recovery and may even worsen it.
Of note, screening for HIV and hepatitis can sometimes reveal the diagnosis, but usually these cardiomyopathies are asymptomatic until the EF drops low enough to cause CHF symptoms.
There are some myocarditities which do not recover, though predicting which will is very difficult.
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2. Pressure Volume Loop Interpretations
What caused the shift from curve A to curve B?
A. Labetalol
B. Infiltrative Cardiomyopathy
C. Amlodipine
D. Dopamine
ANSWER: A.
In this case, a Starling curve is on the left and a Force-Tension curve is on the right. These show no change in preload on the left curve, but a drop in stroke volume which means a drop in contractility. On the right, there is a drop in afterload but also a drop in contractility. Only labetalol and drop afterload (alpha) and decrease contractility. Remember: Think simply for the boards.
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A. Aortic and mitral valve regurgitation.
B. Pulmonary and tricuspid regurgitation.
C. Residual VSD (ventricular septal defect).
D. RV outflow obstruction with significant gradient.
ANSWER : B.
This patient has a history of TOF with repair, usually involving a transannular pulmonary outflow tract patch which usually causes severe pulmonic regurgitation (the diastolic murmur heard on exam). It is usually associated with elevated JVP and increase in the murmur during inspiration. The holosytolic murmur is tricuspid regurgitation which leads to right atrial enlargement and the risk of atrial arrhythmia.
ToF is the most common cyanotic congenital heart disease accounting for 10% of all congenital defects. It is important to know about this condition and sequelae of the repair for the boards.
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