CVICU

Question 1

The intra-aortic balloon pump:

a) Inflates during diastole, resulting in afterload reduction
b) Inflates during diastole, resulting in increased myocardial perfusion
c) Deflates during diastole, resulting in afterload reduction
d) Deflates during diastole, resulting in increased myocardial perfusion

Answer 1

b) Inflates during diastole, resulting in increased myocardial perfusion

Question 2

A 36 year-old male presents to ER with palpitations and lightheadedness. He denies chest pain and his blood pressure is 123/72 mmHg. The following rhythm is on the monitor.

What is the correct first action?

a) Cardiovert at 50 J
b) Cardiovert at 100J
c) Have the patient perform vagal maneuvers
d) Administer 6 mg Adenosine, rapid IV push
e) Administer 150 mg Amiodarone over 10 min

Answer 2

c) Have the patient perform vagal maneuvers

Question 3

Which of the following is a clinical indicator of ventricular afterload?

LVEDP

CVP

PCWP

MAP

Answer 3

MAP

Question 4

Synchronized electrcardioversion attempts to deliver the energy during which phase of the electrocardiogram?

P wave

R wave

T wave

Any of the above

Answer 4

R wave

Question 5

Stroke volume is determined by which of the following factors?

I. Preload
II. Afterload
III. Contractility
IV. Conduction rate

Answer 5

i, II, III

Question 6

Which of the following parameters gives an indication of the contractility of the heart?

Cardiac output

Ejection fraction

Systemic vascular resistance

Mean arterial blood pressure

Answer 6

Ejection fraction

Question 7

Which of the following drugs has all these properties: is a positive inotrope, a positive chronotrope and an α1
adrenergic agent?

Vasopressin

Milrinone

Norepinephrine

Isoproterenol

Answer 7

Norepinephrine

Question 8

Which of the following mechanisms compensates for heart failure?

I. Improved contractility
II. Vasoconstriction
III. Fluid retention
IV. Vasodilation

Answer 8

I, II, III

Question 9

Your patient presents to ER short of breath with audible coarse crackles and complaining of chest pain. The patient is pale and cool and has BP 80/50 mmHg. The rhythm on the biphasic monitor is as follows:

Answer 9

Perform synchronized cardioversion 100 J

Question 10

An anti-arrhythmic drug that works by blocking calcium channels is:

Adenosine

Propanolol

Cardizem

Procainamide

Diprivan

Answer 10

Cardizem

Question 11

Answer 11

Second degree (Type II) block

Question 12

Which of the following factors is the most important in controlling cardiac output in healthy people?

Pumping ability

Heart rate

Conduction rate

Venous return

Answer 12

Venous return

Question 13

Cardiac tamponade may exhibit which of the following signs and symptoms:

a) Pulsus paradoxus
b) Bounding pulses
c) Muffled heart sounds
d) All of the above
e) a) and c) only

Answer 13

a) and c) only

Question 14

Answer 14

Normal sinus rhythm with first degree heart block

Question 15

Answer 15

Supraventricular tachycardia

Question 16

A myocardial infarction is most commonly caused by:

Ruptured atherosclerotic plaque

Coronary artery vasospasm

Embolism to coronary artery

Increased myocardial demand

Profound hypotension

Answer 16

Ruptured atherosclerotic plaque

Question 17

Answer 17

Atrial fibrillation

Question 18

In a normal, healthy heart the major factor in determining stroke volume is:

Preload

Afterload

Contractility

Heart rate

Answer 18

Preload

Question 19

Which of the following is a branch of the right coronary artery?

Anterior interventricular branch

Circumflex branch

Coronary sinus

Left anterior descending artery

Posterior interventricular branch

Answer 19

Posterior interventricular branch

Question 20

Your patient requires a dose of adenosine for confirmed supraventricular tachycardia (SVT). His only line is a peripheral intravenous line in the right arm. How should you proceed?

a) Slowly administer the dose over 30 seconds.
b) Administer the dose quickly, and then immediately follow with a saline flush.
c) Hold the patient’s right arm in an upright position while administering the dose.
d) Both b) and c).

Answer 20

Both b) and c).

Question 21

Which of the following drugs have both inotropic and vasodilatory properties?

Milrinone

Vasopressin

Epinephrine

High dose Dopamine

Answer 21

Milrinone

Question 22

A patient is in refractory ventricular fibrillation. High-quality CPR is in progress and one dose of epinephrine was given after the second shock. An anti-arrhythmic was given following the third shock. Which of the following drug/dose should be administered next?

Epinephrine 1 mg

Epinephrine 3 mg

Amiodarone 150 mg

Magnesium 1 g

Answer 22

Epinephrine 1 mg

Question 23

Which of the following are the major vascular factors that determine venous return and cardiac output?

I. Right atrial pressure
II. Mean filling pressure of the systemic circulation
III. Vascular resistance to blood flow between the peripheral vessels and the right atrium
IV. Aortic pressure

Answer 23

I, II, III

Question 24

Which of the following anti-arrhythmic drugs can be used for both narrow complex and wide complex tachyarrhythmias?

Verapamil

Metoprolol

Atropine

Amiodarone

Answer 24

Amiodarone

Question 25

Place the five phases of a myocardial action potential in the correct order.

I. Fast sodium channels are inactivated.
II. Cell returns to its “resting” state.
III. “Plateau” phase
IV. Initial rapid depolarization of myocardial tissues
V. Calcium channels close.

Answer 25

IV, I, III, V, II

Question 26

A patient’s 12-lead ECG shows significant ST segment elevation in leads I, V5 and V6. This indicates:

Lateral myocardial infarction

Lateral myocardial ischemia

Anterior myocardial infarction

Anterior myocardial ischemia

Answer 26

Lateral myocardial infarction

Question 27

Oxygen Extraction Ratio Equation

Answer 27

O2ER = [(CaO2 - CvO2)/CaO2] = VO2/DO2.

Question 28

If you were to extubate this patient, how would you proceed? Choose the most appropriate sequence.

I. Explain the procedure.
II. Gather the equipment.
III. Advise the patient to take a deep breath, then cough.
IV. Pull the tube out as the patient coughs.
V. Deflate the cuff.
VI. Suction the patient’s ETT and oropharynx.
VII. Ensure a cuff leak is heard.

Answer 28

II, I, VI, V, VII, III, IV

Question 29

It is decided to give inotropic support. Which of the following agents would provide a positive inotropic effect, yet will not increase left ventricular afterload?

Epinephrine

Vasopressin

Dopamine

Inamrinone

Answer 29

Inamrinone

Question 30

Which of the following drugs has all of these properties, positive inotrope, positive chronotropic, and alpha 1 adrenergic agent

Vasopressin

Milirone

Norepinephrine

Isoprpterenol

Answer 30

Norepinephrine