EMERGENCY MEDICINE EOR EXAM LATEST 2024-2025 ACTUAL EXAM 250
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |
ALREADY GRADED A+
Dilated Cardiomyopathy: most common cause is ____. Others? - correct answer alcohol; 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? - correct answer PE: 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 -
correct answer cardiac septum; S4
Restrictive cardiomyopathy: often caused by a ____process, or post-radiation or post open-
heart surgery. What is the most common first symptom? - correct answer --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? - correct answer 1. 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? - correct
answer 1. 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? - correct
answer CCB
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. - correct answer First
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. - correct answer Bundle 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? - correct answer vagal maneuvers or antianxiety medication
What are some drugs associated with Torsades de pointes? - correct answer tricyclic
antidepressants, erythromycin, ketoconazole, haloperidol, cisapride, disopyramide,
pentamidine, sotalol, class I anti-arrhythmics
CHF - Systolic dysfunction means a problem with the ____. What drug is contraindicated? -
correct answer pump; CCB!
CHF - Diastolic dysfunction means a problem with the ____. - correct answer compliance 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. - correct answer Frank-Starling principle
_____is released from cardiac ventricles in response to increased wall tension. - correct
answer BNP - B-type natriuretic peptide
What is the pharmacologic therapy for heart failure? - correct answer 1. 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. - correct answer Class I, Class II, Class III, Class IV
Stage 1 Hypertension is defined as greater than ____. Stage 2 Hypertension is defined as
greater than ____. - correct answer 140/90; 160/100
Hypertension Drug of Choice for:
angina
diabetes
hyperlipidemia
CHF
Previous MI
Chronic Renal Failure
Asthma, COPD - correct answer Angina - 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 ______. - correct answer identifiable 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. - correct answer Malignant
Malignant hypertension bp? What is the rule of thumb for lowering? - correct answer greater
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? - correct
answer nitroprusside; 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? -
correct answer 90mmHg;
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 - correct answer Inferior MI; right coronary artery
ST Elevations in I, aVL, V4, V5, V6 - correct answer lateral wall MI, left circumflex artery
ST Elevations in V1, V2, V3, V4, V5 - correct answer Anterioseptal MI, left anterior descending
artery
ST Elevations in V1, V2 - correct answer posterior wall MI, posterior descending artery
No nitroglycerin in which kind of MI? - correct answer inferior
What are the pre hospital treatments for ACS? - correct answer MONA; 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? -
correct answer BB - unless brady or severe COPD - then do NDCCB (verapamil/diltiazem)
ACEi - if cough, use ARB
What are the adjunctive tx for fibrinolysis or PCI? - correct answer 1. 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? - correct
answer bare metal - 30d-12m
drug eluting - >/=12mon
What meds should a patient go home with after ACS? - correct answer Nitroglycerin
BB
ACEi
ASA/Clopidogrel
anticoagulant (up to 8days for LMWH)
