Rosh Review- Cardiology YEAR
2024/2025 / ACCURATE CURRENTLY
TESTING EXAM VERSIONS WITH
ACTUAL QUESTIONS AND
DETAILED ANSWERS
What is the adequate anti arrhythmic for patients in Atrial fibrillation with RVR?
What is the adequate anticoagulant for patients in Atrial fibrillation? - <<ANSWER>>Anti
arrhythmic:
Diltiazem or Cardizem (CCBs)
Anticoagulant:
Warfarin (w/ CHAD2VASC score >1)
Anti platelet or anticoagulant considered for CHAD2VASC score of 1
What is the scoring scale used to assess treatment for patients with atrial fibrillation? -
<<ANSWER>>CHADS2VASC!
C-CHF +1
H-Hypertension +1
A- Age>65 +1, >75 +2
D- Diabetes +1
S- Stroke history (DVT/TIA/CVA/Thromboembolism) +2
V- Vascular history +1
Female -+1
0- no need for treatment
1- consider anti platelet or anticoagulation
>2- anticoagulation necessary
,What is the INR range for patients taking warfarin for atrial fibrillation? -
<<ANSWER>>2-3 !
What presents with intermittent claudication (pain in a muscle group induced by
exercise and relieved with rest), decreased distal pedal pulses, cool, shiny extremity
with decreased hair?
Dx and Tx? - <<ANSWER>>Peripheral Arterial Disease!
Dx:
ABI- Ankle-Brachial Index (measure BP in arm vs leg) <.9% indicates stenosis , <.4%
indicates ischemia --> Simple, quick, noninvasive most useful screening tool
Arteriography--> Gold standard (visualizes atherosclerosis inducing ischemia)
US--> noninvasive, used for visualizing stenosis
Tx:
Lifestyle modifications, increased exercise & tobacco cessation
Statins, ASA, Antiplatelets (Clopidogrel, Cilostazol)
Peripheral arterial disease most commonly affects which vessels? -
<<ANSWER>>Superficial femoral artery (calf pain)
Aortoiliac system (thigh/buttock pain).
Which of the following features can differentiate myocardial infarction from pericarditis?
- <<ANSWER>>Reciprocal changes in EKG!
Meaning... ST depression in the leads opposing ST elevation!--> ONLY occurs in MI,
will never occur in pericarditis
Ex:
Anterior vs Inferior are reciprocal leads, so if anterior has elevations, inferior would have
depressions
What is Dressler's syndrome? - <<ANSWER>>Post-myocardial infarction pericarditis.
What presents with pleuritic chest pain radiating to back, worse when laying back,
improved when leaning forward, with tachycardia and pericardial friction rub?
Dx and Tx? - <<ANSWER>>Pericarditis!
Dx:
,EKG:
Diffuse ST elevations(concave)
May also show PR depression/elevation
Tx:
NSAIDs (Indomethacin)
What is the most common cause of Pericarditis? - <<ANSWER>>Idiopathic!!
2nd most commonly cause by
Viral--> Cocksackie!
What cardiac biomarker occurs first?
Which one is most specific?
Timeline of each? - <<ANSWER>>1st occurring:
Myoglobin
Most Specific:
Troponin I or T
Timeline:
Myoglobin--> 1-2 hours onset, peaks 8-10 hours, gone by 1-2 days
Creatine Phosphokinase (CK-MB)--> 3-12 hour onset, peaks 24 hours, gone 48-72
hours
Troponin --> 3-12 hour onset, peak 24-48 hours, lasts up to 5-14 days
What is the role of beta-adrenergic blocking agents in acute myocardial infarction? -
<<ANSWER>>Within 24 hours of presentation reduce the risk of developing ventricular
dysrhythmias!
Which cardiac biomarker is useful for assessing a re-infarction during the hospital stay?
- <<ANSWER>>CK-MB , because troponin will last for up to 14 days and therefore
would not be good indicator of whether another heart attack occurred !
What is the earliest ECG sign of MI? - <<ANSWER>>hyperacute T waves
What cardiac biomarker has the highest sensitivity and specificity? -
<<ANSWER>>Troponin I!
What is the #1 cause of death in the US? - <<ANSWER>>Ischemic Heart Disease!
, What is the most common symptom of cardiac ischemia in patients older than 85 years?
- <<ANSWER>>Dyspnea!
Which of the following is the most predictive risk factor for cardiac ischemia? -
<<ANSWER>>PMH of CAD!
Tobacco smoking, family history of CAD, and DM are also risk factors, but not as strong
as having personal history of CAD
What is the most common cause of cardiac related syncope? - <<ANSWER>>Cardiac
Dysrhythmias
What is the scaling used for assessing syncope? - <<ANSWER>>San Francisco
Syncope Scale:
CHESS
C-CHF
H-Hematocrit <30%
E-EKG abnormal
S- SOB
S- Systolic <90
What presents with Adolescent athlete + syncope?
Dx and Tx? - <<ANSWER>>HOCM (Hypertrophic Cardiomyopathy)
Autosomal DOMINANT pattern!!!
Dx:
EKG
Echo
Tx:
ICD
What presents with young woman with abdominal pain and syncope? -
<<ANSWER>>Ectopic Pregnancy
What presents with elderly male, abdominal/flank pain and syncope? -
<<ANSWER>>AAA (Abdominal Aortic Aneurysm)
infrarenal aortic diameter ≥ 3 cm
What presents with sudden onset HA and syncope? - <<ANSWER>>Subarachnoid
Hemorrhage! (SAH)
2024/2025 / ACCURATE CURRENTLY
TESTING EXAM VERSIONS WITH
ACTUAL QUESTIONS AND
DETAILED ANSWERS
What is the adequate anti arrhythmic for patients in Atrial fibrillation with RVR?
What is the adequate anticoagulant for patients in Atrial fibrillation? - <<ANSWER>>Anti
arrhythmic:
Diltiazem or Cardizem (CCBs)
Anticoagulant:
Warfarin (w/ CHAD2VASC score >1)
Anti platelet or anticoagulant considered for CHAD2VASC score of 1
What is the scoring scale used to assess treatment for patients with atrial fibrillation? -
<<ANSWER>>CHADS2VASC!
C-CHF +1
H-Hypertension +1
A- Age>65 +1, >75 +2
D- Diabetes +1
S- Stroke history (DVT/TIA/CVA/Thromboembolism) +2
V- Vascular history +1
Female -+1
0- no need for treatment
1- consider anti platelet or anticoagulation
>2- anticoagulation necessary
,What is the INR range for patients taking warfarin for atrial fibrillation? -
<<ANSWER>>2-3 !
What presents with intermittent claudication (pain in a muscle group induced by
exercise and relieved with rest), decreased distal pedal pulses, cool, shiny extremity
with decreased hair?
Dx and Tx? - <<ANSWER>>Peripheral Arterial Disease!
Dx:
ABI- Ankle-Brachial Index (measure BP in arm vs leg) <.9% indicates stenosis , <.4%
indicates ischemia --> Simple, quick, noninvasive most useful screening tool
Arteriography--> Gold standard (visualizes atherosclerosis inducing ischemia)
US--> noninvasive, used for visualizing stenosis
Tx:
Lifestyle modifications, increased exercise & tobacco cessation
Statins, ASA, Antiplatelets (Clopidogrel, Cilostazol)
Peripheral arterial disease most commonly affects which vessels? -
<<ANSWER>>Superficial femoral artery (calf pain)
Aortoiliac system (thigh/buttock pain).
Which of the following features can differentiate myocardial infarction from pericarditis?
- <<ANSWER>>Reciprocal changes in EKG!
Meaning... ST depression in the leads opposing ST elevation!--> ONLY occurs in MI,
will never occur in pericarditis
Ex:
Anterior vs Inferior are reciprocal leads, so if anterior has elevations, inferior would have
depressions
What is Dressler's syndrome? - <<ANSWER>>Post-myocardial infarction pericarditis.
What presents with pleuritic chest pain radiating to back, worse when laying back,
improved when leaning forward, with tachycardia and pericardial friction rub?
Dx and Tx? - <<ANSWER>>Pericarditis!
Dx:
,EKG:
Diffuse ST elevations(concave)
May also show PR depression/elevation
Tx:
NSAIDs (Indomethacin)
What is the most common cause of Pericarditis? - <<ANSWER>>Idiopathic!!
2nd most commonly cause by
Viral--> Cocksackie!
What cardiac biomarker occurs first?
Which one is most specific?
Timeline of each? - <<ANSWER>>1st occurring:
Myoglobin
Most Specific:
Troponin I or T
Timeline:
Myoglobin--> 1-2 hours onset, peaks 8-10 hours, gone by 1-2 days
Creatine Phosphokinase (CK-MB)--> 3-12 hour onset, peaks 24 hours, gone 48-72
hours
Troponin --> 3-12 hour onset, peak 24-48 hours, lasts up to 5-14 days
What is the role of beta-adrenergic blocking agents in acute myocardial infarction? -
<<ANSWER>>Within 24 hours of presentation reduce the risk of developing ventricular
dysrhythmias!
Which cardiac biomarker is useful for assessing a re-infarction during the hospital stay?
- <<ANSWER>>CK-MB , because troponin will last for up to 14 days and therefore
would not be good indicator of whether another heart attack occurred !
What is the earliest ECG sign of MI? - <<ANSWER>>hyperacute T waves
What cardiac biomarker has the highest sensitivity and specificity? -
<<ANSWER>>Troponin I!
What is the #1 cause of death in the US? - <<ANSWER>>Ischemic Heart Disease!
, What is the most common symptom of cardiac ischemia in patients older than 85 years?
- <<ANSWER>>Dyspnea!
Which of the following is the most predictive risk factor for cardiac ischemia? -
<<ANSWER>>PMH of CAD!
Tobacco smoking, family history of CAD, and DM are also risk factors, but not as strong
as having personal history of CAD
What is the most common cause of cardiac related syncope? - <<ANSWER>>Cardiac
Dysrhythmias
What is the scaling used for assessing syncope? - <<ANSWER>>San Francisco
Syncope Scale:
CHESS
C-CHF
H-Hematocrit <30%
E-EKG abnormal
S- SOB
S- Systolic <90
What presents with Adolescent athlete + syncope?
Dx and Tx? - <<ANSWER>>HOCM (Hypertrophic Cardiomyopathy)
Autosomal DOMINANT pattern!!!
Dx:
EKG
Echo
Tx:
ICD
What presents with young woman with abdominal pain and syncope? -
<<ANSWER>>Ectopic Pregnancy
What presents with elderly male, abdominal/flank pain and syncope? -
<<ANSWER>>AAA (Abdominal Aortic Aneurysm)
infrarenal aortic diameter ≥ 3 cm
What presents with sudden onset HA and syncope? - <<ANSWER>>Subarachnoid
Hemorrhage! (SAH)
