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Clinical Medicine 2 > Exam 1 - Cardiology quizes > Flashcards

Exam 1 - Cardiology quizes Flashcards

1
Q

True or False: Cardiovascular disease is the leading cause of death in adults in the US

A

True

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2
Q 
An occlusion of the L circumflex artery will most likely cause ST elevations in which of the
following leads?
a. I, aVL, V5, V6
b. II, III, aVF
c. aVR, V1
d. V2-V4
A

a. I, aVL, V5, V6

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3
Q

A 65 year old male undergoes an exercise stress echocardiogram. It demonstrates a reversible
defect in the inferior portion of the heart with regional wall motion abnormalities which was
evident immediately after exercise but not at rest. Which of the following is the most likely
explanation for these findings?
a. The patient has evidence of an old myocardial infarction
b. The patient has evidence of unstable angina
c. The patient has evidence of inducible ischemia
d. The patient has coronary vasospasm

A

c. The patient has evidence of inducible ischemia

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4
Q

Which of the following is considered a risk factor for coronary artery disease?

a. Alcohol abuse
b. Marijuana abuse
c. Heroin abuse
d. Cocaine abuse

A

d. Cocaine abuse

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5
Q

Which of the following best describes a patient with stable cardiac angina?
a. A patient with mild coronary artery disease and no symptoms regardless of level of
exertion
b. A patient with coronary artery disease who occasionally experiences chest pain while
walking up his stairs at home but other times can ascend them briskly without symptoms
c. A patient with coronary artery disease who develops shortness of breath whenever he walks his dog 2 blocks and it resolves after he rests for a moment.
d. A patient with constant low grade chest pain that he can tolerate while performing his daily activities

A

c. A patient with coronary artery disease who develops shortness of breath whenever he walks his dog 2 blocks and it resolves after he rests for a moment.

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6
Q

True or False: Patients who carry their excess body fat in their hips, buttocks and upper thighs
are less likely to have coronary artery disease compared to individuals who carry their excess
body fat in the central abdomen.
a. True
b. False

A

True

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7
Q

An elevation in serum Troponin levels indicates which of the following?

a. The patient has suffered cardiac ischemia
b. The patient has suffered chest pain
c. The patient has suffered death of myocardial tissue
d. The patient has suffered from cardiomyopathy

A

c. The patient has suffered death of myocardial tissue

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8
Q

Which of the following patients should most likely undergo a stress test with imaging rather
than an ETT (exercise treadmill test)?
a. Women
b. Patients with multiple cardiovascular risk factors
c. Patients who have had prior myocardial infarction
d. Patients who are very thin

A

c. Patients who have had prior myocardial infarction

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9
Q

Which of the following medications is used to prevent in-stent re-thrombosis after coronary
stent placement?
a. Warfarin (Coumadin)
b. Clopidogrel (Plavix)
c. Aspirin
d. Glycoprotein IIB/IIIa inhibitor (Integrilin)

A

b. Clopidogrel (Plavix)

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10
Q

Which of the following best describes Prinzemetal Angina?

a. Chest pain that occurs with minimal exertion
b. A genetic preponderance to coronary artery disease
c. Demand ischemia from hypovolemia in a patient with coronary artery disease
d. Intermittent coronary vasospasm

A

d. Intermittent coronary vasospasm

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11
Q

True or False: Pre-menopausal women are somewhat protected from CAD compared to
post-menopausal women
a. True
b. False

A

True

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12
Q 
An occlusion in the right coronary artery (RCA) will most likely cause myocardial infarction in
which part of the heart?
a. Anterior
b. Left lateral
c. Inferior
d. Posterior
A

c. Inferior

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13
Q

A 70 year old female undergoes a pharmacologic stress echocardiogram. It demonstrates a
fixed defect at the apex of the heart during both rest and exercise. There is no reversible wall
motion abnormality. What do these findings suggest?
a. The patient has acute cardiac ischemia of the inferior portion of the heart
b. The patient has had a myocardial infarction in the past
c. The patient has ischemic cardiomyopathy
d. The patient has no significant coronary artery disease

A

b. The patient has had a myocardial infarction in the past

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14
Q 
The “classic” presentation of a patient with cardiac chest pain is described as which of the
following?
a. Sharp and tearing
b. Burning
c. Crushing pressure
d. Aching and sore
A

c. Crushing pressure

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15
Q

Which of the following patient’s should be rushed to the cardiac catheterization lab for urgent reperfusion therapy?
a. A patient with chest pain at rest and T wave flattening on EKG
b. A patient with positive troponin, significant hypotension and a normal EKG
c. A patient with transient elevations in ST segments in 2 leads and no cardiovascular risk
factors
d. A patient with exertional chest pain and ST depressions on EKG

A

b. A patient with positive troponin, significant hypotension and a normal EKG

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16
Q

True or False: After a person quits smoking, it is no longer a cardiovascular risk factor for them

a. True
b. False

A

False

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17
Q

Which of the following medications has been demonstrated to improve survival and long-term
outcomes for patients who suffer myocardial infarction?
a. Metoprolol
b. Nitroglycerin
c. Heparin
d. Morphine

A

a. Metoprolol

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18
Q

Of the following medications, which is the most important to provide immediately to a patient
who presents with symptoms concerning for myocardial infarction?
a. Metoprolol
b. Oxygen
c. Atorvastatin
d. Aspirin

A

d. Aspirin

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19
Q

Which of the following stress tests is the best study for an obese patient?

a. Exercise treadmill test
b. Pharmacologic stress echo
c. Nuclear medicine myoview stress test
d. Positron emission tomography

A

d. Positron emission tomography

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20
Q

A 25 year old female with no cardiovascular risk factors presents with “non-anginal” (atypical)
chest discomfort and a normal EKG. Which of the following is most likely the best strategy for
this patient?
a. Reassurance (no stress test)
b. ETT (exercise treadmill test)
c. ESE (exercise stress echocardiogram)
d. Pharmacologic nuclear medicine myoview stress test

A

a. Reassurance (no stress test)

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21
Q

Which of the following is generally true regarding dilated cardiomyopathy?

a. It typically occurs immediately after a myocardial infarction
b. Myocardial contractility is generally maintained
c. Patients with dilated cardiomyopathy often develop heart failure
d. It results in thickening of the ventricular walls

A

c. Patients with dilated cardiomyopathy often develop heart failure

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22
Q

Which of the following is the most common cause of dilated cardiomyopathy?

a. Infections
b. Stress
c. Toxins
d. Genetics

A

d. Genetics

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23
Q

Which of the following is true regarding Chagas disease?

a. It is commonly associated with mural thrombus
b. It is a bacterial infection
c. It causes restrictive cardiomyopathy
d. It is endemic in Asian countries

A

a. It is commonly associated with mural thrombus

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24
Q

Which of the following is a feature of Takotsubo?

a. It occurs most commonly in young men
b. It is associated at times with ST elevation
c. It typically results in syncope
d. It is caused by excess alcohol consumption

A

b. It is associated at times with ST elevation

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25
Q

True or False: cardiomyopathy caused by alcohol is not reversible

a. True
b. False

A

False

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26
Q

Which of the following is true regarding restrictive cardiomyopathy?

a. Ventricles are generally dilated
b. Systolic function is reduced
c. It results in reduced cardiac output
d. It results in mitral regurgitation

A

c. It results in reduced cardiac output

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27
Q

Which of the following is a typical cause of restrictive cardiomyopathy?

a. Viral infection
b. Ischemic heart disease
c. Malignancy
d. Amyloidosis

A

d. Amyloidosis

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28
Q 
Which of the following is a common clinical manifestation of severe hypertrophic obstructive
cardiomyopathy?
a. Systolic congestive heart failure
b. ST elevation myocardial infarction
c. Ventricular arrhythmias
d. Sinus bradycardia and sinus pauses
A

c. Ventricular arrhythmias

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29
Q

Hypertrophic obstructive cardiomyopathy is a leading cause of sudden death in which population?

a. Young children
b. Teenagers and young adults
c. Middle aged men
d. Elderly persons

A

b. Teenagers and young adults

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30
Q 
Which of the following is the best diagnostic study for diagnosing arrhythmogenic right
ventricular cardiomyopathy (ARVC)
a. Transthoracic echocardiogram
b. Cardiac CT
c. Cardiac MRI
d. 30 day event monitor
A

c. Cardiac MRI

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31
Q

Which of the following is true regarding patient’s with dilated cardiomyopathy?

a. They usually have a normal cardiac ejection fraction
b. Chest –xray often demonstrates cardiomegaly
c. They have thickened ventricular myocardium
d. They often have concomitant coronary artery disease

A

b. Chest –xray often demonstrates cardiomegaly

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32
Q

At what EF% should a patient with asymptomatic dilated cardiomyopathy be considered for
prophylactic implantable cardioverter-defibrillator?
a. <25%
b. <30%
c. <35%
d. <40%

A

c. <35%

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33
Q

True or False: patients with dilated cardiomyopathy who have a family history of sudden death should be considered for implantable cardioverter-defibrillator regardless of their EF%.

a. True
b. False

A

True

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34
Q

Which of the following substances causes the most cases of toxic cardiomyopathy?

a. Tobacco (cigarettes)
b. Alcohol
c. Cocaine
d. Prescription medications

A

b. Alcohol

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35
Q

True or False: patients with hypertrophic obstructive cardiomyopathy (HOCM) are more likely
to experience symptoms when they are dehydrated compared to when they are well hydrated
a. True
b. False

A

True

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36
Q

Which of the following statements is true

a. The murmur of HOCM increases with the Valsalva maneuver
b. The murmur of HOCM decreases with the Valsalva maneuver
c. The murmur of HOCM increases with squatting
d. The murmur of HOCM does not change regardless of position

A

a. The murmur of HOCM increases with the Valsalva maneuver

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37
Q

Which of the following cardiomyopathies typically present with an apical aneurysm

a. Hypertrophic cardiomyopathy
b. Chagas Disease
c. Tachycardia induced cardiomyopathy
d. Arrhythmogenic right ventricular cardiomyopathy

A

b. Chagas Disease

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38
Q

Which of the following is the hallmark feature of arrhythmogenic right ventricular
cardiomyopathy?
a. Atrial arrhythmias
b. Thickened septum
c. Replacement of myocardium with fibro-fatty tissue
d. Mitral regurgitation

A

c. Replacement of myocardium with fibro-fatty tissue

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39
Q

Which of the following conditions is the precipitant for Takotsubo?

a. Coronary vasospasm
b. Sustained tachycardia
c. Alcohol abuse
d. Severe psychological stress

A

d. Severe psychological stress

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40
Q

True or False: A patient with restrictive cardiomyopathy is pre-load dependent?

a. True
b. False

A

True

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41
Q

Which of the following most accurately describes the term “afterload.”

a. Maximum diastolic stretch prior to contraction
b. The total intravascular volume
c. The force that the heart must generate to eject blood
d. The average cardiac output in one minute

A

c. The force that the heart must generate to eject blood

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42
Q

Which of the following findings is frequently consistent with systolic dysfunction?

a. Impaired ventricular filling
b. Elevations in pulmonary artery pressure
c. Aortic stenosis
d. Reduction in ejection fraction

A

d. Reduction in ejection fraction

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43
Q

Which of the following describes Class III symptoms according to the New York Heart Association Classification of heart failure?

a. Symptoms only with minimal exertion
b. Symptoms at rest
c. Symptoms with normal activity of daily living
d. Symptoms that are worsening

A

a. Symptoms only with minimal exertion

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44
Q

All of the following are common symptoms of congestive heart failure EXCEPT?

a. Dyspnea on exertion
b. Syncope
c. Orthopnea (sleep with pillows)
d. Paroxysmal nocturnal dyspnea

A

b. Syncope

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45
Q 
All of the following are physical exam findings generally associated with congestive heart
failure EXCEPT?
a. Hypoxia 
b. Positive hepatojugular reflux 
c. S3 gallop 
d. Bradycardia
A

d. Bradycardia

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46
Q 
Which of the following laboratory tests is most highly associated with decompensated
congestive heart failure?
a. Troponin 
b. Creatinine 
c. Brain natriuretic peptide 
d. D-Dimer
A

c. Brain natriuretic peptide

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47
Q

True or False: Patients with long-standing chronic congestive heart failure who develop decompensation of their heart failure may have clear lungs to auscultation and normal chest x-rays.

a. True
b. False

A

True

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48
Q 
Which of the following medications is recommended as first line for a new diagnosis of
systolic congestive heart failure?
a. Beta-blocker 
b. ACE-inhibitor 
c. Digoxin 
d. Isosorbide Dinitrate
A

b. ACE-inhibitor

49
Q

Which of the following electrolytes is most often depleted during furosemide use?

a. Sodium
b. Phosphorus
c. Magnesium
d. Potassium

A

d. Potassium

50
Q

Which of the following conditions is the most likely complication from diuretic use?

a. Hypernatremia
b. Acute kidney injury
c. Hypersensitivity reaction
d. Shock liver

A

b. Acute kidney injury

51
Q

Which of the following types of cardiac conditions is pre-load dependent?

a. Systolic CHF secondary to ischemic heart disease
b. Diastolic CHF secondary to long standing hypertension
c. Systolic CHF secondary to dilated cardiomyopathy
d. Severe mitral regurgitation resulting in pulmonary edema

A

b. Diastolic CHF secondary to long standing hypertension

52
Q

Which of the following medications has positive inotropic action?

a. Lisinopril
b. Furosemide
c. Diltiazem
d. Digitalis

A

d. Digitalis

53
Q

How is congestive heart failure diagnosed?

a. With a chest X-ray
b. With a brain natriuretic peptide level
c. Based on physical exam findings
d. Based on history, physical exam and supported by objective data

A

d. Based on history, physical exam and supported by objective data

54
Q

Which of the following symptoms is consistent with early right sided heart failure

a. Lower extremity swelling
b. Dyspnea on exertion
c. Orthopnea
d. Hypoxia

A

a. Lower extremity swelling

55
Q

Which of the following is a common cause of systolic congestive heart failure?

a. Atrial fibrillation with rapid ventricular response
b. Mitral regurgitation
c. Acute myocardial infarction
d. Left ventricular hypertrophy

A

c. Acute myocardial infarction

56
Q

Which of the following descriptions represents Class II symptoms of heart failure according to
the New York Association Functional Classification of Heart Failure?
a. Symptoms with only significant activity
b. Symptoms with ordinary activity of daily living
c. Symptoms with only minimal exertion
d. Symptoms at rest

A

b. Symptoms with ordinary activity of daily living

57
Q

All of the following are common symptoms of heart failure EXCEPT?

a. Dyspnea on exertion
b. Weight gain
c. Chest discomfort
d. Lightheadedness

A

d. Lightheadedness

58
Q 
All of the following are Chest X-ray findings associated with acute decompensated CHF
EXCEPT?
a. Blunting of the costophrenic angles 
b. Cephalization 
c. Kerly B lines 
d. Apical opacities
A

d. Apical opacities

59
Q

Which of the following medications is considered an adjuvant to furosemide?

a. Spironolactone
b. Budesonide
c. Lisinopril
d. Diovan

A

a. Spironolactone

60
Q

Which of the following laboratory tests is the most important to order for a patient after a
diagnosis of atrial fibrillation?
a. White blood cell count
b. Creatinine c. Thyroid stimulating hormone
d. Calcium level

A

c. Thyroid stimulating hormone

61
Q

Which of the following is a risk factor for atrial fibrillation?

a. Valvular disease
b. Female gender
c. Orthostatic hypotension
d. Coronary artery stenosis

A

a. Valvular disease

62
Q

True or False: patients with intermittent atrial fibrillation are less likely to develop cerebrovascular accidents compared to patient’s with persistent atrial fibrillation.

a. True
b. False

A

False

63
Q

Which of the following is a common trigger for an episode of atrial fibrillation?

a. Sedentary lifestyle
b. Benzodiazepine medications
c. Acute myocardial infarction
d. Surgery

A

d. Surgery

64
Q

Which of the following imaging studies is most important for a patient with a new diagnosis of atrial fibrillation?

a. Chest x-ray
b. Transthoracic echocardiogram
c. Chest CT
d. Cardiac MRI

A

b. Transthoracic echocardiogram

65
Q

Which of the following treatments is usually the first line for an otherwise healthy patient who
presents with a new diagnosis of atrial fibrillation?
a. Beta-blocker therapy
b. Calcium channel blocker therapy
c. Anticoagulation
d. Non-urgent direct current cardioversion

A

d. Non-urgent direct current cardioversion

66
Q

Which of the following patients needs full anticoagulation (for 3 weeks) prior to rhythm
control?
a. Patients who have been in afib >48hours
b. Patients who have slow heart rates
c. Patients who have hypertension

A

a. Patients who have been in afib >48hours

67
Q

Which of the following is a common complication of afib with RVR?

a. Myocardial infarction
b. Pulmonary edema
c. Syncope
d. Mental status changes

A

b. Pulmonary edema

68
Q

Which of the following is one of the first line treatments for afib with RVR?

a. Amiodarone
b. Digoxin
c. Diltiazem
d. Atenolol
* CCB or B-blocker*

A

c. Diltiazem

69
Q

True or False: fast rates of atrial fibrillation are harder to control than fast rates of atrial flutter?

a. True
b. False

A

False

70
Q

Which of the following is true regarding atrial fibrillation?

a. It is an organized and irregular rhythm
b. It involves loss of effective atrial contractility
c. It has a propensity to go slow
d. It often leads to acute coronary syndrome

A

b. It involves loss of effective atrial contractility

71
Q

True or False: Atrial flutter is the most common sustained arrhythmia

a. True
b. False

A

False

72
Q

Which of the following is a common trigger for an episode of atrial fibrillation?

a. Marijuana use
b. Diarrhea
c. Alcohol intoxication
d. Chronic cocaine use

A

c. Alcohol intoxication

73
Q

Where is the ectopic foci of afib most often located?

a. At the ostial portion of the pulmonary veins
b. Medial to the mitral valve
c. Around the aortic outflow tract
d. At the site of the SVC

A

a. At the ostial portion of the pulmonary veins

74
Q

Which of the following is considered a risk factor for atrial fibrillation?

a. Age >50
b. Prolonged PR interval
c. Hypotension
d. Female gender

A

b. Prolonged PR interval

75
Q

Which of the following best describes, “Paroxysmal afib”?

a. Afib that is constant
b. Afib episode that occurred at only one time
c. Afib that comes and goes – aka “intermittent”
d. Afib without underlying structural heart disease

A

c. Afib that comes and goes – aka “intermittent”

76
Q

Which of the following patients should almost certainly be managed with life-long
anticoagulation for atrial fibrillation?
a. Patients older than 65
b. Patients with hypertension
c. Patient’s with CAD
d. Patient’s with a history of transient ischemic attack

A

d. Patient’s with a history of transient ischemic attack

77
Q

Which of the following is a reasonable first line treatment to control the rate of atrial
fibrillation with RVR?
a. Metoprolol 5mg IV x1
b. Diltiazem gtt 5-15mg/hr; titrate to HR less than 105
c. Amiodarone 150mg IV x1
d. Digoxin 25mg po x1

A

a. Metoprolol 5mg IV x1

78
Q

A 60 year old patient arrives to the ER with new afib. The patient is hemodynamically stable. It
is unclear how long the patient has been in afib. He has no other medical problems. TTE
demonstrates no evidence of large mural thrombus. Which of the following is the best next
step?
a. Immediate Urgent DC cardioversion
b. Non-urgent DC cardioversion scheduled for the next day
c. Initiate life-long Warfarin management
d. Perform a transesophageal echocardiogram

A

d. Perform a transesophageal echocardiogram
* remember, TTE is not specific for the thrombus, so must get the TEE to evaluate for mural thrombus before DC cardioversion is indicated.

79
Q

Which of the following is a potential long term complication of amiodarone therapy?

a. Long sinus pauses
b. Chronic interstitial pneumonitis
c. Kidney dysfunction
d. Cerebrovascular accidents

A

b. Chronic interstitial pneumonitis

80
Q

Which of the following is a common cause of sinus tachycardia?

a. Cerebrovascular accident (CVA)
b. Acute myocardial infarction
c. Pulmonary embolism
d. Hypothyroidism

A

c. Pulmonary embolism

81
Q

Which of the following is the best treatment for sinus tachycardia

a. Intravenous fluids
b. Beta-blocker therapy
c. Oral benzodiazepines
d. No specific treatment for the rhythm

A

d. No specific treatment for the rhythm

82
Q

Which of the following is true about supraventricular tachycardia (SVT)?

a. There are no discernible p waves
b. It’s usually a wide complex rhythm
c. It’s usually caused by ectopic atrial foci
d. It’s onset is typically gradual

A

a. There are no discernible p waves

83
Q

Which of the following is the first line medication for treatment of sustained SVT?

a. Diltiazem
b. Adenosine
c. Metoprolol
d. Amiodarone

A

b. Adenosine

84
Q

Which of the following is the best immediate treatment for an unstable patient in SVT?

a. Defibrillation
b. Ventricular pacing
c. Direct current cardioversion
d. Coronary angiography

A

c. Direct current cardioversion

85
Q

Which of the following is the most common type of SVT?

a. Atrioventricular nodal reentry tachycardia
b. Atrioventricular reentry tachycardia
c. Accelerated junctional rhythm
d. Wolf-Parkinson-white syndrome

A

a. Atrioventricular nodal reentry tachycardia

86
Q 
Which of the following medications is the best to use for a patient in stable ventricular
tachycardia in a conscious patient?
a. Epinephrine
b. Amiodarone
c. Lidocaine
d. Metoprolol
A

b. Amiodarone

87
Q

Which of the following medications is known to cause QTc prolongation?

a. Nifedipime
b. Fluoxetine
c. Amoxicillin
d. Chlorpromazine

A

d. Chlorpromazine

88
Q 
If a patient with Torsades de Pointe does not respond to Magnesium therapy, what is the next
line therapy?
a. Defibrillation
b. Cardioversion
c. Transvenous overdrive pacing
d. Potassium infusion
A

c. Transvenous overdrive pacing

89
Q

Which of the following is true regarding ventricular fibrillation?

a. Patients are always pulseless
b. It is usually caused by medications
c. It often converts to ventricular tachycardia
d. It is sometimes a progression of atrial fibrillation

A

a. Patients are always pulseless

90
Q

Which of the following is true regarding supraventricular tachycardia?

a. It often begins suddenly
b. It often causes syncope
c. Treatment involves direct current cardioversion
d. It can progress into ventricular tachycardia

A

a. It often begins suddenly

91
Q

What is the first course of action to take if a person is found down without a pulse

a. Go find a defibrillator
b. Start chest compressions
c. Administer a dose of Amiodarone
d. Administer a dose of Epinephrine

A

b. Start chest compressions

92
Q 
Which of the following is the best course of treatment for a patient who is found to have
pulseless ventricular tachycardia?
a. Synchronized DC cardioversion
b. Radiofrequency ablation
c. Defibrillation
d. Transcutanous overdrive pacing
A

c. Defibrillation

93
Q

Which of the following is likely to present with syncope?

a. Sinus tachycardia
b. Brugada syndrome
c. Supraventricular tachycardia
d. Torsade de pointe

A

b. Brugada syndrome

94
Q

A 75 year old female presents to the ER with SVT at a rate of 200bpm. BP is normal. Which of
the following is the first line treatment?
a. Adenosine 6mg IVP
b. Carotid massage
c. Vagal maneuvers
d. Metoprolol 5mg IVP

A

c. Vagal maneuvers

95
Q

All of the following are common causes of sinus tachycardia EXCEPT?

a. Anxiety
b. Exercise
c. Sepsis
d. Hypothyroidism

A

d. Hypothyroidism

96
Q

What is the definition of sustained v-tach?

a. Vtach lasting more than 10 seconds
b. Vtach lasting more than 20 seconds
c. Vtach lasting more than 30 seconds
d. Vtach lasting more than 40 seconds

A

c. Vtach lasting more than 30 seconds

97
Q

When a patient dies after having an acute myocardial infarction, what is the most likely cause
of death?
a. Watershed infarction (hypoperfusion of the brain)
b. Acute pulmonary edema and hypoxia
c. Ventricular fibrillation
d. Sudden extravasation of body fluids

A

c. Ventricular fibrillation

98
Q

Which of the following electrolyte disorders leads to Torsade de pointe?

a. Hyperkalemia
b. Hypercalcemia
c. Hypophosphatemia
d. Hypomagnesemia

A

d. Hypomagnesemia

99
Q

A 45 year old female arrives to the ER complaining of heart palpitations and chest discomfort.
The heart rate is regular and 118bpm. Based on this limited information, which of the following is the most likely condition?
a. Sinus tachycardia
b. Supraventricular tachycardia
c. Atrial flutter
d. Torsade de pointe

A

a. Sinus tachycardia

100
Q

Which of the following is the most common cause of atrio-ventricular block?

a. Sclerosis and fibrosis
b. Ischemic heart disease
c. Sarcoidosis
d. Wilson’s disease

A

a. Sclerosis and fibrosis

101
Q

Which of the following is true about 1st degree AVB?

a. It is defined by a PR interval > 0.1secs
b. The ratio of p waves to QRS complex is > 1:1
c. It is unlikely to degrade to second degree AVB
d. Patient’s should be referred to an electrophysiologist

A

c. It is unlikely to degrade to second degree AVB

102
Q

Which of the following medications is most likely to cause conduction blocks?

a. Amiodarone
b. Levofloxacin
c. Furosemide
d. Digoxin

A

d. Digoxin

103
Q

Which of the following statements is true regarding 2nd degree Mobitz Type I AV block?

a. It is an indication for an urgent cardiac pacemaker
b. It can be seen as a benign condition in athletes
c. It often occurs as the result of atrial fibrillation
d. It commonly progresses to complete heart block

A

b. It can be seen as a benign condition in athletes

104
Q

Which of the following is true regarding 2nd degree Mobitz Type II AV block

a. The PR intervals are consistent
b. The treatment involves the use of nodal blocking agents
c. There is an atrio-ventricular accessory pathway
d. Patient’s often require defibrillation

A

a. The PR intervals are consistent

105
Q

True or False: In general, for third degree AV Blocks, the more distal blocks are more likely to cause syncope

a. True
b. False

A

a. True

106
Q

A 35 year old female presents to the ER with chest pain. The pain is described as sharp and

constant. The patient has no cardiovascular risk factors. Her EKG demonstrates a new left bundle branch block. A prior EKG from 3 weeks ago did not have the LBBB. Which of the following is the next step in management?
a. Activate the cardiac cath lab for urgent reperfusion therapy
b. Initiate heparin drip
c. Consult cardiology service

A

c. Consult cardiology service

107
Q

Which of the following is true regarding LBBB?

a. It is an independent predictor of all-cause mortality in patients with CAD
b. It predicts poor health outcomes in all patients
c. It is impossible to identify a myocardial infarction because of ST-T abnormalities
d. It is associated with chronic pulmonary disease

A

a. It is an independent predictor of all-cause mortality in patients with CAD

108
Q

Which of the leads on EKG have “bunny ears” (R, r’) in right bundle branch block?

a. I, III, avL
b. V1-V3
c. V4-V6
d. aVR, aVL, aVF

A

b. V1-V3

109
Q

A 60 year old female with HTN presents for routine physical exam. She is found on EKG to
have RBBB. There is no prior EKG with which to compare. She feels well and has no complaints. Her physical exam is normal. Which of the following is the best course of action?
a. Refer to cardiology for consultation
b. Work up for pulmonary processes
c. Reassurance and routine follow up
d. Send to the ER for urgent evaluation

A

c. Reassurance and routine follow up

110
Q

Which of the following conduction disturbances is most likely to degrade into a worse condition?

a. Right bundle branch block
b. First degree AVB
c. Second degree AVB Mobitz Type I
d. Second degree AVB Mobitz Type II

A

d. Second degree AVB Mobitz Type II

111
Q

True or False: the presence of left bundle branch block is associated with higher short-term and long-term mortality following an acute myocardial infarction

a. True
b. False

A

a. True

112
Q

Which of the following types of conduction abnormalities can be seen as a feature of acute myocardial infarction

a. First degree AVB
b. Second degree AVB
c. Third degree AVB
d. All of the above

A

d. All of the above

113
Q

What is the treatment of Lyme carditis in a symptomatic patient with PR interval >300 milliseconds?

a. Doxycyline 200mg oral x1 dose
b. Doxycycline 200mg daily oral x 21-28 days
c. Ceftriaxone 2gm IV daily x 21-28 days
d. Ceftriaxone 2gm IV daily until PR <300 millisecond then oral doxy to complete 21-28 days

A

d. Ceftriaxone 2gm IV daily until PR <300 millisecond then oral doxy to complete 21-28 days

114
Q

True or False: AV conduction blocks are sometimes transient

a. True
b. False

A

a. True

115
Q

Which of the following statements is true regarding first degree AVB?

a. Patients typically present with heart palpitations
b. Patients have increased risk of developing atrial fibrillation
c. Patients should be referred for immediate pacemaker placement
d. It is likely to degrade to second degree AVB

A

b. Patients have increased risk of developing atrial fibrillation

116
Q

Which of the following is true regarding third degree AVB

a. Atrial impulses are delayed through the AV node
b. The PR intervals are consistent
c. Patients typically present with congestive heart failure
d. Escape rhythms can be narrow complex

A

d. Escape rhythms can be narrow complex

117
Q

True or False: A patient with first degree AVB who has a wide QRS complex should be referred to an electrophysiologist

a. True
b. False

A

a. True

118
Q

Which of the following is true regarding a right bundle branch block?
a. Patients often present with syncope
b. It is most commonly associated with long-standing chronic obstructive pulmonary
disease
c. It is still possible to diagnose ST elevation on EKG with baseline RBBB
d. Patients should undergo immediate echocardiogram upon diagnosis of RBBB

A

c. It is still possible to diagnose ST elevation on EKG with baseline RBBB

119
Q

What is the main treatment of complete heart block without CAD?

a. Pacemaker placement
b. Digoxin
c. Reperfusion therapy
d. Ablation of accessory pathway

A

a. Pacemaker placement

Clinical Medicine 2 (14 decks)

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