CARDIOLOGY BOARDS ABIM EXAM LATEST
VERSION 2023-2024 ACTUAL EXAM 250 QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
What is a positive stress test - ANSWER-Flat or Down sloping St-segment depression >1 mm occurring 80
msec after j point
When to stop a stress test - ANSWER-St segment depression > 2 mm, ventricular tachycardia, drop in
SBP > 15, chest pain, dyspnea, lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - ANSWER-Myocardial perfusion imaging with
adenosine,NOT exercising!
Know the algorithm for stress testing - ANSWER-See page 5-3,figure 5-1
When to not use doutamine for stress - ANSWER-History of VT, severe HTN, Low BP, poor echo images
When to not use adenosine for stress - ANSWER-Bronchospasm, severe valvular dysfunction, severe
carotid stenosis, 2nd degree heart block, theophylline dependent
Normals for PA catheter pressures - ANSWER-RA <7, RV 30/7, PCWP 3-11
PA cath findings in tamponade or restrictive pericarditis - ANSWER-Diastolic pressures elevated and
equalized in all chambers, low BP
PA cath findings with RV AMI - ANSWER-Elevated RA and PA pressures, decreased or nl PCWP,
hypotension, and inferior MI. R side is decompensated, cannot fill L side of the heart
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 - ANSWER-Aortic stenosis
How do positional maneuvers affect blood flow and murmurs - 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 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
, KNOW - S3 with LV dysfunction is a poor prognostic factor - ANSWER-...
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 of x descent is TC valve closure
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
Large r side v waves - ANSWER-Septal rupture
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
