Cardiology Board Review general tips

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

Data

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

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

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

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

Symptoms

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

Treatment versus Diagnosis Options

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

Dimensions

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

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

Wrong answers are counted against you. Review still images

Distribution

  • 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

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

On Cardiac Mediciation

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

South America

Scuba DIver

PFO with paradoxical embolism. TIA after scuba diving is PFO

Preganancy

Peripartum CMP Coronary dissection Mechanical valve

Long Plane Flight

Weight Loss

  • Fen fen

Deafness

Long QT syndrome

Swimming and Syncope

Long QT syndrome

Irish

Japan

Apical HOCM

Black Patient

Haitian Patient

Portugese Patient

Dialysis Patient

If you see a Fairly Normal EKG Consider the Following Diagnoses

PET Images

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

Long Narratives

Read last paragraph, read questions

Shipyard

Asbestosis

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

Vomitting

Hypokalemia

The Asymptomatic Patient

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

Clinical Trials

  • 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

  • Is this a pericardial knock.

Splinter Hemorrhages

Will be called subungual hemorrhages

Forced Breath Holding

This is another term for the valsalva maneuver

What is not on the Test

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

Common Diseases and Questions

Physical Examination

  • Know maneuvers that provoke findings
  • Valsalva maneuver
  • Leg rasing
  • Know how to differentiate chronic versus acute dz on PE

Criteria for Thrombolysis in a Stroke Patient

  • 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

  • Increasing age
  • Female gender
  • Elevated blood pressure
  • Black race
  • Prior stroke
  • Low body weight
  • Know how to interpret peripehreal testing

Marfan intervatnion

Diagnosis of Storke

vascularitis' GCA Takaysus AAA Thoracic abeurysm ao vasculitis

PFOASDVSDteralog Ebsteins always there pulmoanry bvalve bicuspid ao dis

no complex cong no double outlet

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

Know the treatment

Pulmonary Hypertension

  • Know managment including use fo calcium channel blockers

Lateral CXR

Look for

Physiology

  • RAS system
  • Endothelial function
  • Platelet receptor physiology