Emergency Medicine EOR Exam with
verified answers
Dilated Cardiomyopathy: most common cause is ____. Others? - ANSWERSalcohol;
may also be idiopathic, myocarditis, or drugs (doxorubicin) -- 1 in 3 cases of heart
failure are caused by dilated cardiomyopathy
What PE and EKG changes are seen with dilated cardiomyopathy? - ANSWERSPE:
S3, JVD, crackles - possible mitral regurg
EKG: nonspecific ST and T wave changes, LBBB
Hypertrophic cardiomyopathy: is due to hypertrophy of the _____. PE reveals mitral
regurgitation, a ____heart sound, and prominent left ventricular impulse. EKG reveals
LVH - ANSWERScardiac septum; S4
Restrictive cardiomyopathy: often caused by a ____process, or post-radiation or post
open-heart surgery. What is the most common first symptom? - ANSWERS--infiltrative
process - amyloidosis, sarcoidosis, and hemochromatosis -- changes in myocardium
--most common first symptom is exertion intolerance and fluid retention, signs of right
heart failure
Atrial fibrillation - regularly irregular - the most common sustained arrhythmia in adults -
what three treatments are used? - ANSWERS1. rate control w BB, CCB, or digoxin
2. Anticoagulation w heparin & warfarin
3. rhythm control w amiodarone or cardioversion
Atrial flutter - sawtooth pattern in II, III, aVF - what three treatments are used? -
ANSWERS1. cardioversion if no contraindications
2. acute rate control tx w BB, CCB - amiodarone, sotalol, quinidine, or procainamide
3. If site of reentrant is known, catheter ablation
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? - ANSWERSCCB
BLOCKS
1. ____=prolonged PR interval
2.____=progressive increase in PR until Pwave is blocked.
3._____=sudden block in P wave w no change in PR
4._____=atrial and ventricular rhythm are independent of each other. - ANSWERSFirst
degree; Wenckebach Mobitz type I; Mobitz type II, Third degree block
A _____may develop after acute MI, PE, aortic stenosis and is due to a conduction
delay in the right or left bundles. - ANSWERSBundle branch block
, Paroxysmal supraventricular tachycardia is a reentry tachycardia, commonly noted in
elderly patients with underlying heart disease. What treatment may be helpful before
using adenosine ie. the drug of choice? - ANSWERSvagal maneuvers or antianxiety
medication
What are some drugs associated with Torsades de pointes? - ANSWERStricyclic
antidepressants, erythromycin, ketoconazole, haloperidol, cisapride, disopyramide,
pentamidine, sotalol, class I anti-arrhythmics
CHF - Systolic dysfunction means a problem with the ____. What drug is
contraindicated? - ANSWERSpump; CCB!
CHF - Diastolic dysfunction means a problem with the ____. - ANSWERScompliance
or relaxation of the heart during ventricular filling
The ________principle means that as preload increases, the ventricle is stretched
during diastole filling and the ejection fraction is increased. - ANSWERSFrank-Starling
principle
_____is released from cardiac ventricles in response to increased wall tension. -
ANSWERSBNP - B-type natriuretic peptide
What is the pharmacologic therapy for heart failure? - ANSWERS1. diuretics for fluid
retention
2. ACEi
3. vasodilators (hydralazine & nitrates)
4. BB for LV dysfunction
5. digitalis to increase cardiac contractility
Functional Classification of Heart Failure:
___-No cardiac symptoms with ordinary activity.
___-Cardiac symptoms w MARKED activity but asymptomatic at rest
___-Cardiac symptoms w MILD activity but asymptomatic at rest
___-Cardiac symptoms at rest. - ANSWERSClass I, Class II, Class III, Class IV
Stage 1 Hypertension is defined as greater than ____. Stage 2 Hypertension is defined
as greater than ____. - ANSWERS140/90; 160/100
Hypertension Drug of Choice for:
angina
diabetes
hyperlipidemia
CHF
Previous MI
Chronic Renal Failure
,Asthma, COPD - ANSWERSAngina - BB, CCB
Diabetes - ACEi & CCB, avoid diuretics
Hyperlipidemia - ACEi & CCB, avoid diuretics/BB
CHF - diuretics & ACEi, avoid CCB/BB
Previous MI - BB/ACEi
Chronic renal failure - diuretics, CCB
Asthma - diuretics & CCB, avoid BB
Secondary hypertension is HTN due to an ______. - ANSWERSidentifiable cause ie.
renovascular disease, coarctation of the aorta, primary aldosteronism, Cushing's,
Pheochromocytoma, OSA, renal parenchymal hypertension
____hypertension is potentially life threatening - HTN plus rentinopathy,
cardiovascular/renal compromise, or encephalopathy. - ANSWERSMalignant
Malignant hypertension bp? What is the rule of thumb for lowering? -
ANSWERSgreater than 220/140; 10% in first hour and 15% for the next 3-12 hours, to
normal over next 2 days
What is the agent of choice for BP lowering for patients with hypertensive
encephalopathy, intracranial bleeding, and heart failure? Use with what for dissecting
aneurysm? - ANSWERSnitroprusside; propranolol -- clonidine can also be used but
sedation is common
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? - ANSWERS90mmHg;
1. IV Fluids
2. Vasopressors - dopasmine, dobutamine (risk is aggravation of arrhythmias and
increase myocardial oxygen demand)
3. intra-aortic balloon pump
ST Elevations in II, III, aVF - ANSWERSInferior MI; right coronary artery
ST Elevations in I, aVL, V4, V5, V6 - ANSWERSlateral wall MI, left circumflex artery
ST Elevations in V1, V2, V3, V4, V5 - ANSWERSAnterioseptal MI, left anterior
descending artery
ST Elevations in V1, V2 - ANSWERSposterior wall MI, posterior descending artery
No nitroglycerin in which kind of MI? - ANSWERSinferior
What are the pre hospital treatments for ACS? - ANSWERSMONA; morphine, oxygen,
nitroglycerin (0.4mg SL x3 prn), aspirin (325mg)
, What two meds should be given to all ACS patients that do not have contraindications?
- ANSWERSBB - unless brady or severe COPD - then do NDCCB (verapamil/diltiazem)
ACEi - if cough, use ARB
What are the adjunctive tx for fibrinolysis or PCI? - ANSWERS1. antiplatelets (ASA,
clopidogrel)
2. anticoagulants (UFH, LMWH, DTI, direct factor Xai)
How long should Plavix/Clopidogrel be used for bare metal or drug eluting stents? -
ANSWERSbare metal - 30d-12m
drug eluting - >/=12mon
What meds should a patient go home with after ACS? - ANSWERSNitroglycerin
BB
ACEi
ASA/Clopidogrel
anticoagulant (up to 8days for LMWH)
aldosterone agonist
statin
LIFESTYLE CHANGES
Cardiac Markers: _____is detectable within 1-2 hours after acute MI. Duration <1 day.
Low specificity. - ANSWERSMyoglobin
Cardiac Markers: _____is the test of choice and appears 2-6 hours after MI and stays
elevated for 5-10 days. - ANSWERSTroponin
Cardiac Markers: _____appears 3-6 hours after MI and stays elevated for 2-4 days.
Specific to heart muscle. - ANSWERSCreatine kinase Mb
Timeline:
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. - ANSWERS12; 30min; 90min
Cardiology - ANSWERSis fun!
What are the treatments for bradyarrhythmias? - ANSWERSatropine, pacing, or
epinephrine/dopamine
For synchronized cardioversion, use ____Joules for paroxysmal supraventricular
tachycardia and _____Joules for a fib and VT. - ANSWERS50J, 100J
_____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
verified answers
Dilated Cardiomyopathy: most common cause is ____. Others? - ANSWERSalcohol;
may also be idiopathic, myocarditis, or drugs (doxorubicin) -- 1 in 3 cases of heart
failure are caused by dilated cardiomyopathy
What PE and EKG changes are seen with dilated cardiomyopathy? - ANSWERSPE:
S3, JVD, crackles - possible mitral regurg
EKG: nonspecific ST and T wave changes, LBBB
Hypertrophic cardiomyopathy: is due to hypertrophy of the _____. PE reveals mitral
regurgitation, a ____heart sound, and prominent left ventricular impulse. EKG reveals
LVH - ANSWERScardiac septum; S4
Restrictive cardiomyopathy: often caused by a ____process, or post-radiation or post
open-heart surgery. What is the most common first symptom? - ANSWERS--infiltrative
process - amyloidosis, sarcoidosis, and hemochromatosis -- changes in myocardium
--most common first symptom is exertion intolerance and fluid retention, signs of right
heart failure
Atrial fibrillation - regularly irregular - the most common sustained arrhythmia in adults -
what three treatments are used? - ANSWERS1. rate control w BB, CCB, or digoxin
2. Anticoagulation w heparin & warfarin
3. rhythm control w amiodarone or cardioversion
Atrial flutter - sawtooth pattern in II, III, aVF - what three treatments are used? -
ANSWERS1. cardioversion if no contraindications
2. acute rate control tx w BB, CCB - amiodarone, sotalol, quinidine, or procainamide
3. If site of reentrant is known, catheter ablation
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? - ANSWERSCCB
BLOCKS
1. ____=prolonged PR interval
2.____=progressive increase in PR until Pwave is blocked.
3._____=sudden block in P wave w no change in PR
4._____=atrial and ventricular rhythm are independent of each other. - ANSWERSFirst
degree; Wenckebach Mobitz type I; Mobitz type II, Third degree block
A _____may develop after acute MI, PE, aortic stenosis and is due to a conduction
delay in the right or left bundles. - ANSWERSBundle branch block
, Paroxysmal supraventricular tachycardia is a reentry tachycardia, commonly noted in
elderly patients with underlying heart disease. What treatment may be helpful before
using adenosine ie. the drug of choice? - ANSWERSvagal maneuvers or antianxiety
medication
What are some drugs associated with Torsades de pointes? - ANSWERStricyclic
antidepressants, erythromycin, ketoconazole, haloperidol, cisapride, disopyramide,
pentamidine, sotalol, class I anti-arrhythmics
CHF - Systolic dysfunction means a problem with the ____. What drug is
contraindicated? - ANSWERSpump; CCB!
CHF - Diastolic dysfunction means a problem with the ____. - ANSWERScompliance
or relaxation of the heart during ventricular filling
The ________principle means that as preload increases, the ventricle is stretched
during diastole filling and the ejection fraction is increased. - ANSWERSFrank-Starling
principle
_____is released from cardiac ventricles in response to increased wall tension. -
ANSWERSBNP - B-type natriuretic peptide
What is the pharmacologic therapy for heart failure? - ANSWERS1. diuretics for fluid
retention
2. ACEi
3. vasodilators (hydralazine & nitrates)
4. BB for LV dysfunction
5. digitalis to increase cardiac contractility
Functional Classification of Heart Failure:
___-No cardiac symptoms with ordinary activity.
___-Cardiac symptoms w MARKED activity but asymptomatic at rest
___-Cardiac symptoms w MILD activity but asymptomatic at rest
___-Cardiac symptoms at rest. - ANSWERSClass I, Class II, Class III, Class IV
Stage 1 Hypertension is defined as greater than ____. Stage 2 Hypertension is defined
as greater than ____. - ANSWERS140/90; 160/100
Hypertension Drug of Choice for:
angina
diabetes
hyperlipidemia
CHF
Previous MI
Chronic Renal Failure
,Asthma, COPD - ANSWERSAngina - BB, CCB
Diabetes - ACEi & CCB, avoid diuretics
Hyperlipidemia - ACEi & CCB, avoid diuretics/BB
CHF - diuretics & ACEi, avoid CCB/BB
Previous MI - BB/ACEi
Chronic renal failure - diuretics, CCB
Asthma - diuretics & CCB, avoid BB
Secondary hypertension is HTN due to an ______. - ANSWERSidentifiable cause ie.
renovascular disease, coarctation of the aorta, primary aldosteronism, Cushing's,
Pheochromocytoma, OSA, renal parenchymal hypertension
____hypertension is potentially life threatening - HTN plus rentinopathy,
cardiovascular/renal compromise, or encephalopathy. - ANSWERSMalignant
Malignant hypertension bp? What is the rule of thumb for lowering? -
ANSWERSgreater than 220/140; 10% in first hour and 15% for the next 3-12 hours, to
normal over next 2 days
What is the agent of choice for BP lowering for patients with hypertensive
encephalopathy, intracranial bleeding, and heart failure? Use with what for dissecting
aneurysm? - ANSWERSnitroprusside; propranolol -- clonidine can also be used but
sedation is common
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? - ANSWERS90mmHg;
1. IV Fluids
2. Vasopressors - dopasmine, dobutamine (risk is aggravation of arrhythmias and
increase myocardial oxygen demand)
3. intra-aortic balloon pump
ST Elevations in II, III, aVF - ANSWERSInferior MI; right coronary artery
ST Elevations in I, aVL, V4, V5, V6 - ANSWERSlateral wall MI, left circumflex artery
ST Elevations in V1, V2, V3, V4, V5 - ANSWERSAnterioseptal MI, left anterior
descending artery
ST Elevations in V1, V2 - ANSWERSposterior wall MI, posterior descending artery
No nitroglycerin in which kind of MI? - ANSWERSinferior
What are the pre hospital treatments for ACS? - ANSWERSMONA; morphine, oxygen,
nitroglycerin (0.4mg SL x3 prn), aspirin (325mg)
, What two meds should be given to all ACS patients that do not have contraindications?
- ANSWERSBB - unless brady or severe COPD - then do NDCCB (verapamil/diltiazem)
ACEi - if cough, use ARB
What are the adjunctive tx for fibrinolysis or PCI? - ANSWERS1. antiplatelets (ASA,
clopidogrel)
2. anticoagulants (UFH, LMWH, DTI, direct factor Xai)
How long should Plavix/Clopidogrel be used for bare metal or drug eluting stents? -
ANSWERSbare metal - 30d-12m
drug eluting - >/=12mon
What meds should a patient go home with after ACS? - ANSWERSNitroglycerin
BB
ACEi
ASA/Clopidogrel
anticoagulant (up to 8days for LMWH)
aldosterone agonist
statin
LIFESTYLE CHANGES
Cardiac Markers: _____is detectable within 1-2 hours after acute MI. Duration <1 day.
Low specificity. - ANSWERSMyoglobin
Cardiac Markers: _____is the test of choice and appears 2-6 hours after MI and stays
elevated for 5-10 days. - ANSWERSTroponin
Cardiac Markers: _____appears 3-6 hours after MI and stays elevated for 2-4 days.
Specific to heart muscle. - ANSWERSCreatine kinase Mb
Timeline:
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. - ANSWERS12; 30min; 90min
Cardiology - ANSWERSis fun!
What are the treatments for bradyarrhythmias? - ANSWERSatropine, pacing, or
epinephrine/dopamine
For synchronized cardioversion, use ____Joules for paroxysmal supraventricular
tachycardia and _____Joules for a fib and VT. - ANSWERS50J, 100J
_____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
