Heart❤️

Question 1

The first best appropriate test in investigating the chest pain is …

Answer 1

𝑬𝑪𝑮

Question 2

What are three main criteria to diagnose ACS (Acute
Coronary Syndrome)?

Answer 2

1）𝑇𝑦𝑝𝑖𝑐𝑎𝑙 𝑐ℎ𝑒𝑠𝑡 𝑝𝑎𝑖𝑛
2）𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒 𝐸𝐶𝐺 𝑓𝑖𝑛𝑑Ings
3）𝐸𝑙𝑒𝑣𝑎𝑡𝑒𝑑 𝑙𝑒𝑣𝑒𝑙 𝑜𝑓 𝑐𝑎𝑟𝑑𝑢𝑎𝑐 𝑚𝑎𝑟𝑘𝑒𝑟𝑠

Question 3

𝑊ℎ𝑎𝑡 𝑎𝑟𝑒 𝑡𝑦𝑝𝑖𝑐𝑎𝑙 𝑠𝑖𝑔𝑛𝑠 & 𝑠𝑦𝑚𝑝𝑡𝑜𝑚𝑠 𝑜𝑓 MI？

Answer 3

．𝑅𝑒𝑡𝑟𝑜𝑠𝑡𝑒𝑟𝑛𝑎𝑙 𝑐ℎ𝑒𝑠𝑡 𝑝𝑎𝑖𝑛 𝑟𝑎𝑑𝑖𝑎𝑡𝑖𝑛𝑔 𝑡𝑜 𝑙𝑒𝑓𝑡 (𝑤𝑖𝑡ℎ 𝑜𝑟 𝑤𝑖𝑡ℎ𝑜𝑢𝑡 𝑟𝑖𝑔ℎ𝑡）， 𝑠ℎ𝑜𝑢𝑙𝑑𝑒𝑟， 𝑎𝑟𝑚， 𝑛𝑒𝑐𝑘， 𝑗𝑎𝑤
． 𝐴𝑠𝑠𝑜𝑐𝑖𝑎𝑡𝑒𝑑 𝑤𝑖𝑡ℎ 𝑑𝑖𝑎𝑝ℎ𝑜𝑟𝑒𝑠𝑖𝑠，𝑛𝑎𝑢𝑠𝑒𝑎， 𝑎𝑛𝑥𝑖𝑒𝑡𝑦

Question 4

𝑾𝒉𝒂𝒕 𝒂𝒓𝒆 3 𝑬𝒔 𝒕𝒉𝒂𝒕 𝒄𝒂𝒖𝒔𝒆 𝑨𝑪𝑺?

Answer 4

𝑬𝒙𝒆𝒓𝒕𝒊𝒐𝒏
𝑬𝒎𝒐𝒕𝒊𝒐𝒏
𝑬𝒂𝒕𝒊𝒏𝒈

Question 5

Duration of ACS is …and usually relieves by … and …

Answer 5

< 10-15 min
rest- nitrates

Question 6

What is Levine’s sign?

Answer 6

Clutchung fist over sternum when describing chest pain
.

Question 7

What are anginal equivalents?

Answer 7

Dyspenea, acute LV failure, flash pulmonary edema.

Question 8

Close to … of MIs are
“silent” or unrecognized due to atypical symptoms.

Answer 8

30%

Question 9

Silent MIs are more common in …

Answer 9

• Females
• Diabetics
• Seniors
• Post-heart transplant

Question 10

𝑾𝒉𝒂𝒕 𝒂𝒓𝒆 𝒄𝒂𝒓𝒅𝒊𝒂𝒄 𝒎𝒂𝒓𝒌𝒆𝒓𝒔?

Answer 10

CPK / LDH / CK-MB / Troponin I

Question 11

The physical findings that are most highly associated with cardiac disease include …

Answer 11

hypotension, diaphoresis, and a new S3 gallop

Question 12

… of patients with cardiac disease will have their pain reproduced by chest wall pressure.

Answer 12

15%

Question 13

کدام خصوصیات در درد سینه احتمال منشأ قلبی را کم می‌کند؟

Answer 13

• Sharp quality pain
• Continuous pain for
  days or lasting fewer than 2 minutes
• If a patient can pinpoint with one finger the localized painful area and is found tender on palpation.

Question 14

A normal troponin and/or CPK-MB do not rule out cardiac disease; except in cases where the chest pain has been continuous for over…

Answer 14

12 hours

Question 15

… of all patients with an MI will have a normal ECG in the ED.

Answer 15

9%

Question 16

Only…% of those with an Ml have a diagnostic ECG in the
ED. Additionally, those with … may have a normal ECG.

Answer 16

50

angina

Question 17

….is more sensitive in the first … hours than is the troponin (about … versus …).

Answer 17

CK- MB
6
84% 74%

Question 18

An increased … is associated with increased short term and in-hospital mortality.

Answer 18

troponin

Question 19

Patients with … disease may have a mildly elevated troponin at baseline due to poor clearance,

Answer 19

renal

Question 20

… like MI, can elevate the serum troponin.

Answer 20

pulmonary emboli

Question 21

𝑾𝒉𝒊𝒄𝒉 𝒄𝒐𝒏𝒅𝒊𝒕𝒊𝒐𝒏𝒔 𝒐𝒕𝒉𝒆𝒓 𝒕𝒉𝒂𝒏 𝑴𝑰, 𝒄𝒂𝒏 𝒆𝒍𝒆𝒗𝒂𝒕𝒆 𝒕𝒓𝒐𝒑𝒐𝒏𝒊𝒏?

Answer 21

CHF, PE, burns, sepsis or
other critical illnesses,
stroke.

Question 22

What is the role of ECG in therapeutic
decisions in MI?

Answer 22

Presence or absence of
elevation in ST segment of
ECG

Question 23

Aspirin given within half an hour of chest pain is similar to … treatment.

Answer 23

thrombolytic

Question 24

patient with chest pain that may be cardiac in origin, current use of warfarin or aspirin should not prevent the … in the emergency department.

Answer 24

administration of aspirin

Question 25

….and … from NSAIDs, are reversible platelet inhibitors that do not give adequate platelet inhibition.

Answer 25

Iboprofen Maproxen

Question 26

…. and ….. can block the effect of aspirin by making binding sites on platelets unavailable.

Answer 26

Ibuprofen Naproxen

Question 27

stopping … is considered good practice for any patient who is admitted for possible CAD.

Answer 27

NSAIDs

Question 28

In ACS percentage of Unstable Angina (UA) is … % NSTEMI … % STEMI: plaque rupture and thrombus formation … %

Answer 28

38 25 30

Question 29

The microemboli breaks away from the ruptured plaque and causes … or …

Answer 29

subendocardial infarction NSTEMI ischemia UA

Question 30

The microemboli breaks away from the ruptured plaque and causes … or ….

Answer 30

subendocardial infarction NSTEMI ischemia UA

Question 31

𝑰𝒏 𝒄𝒉𝒆𝒔𝒕 𝒑𝒂𝒊𝒏, 𝒏𝒆𝒙𝒕 𝒔𝒕𝒆𝒑 𝒂𝒇𝒕𝒆𝒓 𝑬𝑪𝑮 & 𝒉𝒆𝒂𝒓t 𝒆𝒏𝒛𝒚𝒎𝒆𝒔 𝒘𝒊𝒍𝒍 𝒃𝒆 ...

Answer 31

𝒔𝒕𝒓𝒆𝒔𝒔 𝒕𝒆𝒔𝒕

Question 32

If stress test shows ischemia, the next step will be ..

Answer 32

angiography

Question 33

… is the most alarming thing a stress test could show.

Answer 33

Reversible ischemia

Question 34

… is the most alarming thing a stress test could show.

Answer 34

Reversible ischemia

Question 35

… is a defect that remains unchanged between exercise

Answer 35

Fixed defect

Question 36

The best initial test to evaluate valve function or ventricular wall motion is …

Answer 36

Echocardiography

Question 37

The most accurate method for evaluating ejection fraction is …

Answer 37

Nuclear ventriculogram (MUGA scan)

Question 38

…. is the only one that have resulted in lower mortality in chest pain.

Answer 38

Low molecular weight Heparin (LMWH)

Question 39

… is the most useful intervention to improve functional capacity and reduce symptomatic claudication in patients with peripheral arterial disease.

Answer 39

A supervised graded exercise program

Question 40

… reduce overall cardiovascular mortality.

Answer 40

Antiplatelet agents (e.g., aspirin, clopidogrel)

Question 41

… should also be given to all patients with clinically significant atherosclerotic cardiovascular disease.

Answer 41

Lipid-lowering therapy with statins

Question 42

What is Vincent Angina?

Answer 42

Chest pain because of pharyngitis and tonsillitis, kind of referred pain from the infection location

Question 43

... is a type of severe cellulitis of the floor of the mouth, in which pus can trickle down to the chest cavity.

Answer 43

Ludwig's angina

Question 44

Pain in … is related to activity, occasionally it occurs at rest as well and is linked with rupture of atherosclerotic plaque.

Answer 44

unstable angina

Question 45

A chest pain that happens after an episode of MI (post MI), after PCI or after CABG is also referred to as …

Answer 45

unstable angina

Question 46

Based on Canadian Cardiovascular Society (CCS), angina caused with strenuous, rapid, or prolonged activity if indicated as class … angina.

Answer 46

I (one)

Question 47

According to CCS angina that occur during walking > 2 blocks (same level) or > 1 flight of stairs with slight imitation of ordinary activity is referred to class ...

Answer 47

II (two)

Question 48

According to CCS, angina that occurs while walking < 2 blocks (same level) or climbing <1 flight of stairs, i.e., limitation of ordinary household activity is referred to class ...

Answer 48

III (three)

Question 49

In class ... angina, no physical activity is possible without discomfort OR Angina occurs at rest.

Answer 49

IV (four)

Question 50

چه مقدار LDL در فرد دیابتی پرخطر محسوب می‌شود؟

Answer 50

بالاتر از mg/dl ۷۰ یا ۱/۸ mEq/L

Question 51

چه بیمارانی برای آسپرین Eligible هستند؟

Answer 51

1- coronary artery diseases 2- peripheral artery diseases (e.g leg cramp) (Not just diabetic)

Question 52

نسبت ankle/brachial در حد …. نشانه‌ی آترواسکلروزِ moderate است و باید … شروع شود.

Answer 52

۱:۵ - ۱:۸ آسپرین