ALU 301 Chapter 6 Exam Questions With
Complete Solutions
Factors to evaluate for Cardiac testing
1. How well the heart is functioning - left ventricular function, commonly measured as ejection
fraction (EF).
2. How much heart muscle is damaged or at risk.
3. If there is a risk of sudden death.
Sensitivity
A test's ability to perceive and measure amounts or differences, whether small or large. A sensitive
medical test is one that will be able to give a positive result when a particular condition is present,
even during early stages. Ex - EKG test.
Specificity
A test's ability to identify exactly one unique object or situation. A specific medical test is only positive
for one particular disease or condition. Ex - EKG test.
Bayes' Theorem
"Conditional probability" - a ration method to minimize the diagnostic uncertainty (i.e. false positives
and false negatives) surrounding cardiac testing. The results of one cardiac test can be used to
improve the accuracy of the tests that follow.
Benefits of Bayes' Theorem
It provides a much more rational approach allowing the risk assessment to start with some simple
parameters such as age, sex, and the results of routine underwriting, and to use those results to help
understand the risk when more powerful cardiac testing has also been performed.
Most basic cardiac diagnostic workup
The history and physical taken by a physician.
Most valuable element of the physical exam?
Auscultation with the stethoscope. By listening for the timing and intensity of heart sounds, the
physician can detect the various murmurs associated with heart disease.
Heart murmurs
Diagnosed with a stethoscope and can be systolic, diastolic or continuous.
Murmur grades
Grade 1: Barely audible with utmost concentration
Grade 2: Soft, but easily heard
Grade 3: Loud without thrill
Grade 4: Loud with thrill
Grade 5: Loud, heard with barely any contact between stethoscope and chest wall
Grade 6: Loud, heard with stethoscope off the chest wall
Pericardial friction rub
A superficial, high-pitched, or scratchy sound that is diagnostic of pericarditis.
, Gallop rhythms
Soft, low-pitched sounds that can be normal if found in young, health individuals, but are at times
indicative of serious hypertensive disease, cardiac dysfunction, or early heart failure.
Troponins
When increased, troponins are the most sensitive and specific biomarkers for myocardial damage and
can be elevated when other biomarkers are not.
Creatine Phosphokinase (CPK)
Usually elevated at the time of acute MI presentation, but can be normal on first testing. Elevated CPK
values usually peak 15-20 hours after the onset of symptoms.
CPK-BB
Concentrated in the brain and lungs (CPK-1)
CPK-MB
Found mostly in the heart (CPK-2)
CPK-MM
Found mostly in skeletal muscle (CPK-3)
Aspartate Aminotransferase (AST)
This enzyme is also present in the heart muscle. It is released into the circulation following the injury
or death of myocardial cells. The amount of AST in the blood is directly related to the size of the
infarct and the amount of time that has passed since the onset of the coronary occlusion.
Lactic Acid Dehydrogenase (LDH)
Begins to rise about 12 hours after an infarct and usually returns to normal after CPK and AST have
returned to normal.
Cardiac Radiography
Commonly known as x-ray. Involves examination of posteroanterior (PA) and lateral chest films to
detect pulmonary and cardiac disease. Chest film remains an important tool in emergency room and
hospital settings for the evaluation of dyspnea, pneumonia and heart failure.
Resting Electrocardiogram (EKG)
A recording or tracing of the electrical impulses within the heart, which regulate the heart's
contractions. Characteristic EKG abnormalities are crucial to the diagnosis of arrhythmias, ischemia
and infarction, atrial and ventricular enlargement, conduction delays, and pericarditis.
EKG limb leads
I, II, III, AVR, AVL, AVF
EKG chest leads
Complete Solutions
Factors to evaluate for Cardiac testing
1. How well the heart is functioning - left ventricular function, commonly measured as ejection
fraction (EF).
2. How much heart muscle is damaged or at risk.
3. If there is a risk of sudden death.
Sensitivity
A test's ability to perceive and measure amounts or differences, whether small or large. A sensitive
medical test is one that will be able to give a positive result when a particular condition is present,
even during early stages. Ex - EKG test.
Specificity
A test's ability to identify exactly one unique object or situation. A specific medical test is only positive
for one particular disease or condition. Ex - EKG test.
Bayes' Theorem
"Conditional probability" - a ration method to minimize the diagnostic uncertainty (i.e. false positives
and false negatives) surrounding cardiac testing. The results of one cardiac test can be used to
improve the accuracy of the tests that follow.
Benefits of Bayes' Theorem
It provides a much more rational approach allowing the risk assessment to start with some simple
parameters such as age, sex, and the results of routine underwriting, and to use those results to help
understand the risk when more powerful cardiac testing has also been performed.
Most basic cardiac diagnostic workup
The history and physical taken by a physician.
Most valuable element of the physical exam?
Auscultation with the stethoscope. By listening for the timing and intensity of heart sounds, the
physician can detect the various murmurs associated with heart disease.
Heart murmurs
Diagnosed with a stethoscope and can be systolic, diastolic or continuous.
Murmur grades
Grade 1: Barely audible with utmost concentration
Grade 2: Soft, but easily heard
Grade 3: Loud without thrill
Grade 4: Loud with thrill
Grade 5: Loud, heard with barely any contact between stethoscope and chest wall
Grade 6: Loud, heard with stethoscope off the chest wall
Pericardial friction rub
A superficial, high-pitched, or scratchy sound that is diagnostic of pericarditis.
, Gallop rhythms
Soft, low-pitched sounds that can be normal if found in young, health individuals, but are at times
indicative of serious hypertensive disease, cardiac dysfunction, or early heart failure.
Troponins
When increased, troponins are the most sensitive and specific biomarkers for myocardial damage and
can be elevated when other biomarkers are not.
Creatine Phosphokinase (CPK)
Usually elevated at the time of acute MI presentation, but can be normal on first testing. Elevated CPK
values usually peak 15-20 hours after the onset of symptoms.
CPK-BB
Concentrated in the brain and lungs (CPK-1)
CPK-MB
Found mostly in the heart (CPK-2)
CPK-MM
Found mostly in skeletal muscle (CPK-3)
Aspartate Aminotransferase (AST)
This enzyme is also present in the heart muscle. It is released into the circulation following the injury
or death of myocardial cells. The amount of AST in the blood is directly related to the size of the
infarct and the amount of time that has passed since the onset of the coronary occlusion.
Lactic Acid Dehydrogenase (LDH)
Begins to rise about 12 hours after an infarct and usually returns to normal after CPK and AST have
returned to normal.
Cardiac Radiography
Commonly known as x-ray. Involves examination of posteroanterior (PA) and lateral chest films to
detect pulmonary and cardiac disease. Chest film remains an important tool in emergency room and
hospital settings for the evaluation of dyspnea, pneumonia and heart failure.
Resting Electrocardiogram (EKG)
A recording or tracing of the electrical impulses within the heart, which regulate the heart's
contractions. Characteristic EKG abnormalities are crucial to the diagnosis of arrhythmias, ischemia
and infarction, atrial and ventricular enlargement, conduction delays, and pericarditis.
EKG limb leads
I, II, III, AVR, AVL, AVF
EKG chest leads
