Book: Adult-Gerontology Acute Care Nurse Practitioner
Certification Review: Cardiology questions with correct
answers
1.1. A 45-year-old man presented to the emergency department after he
suffered from syncope. He has no significant history except for an upper
respiratory tract infection 1 week ago. Physical exam revealed temperature
98.9°F, pulse 90 beats/min, blood pressure 100/60 mmHg, and respiratory
rate 13 breaths/min. His neck veins are distended, and his heart sounds are
muffled and distant. Auscultation of the lungs reveals bilateral vesicular
breathing with no added sounds and chest x-ray showed small bilateral
pleural effusion with enlarged cardiac silhouette. Electrocardiography was
done and it showed varied QRS complex from beat to beat. Which of the
following complications is obviously developing in this patient?
1. Cardiac tamponade.
2. Cardiomyopathy.
3. Pulmonary embolism.
4. Myocardial infarction.: 1. Cardiac Tamponade
Rationale: This patient with a previous history of upper respiratory tract
infection probably suffered from a developing cardiac tamponade. This
resulted in a pericar- dial effusion that formed as a complication of the
previous upper respiratory infection. The electrocardiogram findings
described the typical electrical alternans that is seen in cardiac
tamponade as a result of the heart swinging back and forth within the
,increased amount of fluid in the pericardial cavity.
2.2. Which of the following are the main components of the Beck triad
in cardiac tamponade?
1. Hypotension, electrical alternans, prominent x-descent in neck veins.
2. Muffled heart sounds, friction rub, hypotension.
3. Jugular venous distension, Kussmaul sign, electrical alternans.
4. Hypotension, muffled heart sounds, jugular venous distension.: 4.
Hypoten- sion, muffled heart sounds, jugular venous distension.
Rationale: Beck's triad alerts clinicians that cardiac tamponade is
potentially pre- sent. The main components of cardiac tamponade are
hypotension, muffled heart sounds, and jugular venous distension. This
triad is often associated with prominent x-descent and absent y-descent
and pulsus paradoxus. These features are caused by failure of
ventricular filling and limited cardiac output. The Kussmaul sign is seen
in restrictive cardiomyopathy and constrictive pericarditis. A friction rub
can be seen in any condition associated with pericardial inflammation.
3.3. A 66-year-old man, known to have melanoma, presents to the
emergency department with dizziness and shortness of breath for that last 3
days. On exam his blood pressure is 80/50 mmHg. He has muffled heart
sounds and pedal edema. Chest x-ray revealed an enlarged cardiac
silhouette. Which of
, the following is most likely true of his physical exam?
1. Clear lungs with decreased jugular venous pressure (JVP).
2. Increased JVP with inspiration.
3. A greater than 10 mmHg drop in his systolic blood pressure with
inspira- tion.
4. Pericardial knock.: 3. A greater than 10 mmHg drop in his systolic
blood pressure with inspiration.
Rationale: This patient most likely has a developing cardiac tamponade
from a previously formed pericardial effusion. Melanoma is a known
tumor to infiltrate
the pericardium. Cardiac tamponade is characterized by increased jugular
venous pressure, muffled heart sounds, hypotension, and pulsus
paradoxus (greater than 10 mmHg drop in systolic blood pressure with
inspiration). Answer 1 is not correct because the JVP increases. A
pericardial knock is more likely to be noted in constrictive pericarditis.
4.4. A 70-year-old woman, known to have breast cancer, presents to the
emergency department with a sudden attack of syncope. On exam she is
hypotensive, blood pressure (BP) is 75/50 mmHg, bilateral vesicular
breathing with no added sounds are heard on auscultation of the chest,
distant heart sounds, and more than 10 mmHg drop of systolic BP with
inspiration. Which of the following findings is most probably seen on
electrocardiogram when requested?
1. Prolonged PR interval with dropped P-wave.
, 2. Widespread ST elevation.
3. Varied QRS complex from beat to beat.
4. Delta wave in almost all leads.: 3. Varied QRS complex from beat to
beat. Rationale: This patient most likely has cardiac tamponade, which is
characterized by altered and varied QRS complexes from beat to beat
caused by the heart swinging in the accumulating fluid in the pericardial
cavity.
5.5. All of the following physical findings could be found in cardiac
tampon- ade, except:
1. Sinus bradycardia.
2. Sinus tachycardia.
3. Increased jugular venous pressure.
4. None of the above.: 4. None of the above.
Rationale: Cardiac tamponade is associated with sinus tachycardia in
almost all cases, but sinus bradycardia could be found in subacute
cardiac tamponade asso- ciated with hypothyroidism. The Beck triad
(hypotension, increased jugular venous
Certification Review: Cardiology questions with correct
answers
1.1. A 45-year-old man presented to the emergency department after he
suffered from syncope. He has no significant history except for an upper
respiratory tract infection 1 week ago. Physical exam revealed temperature
98.9°F, pulse 90 beats/min, blood pressure 100/60 mmHg, and respiratory
rate 13 breaths/min. His neck veins are distended, and his heart sounds are
muffled and distant. Auscultation of the lungs reveals bilateral vesicular
breathing with no added sounds and chest x-ray showed small bilateral
pleural effusion with enlarged cardiac silhouette. Electrocardiography was
done and it showed varied QRS complex from beat to beat. Which of the
following complications is obviously developing in this patient?
1. Cardiac tamponade.
2. Cardiomyopathy.
3. Pulmonary embolism.
4. Myocardial infarction.: 1. Cardiac Tamponade
Rationale: This patient with a previous history of upper respiratory tract
infection probably suffered from a developing cardiac tamponade. This
resulted in a pericar- dial effusion that formed as a complication of the
previous upper respiratory infection. The electrocardiogram findings
described the typical electrical alternans that is seen in cardiac
tamponade as a result of the heart swinging back and forth within the
,increased amount of fluid in the pericardial cavity.
2.2. Which of the following are the main components of the Beck triad
in cardiac tamponade?
1. Hypotension, electrical alternans, prominent x-descent in neck veins.
2. Muffled heart sounds, friction rub, hypotension.
3. Jugular venous distension, Kussmaul sign, electrical alternans.
4. Hypotension, muffled heart sounds, jugular venous distension.: 4.
Hypoten- sion, muffled heart sounds, jugular venous distension.
Rationale: Beck's triad alerts clinicians that cardiac tamponade is
potentially pre- sent. The main components of cardiac tamponade are
hypotension, muffled heart sounds, and jugular venous distension. This
triad is often associated with prominent x-descent and absent y-descent
and pulsus paradoxus. These features are caused by failure of
ventricular filling and limited cardiac output. The Kussmaul sign is seen
in restrictive cardiomyopathy and constrictive pericarditis. A friction rub
can be seen in any condition associated with pericardial inflammation.
3.3. A 66-year-old man, known to have melanoma, presents to the
emergency department with dizziness and shortness of breath for that last 3
days. On exam his blood pressure is 80/50 mmHg. He has muffled heart
sounds and pedal edema. Chest x-ray revealed an enlarged cardiac
silhouette. Which of
, the following is most likely true of his physical exam?
1. Clear lungs with decreased jugular venous pressure (JVP).
2. Increased JVP with inspiration.
3. A greater than 10 mmHg drop in his systolic blood pressure with
inspira- tion.
4. Pericardial knock.: 3. A greater than 10 mmHg drop in his systolic
blood pressure with inspiration.
Rationale: This patient most likely has a developing cardiac tamponade
from a previously formed pericardial effusion. Melanoma is a known
tumor to infiltrate
the pericardium. Cardiac tamponade is characterized by increased jugular
venous pressure, muffled heart sounds, hypotension, and pulsus
paradoxus (greater than 10 mmHg drop in systolic blood pressure with
inspiration). Answer 1 is not correct because the JVP increases. A
pericardial knock is more likely to be noted in constrictive pericarditis.
4.4. A 70-year-old woman, known to have breast cancer, presents to the
emergency department with a sudden attack of syncope. On exam she is
hypotensive, blood pressure (BP) is 75/50 mmHg, bilateral vesicular
breathing with no added sounds are heard on auscultation of the chest,
distant heart sounds, and more than 10 mmHg drop of systolic BP with
inspiration. Which of the following findings is most probably seen on
electrocardiogram when requested?
1. Prolonged PR interval with dropped P-wave.
, 2. Widespread ST elevation.
3. Varied QRS complex from beat to beat.
4. Delta wave in almost all leads.: 3. Varied QRS complex from beat to
beat. Rationale: This patient most likely has cardiac tamponade, which is
characterized by altered and varied QRS complexes from beat to beat
caused by the heart swinging in the accumulating fluid in the pericardial
cavity.
5.5. All of the following physical findings could be found in cardiac
tampon- ade, except:
1. Sinus bradycardia.
2. Sinus tachycardia.
3. Increased jugular venous pressure.
4. None of the above.: 4. None of the above.
Rationale: Cardiac tamponade is associated with sinus tachycardia in
almost all cases, but sinus bradycardia could be found in subacute
cardiac tamponade asso- ciated with hypothyroidism. The Beck triad
(hypotension, increased jugular venous
