CARDIOLOGY BOARDS ABIM EXAM 2 LATEST VERSIONS 2023-2024
ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
VERSION A
How do positional maneuvers affect blood flow and murmurs?
a) Standing/Valsalva
b) Squatting/Lying down
c) Sustained handgrip - 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 are the stages of the Valsalva maneuver? - ANSWER--Phase one is the onset of straining with
increased intrathoracic pressure. The heart rate does not change but blood pressure rises.
-Phase two is marked by the decreased venous return and consequent reduction of stroke volume and
pulse pressure as straining continues. The heart rate increases and blood pressure drops.
-Phase three is the release of straining with decreased intrathoracic pressure and normalization of
pulmonary blood flow.
-Phase four marks the blood pressure overshoot (in the normal heart) with return of the heart rate to
baseline.
What causes a physiologic split S2? - ANSWER-Increased blood volume in the RV prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2? - ANSWER-Pulmonary stenosis, PE, LV pacer, RBBB, MR (early AV closure),
ASD, RV failue
What causes a paradoxic split S2 - ANSWER-LBBB, RV pacing, HOCM
What causes an S3? - ANSWER-Rapid LV filling - acute ventricular decompensation, severe AR or MR
What causes a S4? - ANSWER-Decreased ventricular compliance during atrial contraction - ischemic
heart dz, AS, MR, HOCM, hypertrophic or diabetic cardiomyopathy, HTN heart dz, concentric LVH
, CARDIOLOGY BOARDS ABIM EXAM 2 LATEST VERSIONS 2023-2024
ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Can you have a S4 with atrial fibrillation? - ANSWER-No - no atrial contraction
What are the parts of the venous waveform? - ANSWER-A wave - atrial contraction
X descent - atria relax, RV fills rapidly; Bottom/middle of x descent is TC valve closure (c wave)
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens, passive emptying into ventricle
Normals for PA catheter pressures - ANSWER-RA <7, RV 30/7, PCWP 3-11
PA cath findings in tamponade or constrictive pericarditis - ANSWER-Diastolic pressures elevated and
equalized in all chambers, low BP, tachycardia, interventricular dependence (septal bounce)
PA cath findings in cardiogenic shock - ANSWER-Elevated PCWP, RA pressure, and decreased
SBP/cardiac output
PA cath findings in mitral stenosis with RV failure - ANSWER-Elevated RA, PA (very elevated), PCWP, nl
SBP
PA cath findings in pulmonary HTN - ANSWER-Elevated PA, RA pressures, nl PCWP, SBP
Pulsus paradoxus - 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? - ANSWER-Constrictive or restrictive pericarditis, asthma,
tension pneumothorax
, CARDIOLOGY BOARDS ABIM EXAM 2 LATEST VERSIONS 2023-2024
ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
What gives you pulsus bisferiens (two systolic peaks per cycle) - ANSWER-Aortic regurgitation, HOCM
What causes pulsus alternans? - ANSWER-Severe LV dysfunction
What gives elevated a and v waves - ANSWER-Pulmonary HTN, RV infarction
What leads to Large r side v waves - ANSWER-Septal rupture
What diseases lead to Large v waves - ANSWER-TR (right), MR (left)
Rapid x and y descent - ANSWER-Constrictive pericarditis, restrictive cardiomyopathy, tamponade (x
descent only, loss of y descent)
Large a waves - ANSWER-TS, severe RVH (on right), MS
Cannon a waves - ANSWER-AV disassociation - complete heart block, ventricular pacing
Slow Y descent - ANSWER-Delayed atrial emptying - TS
Most important prognostic factor with CAD - ANSWER-Degree of LV dysfunction
Causes of resting ST elevation - ANSWER-MI, pericarditis, LV aneurysm, LBBB, ventricular pacing, LVH,
early repolarization
Giving nitrates causes severe decompensation in a IWMI pt. What happened? - ANSWER-Pt had R side
infarction as well, the preload reduction from the nitrate now meant little flow getting to the L side of
the heart
, CARDIOLOGY BOARDS ABIM EXAM 2 LATEST VERSIONS 2023-2024
ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
MR due to papillary muscle rupture is most common with MI in this region - ANSWER-Inferior;
posteromedial papillary muscle has only single vessel supply (RCA) while the anterolateral has two
vessels
VSD is more likely with MIs here - ANSWER-Anterior, inferior
Contraindications for B-blockers - ANSWER-Bradycardia, hypotension, 2nd or 3rd degree AVB,
pulmonary edema, asthma. NOT DM
When to use non-dihydropyridne CCBs in ACS - ANSWER-Contraindications to B blockers, continued
ischemia, but NO LV dysfunction
What anticoagulant to use with ACS - ANSWER-Enoxaparin good, but have to stop 12-24 hrs before
CABG
Fondaparinux is increased risk of bleeding, do not use if going to do PCI - increased risk of catheter
thrombosis and coronary complications
If using Fondaparinux and decide to do PCI, change to heparin or bivalirudin
What are the platelet P2Y12 receptor blockers - ANSWER-Clopidogrel, ticlodipine, prasugrel, ticagrelor
Prasugrel or ticagrelor vs clopidogrel - ANSWER-Faster onset, more anti platelet activity, more risk of
bleeding
GP IIb/IIIa inhibitors, action and use - ANSWER-Abciximab, eptifibatide, tirofiban, limifiban
Block platelet aggregation
Use in any ACS pt going to cath for probable PCI
Cocaine/ meth use and UA/NSTEMI - ANSWER-give NTG and CCBs
If no better, do cath
If cath not available, give fibrinolytics
ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
VERSION A
How do positional maneuvers affect blood flow and murmurs?
a) Standing/Valsalva
b) Squatting/Lying down
c) Sustained handgrip - 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 are the stages of the Valsalva maneuver? - ANSWER--Phase one is the onset of straining with
increased intrathoracic pressure. The heart rate does not change but blood pressure rises.
-Phase two is marked by the decreased venous return and consequent reduction of stroke volume and
pulse pressure as straining continues. The heart rate increases and blood pressure drops.
-Phase three is the release of straining with decreased intrathoracic pressure and normalization of
pulmonary blood flow.
-Phase four marks the blood pressure overshoot (in the normal heart) with return of the heart rate to
baseline.
What causes a physiologic split S2? - ANSWER-Increased blood volume in the RV prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2? - ANSWER-Pulmonary stenosis, PE, LV pacer, RBBB, MR (early AV closure),
ASD, RV failue
What causes a paradoxic split S2 - ANSWER-LBBB, RV pacing, HOCM
What causes an S3? - ANSWER-Rapid LV filling - acute ventricular decompensation, severe AR or MR
What causes a S4? - ANSWER-Decreased ventricular compliance during atrial contraction - ischemic
heart dz, AS, MR, HOCM, hypertrophic or diabetic cardiomyopathy, HTN heart dz, concentric LVH
, CARDIOLOGY BOARDS ABIM EXAM 2 LATEST VERSIONS 2023-2024
ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Can you have a S4 with atrial fibrillation? - ANSWER-No - no atrial contraction
What are the parts of the venous waveform? - ANSWER-A wave - atrial contraction
X descent - atria relax, RV fills rapidly; Bottom/middle of x descent is TC valve closure (c wave)
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens, passive emptying into ventricle
Normals for PA catheter pressures - ANSWER-RA <7, RV 30/7, PCWP 3-11
PA cath findings in tamponade or constrictive pericarditis - ANSWER-Diastolic pressures elevated and
equalized in all chambers, low BP, tachycardia, interventricular dependence (septal bounce)
PA cath findings in cardiogenic shock - ANSWER-Elevated PCWP, RA pressure, and decreased
SBP/cardiac output
PA cath findings in mitral stenosis with RV failure - ANSWER-Elevated RA, PA (very elevated), PCWP, nl
SBP
PA cath findings in pulmonary HTN - ANSWER-Elevated PA, RA pressures, nl PCWP, SBP
Pulsus paradoxus - 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? - ANSWER-Constrictive or restrictive pericarditis, asthma,
tension pneumothorax
, CARDIOLOGY BOARDS ABIM EXAM 2 LATEST VERSIONS 2023-2024
ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
What gives you pulsus bisferiens (two systolic peaks per cycle) - ANSWER-Aortic regurgitation, HOCM
What causes pulsus alternans? - ANSWER-Severe LV dysfunction
What gives elevated a and v waves - ANSWER-Pulmonary HTN, RV infarction
What leads to Large r side v waves - ANSWER-Septal rupture
What diseases lead to Large v waves - ANSWER-TR (right), MR (left)
Rapid x and y descent - ANSWER-Constrictive pericarditis, restrictive cardiomyopathy, tamponade (x
descent only, loss of y descent)
Large a waves - ANSWER-TS, severe RVH (on right), MS
Cannon a waves - ANSWER-AV disassociation - complete heart block, ventricular pacing
Slow Y descent - ANSWER-Delayed atrial emptying - TS
Most important prognostic factor with CAD - ANSWER-Degree of LV dysfunction
Causes of resting ST elevation - ANSWER-MI, pericarditis, LV aneurysm, LBBB, ventricular pacing, LVH,
early repolarization
Giving nitrates causes severe decompensation in a IWMI pt. What happened? - ANSWER-Pt had R side
infarction as well, the preload reduction from the nitrate now meant little flow getting to the L side of
the heart
, CARDIOLOGY BOARDS ABIM EXAM 2 LATEST VERSIONS 2023-2024
ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
MR due to papillary muscle rupture is most common with MI in this region - ANSWER-Inferior;
posteromedial papillary muscle has only single vessel supply (RCA) while the anterolateral has two
vessels
VSD is more likely with MIs here - ANSWER-Anterior, inferior
Contraindications for B-blockers - ANSWER-Bradycardia, hypotension, 2nd or 3rd degree AVB,
pulmonary edema, asthma. NOT DM
When to use non-dihydropyridne CCBs in ACS - ANSWER-Contraindications to B blockers, continued
ischemia, but NO LV dysfunction
What anticoagulant to use with ACS - ANSWER-Enoxaparin good, but have to stop 12-24 hrs before
CABG
Fondaparinux is increased risk of bleeding, do not use if going to do PCI - increased risk of catheter
thrombosis and coronary complications
If using Fondaparinux and decide to do PCI, change to heparin or bivalirudin
What are the platelet P2Y12 receptor blockers - ANSWER-Clopidogrel, ticlodipine, prasugrel, ticagrelor
Prasugrel or ticagrelor vs clopidogrel - ANSWER-Faster onset, more anti platelet activity, more risk of
bleeding
GP IIb/IIIa inhibitors, action and use - ANSWER-Abciximab, eptifibatide, tirofiban, limifiban
Block platelet aggregation
Use in any ACS pt going to cath for probable PCI
Cocaine/ meth use and UA/NSTEMI - ANSWER-give NTG and CCBs
If no better, do cath
If cath not available, give fibrinolytics
