Cardiology Fisdap Questions with VERIFIED Answers (Guaranteed
Success)
Q1: Which of the following interventions has the greatest impact on patient survival from sudden
cardiac arrest?
Answer: Early CPR and defibrillation. Early CPR and defibrillation are the two interventions that will
have the greatest impact on patient survival from sudden cardiac arrest (SCA). Early, effective CPR
maintains perfusion to the body's vital organs until defibrillation can be provided. The most common
initial cardiac rhythm observed during SCA is ventricular fibrillation (V- Fib). Early defibrillation, in
conjunction with early CPR, greatly enhances the chance of establishing return of spontaneous
circulation (ROSC). The probability of successful defibrillation decreases over time, especially if CPR is
delayed. For each minute that V-Fib persists, the patient's chance of survival decreases by
approximately 7% to 10%.
Q2: Atropine sulfate exerts its therapeutic effect by:
Answer: Opposing the vagus nerve. Atropine sulfate is a parasympathetic blocker (parasympatholytic,
vagolytic). It is used to increase the heart rate by opposing the vagus nerve when excessive
parasympathetic (vagal) tone causes symptomatic bradycardia. Alpha adrenergic agonists, such as
norepinephrine (Levophed), primarily stimulate alpha-1 receptors and cause vasoconstriction. Drugs
such as propranolol (Inderal) and prazosin (Minipress) block sympathetic nervous system activity by
binding to beta and alpha receptors, respectively. Beta receptor blockade causes a decrease in heart
rate (negative chronotropy), a decrease in contractility (negative inotropy), and a decrease in electrical
conduction velocity (negative dromotropy). Alpha receptor blockade causes vasodilation, and a
subsequent decrease in blood pressure. Drugs that increase cardiac contractility, such as dopamine
(Intropin), do so through their positive inotropic effects.
,Q3: You are treating a 68-year-old woman with chest pressure and shortness of breath that started 2
days ago. Her BP is 76/52 mm Hg and her pulse is 130 beats/min and weak. The cardiac monitor reveals
sinus tachycardia with occasional PVCs and auscultation of her lungs reveals diffuse coarse crackles.
Which of the following treatment interventions is MOST appropriate for this patient?
Answer: Dopamine, 2 to 20 µg/kg/min. Your patient's history and clinical presentation is consistent
with cardiogenic shock. She has had chest pressure and shortness of breath for 2 days and is now
significantly hypotensive with weak pulses. Because of its positive inotropic effect of increasing
myocardial contractility, dopamine is the drug of choice for non- hypovolemic shock (eg, cardiogenic
shock) and may improve perfusion. Typically, dopamine for cardiogenic shock is started at 2 µg/kg/min
and titrated upwards as needed to improve blood pressure and perfusion. At doses of greater than 10
µg/kg/min, dopamine acts predominantly as a vasopressor, which results in systemic vasoconstriction.
Clearly, nitroglycerin is contraindicated in any patient with shock; its potent vasodilatory effects would
further lower the patient's blood pressure and worsen her condition. Amiodarone is not the drug of
choice for this patient; it is given in a dose of 150 mg over 10 minutes for hemodynamically stable
patients with wide or narrow-complex tachycardias that exceed 150 beats/min. Caution must be used
if you consider giving a normal saline bolus; the coarse crackles in her lungs indicate pulmonary edema,
which could easily be exacerbated by large fluid boluses. Her problem is heart failure, not
hypovolemia.
Q4: Appropriate treatment for asystole includes:
Answer: Epinephrine 1:10,000 and advanced airway management. Appropriate treatment for a patient
in asystole includes high-quality CPR with minimal interruptions, vascular access, 1 mg of epinephrine
1:10,000 every 3 to 5 minutes, advanced airway management (eg, ET tube, multilumen airway,
supraglottic airway), and assessing for and ruling out potentially reversible causes (Hs and Ts).
Vasopressin may be given in a one-time dose of 40 units to replace the first or second dose of
epinephrine, but not both. Transcutaneous cardiac pacing (TCP) has not shown to be beneficial for
patients in asystole and is not recommended. Antidysrhythmic drugs, such as amiodarone and
lidocaine, are indicated for patients with ventricular fibrillation or pulseless ventricular tachycardia
they are not given to patients with asystole.
,Q5: You arrive approximately 8 minutes after a 51-year-old male collapsed at a family event. After
determining that he is unresponsive and apneic, you should:
Answer: Assess for a carotid pulse for 5 to 10 seconds. After determining that an adult patient is
unresponsive and apneic, you should assess for a carotid pulse for at least 5 seconds but no more than
10 seconds. If the patient has a pulse, open the airway and provide rescue breathing. If the patient
does not have a pulse, begin CPR (starting with chest compressions), then open the airway and give 2
rescue breaths. Assess the patient's cardiac rhythm as soon as a monitor/defibrillator is available.
Q6: A clinically unstable patient presents with an irregular narrow- complex tachycardia at a rate of 170
per minute. What is the recommended initial energy setting for synchronized cardioversion?
Answer: 120 to 200 joules. If a patient has a heart rate that is greater than 150 per minute, and he or
she is clinically unstable because of the cardiac rhythm, synchronized cardioversion should be
performed. The following initial energy settings are recommended by current emergency cardiac care
(ECC) guidelines: narrow and regular, 50 to 100 joules (biphasic or monophasic); narrow and irregular,
120 to 200 joules biphasic (200 joules monophasic); wide and regular, 100 joules (biphasic or
monophasic); wide and irregular, defibrillation dose (NOT synchronized). If the initial energy dose is
unsuccessful, increase in a stepwise fashion.
Q7: You are assessing a 50-year-old man with acute chest pressure, diaphoresis, and nausea. The
12-lead ECG tracing reveals 3-mm ST segment elevation in leads V3 through V6. This indicates:
Answer: Anterolateral injury. Leads V1 and V2 view the interventricular septum. Leads V3 and V4 view
the anterior wall of the left ventricle. Leads I, aVL, V5 and V6 view the lateral wall of the left ventricle.
Leads II, III, and aVF view the inferior wall of the left ventricle. Myocardial ischemia manifests on the
12-lead ECG with ST segment depression and/or T-wave inversion, whereas myocardial injury
manifests with ST segment elevation that is equal to or greater than 1-mm in two or more contiguous
leads. Therefore, 3-mm ST segment elevation in leads V3 through V6 indicates injury to the anterior
and lateral wall of the left ventricle (anterolateral injury).
, Q8: In addition to CPR, the recommended treatment sequence for an unresponsive, apneic, and
pulseless patient with a regular, wide- complex cardiac rhythm at a rate of 40 beats/min includes:
Answer: 1 mg of epinephrine every 3 to 5 minutes and treating reversible causes. Pulseless electrical
activity (PEA) exists when an unresponsive, apneic, pulseless patient presents with a regular cardiac
rhythm. Treatment for PEA includes immediate high-quality CPR with minimal interruptions, obtaining
vascular access (IV or IO), 1 mg of epinephrine every 3 to 5 minutes, advanced airway management (ie,
ET tube, multilumen or supraglottic airway), and assessing for and treating reversible causes (Hs and
Ts). Vasopressin, in a one-time dose of 40 units, can be given to replace the first or second dose of
epinephrine, but not both. There are insufficient data to recommend transcutaneous pacing (TCP) for
patients with bradycardic PEA or asystole, and the routine use of calcium chloride during cardiac arrest
is not recommended.
Q9: An older man is suddenly awakened in the middle of the night, gasping for air. He is extremely
restless and pale, and is coughing up blood. His clinical presentation is MOST consistent with:
Answer: Left side heart failure. Waking up in the middle of the night with severe difficulty breathing
(paroxysmal nocturnal dyspnea [PND]) and coughing up blood or blood-tinged sputum (hemoptysis)
are consistent with left-sided heart failure and pulmonary edema. Right-sided heart failure typically
does not present with respiratory distress; it commonly manifests with jugular venous distention and
peripheral edema. Shortness of breath and hemoptysis are not consistent with a gastrointestinal (GI)
bleed; signs of a GI bleed include abdominal pain, vomiting up blood (hematemesis), which may be
bright red or have a coffee-ground appearance; dark, tarry stools (melena); or bright red blood in the
stool (hematochezia). Because left-sided heart failure can be caused by other factors, such as a long
history of poorly-controlled hypertension, angina may or may not be present.
Success)
Q1: Which of the following interventions has the greatest impact on patient survival from sudden
cardiac arrest?
Answer: Early CPR and defibrillation. Early CPR and defibrillation are the two interventions that will
have the greatest impact on patient survival from sudden cardiac arrest (SCA). Early, effective CPR
maintains perfusion to the body's vital organs until defibrillation can be provided. The most common
initial cardiac rhythm observed during SCA is ventricular fibrillation (V- Fib). Early defibrillation, in
conjunction with early CPR, greatly enhances the chance of establishing return of spontaneous
circulation (ROSC). The probability of successful defibrillation decreases over time, especially if CPR is
delayed. For each minute that V-Fib persists, the patient's chance of survival decreases by
approximately 7% to 10%.
Q2: Atropine sulfate exerts its therapeutic effect by:
Answer: Opposing the vagus nerve. Atropine sulfate is a parasympathetic blocker (parasympatholytic,
vagolytic). It is used to increase the heart rate by opposing the vagus nerve when excessive
parasympathetic (vagal) tone causes symptomatic bradycardia. Alpha adrenergic agonists, such as
norepinephrine (Levophed), primarily stimulate alpha-1 receptors and cause vasoconstriction. Drugs
such as propranolol (Inderal) and prazosin (Minipress) block sympathetic nervous system activity by
binding to beta and alpha receptors, respectively. Beta receptor blockade causes a decrease in heart
rate (negative chronotropy), a decrease in contractility (negative inotropy), and a decrease in electrical
conduction velocity (negative dromotropy). Alpha receptor blockade causes vasodilation, and a
subsequent decrease in blood pressure. Drugs that increase cardiac contractility, such as dopamine
(Intropin), do so through their positive inotropic effects.
,Q3: You are treating a 68-year-old woman with chest pressure and shortness of breath that started 2
days ago. Her BP is 76/52 mm Hg and her pulse is 130 beats/min and weak. The cardiac monitor reveals
sinus tachycardia with occasional PVCs and auscultation of her lungs reveals diffuse coarse crackles.
Which of the following treatment interventions is MOST appropriate for this patient?
Answer: Dopamine, 2 to 20 µg/kg/min. Your patient's history and clinical presentation is consistent
with cardiogenic shock. She has had chest pressure and shortness of breath for 2 days and is now
significantly hypotensive with weak pulses. Because of its positive inotropic effect of increasing
myocardial contractility, dopamine is the drug of choice for non- hypovolemic shock (eg, cardiogenic
shock) and may improve perfusion. Typically, dopamine for cardiogenic shock is started at 2 µg/kg/min
and titrated upwards as needed to improve blood pressure and perfusion. At doses of greater than 10
µg/kg/min, dopamine acts predominantly as a vasopressor, which results in systemic vasoconstriction.
Clearly, nitroglycerin is contraindicated in any patient with shock; its potent vasodilatory effects would
further lower the patient's blood pressure and worsen her condition. Amiodarone is not the drug of
choice for this patient; it is given in a dose of 150 mg over 10 minutes for hemodynamically stable
patients with wide or narrow-complex tachycardias that exceed 150 beats/min. Caution must be used
if you consider giving a normal saline bolus; the coarse crackles in her lungs indicate pulmonary edema,
which could easily be exacerbated by large fluid boluses. Her problem is heart failure, not
hypovolemia.
Q4: Appropriate treatment for asystole includes:
Answer: Epinephrine 1:10,000 and advanced airway management. Appropriate treatment for a patient
in asystole includes high-quality CPR with minimal interruptions, vascular access, 1 mg of epinephrine
1:10,000 every 3 to 5 minutes, advanced airway management (eg, ET tube, multilumen airway,
supraglottic airway), and assessing for and ruling out potentially reversible causes (Hs and Ts).
Vasopressin may be given in a one-time dose of 40 units to replace the first or second dose of
epinephrine, but not both. Transcutaneous cardiac pacing (TCP) has not shown to be beneficial for
patients in asystole and is not recommended. Antidysrhythmic drugs, such as amiodarone and
lidocaine, are indicated for patients with ventricular fibrillation or pulseless ventricular tachycardia
they are not given to patients with asystole.
,Q5: You arrive approximately 8 minutes after a 51-year-old male collapsed at a family event. After
determining that he is unresponsive and apneic, you should:
Answer: Assess for a carotid pulse for 5 to 10 seconds. After determining that an adult patient is
unresponsive and apneic, you should assess for a carotid pulse for at least 5 seconds but no more than
10 seconds. If the patient has a pulse, open the airway and provide rescue breathing. If the patient
does not have a pulse, begin CPR (starting with chest compressions), then open the airway and give 2
rescue breaths. Assess the patient's cardiac rhythm as soon as a monitor/defibrillator is available.
Q6: A clinically unstable patient presents with an irregular narrow- complex tachycardia at a rate of 170
per minute. What is the recommended initial energy setting for synchronized cardioversion?
Answer: 120 to 200 joules. If a patient has a heart rate that is greater than 150 per minute, and he or
she is clinically unstable because of the cardiac rhythm, synchronized cardioversion should be
performed. The following initial energy settings are recommended by current emergency cardiac care
(ECC) guidelines: narrow and regular, 50 to 100 joules (biphasic or monophasic); narrow and irregular,
120 to 200 joules biphasic (200 joules monophasic); wide and regular, 100 joules (biphasic or
monophasic); wide and irregular, defibrillation dose (NOT synchronized). If the initial energy dose is
unsuccessful, increase in a stepwise fashion.
Q7: You are assessing a 50-year-old man with acute chest pressure, diaphoresis, and nausea. The
12-lead ECG tracing reveals 3-mm ST segment elevation in leads V3 through V6. This indicates:
Answer: Anterolateral injury. Leads V1 and V2 view the interventricular septum. Leads V3 and V4 view
the anterior wall of the left ventricle. Leads I, aVL, V5 and V6 view the lateral wall of the left ventricle.
Leads II, III, and aVF view the inferior wall of the left ventricle. Myocardial ischemia manifests on the
12-lead ECG with ST segment depression and/or T-wave inversion, whereas myocardial injury
manifests with ST segment elevation that is equal to or greater than 1-mm in two or more contiguous
leads. Therefore, 3-mm ST segment elevation in leads V3 through V6 indicates injury to the anterior
and lateral wall of the left ventricle (anterolateral injury).
, Q8: In addition to CPR, the recommended treatment sequence for an unresponsive, apneic, and
pulseless patient with a regular, wide- complex cardiac rhythm at a rate of 40 beats/min includes:
Answer: 1 mg of epinephrine every 3 to 5 minutes and treating reversible causes. Pulseless electrical
activity (PEA) exists when an unresponsive, apneic, pulseless patient presents with a regular cardiac
rhythm. Treatment for PEA includes immediate high-quality CPR with minimal interruptions, obtaining
vascular access (IV or IO), 1 mg of epinephrine every 3 to 5 minutes, advanced airway management (ie,
ET tube, multilumen or supraglottic airway), and assessing for and treating reversible causes (Hs and
Ts). Vasopressin, in a one-time dose of 40 units, can be given to replace the first or second dose of
epinephrine, but not both. There are insufficient data to recommend transcutaneous pacing (TCP) for
patients with bradycardic PEA or asystole, and the routine use of calcium chloride during cardiac arrest
is not recommended.
Q9: An older man is suddenly awakened in the middle of the night, gasping for air. He is extremely
restless and pale, and is coughing up blood. His clinical presentation is MOST consistent with:
Answer: Left side heart failure. Waking up in the middle of the night with severe difficulty breathing
(paroxysmal nocturnal dyspnea [PND]) and coughing up blood or blood-tinged sputum (hemoptysis)
are consistent with left-sided heart failure and pulmonary edema. Right-sided heart failure typically
does not present with respiratory distress; it commonly manifests with jugular venous distention and
peripheral edema. Shortness of breath and hemoptysis are not consistent with a gastrointestinal (GI)
bleed; signs of a GI bleed include abdominal pain, vomiting up blood (hematemesis), which may be
bright red or have a coffee-ground appearance; dark, tarry stools (melena); or bright red blood in the
stool (hematochezia). Because left-sided heart failure can be caused by other factors, such as a long
history of poorly-controlled hypertension, angina may or may not be present.
