Cardiology

Question 1

Define pulsus paradoxus

Answer 1

A difference in SBP >12mmHg during inspiration

Question 2

List 3 causes of pulsus paradoxus

Answer 2

Cardiac tamponade

Tension pneumothorax

Severe asthma

Question 3

Describe Kussmaul’s sign

Answer 3

Increased JVP with inspiration. Normally JVP decreases with inspiration

Question 4

List 5 causes of Kussmaul’s signs

Answer 4

Constrictive pericarditis

Restrictive cardiomyopathy

Right ventricular infarction

Massive pulmonary embolism

Pericardial tamponade

Question 5

What type of cardiomyopathy does hemochromatosis cause. What are the other manifestations of hemochromatosis?

Answer 5

Restrictive cardiomyopathy.

Other manifestations are:

DM

Cirrhosis

Hypogonadism

Arthritis

Question 6

Risk factors of coronary artery disease (CAD)

Answer 6

• Diabetes mellitus
• Hypertension
• Tobacco use
• Hyperlipidemia
• Peripheral arterial disease (PAD)
• Obesity
• Inactivity
• Family history

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1488-1495). . Kindle Edition.

Question 7

When if family history considered significant as a risk factor of CAD?

Answer 7

For family history to be significant, the family member must be young:

• Female relatives < 65
• Male relatives < 55).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1496-1497). . Kindle Edition.

Question 8

What is the single worst or most dangerous factor for CAD?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1502). . Kindle Edition.

Answer 8

Diabetes mellitus

Question 9

Types or features of chest pain not likely to be CAD

Answer 9

Pleuritic Pain (changes with respiration)

• Pulmonary embolism
• Pneumonia
• Pleuritis
• Pericarditis
• Pneumothorax

Positional (changes with bodily position)

• Pericarditis

Tender (pain on palpation)

• Costochondritis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1505-1515). . Kindle Edition.

Question 10

What is the most common cause of chest pain that is not cardiac in etiology?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1516-1517). . Kindle Edition.

Answer 10

Gastroesophageal reflux disease (GERD)

Question 11

A patient comes to the emergency department with chest pain. The pain also occurs in the epigastric area and is associated with a sore throat, a bad metallic taste in the mouth, and a cough. What do you recommend?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1518-1519). . Kindle Edition.

Answer 11

Give a proton pump inhibitor

Question 12

An alcoholic patient comes to the emergency department with chest pain. There is nausea and vomiting and epigastric tenderness. What do you recommend?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1520-1521). . Kindle Edition.

Answer 12

Check amylase and lipase levels.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1526). . Kindle Edition.

Question 13

A patient comes to the emergency department with chest pain. There is right-upper quadrant tenderness and mild fever. What do you recommend?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1522-1523). . Kindle Edition.

Answer 13

Order an abdominal sonogram for gallstones.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1527). . Kindle Edition.

Question 14

Besides chest pain, what are the other clues to ischemic disease as the cause of chest pain?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1528-1534). . Kindle Edition.

Answer 14

• Dull pain
• Lasts 15– 30 minutes
• Occurs on exertion
• Substernal location
• Radiates to the jaw or left arm

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1528-1534). . Kindle Edition.