Cardio

Question 1

ST segment depression and/or T wave inversions suggests

Answer 1

NSTEMI or Unstable Angina

Question 2

If a pt with ACS is allergic to ASA, what do you give?

Answer 2

Clopidogrel

Question 3

If a pt with ACS has the following RF: DVT, reinfarction, stroke, LV thrombus, reocclusion, what do you give?

Answer 3

Heparin

Question 4

CI of nitroglycerin?

Answer 4

Sildenafil within 24 hrs

RV infarction

Question 5

If possible, pt with a STEMI should get PCI within

Answer 5

<90 min from door to surgery

Question 6

If you’re in a rural community >120min from PCI center, give

Answer 6

Antithrombolytics (TPA or other ~ase) within 30 min of arrival to ED

Question 7

ST elevation in Leads I and aVL means infarct where?

Answer 7

Lateral wall

Question 8

ST elevation in leads II, III, aVF means infarct where?

Answer 8

Inferior wall (could be right ventricle)

Question 9

Pt presents with inferior wall infarction and bradycardia. The pt likely received what that led to the bradycardia?

Answer 9

Nitro

Question 10

ST elevation in leads V1 and V2 =

Answer 10

Infarct in septum

Question 11

ST elevations in V3 and V4 =

Answer 11

Infarct in anterior wall

Question 12

ST elevations in V5 and V6 =

Answer 12

Lateral wall infarct

Question 13

Who is more likely to have an atypical presentation of an MI?

Answer 13

Elderly, women, diabetics, hx of stroke or HF

Question 14

Initial ECG changes with heart ischemia

Answer 14

T wave prolongation

Question 15

Pt presents with chest pain, new onset murmur, positive cardio biomarkers, no ST changes would indicate what? May also hear a new S4 or paradoxical S2

Answer 15

NSTEMI

Question 16

What 4 drugs have been shown to decrease mortality in patients with hx of an MI?

Answer 16

ACE-inhibitors, statins, ASA, BBs

Question 17

After PCI and stent placement, what two drugs should be given to decrease coronary artery stent thrombosis?

Answer 17

ASA + Clopidogrel (ticagrelor, prasugrel)

Question 18

After stent placement, what two drugs should be continued and for how long to decrease risk for coronary artery stent thrombosis?

Answer 18

ASA indefinitely

Clopidogrel for 1 year

Question 19

Hydrochlorothiazide can cause elevation of what electrolyte?

Answer 19

Ca2+

Question 20

MC atypical presentation of ACS in elderly pts?

Answer 20

Dyspnea

Question 21

CI of fibrinolytic therapy

Answer 21

Absolute: Hx of intracranial bleed or neoplasm, stroke, facial trauma

Relative: diastolic BP >110, chronic HTN, pregnancy, and anticoagulant use

Question 22

Risk stratification tool used for unstable angina and NSTEMI to determine treatment

Answer 22

TIMI = thrombolysis in myocardial infarction tool

Question 23

Pt presents with chronic stable angina (treated), but is still symptomatic. What do you give?

Answer 23

Ranolazine

Question 24

What is the most specific finding for myocardial ischemia in an exercise stress test?

Answer 24

2mm downsloping of the ST segment

Question 25

Target HR in exercise stress test

Answer 25

85% of max HR

Question 26

When should a high intensity statin be recommended?

Answer 26

When ASCVD risk is >20%

Question 27

If LDL is >100 on a moderate intensity statin, what two drugs could be considered?

Answer 27

Ezetimibe or PCSK9-1 inhibitor

Question 28

LDL >190 at age 40-75 y/o indicates you should start

Answer 28

a moderate intensity statin

Question 29

EKG shows ST elevation in V1-V4. What artery is blocked?

Answer 29

LAD

Question 30

EKG shows ST elevation in leads II, III, and aVF. What artery could be blocked?

Answer 30

Left circumflex or RCA

Question 31

EKG shows ST elevation in leads I, aVL, V5, and V6. What artery could be blocked?

Answer 31

Left circumflex or LAD

Question 32

Chronic stable angina first line treatments

Answer 32

BBs, ASA, Statin

Question 33

Pt with chronic stable angina is still symptomatic on atenolol, ASA, and a stain. What could you try next?

Answer 33

CCBs like amlodipine, nifedipine, verapamil

Question 34

Pt with chronic stable angina does not respond to BBs OR CCBs. What could you give next?

Answer 34

Ranolazine or Nitro

Question 35

Pt presents with syncope and HR is the 40s. She is in sinus rhythm. First line treatment is?

Answer 35

Atropine

Question 36

You see SVTs on the cardiac monitor. First line treatment is

Answer 36

Adenosine

Question 37

What anti platelet drugs are recommended with a STEMI?

Answer 37

ASA, clopidogrel, ticagrelor, epitifibatide, prasugrel

Question 38

When do troponin levels return to baseline post STEMI?

Answer 38

5-14 days

Question 39

At what age should men with low CVD risk start lipid screenings?

Answer 39

35

Question 40

Men with higher CVD risk or women with higher CVD risk should start lipid screenings when?

Answer 40

Men: 25 y/o Women: 35 y/o

Question 41

If pts are below the threshold to begin lipid lowering drugs, they should be screened

Answer 41

every 5 years

Question 42

Children should have a lipid screening when?

Answer 42

Once before and after puberty

Question 43

If a pt has LDL level of 140 and a 10 year ASCVD risk between 10-20%, you should

Answer 43

Initiate drug therapy (statin)

Question 44

At what blood LDL level should a statin immediately be started?

Answer 44

> or = 190mg/dL

Question 45

52 y/o pt presents with T2D. What therapy should you consider to protect their CVD risk?

Answer 45

Statins are recommended to pts with T2D btw ages 40-75y/o

Question 46

LDL consistently above what level is considered an ASCVD risk factor?

Answer 46

160mg/dL

Question 47

Chest pain early in the morning is a characteristic of

Answer 47

prinzmental/vasospastic angina

Question 48

First line treatment for prinzmental angina

Answer 48

CCB or nitrates

Question 49

What drugs are contraindicated in an NSTEMI?

Answer 49

Thrombolytics!!!! Altepase, reteplase

Question 50

Pt presents with elevated cardiac enzymes but no ST elevation. What is the treatment regimen?

Answer 50

O2 if needed Nitrates w/ L-sided HF and NO hypotension BBs or ACEi Antiplatelet (ASA, clopidogrel) Anticoagulant (enoxaparin, bivalirudin, faundaparinux)

Question 51

ST elevation in leads II, III, aVF. What drug is CI?

Answer 51

Nitrates

Question 52

Earliest EKG finding in an acute STEMI

Answer 52

hyperacute T waves

Question 53

What is commonly seen on EKG after a STEM

Answer 53

Q wave (smooth curve)