Cardiology Board Review general tips

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Data[edit | edit source]

There is no random data provided on the test. Capture the one line summary of what they are telling you in all the data. This is there for a reason. Use it to guide you in discerning what they are trying to test you on in this question. They ar testing you on scientifically validated in the peer review literature and in the guidelines. They are asking "Do I know the results of the __ trial". They keep the questions where half the people get it right. They throw out the ones with 80% right or 20% right.

Goal of the Exam[edit | edit source]

They are looking for you to integrate knowledge, not just regurgitate knowledge. This is not a test of basic science or rote knowledge.

Distracting Answers[edit | edit source]

These answers are not that close to the correct answer so that the test is fair. They are somewhat distant from the correct answer. Usually comes down to two answers.

Geography[edit | edit source]

Living in South America should trigger consideration of Chagas disease for instance.

Symptoms[edit | edit source]

Symptoms are provided because the guidelines are often based upon symptoms.

Treatment versus Diagnosis Options[edit | edit source]

Look for the one choice that is not diametrically opposed to the others, that is different from the others.

Dimensions[edit | edit source]

Dimensions are used to trigger your knowledge regarding the need for valve replacement or valve repair. You should know the dimensions that should trigger valve replacement in the guidelines.

EKG Readings[edit | edit source]

Tests for pattern recognition skills. Review lots of complex EKGs. The EKGs can be tough but are fair. It usually comes down to 2 diagnoses, not 5 or 6. If you see VT, it is most likely it. Pick the most serious diagnosis that is threatening to the patient if you are not sure. Don't want left atrial enlargement, want ST elevation, heart block. Not small findings.

Images[edit | edit source]

Wrong answers are counted against you. Review still images

Distribution[edit | edit source]

• Valve dz 12%
• Arrhythmias 12%
• MI 12%
• Coronary artery disease 12.5%
• Vascular medicine 9% (aneurysms, Beurgers disease)
• Pharmacology 5%
• CHF 13%
• Phsyiology 6%
• Congenital heart disease 7%
• Hypertension 7%
• Pericardial disease 3%
• Miscellaneous / ethics / statistics / trial design 1.5%

Ethics[edit | edit source]

• Report impaired MDs
• Patient can shut their AICD off, and make decisions about their care.

On Cardiac Mediciation[edit | edit source]

This is a question about digoxin. They don't say what the medicine is.

South America[edit | edit source]

Scuba DIver[edit | edit source]

PFO with paradoxical embolism. TIA after scuba diving is PFO

Preganancy[edit | edit source]

Peripartum CMP Coronary dissection Mechanical valve

Long Plane Flight[edit | edit source]

• PE, DVT

Weight Loss[edit | edit source]

• Fen fen

Deafness[edit | edit source]

Long QT syndrome

Swimming and Syncope[edit | edit source]

Long QT syndrome

Irish[edit | edit source]

• Hemochromatosis

Japan[edit | edit source]

Apical HOCM

Black Patient[edit | edit source]

• Early repolarization
• Hypertension
• Differential response to medications

Haitian Patient[edit | edit source]

• Increased risk of peripartum cardiomyopathy

Portugese Patient[edit | edit source]

• Amyloid cardiomyoopathy

Dialysis Patient[edit | edit source]

• Hyperkalemia

If you see a Fairly Normal EKG Consider the Following Diagnoses[edit | edit source]

• Long QT syndrome
• Brugada syndrome
• Ebstein's
• ASD
• WPW

PET Images[edit | edit source]

• You are being asked to assess [myocardial viability]]

Long Narratives[edit | edit source]

Read last paragraph, read questions

Shipyard[edit | edit source]

Asbestosis

==Post-operative EKG]] Hypocalcemia will be seen on the EKG

Vomitting[edit | edit source]

Hypokalemia

The Asymptomatic Patient[edit | edit source]

Pilot is seen for an exam. There will not be a normal EKG. Look for:

• Early repolarization
• LVH + HOCM
• WPW
• Long QT
• Brugada
• LBBB
• RBBB
• Atrial fibrillation

Clinical Trials[edit | edit source]

• The board is one to two years behind.
• Trials that are two to five years old are included.
• Will ask about SCDheft trial

Diastolic Sound[edit | edit source]

• Is this a pericardial knock.

Splinter Hemorrhages[edit | edit source]

Will be called subungual hemorrhages

Forced Breath Holding[edit | edit source]

This is another term for the valsalva maneuver

What is not on the Test[edit | edit source]

• Questions with no clear answer
• Controversies
• Trials < 2 years old
• Guidelines < 1-2 years old

Common Diseases and Questions[edit | edit source]

• Constriction
• Restriction
• Myocarditis
• Ebstein's
• Cocaine toxicity
• Thrombophilia and anti-phospholipid syndrome
• Complications
• Contraindications

Physical Examination[edit | edit source]

• Know maneuvers that exacerbate or reduce physical examination findings
• Valsalva maneuver
• Leg rasing
• Know how to differentiate chronic versus acute valvular disease on physical examination

Criteria for Thrombolysis in a Stroke Patient[edit | edit source]

• Know that thrombolysis should be administered to ischemic strokes within 3 hours of symptoms, and in certain subgroups up to 6 hours after symptoms onset

Risk Factors for ICH with Thrombolytic Administration[edit | edit source]

• Increasing age
• Female gender
• Elevated blood pressure
• Black race
• Prior stroke
• Low body weight

Peripheral Vascular Disease[edit | edit source]

• Know how to interpret peripheral arterial testing like ABIs, exercise ABIs

Cerbrovascular Disease[edit | edit source]

• Know the indications for carotid endarterectomy based upon carotid imaging

Marfan mMnagement[edit | edit source]

• Know when to intervene

Peripheral Vascular Disease[edit | edit source]

• Stroke
• Vasculitis
• Giant cell arteritis
• Takaysus arteritis
• Abdominal Aortic Aneurysm
• Thoracic aneurysm diagnosis and managment
• Aortic ulceration and vasculitis

Congenital Heart Disease[edit | edit source]

• PFO
• ASD
• VSD
• Tetralogy of Fallot
• Ebsteins
• Pulmoanry valve disease sometime tested on
• Bicuspid aortic valve disease
• No complex congenital heart disease is tested on like double outlet ventricle

sudden death

platypnea ortho doxia: PFO ASD hered tel

PFO: seconary prev anticog knwo i

23 to 25 valve questions Mitral and aortic rev

AS with poor LV asx pat repair vs repl

low gradient AS choice of prosthesis

pericarial: 3% pericarditis constriction congenital absence of pericardial dz tamponade vs constriction EKG of acute peric trick you into given lytic, always remember peric and PR depression regional tamponade after surgery, take back to surgery, usually of RV low pressure tamponade

TTP on Clopidogrel[edit | edit source]

Know the treatment

Pulmonary Hypertension[edit | edit source]

• Know managment including use fo calcium channel blockers

Lateral CXR[edit | edit source]

Look for

• Pericardial calcification
• Pacer lead position
• RV size is a less likely choice

Physiology[edit | edit source]

• RAS system
• Endothelial function
• Platelet receptor physiology