LTC Rosh Cardio UPDATED ACTUAL Questions and CORRECT Answers
1. The emergency department staff began treatment for Continued chest pain
a woman who presented with chest pain. The pain is
described as retrosternal, worse with minimal activity,
better with rest, sharp in character and 9/10 in inten-
sity. You are paged to admit her to the intensive care
unit under the working diagnosis of unstable angina.
Her vitals have remained stable after beginning an-
tiplatelet, antihypertensive and antithrombotic med-
ications. Two hours after admission, a repeat history
and physical and review of available test results offers
the following information: serial electrocardiograms
reveal increasing R wave amplitude; an echocardio-
gram calculates an ejection fraction of 50%; angina is
reported as 9/10 in intensity; atrial natriuretic peptide
levels are elevated. Which of the following historical
facts would prompt you to immediately consult inter-
ventional cardiology for invasive coronary revascular-
ization?
2. A 65-year-old man presents to the ED for chest pain. Administer clopidogrel
You are concerned for acute coronary syndrome and
want to administer aspirin, but the patient states that
he develops angioedema to aspirin. Which of the fol-
lowing is the most appropriate next step in manage-
ment?
3. A 30-year-old woman with no past medical history pre- Reassurance
sents to the emergency department with substernal
chest pain for two hours. It is not worse with exertion
and was not relieved by sublingual nitroglycerin. She
reports some mild nausea. She does not smoke cig-
arettes or use any illicit drugs. Her family history in-
, cludes a grandmother who died of a myocardial infarc-
tion at 84 years old. Labs in the emergency department
are unremarkable. Point of care troponin is negative,
and ECG reveals sinus rhythm. What is your next step
in management?
4. Which of the following is correct regarding cardiac Serum troponin is more
markers in regards to myocardial infarction? sensitive than creatinine
phosphokinase (CK-MB)
5. A 65-year-old man presents to the ED with sudden Sildenafil
onset of chest pain that began two hours prior to
arrival. He has a history of hypertension treated with
hydrochlorothiazide, hyperlipidemia treated with sim-
vastatin, erectile dysfunction treated with sildenafil,
and takes a daily aspirin. An ECG demonstrates an an-
terior wall myocardial infarction. Which of the patient's
home medications serves as a contraindication for the
use of nitroglycerin to treat his chest pain?
6. Which of the following patients should be classified as A 55-year-old woman with
having unstable angina? a history of hypertension
but no prior cardiac dis-
ease who complains of
one episode of chest pres-
sure that began while
pushing her grocery cart
and lasted 30 minutes
7. Which of the following treatments has a proven mor- ASA
tality benefit in ST-elevation myocardial infarction?
8. Ischemic heart disease
, Which of the following is the most common cause of
sudden cardiac arrest and sudden cardiac death?
9. A 55-year-old man with no history of atherosclerotic Use a cardiovascular risk
cardiovascular disease or diabetes mellitus presents calculator to determine the
to your office with questions about his cholesterol. He patient's 10-year risk for
was previously taking atorvastatin, but stopped be- atherosclerotic cardiovas-
cause his fasting low-density lipoprotein (LDL) choles- cular disease
terol level dropped to 90 mg/dL and he was following
the lifestyle modifications you previously recommend-
ed. Based on the 2018 American College of Cardiol-
ogy/American Heart Association cholesterol manage-
ment guidelines, which of the following is the most
appropriate next step in his management?
10. Which of the following statements is most accurate Up to 33% of patients di-
regarding acute ischemic heart disease? agnosed with acute my-
ocardial infarction do not
have chest pain on pre-
sentation
11. A 70-year-old woman with a long history of coronary Add ranolozine
artery disease is seen in cardiology clinic for routine
follow up. She complains of continued angina despite
medical therapy. She reports chest pain every time she
walks to her mailbox. It does not occur at rest and is
relieved by sublingual nitroglycerin. Her medications
include carvedilol, amlodipine, daytime transdermal
nitroglycerine, sublingual nitroglycerin, aspirin, and
simvastatin. On physical exam her BP is 105/72, HR is
51 and RR 16. What is the next step in management?
12. Non-STEMI
1. The emergency department staff began treatment for Continued chest pain
a woman who presented with chest pain. The pain is
described as retrosternal, worse with minimal activity,
better with rest, sharp in character and 9/10 in inten-
sity. You are paged to admit her to the intensive care
unit under the working diagnosis of unstable angina.
Her vitals have remained stable after beginning an-
tiplatelet, antihypertensive and antithrombotic med-
ications. Two hours after admission, a repeat history
and physical and review of available test results offers
the following information: serial electrocardiograms
reveal increasing R wave amplitude; an echocardio-
gram calculates an ejection fraction of 50%; angina is
reported as 9/10 in intensity; atrial natriuretic peptide
levels are elevated. Which of the following historical
facts would prompt you to immediately consult inter-
ventional cardiology for invasive coronary revascular-
ization?
2. A 65-year-old man presents to the ED for chest pain. Administer clopidogrel
You are concerned for acute coronary syndrome and
want to administer aspirin, but the patient states that
he develops angioedema to aspirin. Which of the fol-
lowing is the most appropriate next step in manage-
ment?
3. A 30-year-old woman with no past medical history pre- Reassurance
sents to the emergency department with substernal
chest pain for two hours. It is not worse with exertion
and was not relieved by sublingual nitroglycerin. She
reports some mild nausea. She does not smoke cig-
arettes or use any illicit drugs. Her family history in-
, cludes a grandmother who died of a myocardial infarc-
tion at 84 years old. Labs in the emergency department
are unremarkable. Point of care troponin is negative,
and ECG reveals sinus rhythm. What is your next step
in management?
4. Which of the following is correct regarding cardiac Serum troponin is more
markers in regards to myocardial infarction? sensitive than creatinine
phosphokinase (CK-MB)
5. A 65-year-old man presents to the ED with sudden Sildenafil
onset of chest pain that began two hours prior to
arrival. He has a history of hypertension treated with
hydrochlorothiazide, hyperlipidemia treated with sim-
vastatin, erectile dysfunction treated with sildenafil,
and takes a daily aspirin. An ECG demonstrates an an-
terior wall myocardial infarction. Which of the patient's
home medications serves as a contraindication for the
use of nitroglycerin to treat his chest pain?
6. Which of the following patients should be classified as A 55-year-old woman with
having unstable angina? a history of hypertension
but no prior cardiac dis-
ease who complains of
one episode of chest pres-
sure that began while
pushing her grocery cart
and lasted 30 minutes
7. Which of the following treatments has a proven mor- ASA
tality benefit in ST-elevation myocardial infarction?
8. Ischemic heart disease
, Which of the following is the most common cause of
sudden cardiac arrest and sudden cardiac death?
9. A 55-year-old man with no history of atherosclerotic Use a cardiovascular risk
cardiovascular disease or diabetes mellitus presents calculator to determine the
to your office with questions about his cholesterol. He patient's 10-year risk for
was previously taking atorvastatin, but stopped be- atherosclerotic cardiovas-
cause his fasting low-density lipoprotein (LDL) choles- cular disease
terol level dropped to 90 mg/dL and he was following
the lifestyle modifications you previously recommend-
ed. Based on the 2018 American College of Cardiol-
ogy/American Heart Association cholesterol manage-
ment guidelines, which of the following is the most
appropriate next step in his management?
10. Which of the following statements is most accurate Up to 33% of patients di-
regarding acute ischemic heart disease? agnosed with acute my-
ocardial infarction do not
have chest pain on pre-
sentation
11. A 70-year-old woman with a long history of coronary Add ranolozine
artery disease is seen in cardiology clinic for routine
follow up. She complains of continued angina despite
medical therapy. She reports chest pain every time she
walks to her mailbox. It does not occur at rest and is
relieved by sublingual nitroglycerin. Her medications
include carvedilol, amlodipine, daytime transdermal
nitroglycerine, sublingual nitroglycerin, aspirin, and
simvastatin. On physical exam her BP is 105/72, HR is
51 and RR 16. What is the next step in management?
12. Non-STEMI
