USMLE PART 3 AND 4 QUESTIONS AND ANSWERS ALL CORRECT
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USMLE
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USMLE
I.Cardiology :
1. A 40-year-old female presents to the emergency room with palpitations and lightheadedness of acute
onset. Also, she has experienced insomnia, fatigability, and weight loss lately. She does not smoke or
consume alcohol. She is not taking any medication. Her blood pressure is 110...
usmle part 3 and 4 questions and answers all correct
a 40 year old female presents to the emergency room with palpitations and lightheadedness of acute onset also
she has experienced insomnia
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USMLE PART 3 AND 4 QUESTIONS AND ANSWERS
USMLE part 3 and 4 2017
ALL CORRECT
I.Cardiology :
1. A 40-year-old female presents to the emergency room with palpitations and lightheadedness of acute
onset. Also, she has experienced insomnia, fatigability, and weight loss lately. She does not smoke or
consume alcohol. She is not taking any medication. Her blood pressure is 110/80 mmHg and heat rate
is 120/min, irregular. Physical examination reveals lid lag and fine tremor of the outstretched hands.
ECG shows atrial fibrillation with rapid ventricular response. What is the next best step in the
management of this patient?
A. Digoxin
B. Propranolol
C. Lidocaine
D. Quinidine
E. Immediate cardioversion
2. A 65-year-old male presents to the emergency department with substernal chest pain, severe shortness
of breath, and diaphoresis that began suddenly 40 minutes ago. Since the pain started, the patient has
vomited twice. The pain radiates to his left arm and does not remit with sublingual nitroglycerine.
EKG shows 2 mm ST elevations in the anterior leads. On physical examination, the patient's
temperature is 36.9°c (98.4.F), blood pressure is 110/70 mm Hg, pulse is 60/min, respirations are
32/min, and oxygen saturation is 90% on 4L oxygen by nasal canula. Cardiac exam reveals a muffled
S1 and S2 and the presence of an S3. Lung exam reveals basilar crackles that extend halfway up the
lung fields bilaterally. Which of the following is the best next step in managing this patient?
A Metoprolol
B. Digoxin
C. Furosemide
D. Spironolactone
E. IV fluids
3. A 55-year-old male with a history of rheumatoid arthritis and rheumatoid lung disease is admitted to
the hospital with palpitations. His restrictive lung disease is of moderate severity, requiring use of 2
liters of oxygen by nasal cannula at all times. He has no known history of coronary artery disease,
hypertension or diabetes. On physical examination, his blood pressure is 110/70 mmHg and heart rate
is 120 and irregular. EKG shows atrial fibrillation with a rapid ventricular rate. Which of the
following medications should be avoided in this patient?
A. Verapamil
B. Digoxin
C. Quinidine
D. Amiodarone
E. Metoprolol
4. A 67-year-old man presents to the emergency department after losing consciousness while shoveling
snow near his house. He reports having had a similar episode one month ago while carrying heavy
bags from the grocery store. The patient has reduced his physical activity level over the last several
months because of progressive exertional dyspnea and fatigue. His past medical history is significant
for diabetes mellitus and hypercholesterolemia. Metformin and simvastatin are his only medications.
Which of the following physical examination findings is most likely in this patient?
A. Pulsus paradoxus
B. Capillary pulsations
C. Late diastolic murmur
D. Systolic ejection murmur
E. Pleural friction rub
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,USMLE part 3 and 4 2017
5. A 69-year-old male undergoes coronary artery bypass and aortic valve replacement surgery. The
procedure goes well, and he is extubated and discharged to the step-down unit on postoperative day 2.
That night, he complains of weakness, chest tightness and shortness of breath. His blood pressure is
70/30 mmHg, respiratory rate is 26/min, and heart rate is 148 beats per minute. Lung auscultation
reveals bibasilar crackles. An EKG rhythm strip is obtained:
Which of the following is the best next step in the management of this patient?
A. Amiodarone
B. Transcutaneous pacing
C. DC cardioversion
D. Lidocaine
E. Digoxin
6. A 72-year-old Caucasian male presents with shortness of breath that awakens him at night. At
baseline he is able to walk less than a block before stopping to catch his breath. Physical examination
findings include bilateral basilar rales and neck vein distention. The patient has a known history of
congestive heart failure, and his last echocardiogram revealed an ejection fraction of 25%. The patient
is compliant with a medication regimen including an ACE inhibitor, beta-blocker, and loop diuretic.
Blood pressure is well controlled. What additional treatment should you begin next?
a. Spironolactone
b. Aspirin
c. Amlodipine
d. Warfarin
e. Hydralazine and isosorbide dinitrate
7. A 70-year-old Caucasian man comes to the emergency department because of the sudden onset of nausea,
vomiting, diaphoresis, and chest pain. His other medical problems include hypertension, diabetes mellitus-type 2,
and aortic stenosis. He has smoked one-and-a-half packs of cigarettes daily for 30 years and drinks 4 ounces of
alcohol daily. His temperature is 37.2 C (99 F), blood pressure is 100/60 mmHg, pulse is 60/min, and respirations are
18/min. The patient's pulse oximetry showed 98% at room air. Examination shows normal first and second he
sounds. Lungs are clear to auscultation. His EKG is shown below.
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Which of the following is the most likely mechanism of this patient's condition?
A. Occlusion of the right coronary artery
B. Occlusion of the left circumflex artery
C. Occlusion of the left anterior descending artery
D. Inflammation of the pericardium
E. Vasospasm of the left circumflex artery
8. A 54-year-old woman presents for a routine physical. She has no complaints. She has no history
of hypertension, diabetes, hypercholesterolemia, or heart disease, and she does not use tobacco,
alcohol or drugs. On physical examination, her pulse is irregular. There are no murmurs. Her lungs
are clear to auscultation and her legs are free of edema. An EKG shows atrial fibrillation with a heart
rate of 72 beats per minute. An echocardiogram is unremarkable except for evidence of atrial
fibrillation. What is the most appropriate management of this patient?
A. Warfarin and clopidogrel
B. Heparin followed by warfarin
C. Low-molecular weight heparin
D. Aspirin alone
E. Warfarin to maintain an INR of 2 to 3
9. A middle-aged man was recently diagnosed with hypertension. The antihypertensive medication
prescribed to him enhances natriuresis, decreases serum angiotensin II concentration, and decreases
aldosterone production. This medication most likely belongs to which of the following drug classes?
A. Angiotensin receptor blocker
B. Direct renin inhibitor
C. Aldosterone receptor antagonist
D. Loop diuretic
E. Alpha-adrenergic blocker
10. A 75-year-old patient presents to the ER after a syncopal episode. He is again alert and in retrospect describes
occasional substernal chest pressure and shortness of breath on exertion. His blood pressure is 110/80 and lungs
have a few bibasilar rales. Which auscultatory finding would best explain his findings?
a. A harsh systolic crescendo-decrescendo murmur heard best at the upper right sternal border
b. A diastolic decrescendo murmur heard at the mid-left sternal border
c. A holosystolic murmur heard best at the apex
d. A midsystolic click
e. A pericardial rub
11. A 46-year-old man comes to the ER because of weakness and chest tightness. He has had these symptoms for
the past one hour. He denies any past medical history. He does not smoke or drink alcohol. His father had a
myocardial infarction at 68 years of age and his mother has myasthenia gravis. His EKG is shown on the slide below.
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, USMLE part 3 and 4 2017
The patient should be evaluated for which of the following?
A. Cushing syndrome
B. Hyperthyroidism
C. Aortic dissection
D. High-frequency deafness
E. High-range proteinuria
12. A 65-year-old female is admitted to the hospital with increasing shortness of breath, weight gain
and lower extremity edema. She has a history of hypertension, nonischemic cardiomyopathy with an
ejection fraction of 30%, and hyperlipidemia. Her home medications include oral aspirin, digoxin,
furosemide, metoprolol, lisinopril and atorvastatin. She is started on intravenous furosemide. On day
three of hospitalization telemetry reveals six beats of wide complex ventricular tachycardia. Physical
examination now shows decreased leg edema and clear lungs. Which of the following is the most
appropriate next step in the management of this patient's tachycardia?
A. Add spironolactone
B. Add metolazone
C. Measure serum electrolytes
D. Discontinue atorvastatin
E. Discontinue metoprolol
13. A 34-year-old male presents with palpitations for the past 4 hours without associated chest pain,
shortness of breath, fevers, or chills. His medical history is significant for Wolff-Parkinson-White
syndrome for the past ten years and three prior episodes of supraventricular tachycardia. He does not
smoke cigarettes, and drinks alcohol on social occasions. He does report having had five cans of beer
while at a party last night. On examination, his blood pressure is 120/80 mmHg and his pulse is
irregularly irregular. EKG shows atrial fibrillation with a rate of 160/min. What is the best next step
in the management of this patient?
A Digoxin
B. Verapamil
C. Lidocaine
D. Procainamide
E. Adenosine
14. A 32-year-old woman is brought to the emergency department with excruciating chest and neck
pain. She is 6'2" and has long extremities. Her hand joints show significant extensibility. Which of the
following additional findings is also likely in this patient?
A Fourth heart sound (S4)
B. Early diastolic murmur
C. Opening snap
D. Fixed splitting of the second heart sound (S2)
E. Kussmaul's sign
15. A 57-year-old male presents to the emergency department with recent-onset dyspnea and cough. He reports
that his symptoms began earlier this morning while he was jogging, when he suddenly started feeling short of breath
and very weak. In the emergency department, laboratory analysis reveals a markedly elevated serum b-type
natriuretic peptide level. Which of the following clinical signs best correlates with this finding?
A. Wheezing
B. Cyanosis
C. Third heart sound
D. Extremity edema
E. Periumbilical bruit
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