McGraW- HILL EMERGENCY MEDICINE
EXAM REVIEW (Tintinalli's) COMPLETE
TEST BANK WITH 800+ ACTUAL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH EXPLANATIONS (100%
CORRECT VERIFIED SOLUTIONS) LATEST
UPDATED VERSION 2025/2026 |ALREADY
GRADED A+ (BRAND NEW!
What is the MOST common cause of cardiogenic shock?
A
Acute aortic insufficiency
B
Aortic stenosis
C
Hypertrophic cardiomyopathy
D
Acute myocardial infarction (AMI)
E
Pericardial tamponade
The correct answer is D. Acute myocardial infarction (AMI)
Explanation:
Cardiogenic shock is mostly commonly due to extensive MI with
suppressed myocardial contractility. Pump failure is the underlying factor
,in most causes of cardiogenic shock (Table 54-2). Hypoperfusion, with or
without hypotension, is the unifying feature of cardiogenic shock,
regardless of etiology. During an AMI, several mechanical complications
can precipitate cardiogenic shock, including acute myocardial
regurgitation due to papillary muscle rupture, ventricular septal defect
(VSD), and free-wall rupture. Mechanical complications cause one-fourth
of the cardiogenic shock following AMI. Right ventricular infarction can
also cause cardiogenic shock due to loss of preload. Cardiac contractility
can also be severely depressed due to sepsis, myocarditis, myocardial
contusion, and cardiomyopathy. Mechanical obstruction to forward blood
flow can als
Which of the following medications should be avoided in stable
patients with a history of heart failure?
A
Acetaminophen
B
Angiotensin-converting enzyme (ACE) inhibitors
C
Angiotensin receptor blockers
D
Beta-blockers
E
Nonsteroidal anti-inflammatory agents
The correct answer is E. Nonsteroidal anti-inflammatory agents
Explanation:
Nonsteroidal anti-inflammatory agents inhibit the effects of ACE inhibitors
and diuretics and can worsen cardiac and renal function. The emergency
physician (EP) should review the medication lists of heart failure patients
and also avoid prescribing nonsteroidal anti-inflammatory drugs (NSAIDs)
when such patients present for injuries or chronic pain. The main risk of
acetaminophen, at excessive levels, is hepatotoxicity. Stable heart failure
patients are discharged on ACE inhibitors and beta-blockers because
these medications have been conclusively shown to decrease mortality.
,Angiotensin receptor blockers have fewer side effects than ACE inhibitors
but can still cause cough or angioedema.
75% of users answered correctly.
A previously well 25-year-old man presents to the ED with 3 days of
dyspnea, and orthopnea, and a recent febrile illness associated with
myalgias, dyspnea, and precordial chest pain. Vital signs are BP
124/82, HR 120, RR 26, T 100.6, room air saturation 96%. Physical exam
findings include a supple neck, faint bibasilar rales, and a friction rub.
His chest x-ray (CXR) is shown here (Figure 2-2). A CBC, serum
electrolytes, blood urea nitrogen, and creatinine are normal. The initial
troponin is 1 ng/mL and myoglobin is 100 ng/mL. His ECG shows sinus
tachycardia with nonspecific ST–T-wave changes. Echocardiography
shows a very small pericardial effusion. What is his most likely
diagnosis?
A
Acute coronary syndrome
B
Myocarditis
C
Pericarditis
D
Pneumonia
E
Pulmonary embolus
The correct answer is B. Myocarditis
Explanation:
This patient, with a pericardial friction rub, elevated cardiac biomarkers,
and radiographic and clinical signs of CHF, has myocarditis, a common
cause of dilated cardiomyopathy. Etiologies of myocarditis include viral,
bacterial, fungal causes, as well as malignant, drug-induced, and
systemic diseases. Echocardiography is nonspecific for myocarditis but
can show myocardial depression (global hypokinesis) and wall motion
, abnormalities in severe cases. Diagnosis of myocarditis may require a
nuclear scan, heart biopsy, or MRI. Cardiac enzymes are elevated with
myocarditis and should be followed serially. Acute coronary syndrome is
unlikely in a young, previously well patient. The pericardium can be
inflamed in myopericarditis. Pulmonary embolus belongs to the
differential diagnosis for acute dyspnea, but other elements in this
presentation suggest myocarditis. Most pat
An 85-year-old male with a history of chronic hypertension presents
with 2 hours of chest pain, which radiates to his back. It is the worst
pain he has ever had and feels it ripping down his back. His initial BP in
the ED is 180/110. He has a widened mediastinum on his chest x-ray,
and his ECG is unchanged. In approximately 45 minutes, you notice
that he has become altered and his BP is now 75/50. What is the most
appropriate diagnostic modality for this patient?
A
CT scan
B
Central venous pressure monitoring
C
Echocardiogram
D
Repeat chest x-ray
E
Repeat ECG
The correct answer is C. Echocardiogram
Explanation:
This patient is likely having an aortic dissection. Aortic dissections are
difficult because of the dynamic nature of their presentations. As the
dissection travels down the aorta, it can cut off circulation to the
brachiocephalic artery, the carotids, the renal vessels, etc. This patient’s
hypotension was most likely due to his dissection spreading anterograde
and causing a pericardial tamponade. Chest x-ray, CT scans, etc., are less
helpful than a bedside cardiac echo. The echo can help in the patient with
EXAM REVIEW (Tintinalli's) COMPLETE
TEST BANK WITH 800+ ACTUAL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH EXPLANATIONS (100%
CORRECT VERIFIED SOLUTIONS) LATEST
UPDATED VERSION 2025/2026 |ALREADY
GRADED A+ (BRAND NEW!
What is the MOST common cause of cardiogenic shock?
A
Acute aortic insufficiency
B
Aortic stenosis
C
Hypertrophic cardiomyopathy
D
Acute myocardial infarction (AMI)
E
Pericardial tamponade
The correct answer is D. Acute myocardial infarction (AMI)
Explanation:
Cardiogenic shock is mostly commonly due to extensive MI with
suppressed myocardial contractility. Pump failure is the underlying factor
,in most causes of cardiogenic shock (Table 54-2). Hypoperfusion, with or
without hypotension, is the unifying feature of cardiogenic shock,
regardless of etiology. During an AMI, several mechanical complications
can precipitate cardiogenic shock, including acute myocardial
regurgitation due to papillary muscle rupture, ventricular septal defect
(VSD), and free-wall rupture. Mechanical complications cause one-fourth
of the cardiogenic shock following AMI. Right ventricular infarction can
also cause cardiogenic shock due to loss of preload. Cardiac contractility
can also be severely depressed due to sepsis, myocarditis, myocardial
contusion, and cardiomyopathy. Mechanical obstruction to forward blood
flow can als
Which of the following medications should be avoided in stable
patients with a history of heart failure?
A
Acetaminophen
B
Angiotensin-converting enzyme (ACE) inhibitors
C
Angiotensin receptor blockers
D
Beta-blockers
E
Nonsteroidal anti-inflammatory agents
The correct answer is E. Nonsteroidal anti-inflammatory agents
Explanation:
Nonsteroidal anti-inflammatory agents inhibit the effects of ACE inhibitors
and diuretics and can worsen cardiac and renal function. The emergency
physician (EP) should review the medication lists of heart failure patients
and also avoid prescribing nonsteroidal anti-inflammatory drugs (NSAIDs)
when such patients present for injuries or chronic pain. The main risk of
acetaminophen, at excessive levels, is hepatotoxicity. Stable heart failure
patients are discharged on ACE inhibitors and beta-blockers because
these medications have been conclusively shown to decrease mortality.
,Angiotensin receptor blockers have fewer side effects than ACE inhibitors
but can still cause cough or angioedema.
75% of users answered correctly.
A previously well 25-year-old man presents to the ED with 3 days of
dyspnea, and orthopnea, and a recent febrile illness associated with
myalgias, dyspnea, and precordial chest pain. Vital signs are BP
124/82, HR 120, RR 26, T 100.6, room air saturation 96%. Physical exam
findings include a supple neck, faint bibasilar rales, and a friction rub.
His chest x-ray (CXR) is shown here (Figure 2-2). A CBC, serum
electrolytes, blood urea nitrogen, and creatinine are normal. The initial
troponin is 1 ng/mL and myoglobin is 100 ng/mL. His ECG shows sinus
tachycardia with nonspecific ST–T-wave changes. Echocardiography
shows a very small pericardial effusion. What is his most likely
diagnosis?
A
Acute coronary syndrome
B
Myocarditis
C
Pericarditis
D
Pneumonia
E
Pulmonary embolus
The correct answer is B. Myocarditis
Explanation:
This patient, with a pericardial friction rub, elevated cardiac biomarkers,
and radiographic and clinical signs of CHF, has myocarditis, a common
cause of dilated cardiomyopathy. Etiologies of myocarditis include viral,
bacterial, fungal causes, as well as malignant, drug-induced, and
systemic diseases. Echocardiography is nonspecific for myocarditis but
can show myocardial depression (global hypokinesis) and wall motion
, abnormalities in severe cases. Diagnosis of myocarditis may require a
nuclear scan, heart biopsy, or MRI. Cardiac enzymes are elevated with
myocarditis and should be followed serially. Acute coronary syndrome is
unlikely in a young, previously well patient. The pericardium can be
inflamed in myopericarditis. Pulmonary embolus belongs to the
differential diagnosis for acute dyspnea, but other elements in this
presentation suggest myocarditis. Most pat
An 85-year-old male with a history of chronic hypertension presents
with 2 hours of chest pain, which radiates to his back. It is the worst
pain he has ever had and feels it ripping down his back. His initial BP in
the ED is 180/110. He has a widened mediastinum on his chest x-ray,
and his ECG is unchanged. In approximately 45 minutes, you notice
that he has become altered and his BP is now 75/50. What is the most
appropriate diagnostic modality for this patient?
A
CT scan
B
Central venous pressure monitoring
C
Echocardiogram
D
Repeat chest x-ray
E
Repeat ECG
The correct answer is C. Echocardiogram
Explanation:
This patient is likely having an aortic dissection. Aortic dissections are
difficult because of the dynamic nature of their presentations. As the
dissection travels down the aorta, it can cut off circulation to the
brachiocephalic artery, the carotids, the renal vessels, etc. This patient’s
hypotension was most likely due to his dissection spreading anterograde
and causing a pericardial tamponade. Chest x-ray, CT scans, etc., are less
helpful than a bedside cardiac echo. The echo can help in the patient with
