xf xf xf
1. Whichx f ofx f thex f followingx f isx f leastx f consistentx f withx f ax f 55-year-
oldx f manx f withx f hyper-
tensionxfandxfdyslipidemiaxfwhoxfisxfpresentingxfwithxfacutexfcoronaryxfsyndrome?
Diaphoresisxfandxfnausea
Ill-
definedxfpainxfthatxfoftenxfradiatesxfRetrosternalxf
painxfforxf30xfminutes
Localizedxfchestxfpainxfthatxfpersistsxfforxfupxftoxf15xfminutes:xfLocalizedxfchestxfpainxfthatxfpersist
sxfforxfupxftoxf15xfminutes
2. Majorxfriskxffactorsxfforxfheartxffailurexfincludexfallxfofxfthexffollowingxfexcept:
Coronaryxfarteryxfdisease.xfMitr
alxfvalvexfprolapse.
Long-standingx f poorly-
controlledx f hypertension.x f Sleepxfapnea.:xfMitralxfvalv
exfprolapse.
3. Youx f seex f ax f 62-year-oldx f malex f withx f COPDx f whox f isx f scheduledx f forx f ax f follow-
upx f onxfrecentx f hospitalizationx f forx f COPDx f exacerbation.x f Asx f hex f ambulatesx f into
x f thex f examxfroom,x f hex f beginsx f tox f stagger,x f perspiresx f profusely,x f andx f complains
x f ofx f generalizedxfpainxfandxfaxftightening xffeeling xfinxfhis xfchest.xfThexfmostxfappropr
iatexfactionxfisxfto:
Havex f himx f liex f downx f withx f feetx f elevatedx f forx f 10x f minutesx f beforex f resumingx f thex
f test.xfObtainxfan xfECGxftoxfdetectxfheartxfrhythmxfabnormalities.
Immediatelyx f initiatex f oxygenx f therapy.
Administerx f nitroglycerinx f andx f callx f 911x f tox f activatex f emergencyx f medicalx f service
s.-
:x f Administerxfnitroglycerinxfandxfcallxf911xftoxfactivatexfemergencyxfmedicalxfservices.
4. Whichxfofxfthexffollowingxfpatientsxfisxfthexfusexfofxfaxfdirectxforalxfanticoagulant
xf(DOAC)xfmostxfappropriate?
Ax f 78-year-
, xf xf xf
oldx f manx f withx f ax f prostheticx f heartx f valvex f andx f recentx f historyx f ofx f transientxfische
micxfattack
Axf62-year-
oldxfwomanxfwithxfaxfhistoryxfofxfvenousxfthromboticxfeventxfandxfanxfup-
comingxfsurgery
Ax f 62-year-oldx f manx f withx f atrialx f fibrillation
, xf xf xf
Axf64-year-oldxfmalexfwithxfpulmonaryxfembolismxfandxfpepticxfulcer:xfAxf62-year-
oldxfmanxfwithxfatrialxffibrillation
5. WhatxfisxfthexfgoalxfINRxfforxfaxf56-year-
oldxfmalexfpatientxfwithxfatrialxffibrillationxftakingxfwarfarin?
1.0-2.0
2.0-3.0
3.0-3.5
3.5-4.0:x f 2.0-3.0
6. recommendedx f forx f patientsx f withx f atrialx f fibrillationx f tox f preventx f thex f formati
onxfofxfbloodxfclotsxfinxfthexfheartxfchambersxfthatxfcanxfleadxftoxfaxfstroke.:xfLifelongxfanticoagu
lantxftherapy
7. INRxfprolongationxfisxfseenxfinxfaboutxf
hoursxfafterxfthexffirstxfwarfarinx f dose:xf48xftoxf72
8. Jimx f isx f ax f 47-year-
oldx f malex f whox f presentsx f withx f complaintsx f ofx f chestx f pain,x f short-
nessxfofxfbreathxfandxfnauseaxfthatxfhasxflastedxfoverxfonexfhour.xfHexfstatesxfthatxfhexf
thinksxfhexfisxfhavingxfaxfheartxfattack.xfWhichxfofxfthexffollowingxfisxfanxfexpectedxffin
dingx f observedx f onx f anx f electrocardiogramx f (ECG)x f ofx f ax f personx f experiencingx f ax
fmyocardialxfinfarction?
AbsencexfofxfpathologicalxfQxfwaves
xfST-segmentxfelevation
QTcxfprolongation
QR-segmentx f depression:x f ST-segmentxfelevation
9. cardiacx f enzymesx f (suchx f asx f CK-
MBx f andx f troponin)x f arex f typicallyx f detectedx f inx f thexfserumxf
afterx f onsetx f ofx f anx f MI,x f thex f ECGx f isx f anx f importantx f diagnosticxftoolx f withinx f the
x f firstx f fewx f hoursx f afterx f thex f MIx f tox f confirmx f thex f diagnosis.:x f 5-7xfhours
10. anxfimportantxfdiagnosticxftoolxfwithinxfthexffirstxffewxfhoursxfafterxfthexfMIxft
oxfconfirmxfthexfdiagnosis.:xfECG
11. Jimxfisxfaxf68-year-oldxfmanxfwhoxfhasxfaxf60xfpack-yearxfsmokingxfhistory,xf20-
, xf xf xf
yearxfhistoryx f ofx f hypertensionx f withx f intermittentx f usex f ofx f anti-
hypertensionx f medica-tions,xfandxfaxf15-
yearxfhistoryxfofxfdyslipidemia.xfAtxftoday'sxfvisitxfhexfstates,xf"Heart
1. Whichx f ofx f thex f followingx f isx f leastx f consistentx f withx f ax f 55-year-
oldx f manx f withx f hyper-
tensionxfandxfdyslipidemiaxfwhoxfisxfpresentingxfwithxfacutexfcoronaryxfsyndrome?
Diaphoresisxfandxfnausea
Ill-
definedxfpainxfthatxfoftenxfradiatesxfRetrosternalxf
painxfforxf30xfminutes
Localizedxfchestxfpainxfthatxfpersistsxfforxfupxftoxf15xfminutes:xfLocalizedxfchestxfpainxfthatxfpersist
sxfforxfupxftoxf15xfminutes
2. Majorxfriskxffactorsxfforxfheartxffailurexfincludexfallxfofxfthexffollowingxfexcept:
Coronaryxfarteryxfdisease.xfMitr
alxfvalvexfprolapse.
Long-standingx f poorly-
controlledx f hypertension.x f Sleepxfapnea.:xfMitralxfvalv
exfprolapse.
3. Youx f seex f ax f 62-year-oldx f malex f withx f COPDx f whox f isx f scheduledx f forx f ax f follow-
upx f onxfrecentx f hospitalizationx f forx f COPDx f exacerbation.x f Asx f hex f ambulatesx f into
x f thex f examxfroom,x f hex f beginsx f tox f stagger,x f perspiresx f profusely,x f andx f complains
x f ofx f generalizedxfpainxfandxfaxftightening xffeeling xfinxfhis xfchest.xfThexfmostxfappropr
iatexfactionxfisxfto:
Havex f himx f liex f downx f withx f feetx f elevatedx f forx f 10x f minutesx f beforex f resumingx f thex
f test.xfObtainxfan xfECGxftoxfdetectxfheartxfrhythmxfabnormalities.
Immediatelyx f initiatex f oxygenx f therapy.
Administerx f nitroglycerinx f andx f callx f 911x f tox f activatex f emergencyx f medicalx f service
s.-
:x f Administerxfnitroglycerinxfandxfcallxf911xftoxfactivatexfemergencyxfmedicalxfservices.
4. Whichxfofxfthexffollowingxfpatientsxfisxfthexfusexfofxfaxfdirectxforalxfanticoagulant
xf(DOAC)xfmostxfappropriate?
Ax f 78-year-
, xf xf xf
oldx f manx f withx f ax f prostheticx f heartx f valvex f andx f recentx f historyx f ofx f transientxfische
micxfattack
Axf62-year-
oldxfwomanxfwithxfaxfhistoryxfofxfvenousxfthromboticxfeventxfandxfanxfup-
comingxfsurgery
Ax f 62-year-oldx f manx f withx f atrialx f fibrillation
, xf xf xf
Axf64-year-oldxfmalexfwithxfpulmonaryxfembolismxfandxfpepticxfulcer:xfAxf62-year-
oldxfmanxfwithxfatrialxffibrillation
5. WhatxfisxfthexfgoalxfINRxfforxfaxf56-year-
oldxfmalexfpatientxfwithxfatrialxffibrillationxftakingxfwarfarin?
1.0-2.0
2.0-3.0
3.0-3.5
3.5-4.0:x f 2.0-3.0
6. recommendedx f forx f patientsx f withx f atrialx f fibrillationx f tox f preventx f thex f formati
onxfofxfbloodxfclotsxfinxfthexfheartxfchambersxfthatxfcanxfleadxftoxfaxfstroke.:xfLifelongxfanticoagu
lantxftherapy
7. INRxfprolongationxfisxfseenxfinxfaboutxf
hoursxfafterxfthexffirstxfwarfarinx f dose:xf48xftoxf72
8. Jimx f isx f ax f 47-year-
oldx f malex f whox f presentsx f withx f complaintsx f ofx f chestx f pain,x f short-
nessxfofxfbreathxfandxfnauseaxfthatxfhasxflastedxfoverxfonexfhour.xfHexfstatesxfthatxfhexf
thinksxfhexfisxfhavingxfaxfheartxfattack.xfWhichxfofxfthexffollowingxfisxfanxfexpectedxffin
dingx f observedx f onx f anx f electrocardiogramx f (ECG)x f ofx f ax f personx f experiencingx f ax
fmyocardialxfinfarction?
AbsencexfofxfpathologicalxfQxfwaves
xfST-segmentxfelevation
QTcxfprolongation
QR-segmentx f depression:x f ST-segmentxfelevation
9. cardiacx f enzymesx f (suchx f asx f CK-
MBx f andx f troponin)x f arex f typicallyx f detectedx f inx f thexfserumxf
afterx f onsetx f ofx f anx f MI,x f thex f ECGx f isx f anx f importantx f diagnosticxftoolx f withinx f the
x f firstx f fewx f hoursx f afterx f thex f MIx f tox f confirmx f thex f diagnosis.:x f 5-7xfhours
10. anxfimportantxfdiagnosticxftoolxfwithinxfthexffirstxffewxfhoursxfafterxfthexfMIxft
oxfconfirmxfthexfdiagnosis.:xfECG
11. Jimxfisxfaxf68-year-oldxfmanxfwhoxfhasxfaxf60xfpack-yearxfsmokingxfhistory,xf20-
, xf xf xf
yearxfhistoryx f ofx f hypertensionx f withx f intermittentx f usex f ofx f anti-
hypertensionx f medica-tions,xfandxfaxf15-
yearxfhistoryxfofxfdyslipidemia.xfAtxftoday'sxfvisitxfhexfstates,xf"Heart
