12 USMLE Cardiology Quick Review Questions with Answers (Set 7)

These 12 quick USMLE review questions test high-yield facts that show up again and again on the exam: sudden death in heart failure, Marfan syndrome, aortic dissection, mitral stenosis, viral myocarditis, electrical alternans, aortic stenosis, MI diagnosis, STEMI treatment and coronary anatomy. 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. Which of the following is the most common cause of sudden death from congestive heart failure?

A- Arrhythmias
B- Emboli
C- Myocardial infarction
D- Pulmonary edema

A- Arrhythmias- Ventricular arrhythmias are provoked by ischemia leading to sudden death. Beta blockers could prevent it. Meanwhile, beta blockers cannot be given in the acute treatment of congestive heart failure.
The correct answer is A

 

Question 2. A patient with a history of Marfan syndrome presents for a routine examination. He is found to have a mid-systolic click. Which of the following treatments is shown to slow the rate of his condition?

A- Lisinopril
B- Losartan
C- Propranolol
D- Verapamil

C- Propranolol- Dilatation of the aortic root is significant complication of Marfan syndrome. Beta blockers slow the rate of aortic dilatation.
The correct answer is C

 

Question 3. Which of the following is the next step in the management of a traumatic aortic dissection following a motor vehicle accident?

A- Adrenaline
B- Consultation with cardiology
C- Emergent surgery
D- Metoprolol

C- Emergent surgery- Aortic dissection is considered a medical emergency that needs instant management. Surgery is the main approach in this condition.
The correct answer is C

 

Question 4. Which one of the following cardiac conditions presents with an opening snap and a diastolic murmur on auscultation?

A- Aortic stenosis
B- Mitral stenosis
C- Pulmonary valve stenosis
D- Ventricular septal defect

B- Mitral stenosis- Opening snap of the mitral valve and low pitch, rumbling murmur heard at the apex are characteristic of mitral stenosis.
The correct answer is B

 

Question 5. A 12-year-old girl complains of fatigue, shortness of breath for 3 days. A week ago, she developed running nose, cough and sore throat and all her symptoms resolved spontaneously in 3 days. She has no history of major illness or surgeries and receives no treatment. Examination reveals a gallop, soft first heart sound and a high pitched holosystolic murmur. There are no joint pains or effusions. Which of the following is the most likely diagnosis?

A- Lobar pneumonia
B- Rheumatic fever
C- Systemic lupus erythematosus
D- Viral myocarditis

D- Viral myocarditis- History is typical for this condition. Viral myocarditis leads to mitral regurgitation as in this case. There is no history suggesting other conditions.
The correct answer is D

 

Question 6. Which one of the following conditions is the most common cardiac cause of electrical alternans?

A- Cardiac tamponade
B- Digitalis treatment
C- Hypercalcemia
D- Restrictive cardiomyopathy

A- Cardiac tamponade- Electrical alternan is alternate variation in direction, amplitude, and duration of any component of the ECG. It occurs mainly in cases of large pericardial effusion, hypertrophic cardiomyopathy, emphysema, and large bilateral pleural effusions.
The correct answer is A

 

Question 7. Which of the following is the most common cause of aortic stenosis in elderly patients?

A- Amyloidosis
B- Bicuspid aortic valve
C- Dystrophic calcification of the aortic valve
D- Myocardial infarction

C- Dystrophic calcification of the aortic valve- It is caused by degenerative changes related to aging. These changes lead to narrowing of the aortic outlet.
The correct answer is C

 

Question 8. A 65-year-old man presents to the emergency room with chest pain for 2 hours. Electrocardiogram shows ST depression. Cardiac enzymes are significantly elevated. Which of the following is the most likely diagnosis?

A- Cardiac tamponade
B- Myocardial infarction
C- Stable angina
D- Unstable angina

B- Myocardial infarction- It is the only condition on the list that shows elevated cardiac enzymes. Unstable angina can be revealed as ST depression but normal cardiac enzymes.
The correct answer is B

 

Question 9. A 45-year-old male presents with sudden-onset chest pain radiating to the left arm. He appears diaphoretic, and an ECG reveals ST-segment elevation in the anterior leads. Which one of the following is the initial medication for this patient?

A- Alteplase
B- Aspirin
C- Clopidogrel
D- Metoprolol
E- Nitroglycerin

B- Aspirin- This patient presents with symptoms suggestive of an acute myocardial infarction characterized by sudden-onset chest pain, diaphoresis, and ST-segment elevation on the ECG, particularly in the anterior leads. Aspirin is the most appropriate initial medication in this situation.
The correct answer is B

 

Question 10. A 55-year-old male presents to the ER with sudden-onset severe chest pain radiating to the left arm. He appears diaphoretic and anxious. His blood pressure is 90/60 mm Hg, heart rate is 110/min, and respiratory rate is 24/min. An electrocardiogram (ECG) reveals ST-segment elevation in leads II, III, and aVF. Which of the following arteries is most likely occluded?

A- Left anterior descending artery
B- Left circumflex artery
C- Left main coronary artery
D- Right coronary artery

D- Right coronary artery- ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction. The right coronary artery supplies the inferior wall of the heart. Therefore, occlusion of the right coronary artery is the most likely cause of the patient’s symptoms.
The correct answer is D

 

Question 11. A 66-year-old woman presents to the emergency department with sudden-onset severe chest pain radiating to her left arm. She appears diaphoretic and is hypotensive. Electrocardiogram (ECG) reveals ST-segment elevation in leads II, III, and aVF. Which of the following is the most appropriate initial pharmacotherapy for this patient?

A- Aspirin
B- Heparin
C- Metoprolol
D- Nitroglycerin
E- Streptokinase

A- Aspirin- This patient’s presentation is consistent with an acute ST-segment elevation myocardial infarction (STEMI). The most appropriate initial treatment is aspirin. Aspirin irreversibly inhibits platelet aggregation and is a cornerstone in the management of acute coronary syndromes. It helps reduce mortality and the risk of recurrent myocardial infarction.
Heparin is often used for anticoagulation in acute coronary syndromes but is not the initial therapy of choice in this scenario. Nitroglycerin is used for symptomatic relief of angina but does not address the underlying cause of the STEMI. Metoprolol is a beta-blocker that may be used later in the management but is not the initial therapy. Streptokinase is a fibrinolytic agent that may be considered in certain cases of STEMI, but it is not the initial pharmacotherapy in this patient with ongoing chest pain and hypotension.
The correct answer is A

 

Question 12. A 57-year-old man presents with a sudden onset of severe chest pain that radiates to his back. He describes the pain as tearing in nature. His blood pressure is significantly different between the right and left arms, with a higher reading in the right arm. On auscultation, there is a diastolic murmur heard along the left sternal border. An imaging study confirms the diagnosis. Which of the following is the most likely cause of this condition?

A- Aortic dissection
B- Aortic regurgitation
C- Aortic stenosis
D- Mitral valve prolapse
E- Tricuspid regurgitation

A- Aortic dissection- This patient’s presentation, including sudden onset of severe tearing chest pain that radiates to the back, significant blood pressure difference between arms, and the diastolic murmur along the left sternal border, is consistent with aortic dissection. Aortic dissection involves a tear in the intimal layer of the aorta, leading to the creation of a false lumen within the vessel wall. Aortic dissection is a medical emergency that requires prompt diagnosis and intervention.
The correct answer is A

 

High-yield points from this set

  • Ventricular arrhythmias cause most sudden deaths in heart failure.
  • Opening snap with a diastolic rumble = mitral stenosis.
  • Electrical alternans = cardiac tamponade.
  • Give aspirin first in suspected STEMI.

Keep practicing

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