Emergency Medicine EOR Exam Questions and
Answers Graded A
Dilated Cardiomyopathy: most common cause is
____. Others? - ANSWER -alcohol; may Atrial flutter - sawtooth pattern in II, III, aVF -
also be idiopathic, myocarditis, or drugs what three treatments are used? -
(doxorubicin) -- 1 in 3 cases of heart failure are ANSWER -1. cardioversion if no
caused by dilated cardiomyopathy contraindications
2. acute rate control tx w BB, CCB - amiodarone,
sotalol, quinidine, or procainamide
3. If site of reentrant is known, catheter ablation
What PE and EKG changes are seen with dilated
cardiomyopathy? - ANSWER -PE: S3, JVD,
crackles - possible mitral regurg
EKG: nonspecific ST and T wave changes, LBBB Multifocal atrial tachycardia - noted in patients
with COPD or severe systemic illness - EKG
shows multiple shaped P waves and differing PR
intervals. ____are agents of choice? -
Hypertrophic cardiomyopathy: is due to ANSWER -CCB
hypertrophy of the _____. PE reveals mitral
regurgitation, a ____heart sound, and prominent
left ventricular impulse. EKG reveals LVH -
ANSWER -cardiac septum; S4 BLOCKS
1. ____=prolonged PR interval
2.____=progressive increase in PR until Pwave is
blocked.
Restrictive cardiomyopathy: often caused by a 3._____=sudden block in P wave w no change in
____process, or post-radiation or post open- PR
heart surgery. What is the most common first 4._____=atrial and ventricular rhythm are
symptom? - ANSWER ---infiltrative process independent of each other. - ANSWER -
- amyloidosis, sarcoidosis, and hemochromatosis First degree; Wenckebach Mobitz type I; Mobitz
-- changes in myocardium type II, Third degree block
--most common first symptom is exertion
intolerance and fluid retention, signs of right
heart failure
A _____may develop after acute MI, PE, aortic
stenosis and is due to a conduction delay in the
right or left bundles. - ANSWER -Bundle
Atrial fibrillation - regularly irregular - the most branch block
common sustained arrhythmia in adults - what
three treatments are used? - ANSWER -1.
rate control w BB, CCB, or digoxin
2. Anticoagulation w heparin & warfarin Paroxysmal supraventricular tachycardia is a
3. rhythm control w amiodarone or cardioversion reentry tachycardia, commonly noted in elderly
patients with underlying heart disease. What
treatment may be helpful before using adenosine
,Emergency Medicine EOR Exam Questions and
Answers Graded A
ie. the drug of choice? - ANSWER -vagal 3. vasodilators (hydralazine & nitrates)
maneuvers or antianxiety medication 4. BB for LV dysfunction
5. digitalis to increase cardiac contractility
What are some drugs associated with Torsades
de pointes? - ANSWER -tricyclic Functional Classification of Heart Failure:
antidepressants, erythromycin, ketoconazole, ___-No cardiac symptoms with ordinary activity.
haloperidol, cisapride, disopyramide, ___-Cardiac symptoms w MARKED activity but
pentamidine, sotalol, class I anti-arrhythmics asymptomatic at rest
___-Cardiac symptoms w MILD activity but
asymptomatic at rest
___-Cardiac symptoms at rest. - ANSWER -
CHF - Systolic dysfunction means a problem with Class I, Class II, Class III, Class IV
the ____. What drug is contraindicated? -
ANSWER -pump; CCB!
Stage 1 Hypertension is defined as greater than
____. Stage 2 Hypertension is defined as greater
CHF - Diastolic dysfunction means a problem than ____. - ANSWER -140/90; 160/100
with the ____. - ANSWER -compliance or
relaxation of the heart during ventricular filling
Hypertension Drug of Choice for:
angina
The ________principle means that as preload diabetes
increases, the ventricle is stretched during hyperlipidemia
diastole filling and the ejection fraction is CHF
Previous MI
increased. - ANSWER -Frank-Starling
Chronic Renal Failure
principle
Asthma, COPD - ANSWER -Angina - BB,
CCB
Diabetes - ACEi & CCB, avoid diuretics
_____is released from cardiac ventricles in Hyperlipidemia - ACEi & CCB, avoid diuretics/BB
response to increased wall tension. - CHF - diuretics & ACEi, avoid CCB/BB
ANSWER -BNP - B-type natriuretic peptide Previous MI - BB/ACEi
Chronic renal failure - diuretics, CCB
Asthma - diuretics & CCB, avoid BB
What is the pharmacologic therapy for heart
failure? - ANSWER -1. diuretics for fluid Secondary hypertension is HTN due to an
retention
______. - ANSWER -identifiable cause ie.
2. ACEi
,Emergency Medicine EOR Exam Questions and
Answers Graded A
renovascular disease, coarctation of the aorta,
primary aldosteronism, Cushing's, ST Elevations in II, III, aVF - ANSWER -
Pheochromocytoma, OSA, renal parenchymal Inferior MI; right coronary artery
hypertension
ST Elevations in I, aVL, V4, V5, V6 -
____hypertension is potentially life threatening - ANSWER -lateral wall MI, left circumflex
HTN plus rentinopathy, cardiovascular/renal artery
compromise, or encephalopathy. -
ANSWER -Malignant
ST Elevations in V1, V2, V3, V4, V5 -
ANSWER -Anterioseptal MI, left anterior
Malignant hypertension bp? What is the rule of descending artery
thumb for lowering? - ANSWER -greater
than 220/140; 10% in first hour and 15% for the
next 3-12 hours, to normal over next 2 days
ST Elevations in V1, V2 - ANSWER -
posterior wall MI, posterior descending artery
What is the agent of choice for BP lowering for
patients with hypertensive encephalopathy,
intracranial bleeding, and heart failure? Use with No nitroglycerin in which kind of MI? -
what for dissecting aneurysm? -
ANSWER -inferior
ANSWER -nitroprusside; propranolol --
clonidine can also be used but sedation is
common
What are the pre hospital treatments for ACS? -
ANSWER -MONA; morphine, oxygen,
nitroglycerin (0.4mg SL x3 prn), aspirin (325mg)
Hypotension is defined as a systolic blood
pressure less than _____mm Hg or a decrease
from baseline by more than 30mmHg. What are
the 3 treatments for improving blood pressure? -
What two meds should be given to all ACS
ANSWER -90mmHg; patients that do not have contraindications? -
1. IV Fluids
ANSWER -BB - unless brady or severe
2. Vasopressors - dopasmine, dobutamine (risk
COPD - then do NDCCB (verapamil/diltiazem)
is aggravation of arrhythmias and increase
ACEi - if cough, use ARB
myocardial oxygen demand)
3. intra-aortic balloon pump
What are the adjunctive tx for fibrinolysis or PCI?
, Emergency Medicine EOR Exam Questions and
Answers Graded A
- ANSWER -1. antiplatelets (ASA,
clopidogrel)
2. anticoagulants (UFH, LMWH, DTI, direct factor Timeline:
Xai) Reperfusion should take place before ___hours
of symptom onset.
Door to needle time for fibrinolysis is ____min.
Door to balloon time for PCI is ___min. -
How long should Plavix/Clopidogrel be used for ANSWER -12; 30min; 90min
bare metal or drug eluting stents? -
ANSWER -bare metal - 30d-12m
drug eluting - >/=12mon
Cardiology - ANSWER -is fun!
What meds should a patient go home with after
ACS? - ANSWER -Nitroglycerin What are the treatments for bradyarrhythmias? -
BB ANSWER -atropine, pacing, or
ACEi epinephrine/dopamine
ASA/Clopidogrel
anticoagulant (up to 8days for LMWH)
aldosterone agonist
statin For synchronized cardioversion, use ____Joules
LIFESTYLE CHANGES for paroxysmal supraventricular tachycardia and
_____Joules for a fib and VT. - ANSWER -
50J, 100J
Cardiac Markers: _____is detectable within 1-2
hours after acute MI. Duration <1 day. Low
specificity. - ANSWER -Myoglobin _____angina is brought on by activity/exercise.
____angina may show transient ST changes and
inverted T waves. ____is pain mainly occurring at
rest due to vasospasm of coronary arteries. -
Cardiac Markers: _____is the test of choice and ANSWER -Stable, unstable,
appears 2-6 hours after MI and stays elevated for prinzmetal/variant (responds well to CCB or
5-10 days. - ANSWER -Troponin nitrates, BB may exacerbate vasospasm)
Cardiac Markers: _____appears 3-6 hours after _________is considered the gold standad test for
MI and stays elevated for 2-4 days. Specific to aortic dissection but is also the most invasive of
heart muscle. - ANSWER -Creatine kinase all the radiographic studies. What is more
Mb normally done in the ED? - ANSWER -
Aortography; CT with contrast
Answers Graded A
Dilated Cardiomyopathy: most common cause is
____. Others? - ANSWER -alcohol; may Atrial flutter - sawtooth pattern in II, III, aVF -
also be idiopathic, myocarditis, or drugs what three treatments are used? -
(doxorubicin) -- 1 in 3 cases of heart failure are ANSWER -1. cardioversion if no
caused by dilated cardiomyopathy contraindications
2. acute rate control tx w BB, CCB - amiodarone,
sotalol, quinidine, or procainamide
3. If site of reentrant is known, catheter ablation
What PE and EKG changes are seen with dilated
cardiomyopathy? - ANSWER -PE: S3, JVD,
crackles - possible mitral regurg
EKG: nonspecific ST and T wave changes, LBBB Multifocal atrial tachycardia - noted in patients
with COPD or severe systemic illness - EKG
shows multiple shaped P waves and differing PR
intervals. ____are agents of choice? -
Hypertrophic cardiomyopathy: is due to ANSWER -CCB
hypertrophy of the _____. PE reveals mitral
regurgitation, a ____heart sound, and prominent
left ventricular impulse. EKG reveals LVH -
ANSWER -cardiac septum; S4 BLOCKS
1. ____=prolonged PR interval
2.____=progressive increase in PR until Pwave is
blocked.
Restrictive cardiomyopathy: often caused by a 3._____=sudden block in P wave w no change in
____process, or post-radiation or post open- PR
heart surgery. What is the most common first 4._____=atrial and ventricular rhythm are
symptom? - ANSWER ---infiltrative process independent of each other. - ANSWER -
- amyloidosis, sarcoidosis, and hemochromatosis First degree; Wenckebach Mobitz type I; Mobitz
-- changes in myocardium type II, Third degree block
--most common first symptom is exertion
intolerance and fluid retention, signs of right
heart failure
A _____may develop after acute MI, PE, aortic
stenosis and is due to a conduction delay in the
right or left bundles. - ANSWER -Bundle
Atrial fibrillation - regularly irregular - the most branch block
common sustained arrhythmia in adults - what
three treatments are used? - ANSWER -1.
rate control w BB, CCB, or digoxin
2. Anticoagulation w heparin & warfarin Paroxysmal supraventricular tachycardia is a
3. rhythm control w amiodarone or cardioversion reentry tachycardia, commonly noted in elderly
patients with underlying heart disease. What
treatment may be helpful before using adenosine
,Emergency Medicine EOR Exam Questions and
Answers Graded A
ie. the drug of choice? - ANSWER -vagal 3. vasodilators (hydralazine & nitrates)
maneuvers or antianxiety medication 4. BB for LV dysfunction
5. digitalis to increase cardiac contractility
What are some drugs associated with Torsades
de pointes? - ANSWER -tricyclic Functional Classification of Heart Failure:
antidepressants, erythromycin, ketoconazole, ___-No cardiac symptoms with ordinary activity.
haloperidol, cisapride, disopyramide, ___-Cardiac symptoms w MARKED activity but
pentamidine, sotalol, class I anti-arrhythmics asymptomatic at rest
___-Cardiac symptoms w MILD activity but
asymptomatic at rest
___-Cardiac symptoms at rest. - ANSWER -
CHF - Systolic dysfunction means a problem with Class I, Class II, Class III, Class IV
the ____. What drug is contraindicated? -
ANSWER -pump; CCB!
Stage 1 Hypertension is defined as greater than
____. Stage 2 Hypertension is defined as greater
CHF - Diastolic dysfunction means a problem than ____. - ANSWER -140/90; 160/100
with the ____. - ANSWER -compliance or
relaxation of the heart during ventricular filling
Hypertension Drug of Choice for:
angina
The ________principle means that as preload diabetes
increases, the ventricle is stretched during hyperlipidemia
diastole filling and the ejection fraction is CHF
Previous MI
increased. - ANSWER -Frank-Starling
Chronic Renal Failure
principle
Asthma, COPD - ANSWER -Angina - BB,
CCB
Diabetes - ACEi & CCB, avoid diuretics
_____is released from cardiac ventricles in Hyperlipidemia - ACEi & CCB, avoid diuretics/BB
response to increased wall tension. - CHF - diuretics & ACEi, avoid CCB/BB
ANSWER -BNP - B-type natriuretic peptide Previous MI - BB/ACEi
Chronic renal failure - diuretics, CCB
Asthma - diuretics & CCB, avoid BB
What is the pharmacologic therapy for heart
failure? - ANSWER -1. diuretics for fluid Secondary hypertension is HTN due to an
retention
______. - ANSWER -identifiable cause ie.
2. ACEi
,Emergency Medicine EOR Exam Questions and
Answers Graded A
renovascular disease, coarctation of the aorta,
primary aldosteronism, Cushing's, ST Elevations in II, III, aVF - ANSWER -
Pheochromocytoma, OSA, renal parenchymal Inferior MI; right coronary artery
hypertension
ST Elevations in I, aVL, V4, V5, V6 -
____hypertension is potentially life threatening - ANSWER -lateral wall MI, left circumflex
HTN plus rentinopathy, cardiovascular/renal artery
compromise, or encephalopathy. -
ANSWER -Malignant
ST Elevations in V1, V2, V3, V4, V5 -
ANSWER -Anterioseptal MI, left anterior
Malignant hypertension bp? What is the rule of descending artery
thumb for lowering? - ANSWER -greater
than 220/140; 10% in first hour and 15% for the
next 3-12 hours, to normal over next 2 days
ST Elevations in V1, V2 - ANSWER -
posterior wall MI, posterior descending artery
What is the agent of choice for BP lowering for
patients with hypertensive encephalopathy,
intracranial bleeding, and heart failure? Use with No nitroglycerin in which kind of MI? -
what for dissecting aneurysm? -
ANSWER -inferior
ANSWER -nitroprusside; propranolol --
clonidine can also be used but sedation is
common
What are the pre hospital treatments for ACS? -
ANSWER -MONA; morphine, oxygen,
nitroglycerin (0.4mg SL x3 prn), aspirin (325mg)
Hypotension is defined as a systolic blood
pressure less than _____mm Hg or a decrease
from baseline by more than 30mmHg. What are
the 3 treatments for improving blood pressure? -
What two meds should be given to all ACS
ANSWER -90mmHg; patients that do not have contraindications? -
1. IV Fluids
ANSWER -BB - unless brady or severe
2. Vasopressors - dopasmine, dobutamine (risk
COPD - then do NDCCB (verapamil/diltiazem)
is aggravation of arrhythmias and increase
ACEi - if cough, use ARB
myocardial oxygen demand)
3. intra-aortic balloon pump
What are the adjunctive tx for fibrinolysis or PCI?
, Emergency Medicine EOR Exam Questions and
Answers Graded A
- ANSWER -1. antiplatelets (ASA,
clopidogrel)
2. anticoagulants (UFH, LMWH, DTI, direct factor Timeline:
Xai) Reperfusion should take place before ___hours
of symptom onset.
Door to needle time for fibrinolysis is ____min.
Door to balloon time for PCI is ___min. -
How long should Plavix/Clopidogrel be used for ANSWER -12; 30min; 90min
bare metal or drug eluting stents? -
ANSWER -bare metal - 30d-12m
drug eluting - >/=12mon
Cardiology - ANSWER -is fun!
What meds should a patient go home with after
ACS? - ANSWER -Nitroglycerin What are the treatments for bradyarrhythmias? -
BB ANSWER -atropine, pacing, or
ACEi epinephrine/dopamine
ASA/Clopidogrel
anticoagulant (up to 8days for LMWH)
aldosterone agonist
statin For synchronized cardioversion, use ____Joules
LIFESTYLE CHANGES for paroxysmal supraventricular tachycardia and
_____Joules for a fib and VT. - ANSWER -
50J, 100J
Cardiac Markers: _____is detectable within 1-2
hours after acute MI. Duration <1 day. Low
specificity. - ANSWER -Myoglobin _____angina is brought on by activity/exercise.
____angina may show transient ST changes and
inverted T waves. ____is pain mainly occurring at
rest due to vasospasm of coronary arteries. -
Cardiac Markers: _____is the test of choice and ANSWER -Stable, unstable,
appears 2-6 hours after MI and stays elevated for prinzmetal/variant (responds well to CCB or
5-10 days. - ANSWER -Troponin nitrates, BB may exacerbate vasospasm)
Cardiac Markers: _____appears 3-6 hours after _________is considered the gold standad test for
MI and stays elevated for 2-4 days. Specific to aortic dissection but is also the most invasive of
heart muscle. - ANSWER -Creatine kinase all the radiographic studies. What is more
Mb normally done in the ED? - ANSWER -
Aortography; CT with contrast
