USMLE Q Bank Step 1-6

A 65 year-old farmer presents to your clinic complaining of shortness of breath for 6 months. Last 2 weeks he noticed that he has to get up several times during the night to be able to breath. He proudly tells you that he had never visited a doctor before although he smokes and drinks every night. On physical examination, there is displaced point of his maximum impulse, rales over both lungs and enlarged liver. Echo shows both right and left ventricular dilation and EF 30%. Laboratory test are normal except high bilirubin, AST 245 and ALT 180.

What is the initial cause of this patient presentation?



C-Lyme disease

D-Chronic hypertension

E-High cholesterol


AST>ALT means the patient had chronic alcoholic abuse lead to cardiomyopathy with liver failure.

The  correct answer is B

7 thoughts on “USMLE Q Bank Step 1-6”

  1. It could be chronique smoking wich lead to a BPCO and then to a right heart failur and cardiac cirrhosis .

  2. The similar signs on both ventricles are unique to cardiomyopathy. In cor pulmonale, congestive heart failure would be different in which the right ventricle is dilated while the left ventricle is the same or even lower size.

  3. Why can’t it be cor pulmonale?

  4. This is true. Thank you Ajay

  5. The points goes against Htn are:

    No LV hypertrophy on Echo is the single most factor which goes against hypertension being the aetiology.!

  6. It could be chronic hypertension but the history of drinking every night and the acute condition of left and right ventricular dilation lean towards cardiomyopathy. Thank you for your great question.

  7. Why it can’t be chronic hypertension ?
    Hypertensive heart disease leading to cardiomyopathy with CCF leading to Congestion of liver and Cirrhosis causing raised AST and ALT.

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