Cardiology Fisdap Final Questions with VERIFIED Answers (Guaranteed
Success)
Q1: Which of the following is an absolute contraindication for fibrinolytic therapy?
Answer: Subdural hematoma 3 years ago. According to current emergency cardiac care (ECC)
guidelines, absolute contraindications for fibrinolytic therapy include ANY prior intracranial
hemorrhage (ie, subdural, epidural, intracerebral hematoma); known structural cerebrovascular lesion
(ie, arteriovenous malformation); known malignant intracranial tumor (primary or metastatic);
ischemic stroke within the past 3 months, EXCEPT for acute ischemic stroke within the past 3 hours;
suspected aortic dissection; active bleeding or bleeding disorders (except menses); and significant
closed head trauma or facial trauma within the past 3 months. Relative contraindications (eg, the
physician may deem fibrinolytic therapy appropriate under certain circumstances) include, a history of
chronic, severe, poorly-controlled hypertension severe uncontrolled hypertension on presentation (SBP
> 180 mm Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months ago; dementia; traumatic or
prolonged (> 10 minutes) CPR or major surgery within the past 3 weeks; recent (within 2 to 4 weeks)
internal bleeding; noncompressible vascular punctures; pregnancy prior exposure (> 5 days ago) or
prior allergic reaction to streptokinase or anistreplase; active peptic ulcer; and current use of
anticoagulants (ie, Coumadin).
,Q2: A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You give him
supplemental oxygen and continue your assessment. As your partner is attaching the ECG leads, you
should:
Answer: Administer up to 325 mg of aspirin. Since oxygen has already been administered to this
patient and your partner is attaching the ECG leads, you should administer aspirin (160 to 325 mg,
non-enteric-coated). Early administration of aspirin has clearly been shown to reduce mortality and
morbidity in patients experiencing an acute coronary syndrome (ACS). After establishing vascular
access, you should assess his vital signs and then administer 0.4 mg of nitroglycerin (up to 3 doses, 5
minutes apart), provided that his systolic BP is greater than 90 mm Hg. If 3 doses of nitroglycerin fail to
completely relieve his chest discomfort, consider administering 2 to 4 mg of morphine IV, provided that
his systolic BP remains above 90 mm Hg.
Q3: Which of the following ECG lead configurations is correct?
Answer: To assess lead II, place the negative lead on the right arm and the positive lead on the left leg.
According to the Einthoven triangle, lead I is assessed by placing the negative (white) lead on the right
arm and the positive (red) lead on the left arm. Lead II is assessed by placing the negative lead on the
right arm and the positive lead on the left leg. Lead III is assessed by placing the negative lead on the
left arm and the positive lead on the left leg.
,Q4: A 61-year-old male presents with chest pressure that woke him up from his nap 30 minutes ago. He
is diaphoretic, anxious, and rates his pain as an an 8 over 10. His past medical history is significant for
hypertension, type II diabetes, and coronary stent placement 2 months ago. He takes lisinopril, Plavix,
and Glucophage, and is wearing a medical alert bracelet stating "allergic to salicylates." His blood
pressure is 160/100 mm Hg, pulse is 110 beats/min, and respirations are 22 breaths/min. The 12-lead
ECG shows sinus tachycardia with 3-mm ST segment elevation in leads V1 through V5. Which of the
following treatment modalities is MOST appropriate for this patient?
Answer: Supplemental oxygen, vascular access, up to three 0.4 mg doses of nitroglycerin, and 2 to 4 mg
of morphine sulfate if his systolic BP is greater than 90 mm Hg and he is still experiencing pain. The
patient is experiencing an acute coronary syndrome (ACS). His 12-lead ECG indicates anteroseptal
injury with lateral extension (ST elevation in leads V1 through V5). Appropriate treatment includes
oxygen (maintain an SpO2 of greater than 94%), vascular access, up to three 0.4 mg doses of
nitroglycerin (NTG), and 2 to 4 mg of morphine if NTG fails to relieve his pain and his systolic BP is
above 90 mm Hg. Some EMS systems may use fentanyl (Sublimaze) for analgesia. Aspirin, a salicylate,
is also given to patients with ACS however, this patient is allergic to salicylates. Obtain a right-sided
12-lead ECG in patients with signs of inferior wall injury (ST elevation in leads II, III, aVF). Inferior wall
infarctions may involve the right ventricle; a right-sided 12-lead ECG will help confirm this. Apply the
multi-pads to the patient, not because he is at risk for bradycardia (more common with inferior
infarctions), but because he is at risk for cardiac arrest due to V-Fib or pulseless V-Tach.
, Q5: You and your team are performing CPR on a 70-year-old male. The cardiac monitor reveals a slow,
organized rhythm. His wife tells you that he goes to dialysis every day, but has missed his last three
treatments. She also tells you that he has high blood pressure, hyperthyroidism, and has had several
cardiac bypass surgeries. Based on the patient's medical history, which of the following conditions is
the MOST likely underlying cause of his condition?
Answer: Hyperkalemia. Although any of the listed conditions could be causing this patient's condition,
the fact that he missed his last three dialysis treatments should make you most suspicious for
hyperkalemia. Dialysis filters metabolic waste products from the blood in patients with renal
insufficiency or failure. If the patient is not dialyzed, these waste products, including potassium and
other electrolytes, accumulate to toxic levels in the blood. In addition to performing high-quality CPR,
managing the airway, and administering epinephrine, your protocols may call for the administration of
calcium chloride and sodium bicarbonate if hyperkalemia is suspected. Albuterol also has been shown
to be effective in treating patients with hyperkalemia becauses it causes potassium to shift back into
the cells; it can be nebulized down the ET tube or administered intravenously. Follow your local
protocols regarding the treatment for suspected hyperkalemia.
Q6: Which of the following represents the MOST appropriate initial drug and dose that is given to all
adult patients in cardiac arrest?
Answer: 10 mL of epinephrine 1:10,000 every 3 to 5 minutes. Once vascular access has been obtained
(IV or IO), the first drug and dose given to all patients in cardiac arrest—regardless of the rhythm on
the cardiac monitor—is epinephrine 1 mg (10 mL) of a 1:10,000 solution, repeated every 3 to 5
minutes. You may consider a one- time dose of vasopressin (40 units) to replace the first or second
dose of epinephrine, but not both. Higher doses of epinephrine may be necessary if special
circumstances exist (ie, severe beta-blocker toxicity). Consult with medical control as needed.
Success)
Q1: Which of the following is an absolute contraindication for fibrinolytic therapy?
Answer: Subdural hematoma 3 years ago. According to current emergency cardiac care (ECC)
guidelines, absolute contraindications for fibrinolytic therapy include ANY prior intracranial
hemorrhage (ie, subdural, epidural, intracerebral hematoma); known structural cerebrovascular lesion
(ie, arteriovenous malformation); known malignant intracranial tumor (primary or metastatic);
ischemic stroke within the past 3 months, EXCEPT for acute ischemic stroke within the past 3 hours;
suspected aortic dissection; active bleeding or bleeding disorders (except menses); and significant
closed head trauma or facial trauma within the past 3 months. Relative contraindications (eg, the
physician may deem fibrinolytic therapy appropriate under certain circumstances) include, a history of
chronic, severe, poorly-controlled hypertension severe uncontrolled hypertension on presentation (SBP
> 180 mm Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months ago; dementia; traumatic or
prolonged (> 10 minutes) CPR or major surgery within the past 3 weeks; recent (within 2 to 4 weeks)
internal bleeding; noncompressible vascular punctures; pregnancy prior exposure (> 5 days ago) or
prior allergic reaction to streptokinase or anistreplase; active peptic ulcer; and current use of
anticoagulants (ie, Coumadin).
,Q2: A middle-aged man presents with chest discomfort, shortness of breath, and nausea. You give him
supplemental oxygen and continue your assessment. As your partner is attaching the ECG leads, you
should:
Answer: Administer up to 325 mg of aspirin. Since oxygen has already been administered to this
patient and your partner is attaching the ECG leads, you should administer aspirin (160 to 325 mg,
non-enteric-coated). Early administration of aspirin has clearly been shown to reduce mortality and
morbidity in patients experiencing an acute coronary syndrome (ACS). After establishing vascular
access, you should assess his vital signs and then administer 0.4 mg of nitroglycerin (up to 3 doses, 5
minutes apart), provided that his systolic BP is greater than 90 mm Hg. If 3 doses of nitroglycerin fail to
completely relieve his chest discomfort, consider administering 2 to 4 mg of morphine IV, provided that
his systolic BP remains above 90 mm Hg.
Q3: Which of the following ECG lead configurations is correct?
Answer: To assess lead II, place the negative lead on the right arm and the positive lead on the left leg.
According to the Einthoven triangle, lead I is assessed by placing the negative (white) lead on the right
arm and the positive (red) lead on the left arm. Lead II is assessed by placing the negative lead on the
right arm and the positive lead on the left leg. Lead III is assessed by placing the negative lead on the
left arm and the positive lead on the left leg.
,Q4: A 61-year-old male presents with chest pressure that woke him up from his nap 30 minutes ago. He
is diaphoretic, anxious, and rates his pain as an an 8 over 10. His past medical history is significant for
hypertension, type II diabetes, and coronary stent placement 2 months ago. He takes lisinopril, Plavix,
and Glucophage, and is wearing a medical alert bracelet stating "allergic to salicylates." His blood
pressure is 160/100 mm Hg, pulse is 110 beats/min, and respirations are 22 breaths/min. The 12-lead
ECG shows sinus tachycardia with 3-mm ST segment elevation in leads V1 through V5. Which of the
following treatment modalities is MOST appropriate for this patient?
Answer: Supplemental oxygen, vascular access, up to three 0.4 mg doses of nitroglycerin, and 2 to 4 mg
of morphine sulfate if his systolic BP is greater than 90 mm Hg and he is still experiencing pain. The
patient is experiencing an acute coronary syndrome (ACS). His 12-lead ECG indicates anteroseptal
injury with lateral extension (ST elevation in leads V1 through V5). Appropriate treatment includes
oxygen (maintain an SpO2 of greater than 94%), vascular access, up to three 0.4 mg doses of
nitroglycerin (NTG), and 2 to 4 mg of morphine if NTG fails to relieve his pain and his systolic BP is
above 90 mm Hg. Some EMS systems may use fentanyl (Sublimaze) for analgesia. Aspirin, a salicylate,
is also given to patients with ACS however, this patient is allergic to salicylates. Obtain a right-sided
12-lead ECG in patients with signs of inferior wall injury (ST elevation in leads II, III, aVF). Inferior wall
infarctions may involve the right ventricle; a right-sided 12-lead ECG will help confirm this. Apply the
multi-pads to the patient, not because he is at risk for bradycardia (more common with inferior
infarctions), but because he is at risk for cardiac arrest due to V-Fib or pulseless V-Tach.
, Q5: You and your team are performing CPR on a 70-year-old male. The cardiac monitor reveals a slow,
organized rhythm. His wife tells you that he goes to dialysis every day, but has missed his last three
treatments. She also tells you that he has high blood pressure, hyperthyroidism, and has had several
cardiac bypass surgeries. Based on the patient's medical history, which of the following conditions is
the MOST likely underlying cause of his condition?
Answer: Hyperkalemia. Although any of the listed conditions could be causing this patient's condition,
the fact that he missed his last three dialysis treatments should make you most suspicious for
hyperkalemia. Dialysis filters metabolic waste products from the blood in patients with renal
insufficiency or failure. If the patient is not dialyzed, these waste products, including potassium and
other electrolytes, accumulate to toxic levels in the blood. In addition to performing high-quality CPR,
managing the airway, and administering epinephrine, your protocols may call for the administration of
calcium chloride and sodium bicarbonate if hyperkalemia is suspected. Albuterol also has been shown
to be effective in treating patients with hyperkalemia becauses it causes potassium to shift back into
the cells; it can be nebulized down the ET tube or administered intravenously. Follow your local
protocols regarding the treatment for suspected hyperkalemia.
Q6: Which of the following represents the MOST appropriate initial drug and dose that is given to all
adult patients in cardiac arrest?
Answer: 10 mL of epinephrine 1:10,000 every 3 to 5 minutes. Once vascular access has been obtained
(IV or IO), the first drug and dose given to all patients in cardiac arrest—regardless of the rhythm on
the cardiac monitor—is epinephrine 1 mg (10 mL) of a 1:10,000 solution, repeated every 3 to 5
minutes. You may consider a one- time dose of vasopressin (40 units) to replace the first or second
dose of epinephrine, but not both. Higher doses of epinephrine may be necessary if special
circumstances exist (ie, severe beta-blocker toxicity). Consult with medical control as needed.
