Sample questions / Cardiovascular

Organ system

Cardiovascular questions for Step 1

Work through cardiovascular vignettes that mix physiology, pathology and pharmacology, the way the exam does. Every explanation covers all five options.

MicrobiologyMedium

Nutritionally variant streptococci

A 62-year-old woman with endocarditis has blood cultures growing nutritionally variant streptococci (Abiotrophia or Granulicatella).

Which culture change is needed for growth?

1. High salt concentration
2. Incubation at 42°C
3. Anaerobic atmosphere
4. Acidic pH
5. Addition of pyridoxal (vitamin B6)

PhysiologyMedium

Fluid challenge

A 28-year-old man has a pulmonary artery catheter. Wedge pressure is 8 mmHg and cardiac output 5 L/min. After fluids, wedge pressure rises to 12 mmHg and cardiac output to 6.5 L/min.

What does this response show?

1. Systolic dysfunction
2. Valvular disease
3. Diastolic dysfunction
4. Normal ventricular function
5. Pericardial disease

BiochemistryMedium

Noonan LEOPARD

A 6-year-old boy has many lentigines, short stature and pulmonary stenosis. His father looks similar.

Which gene mutation is most likely?

1. PTEN
2. KIT
3. PTPN11
4. NF1
5. TSC1

PharmacologyHard

Dual-pathway rivaroxaban in CCD

A man with diabetes and non-revascularizable chronic coronary disease has frequent angina on optimal therapy and no bleeding risk factors.

Which antithrombotic change best reduces major cardiovascular events?

1. Add vorapaxar 2.08 mg daily
2. Switch aspirin to prasugrel 10 mg daily
3. Add low-dose rivaroxaban 2.5 mg orally twice daily to aspirin (dual pathway inhibition)
4. Increase aspirin to 325 mg daily
5. Add clopidogrel 75 mg daily to aspirin

PathologyEasy

Physiologic splitting of S2

A healthy 28-year-old medical student listens to his own heart and notices that S2 splits during inspiration.

What causes the inspiratory split?

1. Decreased right ventricular ejection time
2. Increased right ventricular ejection time
3. Earlier mitral valve closure
4. Later tricuspid valve closure
5. Increased left ventricular ejection time

Other systems

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