BKAT STUDY QUESTIONS AND ANSWERS
What to do first if patient has chest pain. - ANSWERS-Rest!
ECG changes in an acute MI - ANSWERS-ST elevation in 2 or more contiguous leads.
Ischemia d/t full thickness loss of muscle. EMERGENCY.
Inferior leads - ANSWERS-II, III, aVF. RCA occlusion.
Septal leads - ANSWERS-V1 & V2.
Anterior leads - ANSWERS-V1 - V4. LAD lesion.
Lateral leads - ANSWERS-V5, V6, I, and aVL. Circumflex lesion.
Cardiac enzymes - ANSWERS-Troponins, CK-MB, and CK
Changes in CK - ANSWERS-Rise: 3-6 hours; Peak: 24 hours; Normal: 3-4 days
Changes in CK-MB - ANSWERS-Released after myocardial necrosis. Specific for
myocardial damage. Rise: 3-12 hours; Peak: 24 hours; Normal: 2-3 days
Troponin I - ANSWERS-Protein found in cardiac muscle. High sensitivity. Rise: 3-12
hours; Peak: 24 hours; Normal: 5-10 days
Troponin T - ANSWERS-Protein found in cardiac muscle. High sensitivity. Rise: 3-12
hours; Peak: 12-48 hours; Normal: 5-14 days
Common conditions that cause a murmur - ANSWERS-Aortic dissection, aortic
regurgitation (both acute & chronic), mitral valve regurgitation (both acute & chronic),
mitral valve stenosis
Drugs to decrease afterload/SVR/PVR - ANSWERS-(Arterial Dilators) Nitroprusside,
nitroglycerin, amrinone, alpha (Regitine) & Ca channel blockers
Drugs to increase afterload/SVR/PVR - ANSWERS-(Vasopressors) Epinephrine,
norepinephrine, dopamine, neosynephrine
Most common complication after an MI - ANSWERS-Heart failure (left ventricular failure)
First-line drug for angina pectoris - ANSWERS-Nitroglycerin (sublingual)
Sign of right-sided heart failure - ANSWERS-Jugular vein distention (JVD), peripheral
edema, hepatomegaly
,Sign of left-sided heart failure - ANSWERS-Pulmonary crackles, dyspnea, orthopnea,
paroxysmal nocturnal dyspnea
Normal PR interval duration - ANSWERS-0.12-0.20 seconds (3-5 small boxes)
ECG finding in hyperkalemia - ANSWERS-Peaked T waves, widened QRS, flat P wave
Drug of choice for acute pulmonary edema - ANSWERS-Furosemide (Lasix) plus oxygen
and morphine
Life-threatening complication of a myocardial infarction - ANSWERS-Ventricular
fibrillation (or cardiogenic shock)
Best initial test for suspected acute coronary syndrome - ANSWERS-12-lead ECG within
10 minutes of arrival
Which cardiac enzyme is most specific for myocardial injury? - ANSWERS-Troponin I or T
Pericarditis ECG finding - ANSWERS-Diffuse ST elevation (saddle-shaped) with PR
depression
Murmur of aortic stenosis - ANSWERS-Systolic ejection murmur, radiating to carotids
Murmur of mitral regurgitation - ANSWERS-Holosystolic murmur at apex, radiating to
axilla
First intervention for a patient with chest pain and hypotension - ANSWERS-Administer
IV fluids (if no signs of heart failure) or consider vasopressor
Absolute contraindication to thrombolytics in STEMI - ANSWERS-Active bleeding, recent
surgery (<2 weeks), or history of hemorrhagic stroke
Most common location for an acute MI - ANSWERS-Anterior wall (LAD distribution)
What is the most common symptom of acute coronary syndrome in elderly patients? -
ANSWERS-Dyspnea without chest pain
What is the first drug given sublingually for active chest pain in suspected MI? -
ANSWERS-Nitroglycerin (if SBP >90 and no recent PDE inhibitor use)
Which ECG lead is most sensitive for posterior wall MI? - ANSWERS-V1, V2, V3, V4
(reciprocal changes: horizontal ST depression, tall R wave)
Posterior leads to confirm posterior MI - ANSWERS-V7, V8, V9
, Right ventricular MI is best seen in which leads? - ANSWERS-V4R, V3R, V1R
Treatment for right ventricular MI with hypotension - ANSWERS-Aggressive IV fluids
(normal saline), avoid nitrates
ECG finding in acute pericarditis - ANSWERS-Diffuse ST elevation with PR depression, no
reciprocal changes
ECG finding in early repolarization (benign) - ANSWERS-ST elevation with notched J
point, concave upward, usually in young healthy males
Most lethal complication within first hour of STEMI - ANSWERS-Ventricular fibrillation
What is the first action for pulseless VT or VF in a patient with chest pain? - ANSWERS-
Defibrillation (unsynchronized shock) followed by CPR
Drug of choice for stable monomorphic VT with pulse - ANSWERS-Amiodarone or
procainamide
ECG finding in digitalis toxicity - ANSWERS-Scooped ST depression (reverse checkmark),
arrhythmias like PAT with block
Which electrolyte imbalance predisposes to digoxin toxicity? - ANSWERS-Hypokalemia
ECG change in hypokalemia - ANSWERS-U waves, flat T waves, prolonged QT
ECG change in hypercalcemia - ANSWERS-Short QT interval
ECG change in hypocalcemia - ANSWERS-Prolonged QT interval
ECG finding in pulmonary embolism - ANSWERS-S1Q3T3 pattern (S wave in lead I, Q
wave and inverted T in lead III), sinus tachycardia, RBBB
Most common arrhythmia after MI - ANSWERS-Premature ventricular contractions
(PVCs)
Treatment for acute STEMI with symptom onset <12 hours - ANSWERS-Primary PCI
(percutaneous coronary intervention) within 90 minutes, or fibrinolytics if PCI not
available
Absolute contraindication to fibrinolytic therapy - ANSWERS-Any prior intracranial
hemorrhage, active bleeding, recent head trauma, uncontrolled hypertension
(>185/110)
What to do first if patient has chest pain. - ANSWERS-Rest!
ECG changes in an acute MI - ANSWERS-ST elevation in 2 or more contiguous leads.
Ischemia d/t full thickness loss of muscle. EMERGENCY.
Inferior leads - ANSWERS-II, III, aVF. RCA occlusion.
Septal leads - ANSWERS-V1 & V2.
Anterior leads - ANSWERS-V1 - V4. LAD lesion.
Lateral leads - ANSWERS-V5, V6, I, and aVL. Circumflex lesion.
Cardiac enzymes - ANSWERS-Troponins, CK-MB, and CK
Changes in CK - ANSWERS-Rise: 3-6 hours; Peak: 24 hours; Normal: 3-4 days
Changes in CK-MB - ANSWERS-Released after myocardial necrosis. Specific for
myocardial damage. Rise: 3-12 hours; Peak: 24 hours; Normal: 2-3 days
Troponin I - ANSWERS-Protein found in cardiac muscle. High sensitivity. Rise: 3-12
hours; Peak: 24 hours; Normal: 5-10 days
Troponin T - ANSWERS-Protein found in cardiac muscle. High sensitivity. Rise: 3-12
hours; Peak: 12-48 hours; Normal: 5-14 days
Common conditions that cause a murmur - ANSWERS-Aortic dissection, aortic
regurgitation (both acute & chronic), mitral valve regurgitation (both acute & chronic),
mitral valve stenosis
Drugs to decrease afterload/SVR/PVR - ANSWERS-(Arterial Dilators) Nitroprusside,
nitroglycerin, amrinone, alpha (Regitine) & Ca channel blockers
Drugs to increase afterload/SVR/PVR - ANSWERS-(Vasopressors) Epinephrine,
norepinephrine, dopamine, neosynephrine
Most common complication after an MI - ANSWERS-Heart failure (left ventricular failure)
First-line drug for angina pectoris - ANSWERS-Nitroglycerin (sublingual)
Sign of right-sided heart failure - ANSWERS-Jugular vein distention (JVD), peripheral
edema, hepatomegaly
,Sign of left-sided heart failure - ANSWERS-Pulmonary crackles, dyspnea, orthopnea,
paroxysmal nocturnal dyspnea
Normal PR interval duration - ANSWERS-0.12-0.20 seconds (3-5 small boxes)
ECG finding in hyperkalemia - ANSWERS-Peaked T waves, widened QRS, flat P wave
Drug of choice for acute pulmonary edema - ANSWERS-Furosemide (Lasix) plus oxygen
and morphine
Life-threatening complication of a myocardial infarction - ANSWERS-Ventricular
fibrillation (or cardiogenic shock)
Best initial test for suspected acute coronary syndrome - ANSWERS-12-lead ECG within
10 minutes of arrival
Which cardiac enzyme is most specific for myocardial injury? - ANSWERS-Troponin I or T
Pericarditis ECG finding - ANSWERS-Diffuse ST elevation (saddle-shaped) with PR
depression
Murmur of aortic stenosis - ANSWERS-Systolic ejection murmur, radiating to carotids
Murmur of mitral regurgitation - ANSWERS-Holosystolic murmur at apex, radiating to
axilla
First intervention for a patient with chest pain and hypotension - ANSWERS-Administer
IV fluids (if no signs of heart failure) or consider vasopressor
Absolute contraindication to thrombolytics in STEMI - ANSWERS-Active bleeding, recent
surgery (<2 weeks), or history of hemorrhagic stroke
Most common location for an acute MI - ANSWERS-Anterior wall (LAD distribution)
What is the most common symptom of acute coronary syndrome in elderly patients? -
ANSWERS-Dyspnea without chest pain
What is the first drug given sublingually for active chest pain in suspected MI? -
ANSWERS-Nitroglycerin (if SBP >90 and no recent PDE inhibitor use)
Which ECG lead is most sensitive for posterior wall MI? - ANSWERS-V1, V2, V3, V4
(reciprocal changes: horizontal ST depression, tall R wave)
Posterior leads to confirm posterior MI - ANSWERS-V7, V8, V9
, Right ventricular MI is best seen in which leads? - ANSWERS-V4R, V3R, V1R
Treatment for right ventricular MI with hypotension - ANSWERS-Aggressive IV fluids
(normal saline), avoid nitrates
ECG finding in acute pericarditis - ANSWERS-Diffuse ST elevation with PR depression, no
reciprocal changes
ECG finding in early repolarization (benign) - ANSWERS-ST elevation with notched J
point, concave upward, usually in young healthy males
Most lethal complication within first hour of STEMI - ANSWERS-Ventricular fibrillation
What is the first action for pulseless VT or VF in a patient with chest pain? - ANSWERS-
Defibrillation (unsynchronized shock) followed by CPR
Drug of choice for stable monomorphic VT with pulse - ANSWERS-Amiodarone or
procainamide
ECG finding in digitalis toxicity - ANSWERS-Scooped ST depression (reverse checkmark),
arrhythmias like PAT with block
Which electrolyte imbalance predisposes to digoxin toxicity? - ANSWERS-Hypokalemia
ECG change in hypokalemia - ANSWERS-U waves, flat T waves, prolonged QT
ECG change in hypercalcemia - ANSWERS-Short QT interval
ECG change in hypocalcemia - ANSWERS-Prolonged QT interval
ECG finding in pulmonary embolism - ANSWERS-S1Q3T3 pattern (S wave in lead I, Q
wave and inverted T in lead III), sinus tachycardia, RBBB
Most common arrhythmia after MI - ANSWERS-Premature ventricular contractions
(PVCs)
Treatment for acute STEMI with symptom onset <12 hours - ANSWERS-Primary PCI
(percutaneous coronary intervention) within 90 minutes, or fibrinolytics if PCI not
available
Absolute contraindication to fibrinolytic therapy - ANSWERS-Any prior intracranial
hemorrhage, active bleeding, recent head trauma, uncontrolled hypertension
(>185/110)
