CARDIOLOGY FISDAP 574 PREP SET 2026
TESTED QUESTIONS WITH RATIONALE
◉ Which of the following is an absolute contraindication for
fibrinolytic therapy? Answer: Subdural hematoma 3 years ago.
According to current emergency cardiac care (ECC) guidelines,
absolute contraindications for fibrinolytic therapy include ANY prior
intracranial hemorrhage (ie, subdural, epidural, intracerebral
hematoma); known structural cerebrovascular lesion (ie,
arteriovenous malformation); known malignant intracranial tumor
(primary or metastatic); ischemic stroke within the past 3 months,
EXCEPT for acute ischemic stroke within the past 3 hours; suspected
aortic dissection; active bleeding or bleeding disorders (except
menses); and significant closed head trauma or facial trauma within
the past 3 months. Relative contraindications (eg, the physician may
deem fibrinolytic therapy appropriate under certain circumstances)
include, a history of chronic, severe, poorly-controlled hypertension;
severe uncontrolled hypertension on presentation (SBP > 180 mm
Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months
ago; dementia; traumatic or prolonged (> 10 minutes) CPR or major
surgery within the past 3 weeks; recent (within 2 to 4 weeks)
internal bleeding; noncompressible vascular punctures; pregnancy;
prior exposure (> 5 days ago) or prior allergic reaction to
streptokinase or anistreplase; active peptic ulcer; and current use of
anticoagulants (ie, Coumadin).
,◉ A middle-aged man presents with chest discomfort, shortness of
breath, and nausea. You give him supplemental oxygen and continue
your assessment. As your partner is attaching the ECG leads, you
should: Answer: Administer up to 325 mg of aspirin.
Since oxygen has already been administered to this patient and your
partner is attaching the ECG leads, you should administer aspirin
(160 to 325 mg, non-enteric-coated). Early administration of aspirin
has clearly been shown to reduce mortality and morbidity in
patients experiencing an acute coronary syndrome (ACS). After
establishing vascular access, you should assess his vital signs and
then administer 0.4 mg of nitroglycerin (up to 3 doses, 5 minutes
apart), provided that his systolic BP is greater than 90 mm Hg. If 3
doses of nitroglycerin fail to completely relieve his chest discomfort,
consider administering 2 to 4 mg of morphine IV, provided that his
systolic BP remains above 90 mm Hg.
◉ Which of the following ECG lead configurations is correct?
Answer: To assess lead II, place the negative lead on the right arm
and the positive lead on the left leg.
According to the Einthoven triangle, lead I is assessed by placing the
negative (white) lead on the right arm and the positive (red) lead on
the left arm. Lead II is assessed by placing the negative lead on the
right arm and the positive lead on the left leg. Lead III is assessed by
placing the negative lead on the left arm and the positive lead on the
left leg.
,◉ A 61-year-old male presents with chest pressure that woke him
up from his nap 30 minutes ago. He is diaphoretic, anxious, and rates
his pain as an an 8 over 10. His past medical history is significant for
hypertension, type II diabetes, and coronary stent placement 2
months ago. He takes lisinopril, Plavix, and Glucophage, and is
wearing a medical alert bracelet stating "allergic to salicylates." His
blood pressure is 160/100 mm Hg, pulse is 110 beats/min, and
respirations are 22 breaths/min. The 12-lead ECG shows sinus
tachycardia with 3-mm ST segment elevation in leads V1 through V5.
Which of the following treatment modalities is MOST appropriate
for this patient? Answer: Supplemental oxygen, vascular access, up
to three 0.4 mg doses of nitroglycerin, and 2 to 4 mg of morphine
sulfate if his systolic BP is greater than 90 mm Hg and he is still
experiencing pain.
The patient is experiencing an acute coronary syndrome (ACS). His
12-lead ECG indicates anteroseptal injury with lateral extension (ST
elevation in leads V1 through V5). Appropriate treatment includes
oxygen (maintain an SpO2 of greater than 94%), vascular access, up
to three 0.4 mg doses of nitroglycerin (NTG), and 2 to 4 mg of
morphine if NTG fails to relieve his pain and his systolic BP is above
90 mm Hg. Some EMS systems may use fentanyl (Sublimaze) for
analgesia. Aspirin, a salicylate, is also given to patients with ACS;
however, this patient is allergic to salicylates. Obtain a right-sided
12-lead ECG in patients with signs of inferior wall injury (ST
elevation in leads II, III, aVF). Inferior wall infarctions may involve
the right ventricle; a right-sided 12-lead ECG will help confirm this.
, Apply the multi-pads to the patient, not because he is at risk for
bradycardia (more common with inferior infarctions), but because
he is at risk for cardiac arrest due to V-Fib or pulseless V-Tach.
◉ You and your team are performing CPR on a 70-year-old male. The
cardiac monitor reveals a slow, organized rhythm. His wife tells you
that he goes to dialysis every day, but has missed his last three
treatments. She also tells you that he has high blood pressure,
hyperthyroidism, and has had several cardiac bypass surgeries.
Based on the patient's medical history, which of the following
conditions is the MOST likely underlying cause of his condition?
Answer: Hyperkalemia.
Although any of the listed conditions could be causing this patient's
condition, the fact that he missed his last three dialysis treatments
should make you most suspicious for hyperkalemia. Dialysis filters
metabolic waste products from the blood in patients with renal
insufficiency or failure. If the patient is not dialyzed, these waste
products, including potassium and other electrolytes, accumulate to
toxic levels in the blood. In addition to performing high-quality CPR,
managing the airway, and administering epinephrine, your protocols
may call for the administration of calcium chloride and sodium
bicarbonate if hyperkalemia is suspected. Albuterol also has been
shown to be effective in treating patients with hyperkalemia
becauses it causes potassium to shift back into the cells; it can be
nebulized down the ET tube or administered intravenously. Follow
your local protocols regarding the treatment for suspected
hyperkalemia.
TESTED QUESTIONS WITH RATIONALE
◉ Which of the following is an absolute contraindication for
fibrinolytic therapy? Answer: Subdural hematoma 3 years ago.
According to current emergency cardiac care (ECC) guidelines,
absolute contraindications for fibrinolytic therapy include ANY prior
intracranial hemorrhage (ie, subdural, epidural, intracerebral
hematoma); known structural cerebrovascular lesion (ie,
arteriovenous malformation); known malignant intracranial tumor
(primary or metastatic); ischemic stroke within the past 3 months,
EXCEPT for acute ischemic stroke within the past 3 hours; suspected
aortic dissection; active bleeding or bleeding disorders (except
menses); and significant closed head trauma or facial trauma within
the past 3 months. Relative contraindications (eg, the physician may
deem fibrinolytic therapy appropriate under certain circumstances)
include, a history of chronic, severe, poorly-controlled hypertension;
severe uncontrolled hypertension on presentation (SBP > 180 mm
Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months
ago; dementia; traumatic or prolonged (> 10 minutes) CPR or major
surgery within the past 3 weeks; recent (within 2 to 4 weeks)
internal bleeding; noncompressible vascular punctures; pregnancy;
prior exposure (> 5 days ago) or prior allergic reaction to
streptokinase or anistreplase; active peptic ulcer; and current use of
anticoagulants (ie, Coumadin).
,◉ A middle-aged man presents with chest discomfort, shortness of
breath, and nausea. You give him supplemental oxygen and continue
your assessment. As your partner is attaching the ECG leads, you
should: Answer: Administer up to 325 mg of aspirin.
Since oxygen has already been administered to this patient and your
partner is attaching the ECG leads, you should administer aspirin
(160 to 325 mg, non-enteric-coated). Early administration of aspirin
has clearly been shown to reduce mortality and morbidity in
patients experiencing an acute coronary syndrome (ACS). After
establishing vascular access, you should assess his vital signs and
then administer 0.4 mg of nitroglycerin (up to 3 doses, 5 minutes
apart), provided that his systolic BP is greater than 90 mm Hg. If 3
doses of nitroglycerin fail to completely relieve his chest discomfort,
consider administering 2 to 4 mg of morphine IV, provided that his
systolic BP remains above 90 mm Hg.
◉ Which of the following ECG lead configurations is correct?
Answer: To assess lead II, place the negative lead on the right arm
and the positive lead on the left leg.
According to the Einthoven triangle, lead I is assessed by placing the
negative (white) lead on the right arm and the positive (red) lead on
the left arm. Lead II is assessed by placing the negative lead on the
right arm and the positive lead on the left leg. Lead III is assessed by
placing the negative lead on the left arm and the positive lead on the
left leg.
,◉ A 61-year-old male presents with chest pressure that woke him
up from his nap 30 minutes ago. He is diaphoretic, anxious, and rates
his pain as an an 8 over 10. His past medical history is significant for
hypertension, type II diabetes, and coronary stent placement 2
months ago. He takes lisinopril, Plavix, and Glucophage, and is
wearing a medical alert bracelet stating "allergic to salicylates." His
blood pressure is 160/100 mm Hg, pulse is 110 beats/min, and
respirations are 22 breaths/min. The 12-lead ECG shows sinus
tachycardia with 3-mm ST segment elevation in leads V1 through V5.
Which of the following treatment modalities is MOST appropriate
for this patient? Answer: Supplemental oxygen, vascular access, up
to three 0.4 mg doses of nitroglycerin, and 2 to 4 mg of morphine
sulfate if his systolic BP is greater than 90 mm Hg and he is still
experiencing pain.
The patient is experiencing an acute coronary syndrome (ACS). His
12-lead ECG indicates anteroseptal injury with lateral extension (ST
elevation in leads V1 through V5). Appropriate treatment includes
oxygen (maintain an SpO2 of greater than 94%), vascular access, up
to three 0.4 mg doses of nitroglycerin (NTG), and 2 to 4 mg of
morphine if NTG fails to relieve his pain and his systolic BP is above
90 mm Hg. Some EMS systems may use fentanyl (Sublimaze) for
analgesia. Aspirin, a salicylate, is also given to patients with ACS;
however, this patient is allergic to salicylates. Obtain a right-sided
12-lead ECG in patients with signs of inferior wall injury (ST
elevation in leads II, III, aVF). Inferior wall infarctions may involve
the right ventricle; a right-sided 12-lead ECG will help confirm this.
, Apply the multi-pads to the patient, not because he is at risk for
bradycardia (more common with inferior infarctions), but because
he is at risk for cardiac arrest due to V-Fib or pulseless V-Tach.
◉ You and your team are performing CPR on a 70-year-old male. The
cardiac monitor reveals a slow, organized rhythm. His wife tells you
that he goes to dialysis every day, but has missed his last three
treatments. She also tells you that he has high blood pressure,
hyperthyroidism, and has had several cardiac bypass surgeries.
Based on the patient's medical history, which of the following
conditions is the MOST likely underlying cause of his condition?
Answer: Hyperkalemia.
Although any of the listed conditions could be causing this patient's
condition, the fact that he missed his last three dialysis treatments
should make you most suspicious for hyperkalemia. Dialysis filters
metabolic waste products from the blood in patients with renal
insufficiency or failure. If the patient is not dialyzed, these waste
products, including potassium and other electrolytes, accumulate to
toxic levels in the blood. In addition to performing high-quality CPR,
managing the airway, and administering epinephrine, your protocols
may call for the administration of calcium chloride and sodium
bicarbonate if hyperkalemia is suspected. Albuterol also has been
shown to be effective in treating patients with hyperkalemia
becauses it causes potassium to shift back into the cells; it can be
nebulized down the ET tube or administered intravenously. Follow
your local protocols regarding the treatment for suspected
hyperkalemia.
