10 USMLE Cardiology Quick Review Questions with Answers (Set 8)

These 10 quick USMLE review questions test high-yield facts that show up again and again on the exam: viral myocarditis, malignant pericarditis, tricuspid endocarditis, Chagas disease, cardiac sarcoidosis, atrial fibrillation with heart failure, inferior MI, right ventricular infarction, bacterial meningitis and hyperkalemia. 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 one of the following is the most common cause of viral myocarditis in the USA?

A- Human immunodeficiency virus (HIV)
B- Parvovirus B19
C- Rotavirus
D- Trypanosoma cruzi

B- Parvovirus B19- It is a small DNA virus known for causing erythema infectiosum (fifth disease) in children, which typically presents with a “slapped cheek” rash. It is also associated with more serious complications, including myocarditis. It is the leading cause of viral myocarditis in the USA.
Note: Coxsackie B virus is the classic exam answer for viral myocarditis; parvovirus B19 is now the virus most often detected in heart biopsies in the USA.
The correct answer is B

 

Question 2. Which of the following is the most frequent form of pericarditis associated with malignancy?

A- Fibrinous pericarditis
B- Hemorrhagic pericarditis
C- Serous pericarditis
D- Suppurative pericarditis

B- Hemorrhagic pericarditis- It is most frequently associated with malignancy. It involves bleeding into the pericardial sac and is often seen in patients with metastatic cancer affecting the pericardium. Hemorrhagic pericarditis also occurs in some cases of tuberculosis.
The correct answer is B

 

Question 3. A patient with a history of intravenous drug abuse presents with JVD and a holosystolic murmur at the left sternal border. Which of the following is the best treatment for this patient?

A- Dopamine and observation
B- Morphine and IV beta blockers
C- Treat heart failure and replace the aortic valve
D- Treat heart failure and replace the tricuspid valve

D- Treat heart failure and replace the tricuspid valve- This patient has jugular venous distension (JVD) and a holosystolic murmur at the left sternal border, which are suggestive of tricuspid regurgitation (TR). Given their history of intravenous drug use, infective endocarditis affecting the tricuspid valve is the most likely diagnosis. The first step is to treat heart failure with diuretics, supportive care, and antibiotic therapy to treat the underlying infection. Valve replacement is preferred over repair in severe cases when there is severe regurgitation, persistent infection despite antibiotics, or significant right heart failure.
The correct answer is D

 

Question 4. Which of the following is the most common infectious cause of dilated cardiomyopathy in Central and South America?

A- Coxsackievirus B
B- Human immunodeficiency virus (HIV)
C- Rickettsia
D- Trypanosoma cruzi

D- Trypanosoma cruzi- In Central and South America, the most common infectious cause of dilated cardiomyopathy is Chagas disease, caused by Trypanosoma cruzi. The disease is transmitted by the bite of triatomine bugs (“kissing bugs”) and can lead to chronic myocarditis, progressive heart failure, arrhythmias, and dilated cardiomyopathy.
The correct answer is D

 

Question 5. Which of the following is the most sensitive test to order in a suspected case of myocardial sarcoidosis?

A- Angiography
B- Endocardial biopsy
C- Magnetic Resonance Imaging (MRI)
D- Positron Emission Tomography (PET) Scan

D- Positron Emission Tomography (PET) Scan- PET scan with FDG (Fluorodeoxyglucose) is the most sensitive test for detecting active myocardial inflammation in suspected myocardial sarcoidosis.
The correct answer is D

 

Question 6. A 65-year-old man with a history of atrial fibrillation presents with shortness of breath and ankle swelling. His medication list includes furosemide, warfarin, and metoprolol. Which of the following is the most likely cause of his hypokalemia?

A- Furosemide
B- Metoprolol
C- Warfarin

A- Furosemide- Furosemide is a loop diuretic that causes loss of potassium, leading to hypokalemia. This is a common side effect.
The correct answer is A

 

Question 7. A 58-year-old diabetic patient presents with chest pain. His ECG shows ST elevations in leads II, III and aVF. What is the most likely diagnosis?

A- Anterior MI
B- Inferior MI
C- Lateral MI
D- Posterior MI

B- Inferior MI- ST elevations in leads II, III, aVF indicate an infarct involving the inferior wall of the heart., usually due to RCA occlusion.
The correct answer is B

 

Question 8. A 56-year-old man presents with sudden-onset chest pain and shortness of breath. His ECG shows ST-segment elevation in leads II, III, and aVF. His blood pressure is 80/50 mmHg, and his jugular venous pressure is elevated. Lungs are clear to auscultation. Which of the following is the most appropriate next step in management?

A- Administer intravenous furosemide
B- Give immediate nitroglycerin
C- Initiate aggressive intravenous fluid resuscitation
D- Start high-dose beta-blocker therapy

C- Initiate aggressive intravenous fluid resuscitation- This is an inferior wall myocardial infarction complicated by right ventricular infarction. These patients are preload-dependent, so fluid administration helps maintain cardiac output. Nitroglycerin and diuretics would worsen hypotension.
The correct answer is C

 

Question 9. A 60-year-old male presents with a sudden-onset severe headache, nausea, and vomiting. On examination, there is neck stiffness, and a lumbar puncture reveals an elevated opening pressure with cloudy cerebrospinal fluid (CSF). Which of the following is the most likely causative organism?

A- Arboviruses
B- Enteroviruses
C- Streptococcus pneumoniae
D- Varicella-zoster virus

C- Streptococcus pneumoniae- Cloudy CSF with high opening pressure points to bacterial meningitis. In adults, Streptococcus pneumoniae is the most common cause; in adults over 50, Listeria monocytogenes is also important, so empiric therapy is ceftriaxone plus vancomycin plus ampicillin. Arboviruses, enteroviruses and varicella-zoster cause viral (aseptic) meningitis with clear CSF.
The correct answer is C

 

Question 10. Which of the following is the initial treatment of choice for a case of hyperkalemia accompanied by ECG changes?

A- Calcium gluconate
B- Furosemide
C- Insulin with glucose
D- Sodium polystyrene sulfonate

A- Calcium gluconate- Calcium gluconate is given first to stabilize the heart when hyperkalemia causes ECG changes such as peaked T waves. It protects the myocardium but does not lower the potassium level.
The correct answer is A

 

High-yield points from this set

  • Malignancy most often causes hemorrhagic pericarditis.
  • Chagas disease (Trypanosoma cruzi) is the leading infectious cause of dilated cardiomyopathy in Latin America.
  • RV infarction (inferior STEMI, hypotension, high JVP, clear lungs): give IV fluids.
  • Hyperkalemia with ECG changes: IV calcium gluconate first.

Keep practicing

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