FISDAP CARDIOLOGY CORRECT EXAMS ANSWERS
AND QUESTIONS SET A+
✔✔A patient's medication regimen includes fluoxetine, Toprol, Proscar, lansoprazole,
and Klonopin. Which of these medications is used to treat cardiovascular disorders? -
✔✔Toprol.
Toprol (metaprolol) is a commonly prescribed beta-blocker used to treat various
cardiovascular conditions, including hypertension and tachydysrhythmias. Proscar
(finasteride) is used to treat benign prostatic hyperplasia (BPH). Fluoxetine (Prozac) is a
selective serotonin reuptake inhibitor (SSRI) antidepressant. It is used to treat
conditions such as depression, generalized anxiety disorder, and obsessive-compulsive
disorder (OCD). Lansoprazole (Prevacid)—a proton pump inhibitor—is used to treat
conditions such as heartburn, acid reflux disease, and ulcers. Clonazepam (Klonopin) is
a benzodiazepine sedative-hypnotic; it is used to treat anxiety.
✔✔What are the physiologic effects of nitroglycerin when given to patients with cardiac-
related chest pain, pressure, or discomfort? - ✔✔Smooth muscle relaxation and
decreased preload.
Nitroglycerin (NTG) is a vasodilator. It relaxes the smooth muscle of the vascular walls,
which promotes systemic venous pooling of blood. As a result, venous return to the right
atrium (preload) is decreased; this decreases the cardiac workload. The amount of
resistance that the left ventricle must contract against (afterload) is also decreased
secondary to vasodilation. By dilating the coronary arteries, NTG increases blood
supply to ischemic myocardium and may relieve the chest pain, pressure, or discomfort
associated with acute coronary syndrome (ACS). Nitroglycerin is not an analgesic; if it
relieves the patient's pain, it is because myocardial oxygen supply and demand have
been rebalanced.
✔✔A transmural myocardial infarction is defined as: - ✔✔An MI that involves the entire
thickness of the left ventricular wall from endocardium to epicardium.
A transmural myocardial infarction involves the entire thickness of the left ventricular
wall from endocardium to epicardium; it is associated with ST-segment elevation and,
,eventually, the development of pathologic Q waves. A subendocardial infarction
involves multiple areas of myocardial necrosis confined to the inner one third to one half
of the left ventricular wall; subendocardial infarctions are also referred to as non-Q-wave
infarctions. Myocardial ischemia caused by focal areas of spontaneous coronary
vasospasm, which may lead to infarction, is called Prinzmetal's (variant) angina; the
exact cause of this spontaneous coronary vasospasm is largely unknown.
✔✔A 60-year-old female presents with confusion, shortness of breath, and diaphoresis.
Her blood pressure is 70/40 mm Hg and her heart rate is 40 beats/min. The cardiac
monitor reveals a slow, wide complex rhythm with dissociated P waves. After applying
supplemental oxygen, you should: - ✔✔Begin immediate transcutaneous pacing.
The cardiac rhythm described is a third-degree (complete) AV block, and the patient is
clinically unstable (ie, hypotension, altered mental status, shortness of breath). Third-
degree AV block is characterized by a slow ventricular rate and no P-to-QRS
relationship (AV dissociation). Patients with high-grade AV blocks (eg, second-degree
type II, third-degree) are often clinically unstable and require immediate transcutaneous
cardiac pacing (TCP). Atropine is an appropriate drug for clinically unstable patients
with sinus bradycardia and bradycardia associated with low-grade AV blocks (eg, first-
degree, second-degree type I); it is not recommended for high-grade AV blocks. If TCP
is unsuccessful for this patient, consider an epinephrine infusion (2 to 10 µg/min) or a
dopamine infusion (5 to 10 µg/kg/min), either of which may increase her heart rate and
blood pressure. The patient's hypotension is secondary to severe bradycardia, not
hypovolemia; therefore, a rapid IV fluid bolus is not indicated. If you have reason to
suspect that the patient is experiencing an acute coronary syndrome (ACS), aspirin
should be given.
✔✔The initial dose of diltiazem for a 165-pound patient is approximately: - ✔✔19.
Diltiazem hydrochloride (Cardizem) is a calcium channel blocking drug that is used to
treat rapid ventricular rates associated with atrial fibrillation or atrial flutter. It can also be
used after adenosine to treat refractory reentry supraventricular tachycardia in
hemodynamically stable patients. The initial dose of diltiazem is 0.25 mg/kg IV over 2
minutes; the average initial dose is 15 to 20 mg. It may be repeated in 15 minutes in a
dose of 0.35 mg/kg IV over 2 minutes; the average second dose is 20 to 25 mg. A 165-
pound patient weighs 75 kg. Therefore, the initial dose of diltiazem for a patient of this
weight would be 18.75 mg (approximately 19 mg), and the second dose would be 26.25
mg (approximately 26 mg).
✔✔A 65-year-old man with difficulty breathing and palpitations presents with the cardiac
rhythm shown below, which you should interpret as: - ✔✔Supraventricular tachycardia.
Since this rhythm has narrow (less than 0.12 seconds) QRS complexes and a rate
greater than 150 beats/min, it should be interpreted as supraventricular tachycardia
(SVT), which means that its site of origin is above (supra) the level of the ventricles.
SVT can be either atrial or junctional in origin. Atrial fibrillation is characterized by an
,irregularly irregular rhythm and no discernable P waves. Atrial flutter is characterized by
flutter (F) waves that resemble a saw tooth. Ventricular tachycardia (V-Tach), in contrast
to SVT, is characterized by wide (greater than 0.12 seconds) QRS complexes and no
visible P waves.
✔✔You and your team are attempting to resuscitate a 66-year-old man in cardiac
arrest. The cardiac monitor reveals a slow, wide-complex rhythm. The patient has been
successfully intubated and an IV line has been established. As CPR is ongoing, you
should: - ✔✔Aadminister 10 mL of epinephrine 1:10,000 IV.
The first drug given to any patient in cardiac arrest is epinephrine in a dose of 1 mg (10
mL of a 1:10,000 solution) via the IV or IO route. This dose should be repeated every 3
to 5 minutes. Alternatively, a one-time dose of vasopressin (40 units) can be given to
replace the first or second dose of epinephrine, but not both. Do NOT hyperventilate the
patient as doing so increases intrathoracic pressure and can impair venous return
(preload) and cardiac output, which would decrease the effectiveness of chest
compressions. After an advanced airway has been placed during cardiac arrest, deliver
one breath every 6 to 8 seconds (8 to 10 breaths/min) and ensure that chest
compressions are uninterrupted. There is presently no evidence to support the efficacy
of transcutaneous cardiac pacing (TCP) in patients with bradycardic PEA or asystole.
✔✔Which of the following signs or symptoms occurs more commonly in patients with
stable angina than in those with unstable angina? - ✔✔Chest pain that begins during
exertion.
Angina pectoris occurs when the heart's demand for oxygen exceeds it's available
supply (ischemia) and is a sign of coronary artery disease (CAD). Angina is classified as
being stable or unstable. Stable angina typically follows a predictable pattern (ie, chest
pain, pressure, or discomfort induced by exertion), lasts less than 15 minutes, and is
usually relieved with rest and/or nitroglycerin. While unstable angina (preinfarction
angina) can also occur during exertion, it more commonly occurs when the patient
otherwise would not expect it to, such as when he or she is asleep or is otherwise
resting. Furthermore, unstable angina is often not relieved by rest and/or nitroglycerin
and typically lasts longer than 15 minutes. Chest pressure, tightness, or discomfort
occurs in patients with both stable and unstable angina. If a patient is experiencing
angina, you would expect to see ST segment depression and/or T wave inversion on
the 12-lead ECG as these are indicators of myocardial ischemia. ST segment elevation
indicates myocardial injury (eg, acute MI in progress).
✔✔You are assessing the cardiac rhythm of a woman with respiratory distress. The
rhythm is irregularly irregular with a rate of 120 beats/min. The QRS complexes
measure 0.10 seconds in duration, the P wave to QRS ratio is 1:1, and the P waves
vary in shape. This cardiac rhythm is MOST likely: - ✔✔Multifocal atrial tachycardia.
In multifocal atrial tachycardia (MAT), the pacemaker of the heart moves within various
areas of the atria. MAT is characterized by a ventricular rate that is greater than 100
, beats/min. MAT is irregularly irregular, with variation between R-R intervals based on
the site of the pacemaker for that particular complex. P waves are present, upright, and
precede each QRS complex; however, the shapes of the P waves vary as an indication
of their different sites of origin. The P-R interval generally measures between 0.12 and
0.20 seconds, but also varies slightly based on the origin of the particular complex.
Atrial fibrillation (A-Fib) is also an irregularly irregular rhythm; however, there are no
discernable P waves. A wandering atrial pacemaker essentially contains all the
components of MAT; unlike MAT, however, the ventricular rate is typically less than 100
beats/min. Atrial flutter (A-Flutter) has characteristic flutter waves (F waves) that
resemble a saw tooth. If accompanied by aberrancy, A-flutter has QRS complexes that
are greater than 0.12 seconds in duration, which indicates abnormal (aberrant)
ventricular conduction.
✔✔Which of the following represents the correct medication sequence when treating a
patient with a suspected acute coronary syndrome? - ✔✔Oxygen, aspirin, nitroglycerin,
and morphine.
The mnemonic "MONA" is used to help remember the medications given to patients
who are experiencing an acute coronary syndrome (ACS). Although it does not
represent the correct sequence in which the medications should be given, it is a useful
mnemonic to remember. The appropriate sequence of medications is oxygen (as
needed to maintain an SpO2 of greater than 94%), aspirin (160 to 325 mg), nitrogylcerin
(0.4 mg up to 3 times), and morphine (2 to 4 mg) if the nitroglycerin does not relieve the
chest pain. Pain relief is very important in patients experiencing ACS (eg, unstable
angina or AMI) because it reduces anxiety and subsequent oxygen consumption and
demand.
✔✔Which of the following ECG findings indicates a pathologic delay at the AV node? -
✔✔P-R interval of 0.28 seconds.
Normally, there is a physiologic delay of an impulse at the AV node that allows the atria
to empty into the ventricles. On the ECG, this manifests as a P-R interval—the period of
time that includes atrial depolarization and the delay at the AV node—that is between
0.12 and 0.20 seconds (120 to 200 ms). A pathologic delay at the AV node, such as
what occurs with a first-degree AV block, would manifest with a P-R interval that is
greater than 0.12 seconds (120 ms) in duration. By contrast, A P-R interval that is less
than 0.12 seconds indicates that an impulse is traversing the AV node too fast or is
bypassing it altogether, such as what occurs with Wolff-Parkinson-White (WPW)
syndrome, a preexcitation syndrome in which the electrical impulse follows accessory
pathways around the AV node (bundle of Kent) and prematurely depolarizes the
ventricles. A wide (> 0.12 seconds [120 ms]) QRS complex indicates an intraventricular
conduction delay, such as a bundle branch block. P waves that vary in morphology
(appearance) indicate more than one atrial pacemaker site; an example of this is an
ectopic atrial rhythm.
AND QUESTIONS SET A+
✔✔A patient's medication regimen includes fluoxetine, Toprol, Proscar, lansoprazole,
and Klonopin. Which of these medications is used to treat cardiovascular disorders? -
✔✔Toprol.
Toprol (metaprolol) is a commonly prescribed beta-blocker used to treat various
cardiovascular conditions, including hypertension and tachydysrhythmias. Proscar
(finasteride) is used to treat benign prostatic hyperplasia (BPH). Fluoxetine (Prozac) is a
selective serotonin reuptake inhibitor (SSRI) antidepressant. It is used to treat
conditions such as depression, generalized anxiety disorder, and obsessive-compulsive
disorder (OCD). Lansoprazole (Prevacid)—a proton pump inhibitor—is used to treat
conditions such as heartburn, acid reflux disease, and ulcers. Clonazepam (Klonopin) is
a benzodiazepine sedative-hypnotic; it is used to treat anxiety.
✔✔What are the physiologic effects of nitroglycerin when given to patients with cardiac-
related chest pain, pressure, or discomfort? - ✔✔Smooth muscle relaxation and
decreased preload.
Nitroglycerin (NTG) is a vasodilator. It relaxes the smooth muscle of the vascular walls,
which promotes systemic venous pooling of blood. As a result, venous return to the right
atrium (preload) is decreased; this decreases the cardiac workload. The amount of
resistance that the left ventricle must contract against (afterload) is also decreased
secondary to vasodilation. By dilating the coronary arteries, NTG increases blood
supply to ischemic myocardium and may relieve the chest pain, pressure, or discomfort
associated with acute coronary syndrome (ACS). Nitroglycerin is not an analgesic; if it
relieves the patient's pain, it is because myocardial oxygen supply and demand have
been rebalanced.
✔✔A transmural myocardial infarction is defined as: - ✔✔An MI that involves the entire
thickness of the left ventricular wall from endocardium to epicardium.
A transmural myocardial infarction involves the entire thickness of the left ventricular
wall from endocardium to epicardium; it is associated with ST-segment elevation and,
,eventually, the development of pathologic Q waves. A subendocardial infarction
involves multiple areas of myocardial necrosis confined to the inner one third to one half
of the left ventricular wall; subendocardial infarctions are also referred to as non-Q-wave
infarctions. Myocardial ischemia caused by focal areas of spontaneous coronary
vasospasm, which may lead to infarction, is called Prinzmetal's (variant) angina; the
exact cause of this spontaneous coronary vasospasm is largely unknown.
✔✔A 60-year-old female presents with confusion, shortness of breath, and diaphoresis.
Her blood pressure is 70/40 mm Hg and her heart rate is 40 beats/min. The cardiac
monitor reveals a slow, wide complex rhythm with dissociated P waves. After applying
supplemental oxygen, you should: - ✔✔Begin immediate transcutaneous pacing.
The cardiac rhythm described is a third-degree (complete) AV block, and the patient is
clinically unstable (ie, hypotension, altered mental status, shortness of breath). Third-
degree AV block is characterized by a slow ventricular rate and no P-to-QRS
relationship (AV dissociation). Patients with high-grade AV blocks (eg, second-degree
type II, third-degree) are often clinically unstable and require immediate transcutaneous
cardiac pacing (TCP). Atropine is an appropriate drug for clinically unstable patients
with sinus bradycardia and bradycardia associated with low-grade AV blocks (eg, first-
degree, second-degree type I); it is not recommended for high-grade AV blocks. If TCP
is unsuccessful for this patient, consider an epinephrine infusion (2 to 10 µg/min) or a
dopamine infusion (5 to 10 µg/kg/min), either of which may increase her heart rate and
blood pressure. The patient's hypotension is secondary to severe bradycardia, not
hypovolemia; therefore, a rapid IV fluid bolus is not indicated. If you have reason to
suspect that the patient is experiencing an acute coronary syndrome (ACS), aspirin
should be given.
✔✔The initial dose of diltiazem for a 165-pound patient is approximately: - ✔✔19.
Diltiazem hydrochloride (Cardizem) is a calcium channel blocking drug that is used to
treat rapid ventricular rates associated with atrial fibrillation or atrial flutter. It can also be
used after adenosine to treat refractory reentry supraventricular tachycardia in
hemodynamically stable patients. The initial dose of diltiazem is 0.25 mg/kg IV over 2
minutes; the average initial dose is 15 to 20 mg. It may be repeated in 15 minutes in a
dose of 0.35 mg/kg IV over 2 minutes; the average second dose is 20 to 25 mg. A 165-
pound patient weighs 75 kg. Therefore, the initial dose of diltiazem for a patient of this
weight would be 18.75 mg (approximately 19 mg), and the second dose would be 26.25
mg (approximately 26 mg).
✔✔A 65-year-old man with difficulty breathing and palpitations presents with the cardiac
rhythm shown below, which you should interpret as: - ✔✔Supraventricular tachycardia.
Since this rhythm has narrow (less than 0.12 seconds) QRS complexes and a rate
greater than 150 beats/min, it should be interpreted as supraventricular tachycardia
(SVT), which means that its site of origin is above (supra) the level of the ventricles.
SVT can be either atrial or junctional in origin. Atrial fibrillation is characterized by an
,irregularly irregular rhythm and no discernable P waves. Atrial flutter is characterized by
flutter (F) waves that resemble a saw tooth. Ventricular tachycardia (V-Tach), in contrast
to SVT, is characterized by wide (greater than 0.12 seconds) QRS complexes and no
visible P waves.
✔✔You and your team are attempting to resuscitate a 66-year-old man in cardiac
arrest. The cardiac monitor reveals a slow, wide-complex rhythm. The patient has been
successfully intubated and an IV line has been established. As CPR is ongoing, you
should: - ✔✔Aadminister 10 mL of epinephrine 1:10,000 IV.
The first drug given to any patient in cardiac arrest is epinephrine in a dose of 1 mg (10
mL of a 1:10,000 solution) via the IV or IO route. This dose should be repeated every 3
to 5 minutes. Alternatively, a one-time dose of vasopressin (40 units) can be given to
replace the first or second dose of epinephrine, but not both. Do NOT hyperventilate the
patient as doing so increases intrathoracic pressure and can impair venous return
(preload) and cardiac output, which would decrease the effectiveness of chest
compressions. After an advanced airway has been placed during cardiac arrest, deliver
one breath every 6 to 8 seconds (8 to 10 breaths/min) and ensure that chest
compressions are uninterrupted. There is presently no evidence to support the efficacy
of transcutaneous cardiac pacing (TCP) in patients with bradycardic PEA or asystole.
✔✔Which of the following signs or symptoms occurs more commonly in patients with
stable angina than in those with unstable angina? - ✔✔Chest pain that begins during
exertion.
Angina pectoris occurs when the heart's demand for oxygen exceeds it's available
supply (ischemia) and is a sign of coronary artery disease (CAD). Angina is classified as
being stable or unstable. Stable angina typically follows a predictable pattern (ie, chest
pain, pressure, or discomfort induced by exertion), lasts less than 15 minutes, and is
usually relieved with rest and/or nitroglycerin. While unstable angina (preinfarction
angina) can also occur during exertion, it more commonly occurs when the patient
otherwise would not expect it to, such as when he or she is asleep or is otherwise
resting. Furthermore, unstable angina is often not relieved by rest and/or nitroglycerin
and typically lasts longer than 15 minutes. Chest pressure, tightness, or discomfort
occurs in patients with both stable and unstable angina. If a patient is experiencing
angina, you would expect to see ST segment depression and/or T wave inversion on
the 12-lead ECG as these are indicators of myocardial ischemia. ST segment elevation
indicates myocardial injury (eg, acute MI in progress).
✔✔You are assessing the cardiac rhythm of a woman with respiratory distress. The
rhythm is irregularly irregular with a rate of 120 beats/min. The QRS complexes
measure 0.10 seconds in duration, the P wave to QRS ratio is 1:1, and the P waves
vary in shape. This cardiac rhythm is MOST likely: - ✔✔Multifocal atrial tachycardia.
In multifocal atrial tachycardia (MAT), the pacemaker of the heart moves within various
areas of the atria. MAT is characterized by a ventricular rate that is greater than 100
, beats/min. MAT is irregularly irregular, with variation between R-R intervals based on
the site of the pacemaker for that particular complex. P waves are present, upright, and
precede each QRS complex; however, the shapes of the P waves vary as an indication
of their different sites of origin. The P-R interval generally measures between 0.12 and
0.20 seconds, but also varies slightly based on the origin of the particular complex.
Atrial fibrillation (A-Fib) is also an irregularly irregular rhythm; however, there are no
discernable P waves. A wandering atrial pacemaker essentially contains all the
components of MAT; unlike MAT, however, the ventricular rate is typically less than 100
beats/min. Atrial flutter (A-Flutter) has characteristic flutter waves (F waves) that
resemble a saw tooth. If accompanied by aberrancy, A-flutter has QRS complexes that
are greater than 0.12 seconds in duration, which indicates abnormal (aberrant)
ventricular conduction.
✔✔Which of the following represents the correct medication sequence when treating a
patient with a suspected acute coronary syndrome? - ✔✔Oxygen, aspirin, nitroglycerin,
and morphine.
The mnemonic "MONA" is used to help remember the medications given to patients
who are experiencing an acute coronary syndrome (ACS). Although it does not
represent the correct sequence in which the medications should be given, it is a useful
mnemonic to remember. The appropriate sequence of medications is oxygen (as
needed to maintain an SpO2 of greater than 94%), aspirin (160 to 325 mg), nitrogylcerin
(0.4 mg up to 3 times), and morphine (2 to 4 mg) if the nitroglycerin does not relieve the
chest pain. Pain relief is very important in patients experiencing ACS (eg, unstable
angina or AMI) because it reduces anxiety and subsequent oxygen consumption and
demand.
✔✔Which of the following ECG findings indicates a pathologic delay at the AV node? -
✔✔P-R interval of 0.28 seconds.
Normally, there is a physiologic delay of an impulse at the AV node that allows the atria
to empty into the ventricles. On the ECG, this manifests as a P-R interval—the period of
time that includes atrial depolarization and the delay at the AV node—that is between
0.12 and 0.20 seconds (120 to 200 ms). A pathologic delay at the AV node, such as
what occurs with a first-degree AV block, would manifest with a P-R interval that is
greater than 0.12 seconds (120 ms) in duration. By contrast, A P-R interval that is less
than 0.12 seconds indicates that an impulse is traversing the AV node too fast or is
bypassing it altogether, such as what occurs with Wolff-Parkinson-White (WPW)
syndrome, a preexcitation syndrome in which the electrical impulse follows accessory
pathways around the AV node (bundle of Kent) and prematurely depolarizes the
ventricles. A wide (> 0.12 seconds [120 ms]) QRS complex indicates an intraventricular
conduction delay, such as a bundle branch block. P waves that vary in morphology
(appearance) indicate more than one atrial pacemaker site; an example of this is an
ectopic atrial rhythm.
