62 3 Cardiology

• 3.1 Cardiolo gy Review Questions

I. A 79-year-old female arrives in cardiac arrest receiving active chest compres-

sions by EMS personnel. Which of the following is the most appropriate
description of high-quality CPR?
A. 150 compressions per minute
B. Allowing for Y2 chest recoil to improve perfus ion
C. Approximately 2 inches of compressi on depth
D. Interruption of compressions every minute to take a break
2. An 86-year-old male presents to the emergency room via EMS in cardiac arrest.
Initial rhythm upon EMS's presentation was pulseless electrical activity (PEA)
and CPR was started immediately. He has received three rounds of epinephrine
in transport to the emergency department. The patient continues to be pulseless
and is still in PEA. You start to run through the H's and T's. Which of the fol-
lowing is not considered one of the H 's and T's?
A. Thrombus
B. Hyperkalemia
C. Hypothermia
D. Hyperglycemia
3. A 64-year-old male arrives to the emergency room via EMS with report of ven-
tricular tachycardia that was successfully resolved with synchronized cardio-
version. Which of the following is not a risk factor for ventricular tachycardia?
A. History of myocardial infarction (Ml)
B. Male gender
C. Greater than 50 years of age
D. Structural heart disease
4. One of your patients in the emergency department suddenly becomes unrespon-
sive and requires defibrillation to achieve ROSC. You review the telemetry
strips and it shows polymorphic ventricular tachycardi a. Which of the follow-
ing medication s is most likely responsible for this arrhythmia?
A. Ondansetron
B. Nitroglycerin
C. Aspirin
D. IV potassium chloride
3.1 Cardiology Review Questions
63

5. Your next patient in the emerg ency depar tment is a 58-year-old male
with a past.
medical history of abdom inal aortic aneury sm (AAA ) that the vascu
lar sur-
geons are watching closely. He arrives with right upper quadr ant
abdom inal
pain. Your point-of-care ultrasound reveals the AAA. Which of the
following
measu remen ts of the AAA is an indication for surgery rather than surve
illance
and screen ing?
A. 3cm
B. 4cm
C. 5cm
D. 6cm
6. An 84-year-old female presents to the emerg ency depart ment
via EMS with
report of acute onset, tearing pain in epigastric region that goes into
the back.
They are hypertensive, diaphoretic, and actively vomit ing. You obtain
a STAT
CT that shows an aortic dissec tion that does not include the ascen ding
aorta or
the aortic arch. What is the best next step in manag ement ?

A. Intravenous heparin
B. Emerg ent surgery
C. Medic al manag ement with strict HR and BP control
D. Norep inephr ine
7. An 89-year-old male with a past medical history significant for coron
ary artery
disease, atrial fibrillation, hypertension, hyperlipide mia, and diabet
es presents
to the emerg ency room compl aining of severe pain to his right lower
extremity.
He denies any traum a to the leg. Which of the following is not includ
ed in the
"6 P's" of acute arterial occlus ion?
A. Pain
B. Pallor
C. Poikil otherr nia
D. Pressu re
8. A 37-ye ar-old female arrives to the emerg ency depar tment with
a chief com-
plaint of leg pain. She has a histor y of recent knee surgery to repair
a tom ACL
one week ago. On exam you find the right lower extrem ity 4 cm larger
in cir-
cumfe rence than the contra latera l side with 1+ pitting edema . What
is the best
next step in manag ement?

A. Disch arge with nonsteroidal anti-inflammatory drugs (NSA IDs)

B. Obtai n duple x ultrasound of the lower extrem ities
C. Recom mend elevation of extrem ity and vascu lar suppo rt stocki ngs
D. Admi nister tissue plasm inogen activator (tPA)
 3 Cardiology
64

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• 9. A 22-year-old female with no medical history arrives to the emergency depart
ment with a narrow compl ex tachyc ardia. She report s symptoms of palpitations
and dyspnea. Her vital signs are as follows: BP 124/78 mmHg, HR J 76 bpm,
RR 20 bpm, T 37.2 °C, and SpO2 98% on room air. Upon further history
, the
patient reports binge drinking with friends over the weekend. She denies any
ar
tobacco or recreational drug use. Her ECG shows an irregularly irregul
rhythm in the 170s. What is the best next step in management?
A. Electrical cardioversion
8 . Start an anticoagulant
C. Rate control with a calcium channel blocker
D. Supple mental oxygen
-
IO. An 87-year-old male with a past medical history of end-stage COPD on supple
mental oxyge n arrives to the emergency department via EMS with a narrow
complex tachycardia. During transport, EMS personnel administered IV ade-
nosine with no resolution of the tachycardia. You suspect a specific diagnosis
?
based on the patient's medical history. What is the best next step in management
A. Electrical cardioversion
8. Aggressive treatment of COPD with nebulizer and steroids
C. Rate control with a calcium channel blocker
D. Start warfarin
that
11. You have a 27-year-old male arrive via EMS after syncope with an ECG
y
shows a delta wave and Wolff- Parkinson-White syndrome. You quickly identif
the diagno sis in the now stable, but tachyc ardic patient. What is the best next
step in therapy?
A. Procainamide
8. Beta blocker
C. Calcium channel blocker
D. Adenosine
with
12. A 21-year-old male of Asian descent arrives to the emergency department
a report of syncop e while eating breakfast. He is anxious and reports that his
brother died last year at the dinner table. You immediately obtain an ECG and
you observe a right bundle branch block with ST segment elevation in leads
V l-V2. What is the next best step in management?
A. Left heart catheterization
B. Dual antiplatelet therapy
C. Internal cardia c defibrillator placement
D. Synchronized cardioversion
3.1 Cardiology Review Questions 65

13. A 77-year-old female receives an ECG within 10 minutes of ED arrival for.

chest pain and shows evidence of an inferior ST elevation myocardial infarction
(STEMI). You are working in an emergency department in rural Montana and
the closest hospital is 150 minutes away via ground with no flight option due to
the terrain and weather. What is the best next step in management?
A. Transfer to a PCI center
B. Dual antiplatelet therapy only
C. Intravenous thrombolytics only
D. Intravenous thrombolytics and transfer to a PCI center
14. A 78-year-old male presents to the emergency department in extremis via EMS
with known history of ischemic cardmomyopathy and reduced ejection fraction.
The patient arrives on noninvasive positive pressure ventilation (NIPPY), and
he is able to communicate that he started taking a lot of ibuprofen for a recent
back injury, and he has become progressively dyspneic. His vital signs are with-
out evidence of shock and oxygen saturation is above 92% on NIPPY. What is
the best next step in treatment?
A. Rapid sequence intubation
8. Intravenous diuretic treatment
C. Dobutamine
D. Heparin bolus and infusion
15. A 16-year-old male arrives via EMS to the emergency department after a wit-
nessed syncopal episode while playing basketball. He arrives alert and in no
evidence of acute distress. His ECG shows evidence of high voltage in the
precordial leads and Q-waves in the inferior leads. What is the most likely mur-
mur you will hear on cardiac auscultation?
A. Midsystolic murmur increased with Yalsalva maneuver
B. Midsystolic murmur increased with reverse incline of the stretcher
C. Holosystolic murmur heard best over the apex
D. Diastolic murmur heard best over the left third interspace
16. A 23-year-old female arrives to the emergency department with fever, fatigue,
chest pain, and dyspnea. She has no significant medical, surgical, or social his-
tory. Her troponin is substantially elevated and ECG does not show evidence of
ischemia or pericarditis. Your bedside ultrasound does not reveal a pericardia)
effusion. What is the most common cause of this disease process (worldwide)?
A. Radiation from cancer therapy
B. Staphylococcus aureus
C. Coxsackie virus
D. Trypanosoma cruzi
 66 3 Cardiology

• 17. A 64-year-old female with a known history of active breast cancer presents to
the emergency department hypotensive with associated jugular venous disten-
tion and an ECG with sinus tachycardia and variable amplitudes of the QRS
segments. Your bedside ultrasound confirms your concern with a large pericar-
dia} effusion. What other ultrasound finding is diagnostic for cardiac tamponade?
A. Collapse of the left ventricle during systole
B. Ballooning of the apex of the heart
C. Global hypokinesis
D. Collapse of the right ventricle during diastole
I 8. A 42-year-old male with a past medical history of hepatitis C and IV drug use
presents to the emergency room complaining of chest pain and fever. You note
a murmur on his cardiac exam. Which of the following is the most likely valve
and organism affected by endocarditis due to IV drug use?
A. Mitra] valve/Staphylococcus sp.
B. Aortic valve/Streptococcus sp.
C. Tricuspid valve/Staphylococcus sp.
D. Mitral valve/Streptococcus sp.
19. Which of the following examples of hypertensive emergencies is not paired
correctly with the appropriate treatment?
A. Ischemic stroke/beta blocker
B. Eclampsia/nitroglycerin infusion
C. Aortic dissection/esmolol and nitroprusside
D. Subarachnoid hemorrhage (SAH)/nicardipine
20. A 56-year-old female arrives with a known history of end-stage heart failure
and reports she has a left ventricular assist device (LVAD). Her pulses are
absent, but a MAP of 80 mmHg is found using a manual BP cuff with Doppler.
Which of the following home medication is most likely to be on the patient's
medication list associated with her LVAD?
A. Ondansetron
B. Haloperidol
C. Digoxin
D. Warfarin
3.2 Cardiology Review Answer s
67

3.2

I.
2.
C
D
Cardiology Review Answers
•
3. B
4. A
5. D
6. C
7. D
8. B
9. C
10. B
I 1. A
12. C
13. D
14. B
15. A
16. D
17. D
18. C
19. B
20. D