Emergency Medicine EOR Exam
Questions and Answers48
Dilated Cardiomyopathy: most common cause is ____. Others? - ANSWERS-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? - ANSWERS-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 -
ANSWERS-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? - ANSWERS---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? - ANSWERS-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? - ANSWERS-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? -
ANSWERS-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. - ANSWERS-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. - ANSWERS-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? - ANSWERS-vagal maneuvers or antianxiety medication
What are some drugs associated with Torsades de pointes? - ANSWERS-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? -
ANSWERS-pump; CCB!
,CHF - Diastolic dysfunction means a problem with the ____. - ANSWERS-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. - ANSWERS-Frank-Starling principle
_____is released from cardiac ventricles in response to increased wall tension. - ANSWERS-BNP
- B-type natriuretic peptide
What is the pharmacologic therapy for heart failure? - ANSWERS-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. - ANSWERS-Class I, Class II, Class III, Class IV
Stage 1 Hypertension is defined as greater than ____. Stage 2 Hypertension is defined as greater
than ____. - ANSWERS-140/90; 160/100
Hypertension Drug of Choice for:
angina
diabetes
, hyperlipidemia
CHF
Previous MI
Chronic Renal Failure
Asthma, COPD - ANSWERS-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 ______. - ANSWERS-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. - ANSWERS-Malignant
Malignant hypertension bp? What is the rule of thumb for lowering? - ANSWERS-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? - ANSWERS-
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? -
ANSWERS-90mmHg;
Questions and Answers48
Dilated Cardiomyopathy: most common cause is ____. Others? - ANSWERS-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? - ANSWERS-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 -
ANSWERS-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? - ANSWERS---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? - ANSWERS-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? - ANSWERS-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? -
ANSWERS-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. - ANSWERS-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. - ANSWERS-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? - ANSWERS-vagal maneuvers or antianxiety medication
What are some drugs associated with Torsades de pointes? - ANSWERS-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? -
ANSWERS-pump; CCB!
,CHF - Diastolic dysfunction means a problem with the ____. - ANSWERS-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. - ANSWERS-Frank-Starling principle
_____is released from cardiac ventricles in response to increased wall tension. - ANSWERS-BNP
- B-type natriuretic peptide
What is the pharmacologic therapy for heart failure? - ANSWERS-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. - ANSWERS-Class I, Class II, Class III, Class IV
Stage 1 Hypertension is defined as greater than ____. Stage 2 Hypertension is defined as greater
than ____. - ANSWERS-140/90; 160/100
Hypertension Drug of Choice for:
angina
diabetes
, hyperlipidemia
CHF
Previous MI
Chronic Renal Failure
Asthma, COPD - ANSWERS-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 ______. - ANSWERS-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. - ANSWERS-Malignant
Malignant hypertension bp? What is the rule of thumb for lowering? - ANSWERS-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? - ANSWERS-
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? -
ANSWERS-90mmHg;
