13 USMLE Cardiology Quick Review Questions with Answers (Set 5)

These 13 quick USMLE review questions test high-yield facts that show up again and again on the exam: mural thrombus, aortic stenosis, aortic aneurysm, atherosclerosis risk, pericarditis, chest x-ray findings, pulmonary edema, risk factor control, constrictive pericarditis, paradoxical splitting, heart failure and murmurs. Each question includes the correct answer.

Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.

Prefer video? Watch daily USMLE case questions on MedFocus by Dr. Ray on YouTube.

How to use this page: read the question, pick your answer, then tap Show Answer and Explanation.

Questions

Question 1. In which one of the following locations a mural thrombus commonly occurs following myocardial infarction?

A- Left atrium
B- Left ventricle
C- Right atrium
D- Right ventricle
E- Thoracic aorta

B- Left ventricle- Ischemic heart disease commonly affects the left ventricle. Mural thrombi develop due to damage of the left ventricle. They are common in the right atrium in cases of mitral stenosis.
The correct answer is B

 

Question 2. Which one of the following conditions is the most common cause of aortic stenosis in elderly patients?

A- Bicuspid aorta
B- Calcification of the aortic valve
C- Rheumatic fever
D- Subacute bacterial endocarditis

B- Calcification of the aortic valve- Degenerative changes of the cardiac valves in old age are caused by calcification of the valves.
The correct answer is B

 

Question 3. Which one of the following is the most common etiology of abdominal aortic aneurysm in the United States?

A- Atherosclerosis
B- Cystic medial necrosis
C- Rheumatic heart disease
D- Turner syndrome

A- Atherosclerosis- Other choices are not as common as atherosclerosis though they can lead to the development of aortic aneurysms. They are not as common as atherosclerosis especially in elderly population.
The correct answer is A

 

Question 4. A female patient presents to the emergency room with a suspicious ruptured abdominal aortic aneurysm. Which of the following is the appropriate test needed in this situation?

A- Abdominal CT scan
B- Abdominal MRI
C- Abdominal ultrasonography
D- Abdominal X-ray

C- Abdominal ultrasonography- This patient is most likely hemodynamically unstable. She needs an urgent bedside test to confirm her diagnosis. All other tests are inappropriate in this situation.
The correct answer is C

 

Question 5. A 72-year-old woman presents for her routine examination. She is healthy and exercising regularly. Her weight is 145 lb. and her height is 5’5. She has a family history of breast cancer. Her pulse is 70/min and blood pressure is 120/80. Her lipid panel is within normal limits. Which one of the following is the most likely risk factor to develop atherosclerosis in this woman?

A- Age
B- Blood pressure
C- Exercise
D- Family history of breast cancer
E- Weight

A- Age- Her age is the only risk factor for her but her healthy lifestyle can negate this risk.
The correct answer is A

 

Question 6. Which one of the following cardiac conditions occurs in about 25% of patients with systemic lupus erythematosus (SLE)?

A- Aortic stenosis
B- Atrial hypertrophy
C- Pericarditis
D- Ventricular myxoma

C- Pericarditis- It is seen in 25% of patients with SLE. It is characterized by pleuritic chest pain and pericardial friction rub. Other choices can occur but not as common as pericarditis.
The correct answer is C

 

Question 7. A crescendo-decrescendo murmur is heard during systole at the second right intercostal space and radiates to the carotid artery. Which one of the following findings is most likely seen on the chest X-ray?

A- Boot-shaped heart
B- Enlarged cardiac shadow in both directions
C- Left ventricular hypertrophy
D- Right ventricular hypertrophy

C-Left ventricular hypertrophy- This is a case of aortic stenosis. Left ventricular hypertrophy occurs in most cases followed by other features. Boot-shaped heart characterizes tetralogy of Fallot. Right ventricular hypertrophy may occur later in the process while B is seen in cardiac tamponade.
The correct answer is C

 

Question 8. A 60-year-old man complains of shortness of breath. Examination reveals bilateral pleural effusions and pitting edema up to the level of his thighs. Which of the following is the most likely laboratory finding in this patient?

A- Anemia
B- Hypoalbuminemia
C- Hypoglycemia
D- Neutrophilia

B- Hypoalbuminemia- Low oncotic pressure due to low serum protein leads to accumulation of extravascular fluids resulting in pleural effusion and severe edema.
The correct answer is B

 

Question 9. A 55-year-old man with a history of type 2 diabetes, hypertension and hypercholesterolemia presents for his routine examination. He is tall and obese. His vital signs are pulse 88/min, blood pressure 156/86 and oxygen saturation 98%. Which of the following is the most important action to reduce the risk of stroke in this patient?

A- Blood glucose control
B- Blood pressure control
C- Cholesterol reduction
D- Weight loss

B-Blood pressure control- All these factors are important in improving this patient’s health but high blood pressure is the most important risk factor for stroke.
The correct answer is B

 

Question 10. In case of constrictive pericarditis, examination reveals increased jugular venous pressure with inspiration. Which of the following is considered positive in this patient?

A- Hepatojugular reflux
B- Kussmaul sign
C- Raynaud’s phenomenon
D- S3 gallop

B-Kussmaul sign- It is positive when venous pressure increases with inspiration.
The correct answer is B

 

Question 11. Paradoxical splitting of heart sounds can be heard in which one of the following cardiac conditions?

A- Aortic stenosis
B- Atrial septal defect
C- Pulmonary stenosis
D- Right bundle branch block

A-Aortic stenosis- P2 sound occurs before delayed A2 sound so, it reversed the normal order of valve closure. Wide splitting occurs in pulmonary stenosis and RBBB while fixed splitting occurs in ASD.
The correct answer is A

 

Question 12. Which one of the following differentiates left sided congestive heart failure from right sided congestive heart failure?

A- Fluid retention predominates
B- Hepatojugular reflux
C- Peripheral edema
D- Pleural effusion

D- Pleural effusion- In left sided heart failure, dyspnea predominates as it causes pulmonary edema and plural effusion. Common presentations are orthopnea and paroxysmal nocturnal dyspnea. In right sided heart failure, fluid retention predominates, JVD, peripheral edema, hepatomegaly and ascites
The correct answer is D

 

Question 13. Diastolic heart sounds include the murmur of which one of the following cardiac abnormalities?

A- Aortic stenosis
B- Mitral stenosis
C- Mitral regurgitation
D- Pulmonic stenosis

B-Mitral stenosis- Diastolic heart sounds include murmurs of mitral stenosis, aortic regurgitation and pulmonic regurgitation while systolic heart sounds include murmurs of aortic stenosis, pulmonic stenosis and mitral regurgitation.
The correct answer is B

 

High-yield points from this set

  • Mural thrombi form in the left ventricle after MI.
  • Age-related calcification is the most common cause of aortic stenosis in older adults.
  • Kussmaul sign (JVP rises with inspiration) suggests constrictive pericarditis.
  • Pleural effusion with pulmonary congestion points to left-sided heart failure.

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