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Cardiovascular Physiology — Step 1 practice questions
95 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Physiology questions in this section combine two things the exam tests separately elsewhere. Physiology questions can be reasoned rather than recalled, which makes them the best return on study time. Cardiovascular questions lean heavily on physiology you can reason from first principles: pressure-volume loops, the cardiac cycle, and how preload, afterload and contractility move when something goes wrong.
Sample questions
Sample question 1
A patient has a holosystolic murmur heard best at the apex radiating to the axilla, with a soft S1 and an S3. Which of the following is the most likely lesion?
Explanations
A. Mitral stenosis with an opening snap and diastolic rumble
Mitral stenosis produces a diastolic murmur.
B. Mitral regurgitation, in which retrograde flow into the left atrium throughout systole produces a holosystolic apical murmur radiating to the axilla · correct
Mitral regurgitation produces a HOLOSYSTOLIC murmur because the pressure gradient between ventricle and atrium exists throughout systole, heard best at the APEX with radiation to the AXILLA, often with a soft S1 and an S3 from the volume-loaded ventricle. Contrast the other left-sided lesions: AORTIC STENOSIS gives a crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids with delayed carotid upstroke; MITRAL STENOSIS gives an opening snap with a diastolic rumble; and AORTIC REGURGITATION gives an early decrescendo diastolic murmur with a wide pulse pressure.
C. Aortic stenosis with a crescendo-decrescendo murmur radiating to the carotids
Aortic stenosis radiates to the carotids and is not holosystolic.
D. Tricuspid regurgitation increasing with expiration
Right-sided murmurs increase with INSPIRATION.
E. Aortic regurgitation with a decrescendo diastolic murmur
Aortic regurgitation is diastolic.
Sample question 2
A young, otherwise healthy patient experiences syncope after prolonged standing in a hot environment, preceded by nausea and diaphoresis, with rapid spontaneous recovery. Which of the following is the most likely diagnosis?
Explanations
A. Vasovagal (neurocardiogenic) syncope · correct
Prodromal nausea/diaphoresis, triggered by prolonged standing/heat, with rapid spontaneous recovery, is classic vasovagal (reflex) syncope, a benign and common cause of syncope in young healthy individuals.
B. Stroke
Stroke would not typically present as transient syncope with full rapid recovery in this fashion.
C. Cardiac arrhythmia
Cardiac arrhythmia-related syncope typically occurs abruptly, without this classic prodrome, and often in the setting of underlying heart disease.
D. Seizure
Seizures typically involve postictal confusion and possibly tongue biting/incontinence, not this classic vasovagal prodrome/rapid recovery pattern.
E. Aortic stenosis-related syncope
Aortic stenosis-related syncope is classically EXERTIONAL, not triggered by prolonged standing/heat in this way.
Sample question 3
A 45-year-old man has a blood pressure of 160/45 mm Hg, a head bob with each heartbeat, visible nailbed pulsations, and a high-pitched early diastolic decrescendo murmur at the left sternal border. Which of the following best explains his wide pulse pressure?
Explanations
A. Mitral stenosis reduces left ventricular filling
Mitral stenosis produces a diastolic rumble at the apex with a normal pulse pressure.
B. Increased systemic vascular resistance elevates diastolic pressure
Higher resistance raises diastolic pressure, narrowing pulse pressure.
C. Regurgitant flow back into the ventricle during diastole lowers aortic diastolic pressure, while increased stroke volume raises systolic pressure · correct
In chronic aortic regurgitation, blood returns to the ventricle during diastole so aortic diastolic pressure falls, while the enlarged total stroke volume (forward plus regurgitant) raises systolic pressure — producing a widened pulse pressure and the classic peripheral signs: de Musset head bob, Quincke nailbed pulsations, Corrigan water-hammer pulse, and Duroziez and Traube signs. Causes include bicuspid valve, aortic root dilation, endarteritis, and syphilis.
D. Fixed obstruction to left ventricular outflow reduces stroke volume
Fixed obstruction describes aortic STENOSIS, which NARROWS pulse pressure (pulsus parvus et tardus).
E. Reduced ventricular compliance limits stroke volume
Reduced compliance does not create this hyperdynamic picture.
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