FISDAP CARDIOLOGY EXAM SCRIPT UPDATED EXAM
QUESTIONS AND ANSWERS GRADED A+
✔✔lschemic heart disease is a condition in which:
A) a portion of the heart muscle dies because of a prolonged lack of oxygen
B) there is a decrease in blood flow to one or more portions of the heart muscle.
C) the coronary arteries dilate, thus preventing effective blood flow to the heart.
D) an acute event leads to a significant decrease in the pumping force of the heart. -
✔✔B) there is a decrease in blood flow to one or more portions of the heart muscle.
Chest pain or discomfort that is related to the heart usually stems from a condition
called ischemia (insufficient oxygen). Because of a partial or complete
blockage of blood flow through one or more coronary arteries, the tissue of the heart
muscle (myocardium) fails to get enough oxygen and nutrients relative
to its needs. Therefore, ischemic heart disease is a condition involving a decrease in
blood flow, and therefore oxygen, to one or more portions of the
myocardium. If blood flow to the ischemic portion of the myocardium is not restored, it
eventually dies (myocardial infarction). Dilation of the coronary
arteries increases, not decreases, blood flow to the heart. If an event such as a
myocardial infarction damages the heart and significantly decreases its ability
to contract forcefully, heart failure may occur.
✔✔A middle-aged woman with a history of hypertension and high cholesterol complains
of chest discomfort. She asks you to take her to the hospital where her personal
physician practices, which is 15 miles away. Her blood pressure is 130/70 mm Hg,
pulse is 84 beats/min and regular, and respirations are 18 breaths/min and unlabored.
Which of the following actions is clearly OT appropriate for this patient?
A) Giving oxygen via nasal cannula
B) Taking her to her choice hospital
C) Contacting her physician via phone
D) Allowing her to walk to the ambulance - ✔✔D) Allowing her to walk to the ambulance
You should NEVER allow a patient with a possible cardiac problem to walk to the
ambulance. This causes exertion, which increases cardiac oxygen
consumption and demand and could worsen his or her condition. Give the patient
oxygen in a concentration sufficient to maintain his or her oxygen
saturation equal to or greater than 94%. In general, you should transport patients to the
hospital of their choice. However, transport to a closer hospital
should be considered if you believe the patient is unstable or is at high risk for becoming
unstable. If necessary, consult with the patient's physician via phone
to determine if he or she thinks the patient should go to a closer hospital.
✔✔Shortly after assisting a 60-year-old woman with her second nitroglycerin treatment,
she tells you that she is lightheaded and feels as if she
is going to faint. Her symptoms are MOST likely due to:
A) low blood pressure.
,B) an irregular heartbeat.
C) nervousness and anxiety.
D) a drop in her blood sugar. - ✔✔A) low blood pressure.
Nitroglycerin (NTG) is a vasodilator; as such, it may cause a drop in blood pressure
(hypotension) in some patients. Signs and symptoms of hypotension
include dizziness, lightheadedness, and fainting (syncope), among others. For this
reason, you should always assess a patient's blood pressure before and
after administering nitroglycerin. If the patient's systolic BP is less than 100 mm Hg,
NTG should not be given. The patient is probably nervous and anxious,
and may even have an irregular heartbeat; however, hypotension is a more likely cause
of her symptoms. NTG does not affect a patient's blood sugar level.
✔✔Which of the following clinical presentations is MOST consistent with right heart
fajlure?
A) Tachycardia, poor skin turgor, and hypotension
B) Orthopnea, crackles in the lungs, and tachycardia
C) Peripheral edema and jugular venous distention
D) Paroxysmal nocturnal dyspnea and hypertension - ✔✔C) Peripheral edema and
jugular venous distention
When the right side of the heart fails, blood backs up beyond the right atrium and into
the systemic circulation. Right heart failure produces signs such as
peripheral edema, abdominal distention and pain, and jugular venous distention. When
the left side of the heart fails, blood backs up beyond the left atrium
and into the lungs. Left heart failure produces signs such as dyspnea on exertion,
positional dyspnea (orthopnea), paroxysmal nocturnal dyspnea, coughing
up blood (hemoptysis), and crackles in the lungs. In addition, patients with left heart fa
ilure are commonly hypertensive and tachycardic. Tachycardia, poor
skin turgor, and hypotension are clinical signs of severe dehydration, not heart failure.
✔✔Your assessment of a middle-aged woman with chest pressure reveals that she is
confused, is diaphoretic, and has a blood pressure of
70/50 mm Hg. In caring for this patient, it is MOST important for you to:
A) request an ALS unit to respond to the scene.
B) assist her with her nitroglycerin if she has any.
C) reasses her vital signs at least every 5 minutes.
D) prepare for immediate transport to the hospital. - ✔✔D) prepare for immediate
transport to the hospital.
Your patient is in shock, which is most likely the result of heart failure (cardiogenic
shock). Immediate transport to the closest appropriate hospital is critical.
Assess for and manage problems with airway, breathing, and circulation, and then get
on the road! She needs definitive care that can be provided only at the
hospital. Reassess her vital signs at least every 5 minutes, but do it en route! If you can
rendezvous with an ALS unit en route, do so. However, you should not
,remain at the scene to wait for them. Nitroglycerin is clearly contraindicated for this
patient; her BP is dangerously low.
✔✔A patient reports pain in the upper midabdominal area. This region of the abdomen
is called the:
A) peritoneum.
B) epigastrium.
C) mediastinum.
D) retroperitoneum. - ✔✔B) epigastrium.
The mid-upper region of the abdomen is referred to as the epigastrium because of its
location over the stomach (epi = upon, gastric= stomach). This is a
common site of pain or discomfort in patients experiencing a cardiac problem, which
frequently causes them to attribute their pain or discomfort to
indigestion
✔✔Which of the following is the MOST appropriate response when a patient with chest
pain asks you if he or she is having a heart attack?
A) Yes, so I recommend going to the hospital.
B) I don't know, but we will take good care of you.
C) Probably not, but we should transport you to be safe.
D) I believe you are, but only a physician can tell for sure. - ✔✔B) I don't know, but we
will take good care of you.
Patients experiencing chest pain often have a good idea about what is happening, so do
not lie or offer false reassurance. Conversely, do not tell patients they
are having a heart attack; EMTs are not trained to interpret the 12-lead ECG, and the
12-lead ECG is currently the only way a heart attack can be diagnosed in the
prehospital setting. If asked, "Am I having a heart attack?", an appropriate response
would be "I don't know for sure, but in case you are, we are going to
take good care of you."
✔✔When treating a patient with chest pain, pressure, or discomfort, you should FIRST:
A) administer supplemental oxygen
B) place the patient in a position of comfort.
C) request an ALS ambulance response to the scene.
D) assess the blood pressure and give nitroglycerin. - ✔✔B) place the patient in a
position of comfort.
An important aspect of treating a patient with chest pain, pressure, or discomfort is to
ensure that the patient is in a comfortable position. Most of the time,
the patient will already be in this position upon your arrival. A comfortable position will
help minimize anxiety, which in turn decreases cardiac oxygen
consumption and demand. The decision to administer supplemental oxygen depends on
the patient's oxygen saturation and/or whether or not respiratory
, distress is present. Following your assessment, if you feel that ALS support is needed,
you should request it. If the patient has prescribed, unexpired
nitroglycerin; the systolic blood pressure is greater than 100 mm Hg; and the patient has
not taken the maximum of three doses, you should contact medical
control to obtain permission to assist the patient in taking the nitroglycerin.
✔✔The MOST important initial treatment for a patient whose cardiac arrest was
witnessed is:
A) defibrillation.
B) cardiac drug therapy.
C) rapid transport.
D) high-quality CPR. - ✔✔D) high-quality CPR.
Regardless of whether a patient's cardiac arrest is witnessed or unwitnessed, the single
most important initial treatment is high-quality CPR. Delays in
performing CPR have been clearly linked to poor patient outcomes. After CPR has been
initiated, apply the AED as soon as it is available. Cardiac drug therapy
may enhance the patient's chance of survival. There is evidence suggesting that
transport to the hospital with CPR in progress does not improve survival;
resuscitation at the scene may be more beneficial for the patient; follow your local
protocols and current research trends. Minimally interrupted, highquality
CPR, however, is clearly linked to good patient outcomes.
✔✔In addition to chest pain or discomfort, a patient experiencing an acute coronary
syndrome would MOST likely present with:
A) ashen skin color, diaphoresis, and anxiety.
B) severe projectile vomiting and flush ed skin.
C) irregular breathing and low blood pressure.
D) profound cyanosis, dry skin, and a headache. - ✔✔A) ashen skin color, diaphoresis,
and anxiety.
Chest pain, pressure, or discomfort is the most common symptom of acute coronary
syndrome (ACS; eg, unstable angina, acute myocardial infarction); it
occurs in approximately 80% of cases. Patients with ACS are usually anxious and may
have a feeling of impending doom. Nausea and vomiting are common
complaints; however, projectile vomiting, which is typically associated with increased
intracranial pressure, is uncommon. The skin is often ashen gray and
clammy (diaphoretic) because of poor cardiac output and decreased perfusion. Less
commonly, the patient's skin is cyanotic. Respirations are usually
unlabored unless the patient has congestive heart fai lure, in which case respirations
are rapid and labored; irregular breathing, however, is not common.
Blood pressure may fall as a resu lt of decreased cardiac output; however, most
patients will have a normal or elevated blood pressure. If the patient
complains of a headache, it is usually a side effect of the nitroglycerin he or she took
before your arrival; ACS itself usually does not cause a headache.
QUESTIONS AND ANSWERS GRADED A+
✔✔lschemic heart disease is a condition in which:
A) a portion of the heart muscle dies because of a prolonged lack of oxygen
B) there is a decrease in blood flow to one or more portions of the heart muscle.
C) the coronary arteries dilate, thus preventing effective blood flow to the heart.
D) an acute event leads to a significant decrease in the pumping force of the heart. -
✔✔B) there is a decrease in blood flow to one or more portions of the heart muscle.
Chest pain or discomfort that is related to the heart usually stems from a condition
called ischemia (insufficient oxygen). Because of a partial or complete
blockage of blood flow through one or more coronary arteries, the tissue of the heart
muscle (myocardium) fails to get enough oxygen and nutrients relative
to its needs. Therefore, ischemic heart disease is a condition involving a decrease in
blood flow, and therefore oxygen, to one or more portions of the
myocardium. If blood flow to the ischemic portion of the myocardium is not restored, it
eventually dies (myocardial infarction). Dilation of the coronary
arteries increases, not decreases, blood flow to the heart. If an event such as a
myocardial infarction damages the heart and significantly decreases its ability
to contract forcefully, heart failure may occur.
✔✔A middle-aged woman with a history of hypertension and high cholesterol complains
of chest discomfort. She asks you to take her to the hospital where her personal
physician practices, which is 15 miles away. Her blood pressure is 130/70 mm Hg,
pulse is 84 beats/min and regular, and respirations are 18 breaths/min and unlabored.
Which of the following actions is clearly OT appropriate for this patient?
A) Giving oxygen via nasal cannula
B) Taking her to her choice hospital
C) Contacting her physician via phone
D) Allowing her to walk to the ambulance - ✔✔D) Allowing her to walk to the ambulance
You should NEVER allow a patient with a possible cardiac problem to walk to the
ambulance. This causes exertion, which increases cardiac oxygen
consumption and demand and could worsen his or her condition. Give the patient
oxygen in a concentration sufficient to maintain his or her oxygen
saturation equal to or greater than 94%. In general, you should transport patients to the
hospital of their choice. However, transport to a closer hospital
should be considered if you believe the patient is unstable or is at high risk for becoming
unstable. If necessary, consult with the patient's physician via phone
to determine if he or she thinks the patient should go to a closer hospital.
✔✔Shortly after assisting a 60-year-old woman with her second nitroglycerin treatment,
she tells you that she is lightheaded and feels as if she
is going to faint. Her symptoms are MOST likely due to:
A) low blood pressure.
,B) an irregular heartbeat.
C) nervousness and anxiety.
D) a drop in her blood sugar. - ✔✔A) low blood pressure.
Nitroglycerin (NTG) is a vasodilator; as such, it may cause a drop in blood pressure
(hypotension) in some patients. Signs and symptoms of hypotension
include dizziness, lightheadedness, and fainting (syncope), among others. For this
reason, you should always assess a patient's blood pressure before and
after administering nitroglycerin. If the patient's systolic BP is less than 100 mm Hg,
NTG should not be given. The patient is probably nervous and anxious,
and may even have an irregular heartbeat; however, hypotension is a more likely cause
of her symptoms. NTG does not affect a patient's blood sugar level.
✔✔Which of the following clinical presentations is MOST consistent with right heart
fajlure?
A) Tachycardia, poor skin turgor, and hypotension
B) Orthopnea, crackles in the lungs, and tachycardia
C) Peripheral edema and jugular venous distention
D) Paroxysmal nocturnal dyspnea and hypertension - ✔✔C) Peripheral edema and
jugular venous distention
When the right side of the heart fails, blood backs up beyond the right atrium and into
the systemic circulation. Right heart failure produces signs such as
peripheral edema, abdominal distention and pain, and jugular venous distention. When
the left side of the heart fails, blood backs up beyond the left atrium
and into the lungs. Left heart failure produces signs such as dyspnea on exertion,
positional dyspnea (orthopnea), paroxysmal nocturnal dyspnea, coughing
up blood (hemoptysis), and crackles in the lungs. In addition, patients with left heart fa
ilure are commonly hypertensive and tachycardic. Tachycardia, poor
skin turgor, and hypotension are clinical signs of severe dehydration, not heart failure.
✔✔Your assessment of a middle-aged woman with chest pressure reveals that she is
confused, is diaphoretic, and has a blood pressure of
70/50 mm Hg. In caring for this patient, it is MOST important for you to:
A) request an ALS unit to respond to the scene.
B) assist her with her nitroglycerin if she has any.
C) reasses her vital signs at least every 5 minutes.
D) prepare for immediate transport to the hospital. - ✔✔D) prepare for immediate
transport to the hospital.
Your patient is in shock, which is most likely the result of heart failure (cardiogenic
shock). Immediate transport to the closest appropriate hospital is critical.
Assess for and manage problems with airway, breathing, and circulation, and then get
on the road! She needs definitive care that can be provided only at the
hospital. Reassess her vital signs at least every 5 minutes, but do it en route! If you can
rendezvous with an ALS unit en route, do so. However, you should not
,remain at the scene to wait for them. Nitroglycerin is clearly contraindicated for this
patient; her BP is dangerously low.
✔✔A patient reports pain in the upper midabdominal area. This region of the abdomen
is called the:
A) peritoneum.
B) epigastrium.
C) mediastinum.
D) retroperitoneum. - ✔✔B) epigastrium.
The mid-upper region of the abdomen is referred to as the epigastrium because of its
location over the stomach (epi = upon, gastric= stomach). This is a
common site of pain or discomfort in patients experiencing a cardiac problem, which
frequently causes them to attribute their pain or discomfort to
indigestion
✔✔Which of the following is the MOST appropriate response when a patient with chest
pain asks you if he or she is having a heart attack?
A) Yes, so I recommend going to the hospital.
B) I don't know, but we will take good care of you.
C) Probably not, but we should transport you to be safe.
D) I believe you are, but only a physician can tell for sure. - ✔✔B) I don't know, but we
will take good care of you.
Patients experiencing chest pain often have a good idea about what is happening, so do
not lie or offer false reassurance. Conversely, do not tell patients they
are having a heart attack; EMTs are not trained to interpret the 12-lead ECG, and the
12-lead ECG is currently the only way a heart attack can be diagnosed in the
prehospital setting. If asked, "Am I having a heart attack?", an appropriate response
would be "I don't know for sure, but in case you are, we are going to
take good care of you."
✔✔When treating a patient with chest pain, pressure, or discomfort, you should FIRST:
A) administer supplemental oxygen
B) place the patient in a position of comfort.
C) request an ALS ambulance response to the scene.
D) assess the blood pressure and give nitroglycerin. - ✔✔B) place the patient in a
position of comfort.
An important aspect of treating a patient with chest pain, pressure, or discomfort is to
ensure that the patient is in a comfortable position. Most of the time,
the patient will already be in this position upon your arrival. A comfortable position will
help minimize anxiety, which in turn decreases cardiac oxygen
consumption and demand. The decision to administer supplemental oxygen depends on
the patient's oxygen saturation and/or whether or not respiratory
, distress is present. Following your assessment, if you feel that ALS support is needed,
you should request it. If the patient has prescribed, unexpired
nitroglycerin; the systolic blood pressure is greater than 100 mm Hg; and the patient has
not taken the maximum of three doses, you should contact medical
control to obtain permission to assist the patient in taking the nitroglycerin.
✔✔The MOST important initial treatment for a patient whose cardiac arrest was
witnessed is:
A) defibrillation.
B) cardiac drug therapy.
C) rapid transport.
D) high-quality CPR. - ✔✔D) high-quality CPR.
Regardless of whether a patient's cardiac arrest is witnessed or unwitnessed, the single
most important initial treatment is high-quality CPR. Delays in
performing CPR have been clearly linked to poor patient outcomes. After CPR has been
initiated, apply the AED as soon as it is available. Cardiac drug therapy
may enhance the patient's chance of survival. There is evidence suggesting that
transport to the hospital with CPR in progress does not improve survival;
resuscitation at the scene may be more beneficial for the patient; follow your local
protocols and current research trends. Minimally interrupted, highquality
CPR, however, is clearly linked to good patient outcomes.
✔✔In addition to chest pain or discomfort, a patient experiencing an acute coronary
syndrome would MOST likely present with:
A) ashen skin color, diaphoresis, and anxiety.
B) severe projectile vomiting and flush ed skin.
C) irregular breathing and low blood pressure.
D) profound cyanosis, dry skin, and a headache. - ✔✔A) ashen skin color, diaphoresis,
and anxiety.
Chest pain, pressure, or discomfort is the most common symptom of acute coronary
syndrome (ACS; eg, unstable angina, acute myocardial infarction); it
occurs in approximately 80% of cases. Patients with ACS are usually anxious and may
have a feeling of impending doom. Nausea and vomiting are common
complaints; however, projectile vomiting, which is typically associated with increased
intracranial pressure, is uncommon. The skin is often ashen gray and
clammy (diaphoretic) because of poor cardiac output and decreased perfusion. Less
commonly, the patient's skin is cyanotic. Respirations are usually
unlabored unless the patient has congestive heart fai lure, in which case respirations
are rapid and labored; irregular breathing, however, is not common.
Blood pressure may fall as a resu lt of decreased cardiac output; however, most
patients will have a normal or elevated blood pressure. If the patient
complains of a headache, it is usually a side effect of the nitroglycerin he or she took
before your arrival; ACS itself usually does not cause a headache.
