The Cardiology Board Exam is a difficult test, but the content is very learnable. The average pass rate is ~90% over the past several years, which happens to be higher than most of the other Medical Specialty Boards. On the other hand, Cardiologists may simply more prepared, and that’s the reason for the higher pass rate. In any case we provide sample Cardiology Board Questions to help students orient themselves to the types of questions that appear on the Board.
Sample Cardiology Board Questions
Question 1. Congenital Disorders QID 9572
A 32 year old female is self-referred to your clinic due to establish care after relocating from another state for a job. She has a history of D-type transposition of the great arteries, and she is undwerwent a Mustard procedure as a child. She has no complaints at the time of your encounter. She takes lisinopril 20mg daily, Coreg 12.5 BID, and Lasix 40mg daily. Her vital signs are as follows: BP 116/68, HR 72, O2 saturation 99% on room air. She is 5 feet 4 inches tall and weighs 150 lbs. On physical examination she is calm and in no acute distress. Her JVP is not well seen. Her cardiac rhythm is regular. She has an audible S1 and a loud second component of S2. There is a 2/6, blowing, holosystolic murmur, loudest at left sternal boarder; it varies with respiration. There is a precordial heave, but no rubs or gallops. Her lungs are clear bilaterally, her abdomen is benign, and her lower extremity is warm, without edema. Her peripheral pulses are 2+ bilaterally in the upper and lower extremity. There is no cyanosis. Which of the following findings would be inconsistent with the above?
A. Atrio-Ventricular discordance
B. Systemic right ventricle
C. Prior surgical excision of atrial septum
D. Pulmonary hypertension
E. Risk of developing sinus node dysfunction
Answer: A. Atrio-Ventricular discordance.
This is a 32 year old female with D-type transposition of the great arteries. In this anomaly, the aorta arises from the morphological right ventricle (RV), and the pulmonary artery arises from the morphological left ventricle (LV) (ie, there is ventriculoarterial discordance). However, the morphologic right atrium drains into the morphologic right ventricular (the same is true for the left atrium and ventricle), so there is Atrio-Ventricular concordance. Thus A is the correct answer.
Atrial and arterial switches are performed in childhood to divert blue (deoxygenated) blood to lung and red (oxygenated) blood to the body. The first atrial switch procedure was performed by Senning in 1958 and involves the creation of an atrial baffle from autologous tissue to direct the venous return to the contralateral atrioventricular (AV) valve and ventricle. Thus, deoxygenated blood from the vena cavae is directed to the mitral valve and LV and thence to the pulmonary artery, and pulmonary venous blood is directed into the morphological RV and into the aorta. An alternative operation was subsequently developed by Mustard, who excised the atrial septum (Choice C) and used synthetic material to create the baffle. Both atrial switch procedures provide excellent midterm clinical results but in the long term are associated with important sequelae, including RV dilatation and failure (systemic RV), and pulmonary hypertension, and sinus node dysfunction (Choices B, D, and E).
Teaching point: The “D” in D-TGA refers to the dextroposition of the bulboventricular loop (ie, the position of the RV, which is on the right side). Because the systemic and pulmonary circulations run in parallel, there has to be a communication between the 2, either with an atrial septal defect, a ventricular septal defect (VSD), or at the great arterial level (patent ductus arteriosus) to support life. These connections allow systemic blood to enter the pulmonary circulation for oxygenation and allow oxygenated blood from the pulmonary circuit to enter the systemic circulation.
Question 2. ACS QID 3103
A 64 year old Caucasian male with a history of extensive tobacco use, hypertension, hyperlipidemia, and obesity presents with acute onset chest pain. On arrival, the EKG shown below was obtained: Emergency coronary angiography revealed complete occlusion of the culprit vessel. Percutaneous coronary intervention was unsuccessful and the plan was for medical management. Forty-eight hours after initial presentation, while in the coronary care unit, he suddenly became very dyspneic. His exam was notable for tachycardia, elevated jugular venous pressure, diffuse rales, and an early 2/6 systolic murmur loudest at the cardiac apex. Which of the following is most likely to account for his acute decompensation?
Click here to view larger image.
A. Ventricular septal rupture
B. Severe mitral stenosis
C. Hyperdynamic ventricle
D. Acute mitral regurgitation
E. Pericardial effusion
Answer: D. Acute mitral regurgitation.
The EKG illustrates an inferior STEMI. The history of failure to revascularize his right coronary artery followed by acute onset heart failure 48 hours after presentation, as well his examination is most consistent with acute onset mitral regurgitation, secondary to papillary muscle rupture. The regurgitation into a noncompliant left atrium results in a soft early systolic murmur heard best near the cardiac apex. Ventricular septal rupture causes a holosystolic murmur that is loud and associated with a left sternal border thrill. None of the other options can account for the scenario described.