EMERGENCY MEDICINE EOR EXAM LATEST 2023-2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
Dilated Cardiomyopathy: most common cause is ____. Others? - (answer) 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? - (answer) 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 - (answer) 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? - (answer) --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? - (answer) 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? - (answer) 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? - (answer) CCB
BLOCKS
,EMERGENCY MEDICINE EOR EXAM LATEST 2023-2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
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. - (answer) 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. - (answer) 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? - (answer) vagal maneuvers or antianxiety medication
What are some drugs associated with Torsades de pointes? - (answer) 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? - (answer)
pump; CCB!
CHF - Diastolic dysfunction means a problem with the ____. - (answer) 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. - (answer) Frank-Starling principle
_____is released from cardiac ventricles in response to increased wall tension. - (answer) BNP - B-type
natriuretic peptide
What is the pharmacologic therapy for heart failure? - (answer) 1. diuretics for fluid retention
2. ACEi
,EMERGENCY MEDICINE EOR EXAM LATEST 2023-2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
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. - (answer) Class I, Class II, Class III, Class IV
Stage 1 Hypertension is defined as greater than ____. Stage 2 Hypertension is defined as greater than
____. - (answer) 140/90; 160/100
Hypertension Drug of Choice for:
angina
diabetes
hyperlipidemia
CHF
Previous MI
Chronic Renal Failure
Asthma, COPD - (answer) 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
, EMERGENCY MEDICINE EOR EXAM LATEST 2023-2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
Secondary hypertension is HTN due to an ______. - (answer) 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. - (answer) Malignant
Malignant hypertension bp? What is the rule of thumb for lowering? - (answer) 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? - (answer) 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? - (answer) 90mmHg;
1. IV Fluids
2. Vasopressors - dopasmine, dobutamine (risk is aggravation of arrhythmias and increase myocardial
oxygen demand)
3. intra-aortic balloon pump
ST Elevations in II, III, aVF - (answer) Inferior MI; right coronary artery
ST Elevations in I, aVL, V4, V5, V6 - (answer) lateral wall MI, left circumflex artery
ST Elevations in V1, V2, V3, V4, V5 - (answer) Anterioseptal MI, left anterior descending artery
ST Elevations in V1, V2 - (answer) posterior wall MI, posterior descending artery
No nitroglycerin in which kind of MI? - (answer) inferior
DETAILED ANSWERS
Dilated Cardiomyopathy: most common cause is ____. Others? - (answer) 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? - (answer) 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 - (answer) 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? - (answer) --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? - (answer) 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? - (answer) 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? - (answer) CCB
BLOCKS
,EMERGENCY MEDICINE EOR EXAM LATEST 2023-2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
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. - (answer) 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. - (answer) 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? - (answer) vagal maneuvers or antianxiety medication
What are some drugs associated with Torsades de pointes? - (answer) 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? - (answer)
pump; CCB!
CHF - Diastolic dysfunction means a problem with the ____. - (answer) 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. - (answer) Frank-Starling principle
_____is released from cardiac ventricles in response to increased wall tension. - (answer) BNP - B-type
natriuretic peptide
What is the pharmacologic therapy for heart failure? - (answer) 1. diuretics for fluid retention
2. ACEi
,EMERGENCY MEDICINE EOR EXAM LATEST 2023-2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
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. - (answer) Class I, Class II, Class III, Class IV
Stage 1 Hypertension is defined as greater than ____. Stage 2 Hypertension is defined as greater than
____. - (answer) 140/90; 160/100
Hypertension Drug of Choice for:
angina
diabetes
hyperlipidemia
CHF
Previous MI
Chronic Renal Failure
Asthma, COPD - (answer) 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
, EMERGENCY MEDICINE EOR EXAM LATEST 2023-2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
Secondary hypertension is HTN due to an ______. - (answer) 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. - (answer) Malignant
Malignant hypertension bp? What is the rule of thumb for lowering? - (answer) 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? - (answer) 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? - (answer) 90mmHg;
1. IV Fluids
2. Vasopressors - dopasmine, dobutamine (risk is aggravation of arrhythmias and increase myocardial
oxygen demand)
3. intra-aortic balloon pump
ST Elevations in II, III, aVF - (answer) Inferior MI; right coronary artery
ST Elevations in I, aVL, V4, V5, V6 - (answer) lateral wall MI, left circumflex artery
ST Elevations in V1, V2, V3, V4, V5 - (answer) Anterioseptal MI, left anterior descending artery
ST Elevations in V1, V2 - (answer) posterior wall MI, posterior descending artery
No nitroglycerin in which kind of MI? - (answer) inferior
