- In a patient scheduled for exercise stress testing, which of the following medication class would possible lower the sensitivity of the test?
a. Calcium channel blockers
b. ACE inhibitors
- An elderly patient with several cardiac risk factors is to have a fractured hip repaired. What medication class has been proven to reduce peri-operative mortality and myocardial infarctions in high risk patients?
a. ACE inhibitors
- A thirty year old male with a history of Marfan’s disease has been admitted for syncope and a “ripping” type chest pain. Given his medical history what condition should be considered?
b. Pericardial tamponade
c. Myocardial infarction
d. Thoracic aneurysm
- A patient with AV block has an increasing PR interval until a QRS beat is dropped. Which kind of AV block is this?
a.1st degree AV block
b. 2nd degree AV block, Type I (Wenckebach)
c. 2nd degree AV block, Type II
d. 3rd degree AV block
- Flattened T waves are characteristic of what metabolic abnormality?
d. Digoxin toxicity
- A patient with myocardial ischemia has ST elevation in leads V1-V3. Which coronary artery is most likely involved?
a. Right coronary artery
b. Diagonal artery
c. Circumflex artery
d. Left anterior descending
- A patient with an ST-elevation MI is evaluated for possible thrombolytic treatment. Which of the following medical conditions is NOT an absolute contraindication to the use of thrombolytics?
a. CNS neoplasm
b. CVA in the past year
c. Prior CNS bleed
d. Currently menstruating
- Premature atrial contractions (PAC) are often seen in patients with which condition?
a. Chronic lung disease
b. Chronic renal disease
c. Abdominal aortic aneurysm
- A fifty year old male is admitted for sudden sharp sub-sternal chest pain following an episode of vomiting. His initial chest radiograph shows a pneumomediastinum. What is his likely diagnosis?
a. Thoracic aneurysm
b. Abdominal aortic aneurysm
c. Myocardial infarction
d. Esophageal rupture (Boerhaave syndrome)
- Which of the following physical findings is NOT a part of Beck’s triad seen in cardiac tamponade?
a. Distended neck veins
b. Muffled heart sounds
Answers and Explanations
- C: Beta-blockers can blunt the maximum achievable heart rate and therefore, lower the sensitivity of the stress test.
- B: Beta-blockers have been shown to reduce the risk of perioperative deaths and myocardial infarctions in high risk patients.
- D: Patients with a history of Marfan’s disease are at higher of risk of aneurismal disease, and thoracic aneurysm should be highly considered.
- B: The progressively longer PR interval until a QRS is dropped is characteristic of a 2nd degree AV block, Type I (Wenckebach).
- B: A pattern of flattened T waves is characteristic of hypokalemia.
- D: ST elevation in leads V1-V3 would most likely be due to involvement of the LAD.
- D: Menses is not an absolute contraindication to thrombolytic use.
- A: PAC’s are often seen in patients with chronic lung disease.
- D: The patient’s history and chest x-ray finding are classic for esophageal rupture, and the diagnosis could be confirmed with water-soluble contrast study.
- C: Tachycardia is not a part of Beck’s triad.