Emergency Medicine EOR Exam WITH VERIFIED CORRECT ANSWERS.docx

Emergency Medicine EOR | | |




Exam WITH VERIFIED
| | |




CORRECT ANSWERS |




Dilated |Cardiomyopathy: |most |common |cause |is |____. |Others? |- |correct |answersalcohol; |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 |answersPE: |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 |answerscardiac |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 |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? |- |correct |answers1. |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 |
answers1. |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 |
answersCCB



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 |answersFirst |
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 |answersBundle |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 |answersvagal |maneuvers |or |antianxiety |medication



What |are |some |drugs |associated |with |Torsades |de |pointes? |- |correct |answerstricyclic |
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 |answerspump; |CCB!

,CHF |- |Diastolic |dysfunction |means |a |problem |with |the |____. |- |correct |answerscompliance |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 |answersFrank-Starling |principle



_____is |released |from |cardiac |ventricles |in |response |to |increased |wall |tension. |- |correct |
answersBNP |- |B-type |natriuretic |peptide



What |is |the |pharmacologic |therapy |for |heart |failure? |- |correct |answers1. |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 |answersClass |I, |Class |II, |Class |III, |Class |IV



Stage |1 |Hypertension |is |defined |as |greater |than |____. |Stage |2 |Hypertension |is |defined |as |
greater |than |____. |- |correct |answers140/90; |160/100



Hypertension |Drug |of |Choice |for:

angina

, diabetes

hyperlipidemia

CHF

Previous |MI

Chronic |Renal |Failure

Asthma, |COPD |- |correct |answersAngina |- |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 |answersidentifiable |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 |answersMalignant



Malignant |hypertension |bp? |What |is |the |rule |of |thumb |for |lowering? |- |correct |answersgreater |
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 |
answersnitroprusside; |propranolol |-- |clonidine |can |also |be |used |but |sedation |is |common