CARDIOLOGY BOARDS ABIM EXAM 2 LATEST VERSIONS ACTUAL EXAM
350 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
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
What gives you pulsus bisferiens (two systolic peaks per cycle) - ANSWER: Aortic
regurgitation, HOCM
What causes pulsus alternans? - ANSWER: Severe LV dysfunction
What causes pulsus tardus et parvus? - ANSWER: Late and weak; Aortic stenosis
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
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
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
350 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
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
What gives you pulsus bisferiens (two systolic peaks per cycle) - ANSWER: Aortic
regurgitation, HOCM
What causes pulsus alternans? - ANSWER: Severe LV dysfunction
What causes pulsus tardus et parvus? - ANSWER: Late and weak; Aortic stenosis
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
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
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
