BARKLEY EMERGENCY/CRITICAL CARE PRACTICE
EXAM Comprehensive 200 Question Practice
Examination – New Edition
Section I: Cardiovascular Emergencies
Question 1
A 58-year-old male presents with crushing substernal chest pain
radiating to the left arm and jaw, diaphoresis, and nausea. His ECG shows
ST elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
Correct Answer: C
Rationale: ST elevation in leads II, III, and aVF indicates an inferior
wall myocardial infarction, which is most commonly caused by
occlusion of the right coronary artery (RCA). The LAD (A) supplies
the anterior wall (leads V1–V4). The circumflex (B) supplies the
lateral wall (leads I, aVL, V5–V6). The left main (D) supplies a large
territory and would cause widespread changes.
,Question 2
A 62-year-old female presents with acute onset of severe dyspnea,
orthopnea, and pink frothy sputum. Her blood pressure is 180/100 mmHg,
heart rate 120 bpm, and oxygen saturation 82% on room air. Which
medication is most appropriate initially?
A) IV furosemide
B) IV metoprolol
C) IV diltiazem
D) Oral lisinopril
Correct Answer: A
Rationale: This patient is presenting with acute decompensated
heart failure and pulmonary edema with adequate blood pressure. IV
furosemide is the first-line medication to reduce preload and relieve
pulmonary congestion. IV metoprolol (B) and IV diltiazem (C) are
rate-control agents that may worsen heart failure acutely. Oral
lisinopril (D) is not appropriate for acute management.
Question 3
A 55-year-old male presents with a heart rate of 180 bpm, narrow-
complex tachycardia, and stable blood pressure. Which intervention is
most appropriate initially?
A) Synchronized cardioversion
B) Adenosine 6 mg IV push
C) Amiodarone 150 mg IV
D) Defibrillation
,Correct Answer: B
Rationale: For stable narrow-complex tachycardia (likely SVT),
adenosine is the first-line pharmacologic intervention after vagal
maneuvers. Synchronized cardioversion (A) is for unstable patients.
Amiodarone (C) is for ventricular arrhythmias. Defibrillation (D) is
for pulseless ventricular tachycardia or ventricular fibrillation.
Question 4
A 70-year-old male presents with a heart rate of 40 bpm, hypotension,
and confusion. His ECG shows a third-degree heart block. What is the
most appropriate immediate treatment?
A) Atropine
B) Transcutaneous pacing
C) Dopamine infusion
D) All of the above
Correct Answer: D
Rationale: For symptomatic bradycardia with third-degree heart
block, atropine, transcutaneous pacing, and dopamine are all
appropriate. Atropine is first-line, but pacing may be required if
atropine fails.
Question 5
A 65-year-old female presents with sudden onset of tearing chest pain
radiating to the back. Her blood pressure is 200/110 mmHg in the right
arm and 160/90 mmHg in the left arm. What is the most important initial
diagnostic test?
, A) EKG
B) Chest X-ray
C) CT angiography
D) Troponin
Correct Answer: C
Rationale: The presentation is concerning for aortic dissection. CT
angiography is the gold standard for diagnosis. EKG (A) rules out MI
but is not definitive. Chest X-ray (B) may show widened mediastinum
but is not diagnostic. Troponin (D) is for MI.
Question 6
A 60-year-old male is in pulseless ventricular tachycardia. What is the
immediate treatment?
A) Defibrillation
B) Amiodarone
C) CPR
D) Both A and C
Correct Answer: D
Rationale: Pulseless VT requires immediate defibrillation and high-
quality CPR. Amiodarone (B) is given after defibrillation attempts.
Question 7
A 55-year-old female has a blood pressure of 220/120 mmHg with chest
pain and pulmonary edema. What is the most appropriate treatment?
A) Oral antihypertensives
B) IV nitroprusside
EXAM Comprehensive 200 Question Practice
Examination – New Edition
Section I: Cardiovascular Emergencies
Question 1
A 58-year-old male presents with crushing substernal chest pain
radiating to the left arm and jaw, diaphoresis, and nausea. His ECG shows
ST elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
Correct Answer: C
Rationale: ST elevation in leads II, III, and aVF indicates an inferior
wall myocardial infarction, which is most commonly caused by
occlusion of the right coronary artery (RCA). The LAD (A) supplies
the anterior wall (leads V1–V4). The circumflex (B) supplies the
lateral wall (leads I, aVL, V5–V6). The left main (D) supplies a large
territory and would cause widespread changes.
,Question 2
A 62-year-old female presents with acute onset of severe dyspnea,
orthopnea, and pink frothy sputum. Her blood pressure is 180/100 mmHg,
heart rate 120 bpm, and oxygen saturation 82% on room air. Which
medication is most appropriate initially?
A) IV furosemide
B) IV metoprolol
C) IV diltiazem
D) Oral lisinopril
Correct Answer: A
Rationale: This patient is presenting with acute decompensated
heart failure and pulmonary edema with adequate blood pressure. IV
furosemide is the first-line medication to reduce preload and relieve
pulmonary congestion. IV metoprolol (B) and IV diltiazem (C) are
rate-control agents that may worsen heart failure acutely. Oral
lisinopril (D) is not appropriate for acute management.
Question 3
A 55-year-old male presents with a heart rate of 180 bpm, narrow-
complex tachycardia, and stable blood pressure. Which intervention is
most appropriate initially?
A) Synchronized cardioversion
B) Adenosine 6 mg IV push
C) Amiodarone 150 mg IV
D) Defibrillation
,Correct Answer: B
Rationale: For stable narrow-complex tachycardia (likely SVT),
adenosine is the first-line pharmacologic intervention after vagal
maneuvers. Synchronized cardioversion (A) is for unstable patients.
Amiodarone (C) is for ventricular arrhythmias. Defibrillation (D) is
for pulseless ventricular tachycardia or ventricular fibrillation.
Question 4
A 70-year-old male presents with a heart rate of 40 bpm, hypotension,
and confusion. His ECG shows a third-degree heart block. What is the
most appropriate immediate treatment?
A) Atropine
B) Transcutaneous pacing
C) Dopamine infusion
D) All of the above
Correct Answer: D
Rationale: For symptomatic bradycardia with third-degree heart
block, atropine, transcutaneous pacing, and dopamine are all
appropriate. Atropine is first-line, but pacing may be required if
atropine fails.
Question 5
A 65-year-old female presents with sudden onset of tearing chest pain
radiating to the back. Her blood pressure is 200/110 mmHg in the right
arm and 160/90 mmHg in the left arm. What is the most important initial
diagnostic test?
, A) EKG
B) Chest X-ray
C) CT angiography
D) Troponin
Correct Answer: C
Rationale: The presentation is concerning for aortic dissection. CT
angiography is the gold standard for diagnosis. EKG (A) rules out MI
but is not definitive. Chest X-ray (B) may show widened mediastinum
but is not diagnostic. Troponin (D) is for MI.
Question 6
A 60-year-old male is in pulseless ventricular tachycardia. What is the
immediate treatment?
A) Defibrillation
B) Amiodarone
C) CPR
D) Both A and C
Correct Answer: D
Rationale: Pulseless VT requires immediate defibrillation and high-
quality CPR. Amiodarone (B) is given after defibrillation attempts.
Question 7
A 55-year-old female has a blood pressure of 220/120 mmHg with chest
pain and pulmonary edema. What is the most appropriate treatment?
A) Oral antihypertensives
B) IV nitroprusside
