Diagnostics exam 3 Flashcards
Question: What can cause right axis deviation?
A. Normal finding in children and tall thin adults
B. Q waves of inferior MI
C. Artificial cardiac pacing
D. All of the above
Answer: A
Rationale for why the answer is correct: One cause of a right axis deviation would include: a normal finding in children and tall thin adults. Q waves of inferior MI and artificial cardiac pacemaker would cause a left axis deviation.
Site for question/rationale: 12 lead EKG by Dr. Rita Dello Stritto, page 8 minute 38:58
Question Which lab is the preferred measure for an acute MI?
a. CK-MB
b. Troponin
c. LDH
d. BNP
Answer: B
Rationale for why the answer is correct: Troponin is a protein that rises within 2-3 hours of an MI, it is the preferred lab value for diagnosis of MI. Only one elevated troponin is required to diagnose and AMI.
Site for question/rationale: Cardiac Testing presentation by Dr. Seth, Minute 3:35
Question: What is considered a normal ejection fraction?
a. 80-100%
b. 50-80%
c. 40-90%
d. 45-80%
Answer: B
Rationale for why the answer is correct: A normal ejection fraction is 50-80%.
Site for question/rationale: Cardiac testing presentation by Dr. Seth minute 20:08
Question: What are some contraindications for stress testing? A. CHF B. Angina C. Aortic dissection D. All of the above
Answer: D
Rationale for why the answer is correct: all of the above are contraindications for stress testing. Contraindications for a stress test include CHF, uncontrolled arrhythmias, aortic stenosis, aortic dissection, angina, MI, PE and severe pulmonary HTN.
Question: What is the primary treatment for a patient with Kawasaki disease?
a. IV immunoglobin and aspirin
b. Blood transfusion- Packed RBC’s
c. IV fluids
d. Acetaminophen
Answer: A
Rationale for why the answer is correct: The primary treatment for a patient (usually pediatric) with Kawasaki disease is IV immunoglobin and aspirin. For patients at high risk of coronary artery aneurysms (patients that had longer duration of fever or delay in treatment) the addition of a corticosteroid regimen (along with a special consultation is suggested).
Site for question/rationale: Kawasaki Disease – Elsevier point of care article
Question: A 7-year male child presents to the clinic today to have his skin TB test read. He lives with his mom, dad and older sister. His mom has active TB. Upon reading the skin test it measures at 5mm. What would you conclude from this?
A. The test is negative because it measures 5mm
B. The test is negative because it needs to read 15mm to be positive
C. The test is positive because the patient is a “high risk” by living with someone who has TB
D. The test is negative because it must read at least 10 mm
Answer: C
Rationale for why the answer is correct: Because this pediatric lives in a house hold with a TB patient, he is considered “high risk” so a 5mm read on a TB skin test would be positive. TB skin test is different in children than in adults.
No known risk factors ≥ 15 mm positive
Moderate risk factors (< 4 years, old other medical risk factors, environmental exposure) ≥ 10 mm positive
High risk factors- (lives in a household with TB patient) ≥ 5 mm positive
Question: What is the number one risk factor for COPD? A. Air pollution B. Genetic factors C. Chronic bronchitis D. Tobacco
Answer: D
Rationale for why the answer is correct: Tobacco is the first risk factor for developing COPD. It was stressed in lecture.
Site for question/rationale: COPD and Pulmonary Function Tests part one presentation by Dr. Seth minute 5:17
Question: Which bronchoprovocation challenge has better sensitivity?
a. Exercise challenge
b. Mannitol challenge
c. Methacholine Challenge
d. They are all equally the same
Answer: C
Rationale for why the answer is correct: The methacholine challenge narrows airways and triggers and asthma attack. It is the most consistent bronchoprovocation used and has better sensitivity, but low specificity.
Site for question/rationale: COPD and Pulmonary Function Tests part on
Question: Which measurement is most commonly used to assess the response to bronchodilators?
a. FEV1- Forced Expiratory Volume in the first second of exhalation
b. FVC- Forced Vital Capacity
c. FEV1/FVC Ratio -you obtained from the first two readings
d. FIVC- Forced Inspiratory Vital Capacity
Answer: A
Rationale for why the answer is correct: The FEV1 is the most common measurement used to assess responses to bronchodilators. The FVC can also be used.
Site for question/rationale: COPD and Pulmonary Function Tests part one presentation by Dr. Seth minute 14:10
Question: When can use you use Winter’s formula?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Alkalosis
d. Metabolic Acidosis
Answer: D
Rationale for why the answer is correct: You can only use Winter’s formula when you have a metabolic acidosis. Winter’s formula tries to determine if you have compensation or a secondary primary problem. It predicts what the PCO2 should be if it is a pure metabolic acidosis.
Question: EKGs are used to diagnose all of the following except _.
a. arrhythmias
b. MI’s
c. PE’s
d. blocks
Answer: C
Rationale for why the answer is correct: EKGs are used to diagnose MI’s, arrhythmias, blocks, and ventricular dysfunction. They do not diagnose pulmonary embolisms.
Site for question/rationale: Slide #2 on the handouts for cardiac testing
Question: A patient has been having symptoms that warrant the placement of a Holter monitor. The APRN knows this means _.
a. The patient will wear the Holter monitor for 7 days
b. The Holter monitor will allow the patient to stop keeping a diary of activities and events
c. The Holter monitor will diagnose an MI
d. The Holter monitor allows for ambulatory monitoring of the EKG
Answer: D
Rationale for why the answer is correct: The Holter monitor is made for ambulatory monitoring of the EKG to look for arrhythmias. The patient must keep a diary of activities and events. They wear the monitor continuously for 24-48 hours.
Site for question/rationale: Slide #3 in the handouts for cardiac testing pdf.
Question: Contraindications to stress tests include _ (select all that apply).
a. Angina
b. MI
c. History of congenital heart defect
d. Aortic dissection
e. History of CABG
f. BMI >45
Answer: A, B, & D
Rationale for why the answer is correct: The contraindications for a stress test include: CHF, uncontrolled arrhythmias, aortic stenosis, angina, MI, PE, severe pulmonary HTN, and aortic dissection.
Site for question/rationale: Page 3, slide 2 on the handouts for cardiac testing lecture
Question: A patient is preparing to undergo a cardiac stress test. The APRN knows that the patient will need to have which of the following before beginning _.
a. Chest x ray
b. NPO 12 hours before
c. IV access
d. None of the above
Answer: C
Rationale for why the answer is correct: The patient undergoing a cardiac stress test should be NPO 4 hours prior and have an IV if it is a chemical stress test. There should be ACLS equipment nearby and a 12 lead EKG.
Site for question/rationale: Page 3, slide 2 in the handouts for cardiac testing lecture.
Question: Patients with aortic stenosis may develop _ due to the back up of blood into the LV and lungs (select all that apply).
a. Dyspnea
b. Increased pulse pressure
c. Syncope
d. Angina
e. Facial flushing
Answer: A, C, & D
Rationale for why the answer is correct: Symptoms associated with aortic stenosis include: syncope, dyspnea, angina, lowered pulse pressure, and sudden death.
Site for question/rationale: This is found on page 6, slide 2 in the handouts for cardiac testing lecture.
Question: Which of the following is true regarding acid/base buffering mechanisms?
a. The lungs compensate by increasing respiratory rate when the patient is alkalotic.
b. The kidneys compensate more quickly than the lungs.
c. The kidneys reabsorb and excrete hydrogen ions and HCO3 to correct for acid/base imbalances
d. None of these is correct.
Answer: C
Rationale for why the answer is correct: The kidneys compensate more slowly than the lungs. The lungs will cause hyperventilation for metabolic acidosis, not alkalosis. The kidneys do excrete and reabsorb hydrogen ions and HCO3 to compensate.
Site for question/rationale: Slide #3 on the ABG Anion Gap handouts pdf.
Question: Causes of metabolic acidosis include all of the following EXCEPT _.
a. Diabetic ketoacidosis
b. Sepsis
c. Toxic ingestions
d. Burns
Answer: D
Rationale for why the answer is correct: Causes of metabolic acidosis include DKA, lactic acidosis, sepsis, shock, and toxic ingestions. Causes of metabolic alkalosis include laboratory error, multiple myeloma, burns and low albumin levels.
Site for question/rationale: Page 9, slide #1 on the ABG Anion Gap Handout pdf.
Question: Which of the following is not a risk factor for COPD?
a. Tobacco
b. Male sex
c. Asthma
d. Genetic factors
Answer: B
Rationale for why the answer is correct: The risk factors for COPD are: tobacco, air pollution, noxious exposures, genetic factors, older age, female sex, socioeconomic status, asthma, chronic bronchitis, and infections.
Site for question/rationale: slide #6 in the COPD & PFTs pt. 1 handouts pdf.
Question: __ are potential differentials for COPD (select all that apply).
a. Asthma
b. Pneumothorax
c. Pulmonary edema
d. CHF
e. Pneumonia
Answer: A, D, & E
Rationale for why the answer is correct: The following are differentials for COPD: asthma, alpha-1antitrypsin deficiency, CHF, bronchiectasis, TB, pneumonia, PE, obliterative bronchiolitis, and diffuse pan bronchiolitis.
Site for question/rationale: Slide #8 in the COPD & PFTs pt.1 handouts.
Question: The formula for anion gap is _.
a. Anion Gap = (Na+) – ((Cl-)+(HCO3-))
b. Anion Gap = (Na+) + ((Cl-)+(HCO3-))
c. Anion Gap = (K+) – (Na+) + (HCO3-)
d. Anion Gap = (Na+) – ((K+) + (HCO3-)).
Answer: A
Rationale for why the answer is correct: The correct formula for anion gap is =(Na+)-((Cl-)+(HCO3-)).
Site for question/rationale: Page 11, slide #1 on the ABG anion gap handouts pdf.
Question: A 1-month-old baby arrives to the ER with tachycardia, bounding pulses with widened pulse pressure, and a systolic murmur. Which diagnostic test is the most effective for diagnosing this patient? Answer: A. ECG B. Stress test C. Echocardiogram D. Troponin, CK-MB, and BNP
C: Rationale for why the answer is correct: This patients’ symptoms are consistent with an open PDA. Treatment for this diagnosis consists of indomethacin and Ibuprofen therapy. The most effective diagnostic for this patient would be an echocardiogram. Echocardiograms are sensitive in diagnosing problems with the valves, septum, pericardium, or the walls of the heart. Echocardiograms evaluate the flow of blood through the heart as well.
Question: A 4- year-old patient arrives with fever for 6 days, diffuse maculopapular rash, cracked lips, and erythema to the palms and soles of feet. Which laboratory related diagnostic studies do you anticipate to order? Answer: A. LFT, UA, CBC B. CBC, ESR, CRP C. Blood culture, ESR, LFT D. UA, viral PCR, CBC
B: Rationale for why the answer is correct: This patient meets criteria to be diagnosed with Kawasaki’s Disease. She has 4 cardinal symptoms plus a fever lasting more than 5 days. Under this suspicion the advanced practice provider should anticipate ordering a CBC, ESR, and CRP as initial starting labs. If indicated, a BMP, LFT, UA, and CSF sample can be obtained. A baseline ECG should always be ordered on all potential Kawasaki patients. Rule out testing should be complete with a blood culture and viral RVP PCR also.
Site for question/rationale: Found in the Kawasaki Disease Clinical Key document by Elsevier under the Cardiac Module 5.
Question: Differential diagnoses for a patient with fever for 7 days, cervical lymphadenopathy, erythema to the oral mucosa, feet and hands would include?
Answer:
A. Kawasaki’s Disease, Rheumatic Fever, Scarlet Fever
B. Kawasaki’s Disease, Sepsis, Strep Throat
C. Rheumatic Fever, Viral Pharyngitis, Lymphadenopathy
D. Scarlet Fever, Viral Pharyngitis, Lymphadenopathy
A: Rationale for why the answer is correct: Potential differentials for these symptoms include: Adenovirus, Enterovirus, Scarlet Fever, Rheumatic Fever, Bacterial Lymphadenitis, JRA, SLE, Leukemia, Lymphoma, and or Rocky Mountain Fever.
Site for question/rationale: Found in the Kawasaki Disease Clinical Key document by Elsevier under the Cardiac Module 5.
Question: An ECG reveals tall p waves, left axis deviation and left ventricular hypertrophy. What is the most likely diagnosis? Answer: A. Tetralogy of Fallot B. Hypoplastic Left Heart C. Tricuspid Atresia D. Transposition of the Great Vessels
C:Rationale for why the answer is correct: Tricuspid atresia is associated with an absent valve allowing the blood in the right atrium cannot reach the right ventricle. EKG findings include tall p waves with left superior axis deviation, and LVH with decreased right ventricular pressure. Right axis deviation on ECG is usually associated with Transposition of the Great Vessels, Tetralogy of Fallot, and Hypoplastic Left Heart children.
Question: ST depression on an ECG indicates which cardiac problem? Answer: A. Previous MI damage B. Acute STEMI and MI injury C. Ischemia D. Q-wave MI
C:Rationale for why the answer is correct: Ischemic related injuries are characterized by ST depression on an EKG. Previous MI damage is indicated by T wave inversion, and an acute STEMI can be noticed by its ST elevation.
Site for question/rationale: Found in the 12 Lead EKG Handout under Module 5 on page 5
Question: A 60- year-old patient complains of shortness of breath and is sent to the ER for further evaluation. Which diagnosis is considered must not miss when dealing with a patient with this complaint? Answer: A. Asthma B. COPD C. Pulmonary Embolism D. Emphysema
C: Rationale for why the answer is correct: When diagnosing a patient with a respiratory condition who complains of shortness of breath it is important to evaluate every must not miss diagnosis and treat as ALWAYS emergent until proven otherwise. Some other must not miss diagnoses for this chief complaint includes: upper airway problems (choking, angioedema, anaphylaxis), pulmonary embolism, pneumothorax, STEMI, unstable angina, and most arrythmias.
Question: A 22-month-old presents with respiratory distress and low oxygen saturations after choking on an apple. CXR reveals a foreign body right main stem and requires immediate intervention and transport to the OR. Which procedure/diagnostic measure is used for foreign body removals? Answer: A. Flexible Bronchoscopy B. Rigid Bronchoscopy C. Endobronchial Ultrasound D. Chest CT scan
B:Rationale for why the answer is correct: Flexible bronchoscopies are used for other respiratory diagnostics such as obtaining cultures, biopsies, or evaluation and inspection of the upper and lower airways. Rigid bronchoscopies are used for the removal of foreign bodies as the rigid characteristics allow for easier collection. The other two diagnostics tests are extraneous tests that help with diagnosis and evaluation of other respiratory conditions
Question: Which diagnostic test allows for a lower specificity, better sensitivity, and has the possibility of false positive results when diagnosing Asthma? Answer: A. Gold Criteria B. Mannitol Challenge C. Methacholine Challenge D. Exercise Challenge
C: Rationale for why the answer is correct: Gold criteria determines the extent of asthma severity. The Mannitol challenge does have better sensitivity and lower specificity however it does not normally have false positive results. The Methacholine challenge has both better sensitivity, lower specificity PLUS can have false positive results.
Site for question/rationale: Found in the COPD and PFT’s Handout under Module 6 on page 6 an
Question: Which is the most cost effective radiological diagnostic procedure used to evaluate potential causes of a patient who presents to the clinic with a chief complaint of persistent cough with hemoptysis? Answer: A. Chest CT B. Chest X-ray C. Bronchoscopy D. Endobronchial Ultrasound
B: Rationale for why the answer is correct: Chest x-rays are a cost-effective procedure that shows the heart, lungs, airway, blood vessels, and lymph nodes. Xrays are also a quick method of evaluation. It also shoes bones of the spine, chest, ribs, and collarbone. A CT shows a cross sectional view of the chest cavity. It can evaluate muscles, bones, airways, the heart, and lungs. However, this procedure may be more favorable for diagnosis but it usually is the more costly radiographical procedure.
Question: A 12- year-old patient arrives to the ER with productive cough, fever of 102 for 4 days, chills, and shortness of breath. Which differential diagnosis best fits the patient’s description of symptoms? Answer: A. Congestive Heart Failure B. Pulmonary Embolism C. Asthma D. Pneumonia D: Rationale for why the answer
D: Rationale for why the answer is correct: Pneumonia is characterized by shortness of breath, gradual onset, productive cough, fever, chills, and possible sweats. Congestive Heart Failure, PE, and Asthma do not present with fever or chills but can present with similar symptoms of cough and shortness of breath. PNA is the most fitting diagnosis for the chief complaint’s described above.
Question: What are you looking for when you have a 12 lead EKG completed?
a. Looking at electrical pathway
b. Looking for blood clots
c. Looking to see if patient had a stroke
d. Looking to see if patient will have a MI in the future
Answer: A
Rationale for why the answer is correct: This is the only thing you should be looking for in an EKG. It gives an idea on what may be going on with the patient.
Site for question/rationale: Dr. Stritto, 12 lead ekg, time 0:43
Question: Where does the cardiac conduction start?
a. AV node
b. SA node
c. Purkinje Fibers
d. Right bundle
Answer: B
Rationale for why the answer is correct: This is the correct starting position
Site for question/rationale: Dr. Stritto, 12 lead ekg, time 1:03
Question: Your 10 year old patient has been noted to have a right axis deviation. What is the plan of care?
a. Refer to a cardiologist for further evaluation
b. Order further testing
c. No treatment needed
d. Send to the ER
Answer: C
Rationale for why the answer is correct: This is considered normal in children, therefore, no treatment is needed
Site for question/rationale: Dr. Stritto, 12 lead ekg, time 38:58
Question: A pediatric patient presents with a fever x 5 days and diagnosed with Kawasaki disease. When should treatment begin for this patient?
a. Should allow for the disease to run its course because it is self-limiting
b. Should start treatment within 10 days of fever onset
c. After day 15, recheck patient for worsening symptoms
d. Order cbc, cmp, and have patient return to the clinic within a few days for the results
Answer: B
Rationale for why the answer is correct: this would minimize risk for coronary artery aneurysm formation
Site for question/rationale: Kawasaki disease, Elsevier point of care
Question: A 58-year-old male presents to the clinic with c/o chest pain last night and a little bit this morning when he woke up. He states he is currently “feeling okay.” What should the provider order for him?
a. Stress test to show areas of decreased oxygenation
b. Order a troponin level
c. Order a holter to capture arrhythmias
d. An EKG
Answer: D
Rationale for why the answer is correct: Do not depend on markers for diagnosing MI, look at the EKG
Site for question/rationale: EKG handout for cardiac testing, page 2
Question: A 26-year-old male c/o dry, non-productive cough x 12 weeks. Denies other symptoms. He has tried OTC cough medicine & lozenges. What would be a differential diagnosis?
a. Viral rhinosinusitis
b. Asthma exacerbation
c. Chronic bronchitis
d. pneumonia
Answer: c
Rationale for why the answer is correct: This is a chronic cough, has lasted longer than 8 weeks
Site: Differential Diagnosis, Rhoads, page 37
Question: A 66-year-old female with history of tobacco use, depression, hyperlipidemia presents to the clinic with c/o “I’m short of breath today.” What should the APRN do next?
a. Have patient wait in the waiting room until her actual appt time as she showed up too early
b. Consider this emergent and assess the patient right away
c. Since this patient is a known smoker, consider it normal
d. Instruct the patient to go to the nearest ER instead, as there is nothing that can be done for her at the clinic anyways
Answer: B
Rationale for why the answer is correct: Always emergent, until proven otherwise, considering ABCS, pt could tank on you, if you don’t recognize it
Site for question/rationale: Shortness of breath, Dr. Seth, 1:18
Question: Your patient is getting ready to have his first PFT. He asks, “What are these nose clips for & do I really need to wear them?”
a. To help you not smell the air
b. Helps to prevent air leakage through the nasal passage
c. Actually, these clips are not needed at all, so you don’t have to wear them
d. To create a distraction for you during this test
Answer: B
Rationale for why the answer is correct: This is the correct reason, we need all the air to come from the mouth/lungs
Site for question/rationale: Pulmonary Function Test, Dr Day, 3:23
Question: A 50 year old male states that his father has COPD. He would like to know what is the number one risk factor for him getting COPD as well. What should the APRN, tell the patient?
a. Obesity
b. Asthma
c. Tobacco
d. Age
Answer: c
Rationale for why the answer is correct: Tobacco is the #1 risk factor. Assess the pt to see if he smokes, how much. Offer tobacco cessation if needed
Site for question/rationale: COPD, Dr. Seth, 5:56
Question: Your patient with a history of MI about 2 weeks ago, needs a PFT. You need to refer him to the pulmonologist due to this contraindication. What should you include along with te referral request?
a. The only thing needed, is the referral
b. The bill for the patient
c. Just the patients’ contact information
d. Copy of medical records with possible contraindication
Answer: D
Rationale for why the answer is correct: If not documented in the records that the pt had a MI, you could get sued as well. Include the specific dates of the MI in the records.
Site for question/rationale: COPD & PFT part 2, Dr. Seth, 5:15
Question: Which of the following are limb leads when looking at an EKG? A. I B. ll C. aVF D. V3
Answer: A, B, C
Rationale for why the answer is correct: Limb leads are labeled l, ll, lll, aVR, aVL, aVF. Chest leads are labeled V1, V2, V3, V4, V5, V6 on an EKG.
Site for question/rationale: EKG presentation by Dr. Rita Dello Stritto (timestamp 6:00)
Question: Which does a echocardiogram NOT do?
A. Examine the chambers of the heart
B. Assess for plaque in the arteries
C. Examines flow of blood
D. Determines systolic and diastolic functions
Answer: B
Rationale for why the answer is correct: An echo cannot see inside the vessels therefore cannot assess plaque buildup. An echo visualizes the flow of blood inside the heart.
Site for question/rationale: Cardiac Testing presentation by Dr. Shelly Seth (timestamp 12:00)
Question: Which of the following patients do you suspect is presenting with Kawasaki disease?
A. 12 yr old female, s/s: conjunctivitis and fever x2 days
B. 3 yr old male, s/s: fever x5 days, swollen ankles, very fussy
C. 4 yr old female, s/s: generalized rash, reddened mucous membranes, denies fever
D. 5 yr old male, s/s: jaundice, fever x2 days, lethargic
Answer: B
Rationale for why the answer is correct: Kawasaki disease for many children presents from ages 6 months – 5 years. A fever for 5 or more days is present in 100% of cases. Extreme irritability is very common. A generalized rash is usually reported. Conjunctivitis and edema of hands and feet is usually present.
Question: Which diagnostics can be ordered for a patient with a chief complain of shortness of breath?
A. EKG
B. Peak flow meter with nebulizer treatment
C. Stress test
D. Chest xray
Answer: A, B, D
Rationale for why the answer is correct: EKG, peak flow meter, and a chest xray can all be beneficial in determining the cause of shortness of breath and also ruling in/out cardiac problems. A stress test should never be performed without ruling out life-threatening cardiac disease/arrhythmias.
Question: What is the purpose of the hepatojugular reflex exam? A. To decrease venous return B. To increase venous return C. To increase cerebral circulation D. To assess for cardiac insufficiency
Answer: D
Rationale for why the answer is correct: Examining the hepatojugular reflex is helpful in diagnosing cardiac insufficiency, especially when typical clinical signs, like edema, are missing.
Question: What does this ABG show: pH- 7.2 PCO2- 70 PO2- 40 HCO3- 22 A. Respiratory alkalosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis
Answer: D
Rationale for why the answer is correct: The pH is less that 7.35 so we know that it is acidotic. The PCO2 goes in the opposite direction of the pH in either alkalosis or acidosis and since the pH is low, the CO2 will rise. The bicarb is in the normal range, so we know it is not metabolic.
Site for question/rationale: ABG Anion Gap Handout by Dr. Shelly Seth
Question: What is the most common cause in reduction of FEV1 in a pulmonary function test?
A. Obstruction
B. Bronchospasm
C. Asthma
Answer: A
Rationale for why the answer is correct: Obstruction has been shown to be the most common cause for a low FEV1 percentage.
Site for question/rationale: COPD and PFTs handout by Dr. Shelly Seth
Question: What are some tools to help diagnose/stage COPD? A. CAT B. PET C. mMRC D. GOLD
Answer: A, C, D
Rationale for why the answer is correct: mMRC is the modified British Medical Research Council Questionnaire which measures the severity of dyspnea. GOLD criteria is based on the responsiveness to bronchodilators. This test helps to rule in/out asthma and COPD. It is staged 1-4 with 4 being the worst. CAT is the COPD Assessment Tool and is a questionnaire. A PET scan is not used to diagnose COPD.
Site for question/rationale: COPD & PFTs Handout part l by Dr. Shelly Seth
Question: You are reviewing an EKG on a patient and notice that in lead 1 and V6 the QRS complex is wide and in V1, there is a downward deflection. What do you suspect this patient may have?
a. MI
b. Left Bundle Branch Block
c. Right Bundle Branch Block
d. Left Ventricular Hypertrophy
Answer: b: LBBB
Rationale for why the answer is correct: In a LBBB, the QRS complex is wide in Lead I and V6 and V 1 has a downward deflection. If the QRS complex was narrow in lead I and V6 with a upward deflection in V 1, this would be a RBBB.
Site for question/rationale: 12 Lead EKG presentation by
Question: In reading a 12 lead EKG, which leads are for the inferior wall of the heart?
a. Lead I, aVL, V5, V6
b. V1 and V2
c. Lead II, Lead III, and aVF
d. V3 and V4
Answer: c: Lead II, Lead III, and aVF
Rationale for why the answer is correct: Lead I, aVL, V5 and V6 are for the lateral walls, V1 and V2 are for the septal wall, V3 and V4 are for the anterior walls of the heart.
Site for question/rationale: 12 Lead EKG presentation by Dr. Stritto slide 10.
Question: Which of the following is NOT an indication for ordering a stress test for a patient?
a. Pre-op
b. Rule in or rule out an MI with chest pain
c. Shortness of Breath
d. Prior to exercise regimen
Answer: c: Shortness of breath
Rationale for why the answer is correct: Shortness of breath is not an indication for ordering a stress test while pre-op, possible MI, and new exercise program are.
Site for question/rationale: Cardiac testing presentation by Dr. Seth slide
Question: Which procedure is used to evaluate the vessels on the outside of the heart?
a. Transthoracic Echocardiogram
b. Heart Catherization
c. Stress echocardiogram
d. Transesophageal Echocardiogram
Answer: b: Heart Catherization
Rationale for why the answer is correct: During a heart catherization, dye is injected in the cardiac vessels to determine if there is blockage present. TTE is used to look on the inside of the heart, TEE is used to get detect valvular infections, detect emboli in atrium and detecting acute dissection. The stress echocardiogram is used to monitor the blood flow of the heart when the heart is being stressed.
Question: On a 12 lead EKG, in what situation is a right axis deviation a normal finding?
a. Tall thin adults
b. Short obese adults
c. Chronic heart failure
d. Pneumonia in left lung
Answer: a: Tall thin adults
Rationale for why the answer is correct: Tall thin adults tend to have a heart that drops down a little in the mediastinum. A short obese adult would have the heart pushed up in chest in a different axis. CHF and pneumonia have no effect on heart position.
Question: A patient comes into the clinic c/o SOB, which of the following differential diagnoses is NOT a must miss diagnoses.
a. Dysphagia
b. Foreign object
c. Pneumonia
d. Pulmonary Embolism
Answer: c: Pneumonia
Rationale for why the answer is correct: There a numerous must not miss diagnoses, however pneumonia is not one. For the Lungs, there are two, PE and pneumothorax.
Site for question/rationale: “I’m short of breath” presentation by Dr. Seth slide 3 and 4.
Question: Which of the following medication can be the cause of a chronic cough.
a. Albuterol
b. Clopidogrel
c. Lisinopril
d. Losartan
Answer: c: Lisinopril
Rationale for why the answer is correct: One of the side effects of ACE-I is a chronic cough. None of the other medications listed will cause a cough.
Site for question/rationale: “I have a cough that won’t stop” presentation by Dr. Seth slide 5.
Question: A patient comes into your clinic stating that he is having a difficult time breathing. During your physical ROS, which system is NOT necessary for this patient.
a. Cardiovascular
b. Gastrointestinal
c. Musculoskeletal
d. Genitourinary
Answer: d: Genitourinary
Rationale for why the answer is correct: Pt is coming in for SOB, a full assessment is not necessary at this time so there is no need for a GU exam.
Site for question/rationale: “I’m short of breath” presentation by Dr. Seth slide 9.
Question: A patient comes into your clinic and states that “I have had this nasty cough for months and it won’t go away”. Pt also states that he has been out of the country a few months ago and has been having night sweats. You suspect that the patient has TB and order a CXR and a skin test. The nurse reads the area where the skin test was given and measures a raised portion at 9mm. This indicates what severity of TB?
a. Negative
b. Weakly positive
c. Intermediately positive
d. Strongly positive
Answer: b: weakly positive
Rationale for why the answer is correct: A skin reaction that is <5mm is considered negative, 5-9mm is weakly positive, 10-14mm is intermediately positive, and >15mm is strongly positive.
Site for question/rationale: “I have a cough that won’t stop” presentation by Dr. Seth slide 16.
Question: A patient comes into your clinic with a chronic cough and you use the mMRC questionnaire. The patient states that he can walk about 300 feet before he must stop and take a breather. What mMRC grade should be given to this patient.
a. Grade 1
b. Grade 2
c. Grade 3
d. Grade 4
Answer: c: Grade 3
Rationale for why the answer is correct: According to the grading scale for mMRC, grade 3 states “I stop for breath after walking about 100 yards or after a few minutes on level ground”.
Site for question/rationale: COPD and Pulmonary Function Tests presentation by Dr. Seth slide 1
Question: Which chest leads look at the anterior part of the heart? A. V1 and V6 B. V2 and V3 C. V3 and V4 D. V4 and V2
Answer: C. V3 and V4
Rationale for why the answer is correct: The chest leads are positive vectors. When trying to remember which leads, look at which part of the heart tries to remember SAL’s acronym. S is for septal, meaning leads V1 and V2. A is anterior, meaning leads V3 and V4. L is lateral, meaning leads V5 and V6.
Site for question/rationale: 12 Lead EKG presentation by Dr. Rita. A Dello Stritto at timestamp 21:43.
Question: The cardiac conduction starts at the \_\_\_\_\_\_\_\_. A. AV node B. SA node C. Bundle of HIS D. Purkinje fibers
Answer: B. SA node
Rationale for why the answer is correct: The cardiac conduction starts at the SA node into the AV node, the bundle of HIS, and then the Purkinje fibers.
Site for question/rationale: 12 Lead EKG presentation by Dr. Rita. A Dello Stritto at timestamp 1:03-1:26.
Question: If you have a positive deflection in aVR, you need to consider? A. Inferior MI B. Leads are placed wrong C. Anterior-septal MI D. nSTEMI
Answer: B. Leads are placed wrong
Rationale for why the answer is correct: The lead aVR will always be a negative deflection. If the deflection is positive, the leads are placed wrong.
Site for question/rationale: 12 Lead EKG presentation by Dr. Rita. A Dello Stritto at timestamp 26:10.
Question: Stress test contraindications include?
A. CHF, MI, NPO
B. CHF, family history of chest pain, angina
C. Angina, aortic stenosis, and aortic dissection
D. Patients who are unable to exercise
Answer: C. Angina, aortic stenosis, and aortic dissection.
Rationale for why the answer is correct: Patients who cannot exercise can have a chemical stress test performed. Stress testing contraindications include CHF, uncontrolled arrhythmias, aortic stenosis, angina, MI, PE, severe pulmonary hypertension, and aortic dissection. If you send them down to do a stress test with one of these contraindications, you can kill the patient.
Question: A 3-year-old male patient presents to the clinic for a wellness check. Upon auscultating lungs and heart, you hear a new murmur. What is your next step?
A. Send to ER immediately for a heart catheterization.
B. The patient needs a chemical stress test,
C. Order an echocardiogram
D. None of the above.
Answer: C. Order an echocardiogram
Rationale for why the answer is correct: The echocardiogram is the preferred method to look at valvular abnormalities. If you hear a new murmur on a patient, order an echocardiogram.
Question: A 17-year-old male patient presents with a chief complaint of "I am short of breath." While gathering information from his mother, she states, "He has been getting taller pretty fast this last month." Mother denies patient taking prescribed medication or OTC medications. What is a must-not-miss diagnosis for this patient? A. Spontaneous pneumothorax B. A foreign object (choking) C. COPD exacerbation D. Anaphylaxis
Answer: A. Spontaneous pneumothorax
Rationale for why the answer is correct: Teenage boys growing rapidly will sometimes have a spontaneous pneumothorax, which could be missed without a chest x-ray order.
Site for question/rationale: CC: Shortness of Breath presentation by Dr. Shelly Seth at timestamp 6:38-6:45.
Question: Testing the hepatojugular reflux is helpful to diagnose \_\_\_\_\_. A. Liver disease B. Kidney filtration C. Pulmonary edema D. Cardiac insufficiency
Answer: D. Cardiac insufficiency
Rationale for why the answer is correct: The hepatojugular reflux is helpful to diagnose cardiac insufficiency. It is done by placing the patient supine at a 45-degree angle then apply moderate pressure under the right rib cage for about one minute. Positive reflux occurs when blood builds up in the jugular veins, causing distention.
Question: A 45-year-old female presents with a lingering cough that will not go away. She states the cough has been there for approximately nine weeks. She denies other symptoms. Her only medical history is hypertension. She recently started taking lisinopril 10mg daily for hypertension. What should you do next?
A. Give a breathing treatment for her asthma attack.
B. Discontinue the lisinopril
C. Test her for TB immediately
D. Inform her coughing is not dangerous.
Answer: B. Discontinue the lisinopril
Rationale for why the answer is correct: Lisinopril is an ACE inhibitor that can cause a lingering cough causing providers to discontinue the medication and start the patient on a different hypertensive medication
Question: Children’s disadvantage for developing adult COPD include? A. Carbonaceous particulate matter B. Mother asthma C. 2nd hand smoke D. All of the above.
Answer: D. All of the above
Rationale for why the answer is correct: Child disadvantages for adult COPD include 2nd hand smoke, mother smoking, mother or father history of asthma, and carbonaceous particulate matter.
Site for question/rationale: COPD & PFTs Part 1 presentation by Dr. Shelly Seth at timestamp 4:52.
Question: Alpha-1antitrypsin deficiency can cause what kind of issues? A. Cirrhosis B. PE C. Chest pain D. Viral bronchitis
Answer: A. Cirrhosis
Rationale for why the answer is correct: Alpha-1antitrypsin is a protein that protects the lungs. The genetic issue can accumulate in the liver from faulty metabolism, causing liver disease (cirrhosis) and lung problems (emphysema/COPD).
Question: When reading an ECG the clinician knows that aVR should always be\_\_\_\_\_ A. a negative deflection B. a positive deflection C. on the left leg D. on the right leg
Answer: a negative deflection
Rationale for why the answer is correct: Lead aVR is a unipolar right arm lead
Site for question/rationale: Presentation on 12 Lead EKG at 15:50
Question: When placing the ECG chest leads onto the patient’s chest where should lead V4 be placed?
A. At the angle of Louis
B. At the anterior axillary line
C. At the mid axillary line
D. At the mid clavicular line at the 5th intercostal space
Answer: D. At the mid clavicular line at the 5th intercostal space
Rationale for why the answer is correct: There is not a lead placed on the angle of Louis, V5 is at the anterior axillary line, V6 is at the mid axillary line, and the appropriate place for V4 is the mid clavicular line at the 5th intercostal space
Question: Which of the following describes a Q wave?
A. 0.04 seconds wide or 1/3 the height of the R wave
B. 0.02 seconds wide or 1/4 the height of the T wave
C. 0.04 seconds wide or 1/4 the height of the S wave
d. 0.04 seconds wide or 1/3 the height of the P wave
a: Answer: 0.04 seconds wide or 1/3 the height of the R wave
Rationale for why the answer is correct: The Q- wave is 0.04 seconds wide or 1/3 the height of the R wave, may take 8-48 hours to show up on ECG, never goes away, and indicates that the patient has had an MI.
Site for question/rationale: Presentation on 12 Lead EKG at 28:01
Question: When doing serum testing for an acute MI the Nurse Practitioner should suspect the CK-MB to
A. rise 2-4 hours after onset of signs and symptoms and peak at 48 hours
B. rise 4-6 hours after onset of signs and symptoms and peak at 48 hours
C. rise 2-4 hours after onset of signs and symptoms and peak at 24 hours
D. rise withing 2-3 hours
Answer: C. rise 2-4 hours after onset of signs and symptoms and peak at 24 hours
Rationale for why the answer is correct: The CK-MB is specific for the heart and rises 2-4 hours after onset of signs and symptoms and peak at 24 hours. The troponin T rises withing 2-3 hours.
Site for question/rationale: Cardiac testing presentation at 5:38
Question: Kawasaki disease treatment should start within how many days of onset of fever? B. 10 days C. 3 days D. 5 days A. 7 days
Answer: B. 10 days
Rationale for why the answer is correct: Although Kawasaki disease is self-limited, treatment should start within 10 days of fever onset to minimize risk for coronary artery aneurysm formation.
Site for question/rationale: Clinical Key resource for Kawasaki disease
Question: Which of the following are considered must not miss diagnoses for shortness of breath? A. Angioedema B. Pulmonary Embolism C. Croup D. All of the above
Answer: D. All of the above
Rationale for why the answer is correct: Angioedema and croup are upper airway respiratory emergencies and pulmonary embolism is a pulmonary medical emergency.
Site for question/rationale: Presentation CC: “shortness of breath” at 6:26
Question: Which of the following diagnostic tests can help distinguish between cardiac and pulmonary causes of shortness of breath?
A. Pulse oximeter
B. BMP
C. Peak flow meter with nebulizer treatment showing improvement
D. None of the above
Respiratory
Answer: C. Peak flow meter with nebulizer treatment showing improvement
Rationale for why the answer is correct: A nebulizer treatment would not improve the patient’s shortness of breath if the cause of shortness of breath is cardiac.
Site for question/rationale: Presentation CC: “shortness of breath” at 15:34
Question: Which of the following can be a cause of a chronic cough?
A. The patient is taking an ACE inhibitor
B. The patient is taking a diuretic
C. Viral bronchitis
Viral rhinosinusitis
Answer: A. The patient is taking an ACE inhibitor
Rationale for why the answer is correct: ACE inhibitors particularly Lisinopril can cause a chronic cough. Diuretics do not cause a chronic cough. Viral bronchitis and viral rhinosinusitis are acute causes of cough.
Site for question/rationale: Presentation CC: “Cough” at 3:23
Question: Which of the following are common pediatric obstructive lung diseases? A. Asthma B. Cystic fibrosis C. Bronchopulmonary dysplasia D. All of the above
Answer: D. All of the above
Rationale for why the answer is correct: Obstructive pulmonary diseases are those that inhibit the patient’s ability to exhale all the air from the lungs. This includes asthma, cystic fibrosis and bronchopulmonary dysplasia in the pediatric patient.
Site for question/rationale: Presentation on pulmonary function test VT at 2:18
Question: What is the purpose of Winter’s Formula?
A. Used when you have a respiratory acidosis
B. Used when you have a metabolic acidosis
C. Used when you have a respiratory alkalosis
D. Used when you have a metabolic acidosis
A. Answer: B. Used when you have a metabolic acidosis
Rationale for why the answer is correct: Winter’s formula is for metabolic acidosis compensation and calculates the expected pCO2 compensation in a purely metabolic acidosis
Site for question/rationale: Presentation on ABG’s and Anion Gaps at 14:52
Question: For a 12 Lead ECG, how many leads are placed on the patient?
a. 12
b. 10
c. 9
d. 11
Answer: C
Rationale for why the answer is correct: There are 9 leads/wires that are put on the patient. The Right Arm, Left Arm and Left Leg serve more than one purpose. You should only count the red leads.
Site for question/rationale: 12 lead EKG voice over- Dr. Ritta Dello Stritto
Question: Limb leads are _____ and Chest Leads are______.
a. Unipolar; Bipolar
b. Bipolar; Unipolar
c. Polar; Nonpolar
d. Negative; Positive
Answer: B
Rationale for why the answer is correct: Limb leads are Bipolar and chest leads are Unipolar.
Site for question/rationale: 12 lead EKG voice over- Dr. Ritta Dello Stritto @ 5:32
Question: A loop recorder can be implanted and transmit information for up to
a. 1 year
b. 2 years
c. 6 months
d. 18 months
Answer: B
Rationale for why the answer is correct: A loop recorder is an ambulatory event monitor that can be implanted and transmit information for up to 2 years.
Site for question/rationale: Cardiac testing voiceover-Dr. Shelly Seth @3:08 and Cardiac testing PowerPoint slide 4
Question: A 60-year-old male comes into the ER for a possible MI, a troponin level is drawn, and he is put on a cardiac monitor. His troponin is elevated but there are no changes in his EKG. Your diagnosis is
a. NSTEMI
b. STEMI
c. Heartburn
d. GERD
Answer: A
Rationale for why the answer is correct: If the troponin level is elevated but there are no EKG changes it is a Non- ST elevation Myocardial Infarction (NSTEMI)
Site for question/rationale: Cardiac testing voiceover-Dr. Shelly Seth @ 5:00 and Cardiac testing PowerPoint slide 5
Question: A patient comes in to have an echocardiogram for a suspected atrial-septal defect. What echocardiogram are you going to order?
a. Stress Echocardiogram
b. Transesophageal Echocardiogram
c. Transthoracic Echocardiogram
d. Bubble or Contrast Echocardiogram
Answer: D
Rationale for why the answer is correct: A bubble or Contrast echocardiogram confirms a atrial-septal defect.
Site for question/rationale: Cardiac Testing voiceover- Dr. Shelly Seth @ 18:16 and Cardiac testing PowerPoint slide 13
Question: A patient comes in with the complaint that she is “short of breath”. During the physical exam you note angioedema around the eyes and mouth. What medication can you suspect she is taking?
a. ACE inhibitor
b. Beta Blocker
c. Bronchodilator
d. Antihistamine
Answer: A
Rationale for why the answer is correct: Angioedema usually occurs secondary to medication. Ace inhibitors are the common medication that can cause angioedema in the eyes, mouth, and throat. This can be severe and a medical emergency.
Site for question/rationale: cc: Shortness of Breath presentation @ 4:00 and PowerPoint slide 2
Question: What is the test of choice to rule out a pulmonary embolism?
a. Chest X-ray
b. V/Q scan
c. Computed Tomography Angiography (CTA)
d. MRI
Answer: C
Rationale for why the answer is correct: You order a CTA if the D-dimer is positive and the likelihood of a pulmonary embolism is high. V/Q scan is used when a CTA is contraindicated. CXR is used for acute heart failure, pneumonia, pneumothorax, pleural effusion, COPD, asthma, or foreign body.
Site for question/rationale: cc: Shortness of Breath presentation-Dr. Shelly Seth @ 18:05 and cc: Shortness of Breath PowerPoint slide 11
Question: A patient comes into the clinic and says she has a cough that wont stop. She has had the cough for 5 weeks. This patients cough would be classified as a
a. Acute Cough
b. Subacute Cough
c. Chronic Cough
d. Productive Cough
Answer: B
Rationale for why the answer is correct: A subacute cough lasts from 3 to 8 weeks. An acute cough lasts less than 3 weeks and a chronic cough last greater than 8 weeks.
Site for question/rationale: cc: Cough-Dr. Shelly Seth @ 1:37 and cc: Cough PowerPoint slide 4
Question: Pulmonary Function Tests (PFTs) help identify
a. Airway obstructions
b. Diffusion Defects
c. Respiratory muscle weakness
d. All the above
Answer: D
Rationale for why the answer is correct: PFTs help identify airway obstructions, restrictive lung, chest wall and respiratory muscle defects, diffusion defects, and respiratory muscle weakness.
Site for question/rationale: Pulmonary Function Test VT- Dr. Mercedes Day @ 0:45
Question: You are educating a patient on how to use the incentive spirometer. You tell the patient that they need to continue exhaling for at least ___ seconds until they cannot exhale anymore.
a. 5
b. 6
c. 7
d. 8
Answer: B
Rationale for why the answer is correct: There are three breathing maneuvers when performing incentive spirometry. 1. Tell the patient to take as deep as a breath as possible. 2. Tell the patient to blast out the air into the spirometer. 3. Encourage the patient to continue exhaling for several more seconds, at least 6 seconds, until they cannot exhale anymore.
Site for question/rationale: Pulmonary Function Test VT- Dr. Mercedes Day @ 4:32.
Question: A negative QRS complex means that electricity is moving in which direction?
a. Toward the positive lead
b. Away from the positive lead
c. Neither A or B is correct
d. Both A and B are correct
Answer: B
Rationale for why the answer is correct: When the average vector is moving away from the positive pole of the electrode the QRS complex is negative.
Site for question/rationale: 12 lead EKG PP DR. Rita A. Dello Stritto 10:25 on video
Question: If AVR is positive in deflection what is this an indication of? A. Acute MI in the making B. Bundle branch block C. Limb lead transposition D. None of the answers are correct
Answer: C
Rationale for why the answer is correct: Lead placement dictates feedback on EKG strip. If placement is incorrect then EKG will show inadvertent lead wire misplacement.
Site for question/rationale: 12 lead EKG PP DR. Rita A. Dello Stritto 16:55 on video
- Question: Match the following leads to their designated locations of the heart.
Leads:Location of heart:
A. V1 V2 Septal, Anterior, Lateral
B. V3 V4 Lateral, Septal, Anterior
C. V5 V6 Anterior, Lateral, Septal
Answer: A- Septal, B- Anterior, C- Lateral
Rationale for why the answer is correct: SAL - Septal, Anterior, Lateral locations of lead placement for the chest leads.
Site for question/rationale: 12 lead EKG PP DR. Rita A. Dello Stritto 21:35 on video
Question: A VQ Scan is used when a CTA is contraindicated due to the patient’s renal function being compromised.
A. True
B. False
Answer: A
Rationale for why the answer is correct: Diagnostics that are specific to ruling out SOB and PE are D-dimer and CTA, when a patient’s renal function is compromised the VQ scan is required.
Site for question/rationale: Respiratory shortness of breath PP by Dr Shelly Seth 18:35 on video
Question: What FEV1 values are common in moderately severe COPD patients? A. >70 B. 50-59 C. 35 to 49 D. 60 to 69 E. <35
Answer: B
Rationale for why the answer is correct: The table indicates >70 indicates a mild restrictive pulmonary condition,35-49 indicates severe, 60-69 indicates moderate, >35 very severe.
Site for question/rationale: Table 3, A Stepwise Approach to the Interpretation of Pulmonary Function Tests
Question: What does it mean when a patient has a high anion gap? A. Metabolic acidosis B. Metabolic alkalosis C. Compensated D. None of the above are correct
Answer: A
Rationale for why the answer is correct: Anion gap is used to measure the acid base balance of the body. It is used to determine whether your blood has an imbalance of electrolytes or too much or not enough acid.
Site for question/rationale: ABG anion gap handout Pg 8.
Question: What is NOT considered a contraindication of stress testing?
a. Angina
b. MI
c. Stroke
d. Aortic Stenosis
Answer: C
Rationale for why the answer is correct: Contraindications for stress testing include: CHF, Uncontrolled Arrhythmias, Aortic Stenosis, Angina, PE, MI, Severe pulmonary HTN, and Aortic Dissection.
Site for question/rationale: Cardiac Testing Powerpoint
Question: A patient’s EKG demonstrates a right axis deviation. Which of the following could be the cause?
a. Normal finding in children and tall, thin adults
b. Hyperkalemia
c. Left anterior hemiblock
d. Artificial cardiac pacing
Answer: A
Rationale for why the answer is correct: Right Axis Deviations can occur with normal finding in children and tall, thin adults, right ventricular hypertrophy, chronic lung disease, anterolateral myocardial infarction, left posterior hemiblock, pulmonary embolus, Wolff-Parkinson-White syndrome, atrial septal defect, and ventricular septal defect.
Site for question/rationale: 12 Lead EKG Lecture
Question: A patient’s EKG demonstrates a left axis deviation. Which of the following is NOT a cause?
a. Left anterior hemiblock
b. Emphysema
c. Hypokalemia
d. Hyperkalemia
Answer: C
Rationale for why the answer is correct: Left Axis Deviations can occur due to left anterior hemiblocks, Q waves of inferior myocardial infarction, artificial cardiac pacing, emphysema, hyperkalemia, Wolff-Parkinson-White syndrome, Tricuspid atresia, Ostrium primum ASD, and injection of contrast into left coronary artery
Question: A patient’s EKG demonstrates a northwest deviation. Which of the following is considered a cause of a northwest deviation?
a. Pulmonary Embolus
b. Hypokalemia
c. Hyperkalemia
d. Chronic lung disease
Answer: C
Rationale for why the answer is correct: Northwest Deviations can occur due to emphysema, hyperkalemia, lead transposition, artificial cardiac pacing, and ventricular tachycardia.
Site for question/rationale: 12 Lead EKG Lecture
Question: What is NOT considered a reason for performing a Transthoracic Echocardiography (TTE)?
a. Examines blood flow
b. Diagnosis of cardiovascular disease
c. Determines systolic and diastolic functions
d. Looks for a rupture of wall after an MI
Answer: B
Rationale for why the answer is correct: A Transthoracic Echocardiography (TTE) does not diagnose cardiovascular disease.
Site for question/rationale: Cardiac Testing Powerpoint
Question: A 59-year-old patient presents to clinic with concerns of a cough that has lasted for over 9 weeks. What is considered a differential diagnosis for her chronic cough?
a. Viral bronchitis
b. Viral rhinosinusitis
c. Pneumonia
d. Asthma
Answer: D
Rationale for why the answer is correct: Chronic coughs more than 8 weeks are due to chronic bronchitis, postnasal drip, asthma, ACE inhibitors, and GERD.
Site for question/rationale: “I have a cough that won’t stop” Powerpoint
Question: A 35-year-old patient presents to clinic to have their TB skin test read. When being evaluated, the red area measured at 4 mm. What does this result represent?
a. Negative
b. Weakly positive
c. Intermediately positive
d. Strongly positive
Answer: A
Rationale for why the answer is correct: An adult patient TB skin test is considered negative if it is less than 5 mm.
Site for question/rationale: “I have a cough that won’t stop” Powerpoint
Question: A patient presents to clinic with a complaint of, “I have been getting short of breath when walking up a slight hill.” What grade would this patient be considered on the mMRC tool?
a. Grade 0
b. Grade 1
c. Grade 2
d. Grade 3
Answer: B
Rationale for why the answer is correct: A patient is considered to be an mMRC Grade 1 when they state they are short of breath when hurrying on the level or walking up a slight hill.
Site for question/rationale: COPD and Pulmonary Function Tests Part 1
Question: What is NOT considered a must not miss cardiac diagnosis?
a. Stable angina
b. Unstable angina
c. Arrhythmia
d. NON-STEMI
Answer: A
Rationale for why the answer is correct: Cardiac must not miss diagnoses include: ACS, STEMI, NONSTEMI, Unstable angina, arrhythmias, and tamponades.
Site for question/rationale: “I’m short of breath” Powerpoint
Question: A 62-year-old male patient presents to clinic with concerns of a cough that’s been occurring for 2 weeks. What is considered a differential diagnosis for an acute cough?
a. ACE inhibitors
b. Post-nasal drip from allergies
c. GERD
d. Chronic bronchitis
Answer: B
Rationale for why the answer is correct: A differential diagnosis for an acute cough that is less than 3 weeks includes: viral bronchitis, viral rhinosinusitis, post-nasal drip due to allergies, COPD or asthma exacerbation, and pneumonia.
Site for question/rationale: “I have a cough that won’t stop” Powerpoin
Question: An EKG is a tool that can help diagnose which of the following pathologies?
a. Stable Angina
b. Atherosclerosis
c. Congenital cardiac lesions
d. Complete heart block
Answer: d
Rationale for why the answer is correct: EKG’s can detect/diagnose many types of arrhythmias including complete (3rd degree) heart block
Site for question/rationale: Shelly Seth’s Cardiac Testing Presentation, slide 2
Question Which of the following is the most dependable test for diagnosing a MI?
a. Troponin
b. CK-MB
c. Chest pain
d. Ekg showing ST segment elevation
Answer: d
Rationale for why the answer is correct: troponin, CK-MB, and chest pain have other differential diagnoses. An elevated st segment on and EKG is indicative of and MI
Site for question/rationale: Shelly Seth’s Cardiac Testing Presentation, slide 5
Question: Your patient presents with syncope, dyspnea, angina, low pulse pressure, and a-fib. Which of the following would you suspect as their diagnosis?
a. Aortic Stenosis
b. Ventricular Septal Defect
c. Endocarditis
d. GERD
Answer: a
Rationale for why the answer is correct: The symptoms listed above can occur with AS.
Site for question/rationale: Shelly Seth’s Cardiac Testing Presentation, Slide 17.
Question: which of the following is a possible cause of T wave inversion on an EKG?
a. History of a-fib
b. Previous MI
c. Stable angina
d. hyperkalemia
Answer: b
Rationale for why the answer is correct: Inversion of T waves can be caused by a previous MI event.
Site for question/rationale: Dr. Stritto’s 12 lead EKG presentation, slide 14.
Question: What is a possible cause of right axis deviation?
a. Ventricular tachycardia
b. Emphysema
c. Normal in children and tall thin adults
d. Artificial cardiac pacing
Answer: c
Rationale for why the answer is correct: Right axis deviation can normally be found in kids and tall thin adults. The other three options will show left axis deviation
Site for question/rationale: Dr. Stritto’s 12 lead EKG presentation, slide 24.
Question: Your intubated patient has the following blood gas: pH 7.3 C02 50 HC03 29 Which is the most correct interpretation? a. Metabolic Acidosis b. Metabolic Alkalosis c. Respiratory Acidosis d. Respiratory Alkalosis
Answer: c
Rationale for why the answer is correct: these finding show respiratory acidosis
Site for question/rationale: Dr. Shelly Seth’s ABG’s and Anion Gap Presentation, slide
Question: What is a high anion gap indicative of?
a. Cardiac ischemia
b. Metabolic alkalosis
c. Metabolic acidosis
d. Respiratory acidosis
Answer: c
Rationale for why the answer is correct: a high anion gap = metabolic acidosis
Site for question/rationale: Dr. Shelly Seth’s ABG’s and Anion Gap Presentation, slide 16.
Question: Your patient claims they are short of breath which of the following differentials would be considered a must not miss diagnosis?
a. Pulmonary Embolism
b. Common Cold
c. Influenza
d. Anxiety
Answer: a
Rationale for why the answer is correct: PE is listed as a must not miss diagnosis associated with the complaint of SOB
Site for question/rationale: Dr. Shelly Seth’s “I’m Short of Breath” Presentation, slide 4.
Question: What are the major components of PFT’s (pulmonary function tests)
a. Spirometry, lung volumes, diffusing capacity of lung for carbon monoxide (DLCO)
b. Spirometry, lung volumes, atelectasis
c. Lung volumes, diffusing capacity of lung for carbon monoxide (DLCO), bronchospasms
d. Spirometry, lung volumes, fi02
Answer: a
Rationale for why the answer is correct: the three components listed in “a” are the three components of PFT
Site for question/rationale: Dr. Shelly Seth’s COPD and PFT Part 2, slide 2.
- Question: What does the Diffusing Capacity of Lung for Carbon Monoxide (DCLO) test?
a. Measures gas transfer from alveolar sacks to hemoglobin
b. Measures the amount of blood (in L/min) that is ejected with each cardiac cycle?
c. The number of alveoli on each lung
d. Gas transfer from air into alveolar sacs and how well oxygen can get to the tissues
Answer: d
Rationale for why the answer is correct: answer d contains the two components that a DLCO measures
Site for question/rationale: Dr. Shelly Seth’s COPD & PFT Part 2 Presentation, slide 21
Which condition would you consider in a patient whose EKG shows terminal forces in V1 are pointing upward and a skinny QRS in lead I and V6.
a. Right ventricular hypertrophy
b. Right bundle branch block
c. Left ventricular hypertrophy
d. Left bundle branch block
Answer: B
Rationale for why the answer is correct: A right bundle branch block will show an upward deflection of terminal forces in V1 and skinny QRS complexes in lead I and V6.
Site for question/rationale: 12 Lead EKG Presentation by Dr. Rita Dello Stritto minute 1:03:30.
What does T wave inversion on an EKG suggest?
a. Ischemia
b. Damage to the heart (necrosis, fibrosis)
c. Ventricular hypertrophy
d. Bundle branch block
Answer: B
Rationale for why the answer is correct: T wave inversion suggests a previous MI or heart damage in the patient (necrosis, fibrosis). When the T wave becomes upright again, this indicates fibrosis has occurred.
If left ventricular hypertrophy is suspected, what must the “R” in lead AVL measure?
a. Greater than or equal to 35 mm
b. 5 little squares
c. Greater than 11 mm
d. Greater than 10 mm
Answer: C
Rationale for why the answer is correct: In order to diagnose left ventricular hypertrophy, the “S” in V1 plus the “R” in V5 or V6 must be equal to or greater than 35 mm. Alternatively, the “R” in lead AVL must measure over 11 mm. One little square is equal to 1 mm, one large square is equal to 5 mm.
Site for question/rationale: 12 Lead EKG Presentation by Dr. Rita Dello Stritto minute 50:16.
What is the preferred diagnostic exam for looking at cardiac valvular abnormalities?
a. Heart catheterization
b. Holter monitor
c. Echocardiogram
d. Serum enzymes
Answer: C
Rationale for why the answer is correct: Echocardiograms are the preferred diagnostic method for evaluating valvular abnormalities.
Site for question/rationale: Cardiac Testing presentation by Dr. Shelly Seth minute 21:18.
Which of the following is considered a normal ejection fraction?
a. 67%
b. 43%
c. 91%
d. 2%
Answer: A
Rationale for why the answer is correct: A normal ejection fraction falls within the range of 50-80%.
Site for question/rationale: Cardiac Testing presentation by Dr. Shelly Seth minute 18:28.
Which is the diagnostic test of choice for ruling out a pulmonary embolism?
a. D-dimer
b. V/Q scan
c. CTA
d. MRI
Answer: C
Rationale for why the answer is correct: The computed tomography angiography is the test of choice for ruling out PE. The patient, however, must have good renal function to undergo this diagnostic exam.
Site for question/rationale: CC Shortness of Breath presentation by Dr. Shelly Seth minute 18:15.
You have just performed a TB skin test on a 10-year-old patient whose mother recently tested positive for tuberculosis. Which result would be a positive finding?
a. 7 mm
b. 0 mm
c. 4 mm
d. 2 mm
Answer: A
Rationale for why the answer is correct: Any result equal to or greater than 5 mm in a pediatric patient with high risk factors (lives in the same household with a TB patient) is considered positive.
Site for question/rationale: CC Cough presentation by Dr. Shelly Seth minute 13:23.
Question: How long is pressure held under the right ribcage when assessing the hepatojugular reflex?
a. 30 seconds
b. 2 minutes
c. 45 seconds
d. 60 seconds
Answer: D
Rationale for why the answer is correct: The hepatojugular reflex is tested by placing the patient in a semi-Fowler’s position (45 degrees) and placing pressure under the right ribcage for 1 minute.
Site for question/rationale: Hepatojugular reflex test on Youtube minute 1:21
What is the number one risk factor for the development of COPD in adulthood?
a. Air pollution
b. Tobacco
c. Older age
d. Female sex
Answer: B
Rationale for why the answer is correct: Tobacco is the number one risk factor for the development of COPD.
Site for question/rationale: COPD and PFTs Part 1 by Dr. Shelly Seth minute 5:52.
Which of the following spirometry test results would warrant further investigation?
a. FEV1 of 89%
b. FVC of 62%
c. FEV1/FVC of 71%
d. FEV1/FVC of 90%
Answer: B
Rationale for why the answer is correct: A “normal” FVC is >80%.
Site for question/rationale: COPD and PFTs Part 2 by Dr. Shelly Seth minute 12:46.
A patient comes in to your ER complaining of chest pain and you suspect a myocardial infarction (MI). What important lab is the preferred lab for diagnosing an MI because it rises quicker than any other cardiac lab?
a. Troponin
b. Creatinine Kinase
c. Lactate dehydrogenase
d. Hemoglobin and Hematocrit
Answer: A. Troponin
Rationale for why the answer is correct: Troponin rises quicker than any other cardiac lab and only one elevated troponin is needed to diagnose an acute MI. s
You suspect your patient has an acute MI. He is alert and oriented, but pale and complaining of chest pain and shortness of breath at rest. The troponin and other cardiac labs have not resulted yet, but the EKG shows ST elevation. What is the next step in your plan of care?
a. Wait for the troponin to come back before making any further decision
b. Repeat the EKG
c. Send the patient to the cath lab immediately
d. Start chest compressions
Answer: C. Send the patient to the cath lab immediately.
Rationale for why the answer is correct: If the EKG shows ST elevation with the signs/symptoms of acute MI, send to cath lab without waiting for troponin to come back.
What would you use a bubble echo for?
a. Diagnose elevated right sided heart pressures
b. Diagnose VSD
c. Diagnose ASD
d. Determine ejection fraction
Answer: C. Diagnose ASD.
Rationale for why the answer is correct: The contrast will bubble through the ASD and allow it to be visualized.
Where do you place the V1 chest lead?
a. Mid axillary line, 5th ICS
b. Anterior axillary line, 5th ICS
c. Left 4th ICS
d. Right 4th ICS
Answer: D. Right 4th ICS
Rationale for why the answer is correct: This is where you place the first of the chain of chest leads.
Site for question/rationale: 12 Lead EKG presentation; ~19:00+.
You are writing your SOAP note about a Mrs. Smith who has had a cough for 9 weeks. Which differential are you not likely considering?
a. Asthma
b. Medications
c. GERD
d. Viral rhinosinusitis
Answer: D. Viral rhinosinusitis.
Rationale for why the answer is correct: Viral causes are more likely in an acute cough tthat usually lasts less than 3 weeks. The rest could be causes of a chronic cough (>8 weeks).
Site for question/rationale: “I have a cough that won’t stop” presentation, slides 3-5.
What intervention would not initially be helpful for a 50-year-old male patient with a cough that has been bothering him for a month?
a. Pulse oximetry and physical exam
b. TB test
c. EKG
d. Echocardiogram
Answer: D. Echo
Rationale for why the answer is correct: An echo could be indicated if the EKG is abnormal or the physical exam reveals concerns for cardiac abnormalities, but it would not be an initial intervention for a chief complaint of a subacute cough alone.
Mr. John, 70 years old, comes into your office with a cough and SOB with exertion. He has a history of asthma, family history of “breathing problems and heart attacks,” lives in an urban, industrial neighborhood, works in a factory for a living, and says he does not take any medications regularly, but does smoke a pack of cigarettes per day. When thinking through his potential differentials, what is not a high-risk factor for COPD for Mr. John?
a. History of asthma
b. Lives in urban, industrial neighborhood
c. Factory job
d. Male gender
Answer: D. Male gender
Rationale for why the answer is correct: Tobacco use, air pollution, noxious exposures, genetic factors, older age, female sex, low SES, asthma, chronic bronchitis, and infections are risk factors for COPD. Male gender is less of a risk factor than female gender
You are in clinical and your preceptor asks you what a base excess of -6.8 indicates for your diabetic patient. What is your answer?
a. The patient is within normal range for base excess
b. The patient is very alkalotic
c. The patient is very acidotic
d. The base excess is not relevant to a patient here for diabetes
Answer: C. The patient is very acidotic.
Rationale for why the answer is correct: The base excess is made up of many components in the blood (Hgb, PO4, SO4, HCO3-, albumin, etc.) and shows you how much base is needed to correct the problem to maintain normal pH. Normal range is -2 to 2.
Site for question/rationale: ABG/Anion gap presentation, Dr. Seth, ~6:45+.
Question: What is the purpose of the RL (right leg) lead in a 12 Lead EKG?
A. It measures the cardiac output of the right atrium
B. It measures the electrical conduction of the right ventricle
C. It is used as a ground wire
D. It has no purpose
Answer: C
Rationale for why the answer is correct: The RL wire is used as a ground wire. Not using the RL wire may sometimes cause interference or static to the EKG.
Site for question/rationale: Dr. Stritto’s 12 Lead EKG presentation 4:09
- Question: When looking at the aVR lead, what does a negative QRS indicate?
A. That electricity of the heart is moving towards the aVR lead
B. That electricity of the heart is moving away from the aVR lead
C. That the patient’s heart rate is too fast
D. The patient is experiencing an MI
Answer: B
Rationale for why the answer is correct: When electricity moves away from the positive aVR lead it will drop below the isoelectric line, causing a negative QRS complex on the EKG reading.
Site for question/rationale: Dr. Stritto’s 12 Lead EKG presentation 11:00
Question: With a normal EKG, what can the APRN expect to see on the limb leads?
A. A negative QRS deflection on lead I and positive QRS deflection on lead II & III
B. A negative QRS deflection on all limb leads
C. A positive deflection on lead III only
D. A positive QRS deflection on leads I, II, III
Answer: D
Rationale for why the answer is correct: Limb leads I, II, and III sense the heart’s electrical conduction going towards them, which causes a positive QRS deflection on the EKG.
Site for question/rationale: Dr. Stritto’s 12 Lead EKG presentation 15:45
Question: Along with an EKG, what cardiac marker is preferred to diagnose an AMI? A. CK, CK-MB B. Myoglobin C. Troponin D. BNP
Answer: C
Rationale for why the answer is correct: Troponin is the cardiac marker that is preferred to diagnose an acute MI. It rises within 2-3 hours. If the troponin level is elevated but there are no EKG changes, the patient is experiencing a Non-ST Elevation Myocardial Infarction (NSTEMI).
Site for question/rationale: Dr. Seth’s cardiac testing presentation 5:00
Question: A patient with CHF that is not in distress is determined to have stable angina. What action should the APRN perform next for this patient?
A. Send the patient to the ER
B. Schedule an exercise stress test for the patient
C. Refer the patient to a cardiologist
D. Schedule a chemical stress test
Answer: C
Rationale for why the answer is correct: The patient presents with stable angina, which is not an emergency. A stress test is contraindicated for patients with CHF; therefore, the patient would be referred to a cardiologist.
Site for question/rationale: Dr. Seth’s cardiac testing presentation 8:50
Respiratory
Question: A patient who is a “frequent flyer” comes into the ER every other week requesting narcotics. This patient comes into the ER today and states, “I can’t breathe”! Based on the patient’s history, the APRN knows:
A. This is not an emergency and can focus on other patients
B. This is an emergency until proven otherwise
C. The patient is going to require security to calm him down
D. The patient is going to require a psychiatric consult for her anxiety
Answer: B
Rationale for why the answer is correct: When a patient states that they cannot breathe, it is always considered an emergency until proven otherwise.
Site for question/rationale: Shortness of breath presentation by Dr. Seth 1:00
Question: The APRN is seeing a patient with acute cough. What is an acute cough? A. Cough with no sputum B. A cough that started two weeks ago C. A cough that started four weeks ago D. Cough due to allergies
Answer: B
Rationale for why the answer is correct: An acute cough is defined as lasting less than three weeks. Differentials include viral bronchitis, viral rhinosinusitis, postnasal drip due to allergies, COPD or asthma exacerbation, new asthma, pneumonia.
Question: A 45-year-old male with hx of HTN and hyperlipidemia comes into the clinic with the chief complaint of “This cough won’t go away.” Vital signs are T=98.2, R=22, B/P=130/80, P=77 SpO2= 97%. The patient’s medications include lisinopril and atorvastatin. What is the APRN’s next course of action? A. Decrease the atorvastatin B. Decrease the lisinopril C. Discontinue the atorvastatin Discontinue the lisinopril
Answer: D
Rationale for why the answer is correct: ACE inhibitors, especially lisinopril, have a side effect of cough. It is best for the APRN to discontinue the lisinopril to relieve the patient’s cough.
Site for question/rationale: Cough presentation by Dr. Seth 2:42
Question: When interpreting pulmonary function tests, the APRN can expect obstructive disorders to affect measurements of \_\_\_\_\_\_\_\_ and restrictive disorders to affect measurements of \_\_\_\_\_\_\_\_\_\_\_. A. Volume, Flow B. Flow, Volume C. Rate, Depth D. Depth, Rate
Answer: B
Rationale for why the answer is correct: Generally, obstructive disorders affect measurements of flow and restrictive disorders affect measurements of volume.
Site for question/rationale: Pulmonary function test presentation by Dr. Day 5:00
- Which is correct about the AVR lead?
a. It should have a - deflection
b. It should have a + deflection
c. It should look like lead 1
d. It should look like lead 2
Answer: A
Rationale for why the answer is correct: The AVR lead should always have a – deflection. Checking the AVR is the first step in assessing an EKG and ensures correct lead placement.
Site for question/rationale: 12 Lead EKG PowerPoint, slide 7-8
A now stable 65-year-old male with a hx of 2 MIs comes to clinic for his yearly EKG- what do you NOT expect his EKG to show?
a. ST depression
b. ST elevation
c. A Q wave
d. T wave inversion
Answer: B
Rationale for why the answer is correct: ST elevation indicates MI and is abbreviated STEMI. ST depression shows ischemia, while T wave inversion should previous MI damage, and a Q wave indicates someone has/had an MI and never goes away once present.
Site for question/rationale: 12 Lead EKG PowerPoint, slide 12-15
A preceptor overhears her nurse practitioner student talking to her classmate about right axis deviation- which of the following statements will the preceptor correct because it is not true?
a. If you do not have right axis deviation, you cannot have RVH
b. It is a normal finding in children
c. It could be due to WPW syndrome
d. It could be due to hyperkalemia
Answer: D
Rationale for why the answer is correct: Left axis or northwest deviation could be due to hyperkalemia. Right axis deviation is normal in children and tall, thin adults, is present in RVH (because the R ventricle gets bigger so there is more space to travel), WPW, ASD/VSD, etc.
Site for question/rationale: 12 Lead EKG PowerPoint, slide 24
Which of the following provider scenarios is correct?
a. A provider orders a STAT cath on a stable pt whose EKG is WNL, but troponins are elevated
b. A provider orders an EKG and troponin on a suspected MI pt
c. A provider orders an echo on a pt in order to dx cardiovascular disease
d. A provider orders a stress test on a pt with aortic stenosis
Answer: B
Rationale for why the answer is correct: Do not depend on labs for dx an MI, look at EKG. Troponins are the preferred lab since they rise within 2-3 hrs and only 1 elevated troponin is required to dx an MI. If the troponins are elevated but the EKG is WNL, that indicates an NSTEMI (Non-ST Elevation MI). Echos cannot dx cardiovascular disease, caths do that. Aortic stenosis is a contraindication of stress testing
A 5-month-old baby presents to the urgent care with a hx of fever x7 days and an erythema multiform like rash. No other s/s are present at this time. What should the provider do?
a. Treat with antibiotics because the provider knows this is a bacterial infection
b. Treat with supportive care because the provider knows Kawasaki should present with fever x5 days and at least 4 other s/s
c. Order an EKG, echo, and cardiology consult because the provider knows although this child is an incomplete Kawasaki dx, the baby is high risk due to age and length of fever
d. Treat the rash with benadryl and topical steroids and have the pt follow up with PCP in 2 days if not improved because the provider knows this is typical for a viral illness
Answer: C
Rationale for why the answer is correct: A complete Kawasaki dx presents with fever for 5 or more days and at least 4 of the 5 physical findings. However, incomplete Kawasaki is a dangerous dx dilemma and all suspected pts should have an EKG, echo, and urgent cardiology referral. Especially infants less than 6 months may present with fever for more than 7 days and few other clinical findings
Site for question/rationale: Kawasaki Handout
Which question is the highest priority when a patient presents with “I have a cough that won’t stop”?
a. Are you having weight loss?
b. Do you have pain with swallowing?
c. Do you have heartburn?
d. Do you have any nasal drainage?
Answer: A
Rationale for why the answer is correct: All questions need to be answered however if the patient is losing weight, this indicates there could be something systemically going on and MNM dx. The other questions are pertinent but are not MNM.
Site for question/rationale: “I have a cough that won’t stop” PowerPoint, slide 6-8
Which child in clinic are you most concerned about?
a. A 15-year-old male that presents with chest pain after eating a large meal
b. A 13-year-old female athlete that presents with chest pain that especially hurts when palpated
c. A 16-year-old tall, thin male that presents with SOB at rest
d. A 14-year-old female with a hx of anxiety that presents to the clinic with SOB x2 weeks
Answer: C
Rationale for why the answer is correct: Tall, thin teenage boys are especially at risk for spontaneous pneumothorax due to rapid growth. Chest pain that hurts worse with palpation is likely muscular and chest pain after a large meal can indicate GERD. A pt with SOB for 2 weeks likely does not have an acute disease process and may be attributed to anxiety
A patient with a low FEV1/FVC ratio likely has which type of lungs?
a. Reduced
b. Normal
c. Restrictive
d. Obstructive
Answer: D
Rationale for why the answer is correct: A pt with a low FEV1/FVC has obstructive lungs. Restrictive lungs have normal FEV1/FVC. Normal lungs have normal FEV1/FVC ratios.
Site for question/rationale: Pulmonary Function Test by Mercedes Day PowerPoint, slide 8 and 10
All are risk factors for COPD except which one?
a. Socioeconomic status
b. A BMI of 24
c. Tobacco
d. Genetics
Answer: B
Rationale for why the answer is correct: All are risk factors for COPD except a normal BMI.
Site for question/rationale: COPD and Pulmonary Function Test Part 1 PowerPoint, slide 4
Which is true about ABGs?
a. If it is respiratory in nature, the HCO3- will be out of range
b. We cannot look at the other component (CO2 and HCO3-) to determine compensation
c. If it is respiratory in nature, the CO2 will be out of range
d. If it is metabolic in nature, the CO2 will be out of range
Answer: C
Rationale for why the answer is correct: The pH will tell you if the pt is acidotic or alkalotic. If the CO2 is out of range, it is respiratory in nature. If the HCO3- is out of range, it is metabolic in nature. The other component can help you determine if the patient is compensating or not.
Site for question/rationale: ABG’s and Anion Gap PowerPoint, slide 4
Steve, a 62 yo man presents complaining of chest pain and nausea for the past two hours. He states it began while working in his yard and continued after sitting down to rest for about 30 minutes. An ECG is performed and reveals ST segment elevation in V3 and V4 and ST depression in II and aVF. What area of the heart is showing damage from infarction?
a. The inferior area
b. The anterior area
c. The lateral area
d. The septal area
Answer: b. The anterior area
Rationale for why the answer is correct: V3 and V4 correspond to the anterior area of the heart. Inferior is II, III, & aVF; lateral is I, aVL, V5, & V6; and Septal is V1 & V2
Site for question/rationale: 12 lead EKGs – Dr. Stritto, Slide 11; video 21:46
You are studying an ECG and note a wide QRS (>0.12 seconds) in V1 and V6. You are suspecting a Bundle Branch Block. Which of the following would indicate a Left Bundle Branch Block?
a. Terminal force down in V1
b. Terminal force up in V1
c. Terminal force up in V2
d. None of the above
Answer: a. Terminal force down in V1
Rationale for why the answer is correct: In determining a BBB we look at V1 to determine if left or right BBB. Terminal force of QRS is upright in a RBBB and down in a LBBB.
Site for question/rationale: 12 lead EKGs – Dr. Stritto, Slide 50, 51,& 53; video 1:01:56
Which of the following are possible causes of a left axis deviation in the heart? (Select all that apply)
a. Right ventricular hypertrophy
b. Emphysema
c. Hyperkalemia
d. Left anterior hemiblock
e. Left posterior hemiblock
Answer: b. emphysema, c. hyperkalemia, and d. left anterior hemiblock
Rationale for why the answer is correct: The possible causes of left axis deviation include; left anterior hemiblock, Q waves of inferior MI, Artificial cardiac pacing, Emphysema, Hyperkalemia, WPW, Tricuspid atresia, Ostium primum ASD, and injection of contrast into the left coronary artery. Right ventricular hypertrophy and Left posterior hemiblock are causes of right axis deviation.
Site for question/rationale: 12 lead EKGs – Dr. Stritto, Slide 25; video 39:08
You are looking at a 12-lead ECG and you note that aVR has a downward deflection so there is no transposition of leads. Which of the following would indicate a left axis deviation in this ECG?
a. Lead I – upward deflection; and aVF – upward deflection
b. Lead I – Downward deflection; and aVF – upward deflection
c. Lead I – Upward deflection; and aVF – downward deflection
d. Lead I – Downward deflection; and aVF – downward deflection
Answer: c. Lead I – Upward deflection; and aVF – downward deflection
Rationale for why the answer is correct: Left axis deviation = Lead I – Upward and aVF – downward, Normal axis = Lead I upward and aVF upward, right axis = Lead I – downward and aVF – upward, Extreme axis (No Man’s Land) = Lead I – downward and aVF downward.
Site for question/rationale: 12 lead EKGs – Dr. Stritto Slide 31; video 44:27
A 4 yo male presents with fever for the past six days, a rash on the torso, irritability, red and irritated eyes, and swelling in the face, hands, and feet. Of the following, which lab findings support the diagnosis of Kawasaki disease?
a. WBC – 7,000
b. CRP – 0.8 mg/dL
c. Platelets – 600,000
d. All of the above
Answer: c. Platelets – 600,000
Rationale for why the answer is correct: Platelets in Kawasaki disease are typically over 450,000. CRP is usually elevated over 3 mg/dL, and WBCs are elevated in 50% of patients and typically over 15,000.
Site for question/rationale: Kawasaki Disease - Elsevier Point of Care website
Which of the following is the diagnostic test of choice for ruling out a pulmonary embolism?
a. D-Dimer
b. AP and lateral chest x-ray
c. V/Q scan
d. CT angiogram
Answer: d. CT angiogram
Rationale for why the answer is correct: The CT angiogram is the diagnostic test of choice for ruling out a pulmonary embolism. Chest x-rays and D-Dimer are helpful for the diagnosis but not the test of choice. A V/Q scan is performed if the CT angiogram is contraindicated.
Site for question/rationale: “I’m short of breath” lecture – Dr. Seth, slide 11; video 18:03
Which of the following are differentials of acute cough? (Select all that apply)
a. Viral rhinosinusitis
b. COPD exacerbation
c. GERD
d. Pneumonia
e. Ace inhibitors
Answer: a, b, & d
Rationale for why the answer is correct: Viral rhinosinusitis, COPD exacerbation, and Pneumonia are all differentials of acute cough. GERD and Ace inhibitors are differentials of chronic cough.
Site for question/rationale: “I have a cough that won’t stop” lecture – Dr. Seth slide 3; video 0:56
A 64yo female presents with a three-day history of lethargy and the past two days has suffered from chills. V/S—HR-138, B/P-91/48 (62), RR-22, SpO2-89%RA, Temp 101.2. You order an ABG, and the results are as follows: pH - 7.21, PCO2 - 31, HCO3 – 16, PO2 – 88, BE – -8. Which of the following Acid/Base problem does she have?
a. Partially compensated respiratory acidosis
b. Compensated respiratory acidosis
c. Partially compensated metabolic acidosis
d. Compensated metabolic acidosis
Answer: c. partially compensated metabolic acidosis
Rationale for why the answer is correct: The pH of 7.21 is acidotic, the HCO3 of 16 is acidotic, and the CO2 of 31 is alkalotic, so it is a metabolic acidosis and there is partial compensation going on in the respiratory system with the CO2 being alkalotic. It is not considered compensated because the pH is still abnormal.
Site for question/rationale: ABG’s and Anion Gaps presentation – Dr. Seth Slides 6-15; video 7:43
Which of the following are measurements of flow in spirometry? (Select all that apply)
a. Peak expiratory flow rate (PEFR)
b. Forced vital capacity (FVC)
c. Forced expiratory volume in one second (FEV1)
d. Maximal midexpiratory flow rate (MMEFR)
e. Slow vital capacity (SVC)
Answer: a, c, & d
Rationale for why the answer is correct: PEFR, FEV1, and MMEFR are all measurements of flow whereas FVC and SVC are measurements of volume.
Site for question/rationale: Pulmonary Function Test VT – Dr. Day, slide 4; video 2:22
Which of the following is the highest risk factor for developing Chronic Obstructive Pulmonary Disease (COPD)
a. History of asthma
b. Air pollution
c. Tobacco
d. Chronic bronchitis
Answer: c. Tobacco
Rationale for why the answer is correct: Tobacco use is the number one risk factor for COPD. The others are risk factors but fall behind tobacco in the ranking of factors.
Site for question/rationale: COPD & PFT’s Part 1 – Dr. Seth, Slide 6; video 5:02
Question: Which of the following is false, concerning a 12-lead EKG? A. Limb leads are bipolar B. Chest leads are unipolar C. Right arm is always negative. D. Right arm is always positive.
Answer: D Right are is always positive.
Rationale for why the answer is correct: Limb leads are bipolar, with negative and positive electrical conductions. Chest leads are unipolar, only reading positive or negative electrical conduction. Right arm is always negative, regardless of electrical conduction direction.
Site for question/rationale: Dr. Dello Stritto’s presentation, slide #5 and #6 (@4:13 – 6:36)
Question: Which of the following is correct, regarding the portion of the heart that the chest leads represent?
A. Septal: V1, V2 and V6
B. Anterior: V3 and V4
C. Lateral: only V6
D. Global: all leads represent equal portions of the heart
Answer: B. Anterior V3 and V4
Rationale for why the answer is correct: Septal represents V1 and V2. Anterior represents V3 and V4. Lateral represents V5 and V6. There is no global representation of chest leads
Site for question/rationale: Dr. Dello Stritto’s presentation, slide #10 (@18:55 to 21:04)
Question: Which of the following is false, regarding Q waves?
A. They disappear after reperfusion of the damaged myocardium.
B. May take 8-48 hours to appear at ECG.
C. They can be seen in patients with a previous MI.
D. They measure 1/3 of the height of the R wave.
Answer: A. They disappear after reperfusion of the damaged myocardium.
Rationale for why the answer is correct: Q waves never go away, once they are present. All other options are true regarding Q waves.
Site for question/rationale: Dr. Dello Stritto’s presentation, slide #15 (@27:05 to 27:43)
Question: Which of the following patients should not receive a stress test?
A. 32 y.o. female who has never done a formal exercise plan, but wants to start one now.
B. 39 y.o. male who will be undergoing a total hip replacement in one week.
C. 47 y.o. female with chest pain in whom an MI needs to be ruled out
D. 50 y.o. male marathon runner with uncontrolled arrhythmias
Answer: D. 50 y.o. male marathon runner with uncontrolled arrhythmias.
Rationale for why the answer is correct: Contraindications for a stress test include CHF, uncontrolled arrythmias, PE, severe pulmonary HTN and aortic dissection. All other patients do not have contraindications. Stress testing can be performed prior to an exercise regimen, pre-operative and to rule out MI with chest pain.
- Question: An echocardiogram is:
A. Used to assess the outer shape of the heart.
B. Only a 2-dimensional view
C. Used in patients with long standing HTN
D. Accurate is diagnosing heart disease or plaque in the arteries.
Answer: C. Used in patients with long standing HTN
Rationale for why the answer is correct: An echocardiogram is used to assess the inside of the heart, can be 2 or 3 dimensional and is not diagnostic of cardiovascular disease or plaque in the arteries.
Question: Which of the following would the APRN not consider as a warning sign in a patient with a cough? A. Dyspnea B. Severe post nasal drip C. Hemoptysis D. Unintentional weight loss
Answer: B. Severe post nasal drip
Rationale for why the answer is correct: Warning signs for patients with a cough including dyspnea, wheezing, unintentional weight loss, hemoptysis, fever, night sweats and TB exposure.
Site for question/rationale: Dr. Seth’s cough presentation, slide #4 (@3:34-4:19)
Question: Which of the following would the APRN include during a physical exam of a patient with a cough? A. Assessment of thyroid gland. B. Lung auscultation. C. Esophageal pain on palpation. D. All of the above.
Answer: D. All of the above.
Rationale for why the answer is correct: The APRN would include all of these options, in assessing a patient with a chief complaint of a cough.
Question: Which patient would the APRN refer to emergency medical services, who presents with shortness of breath?
A. 28 y.o. female with cyanosis at fingertips for 2 days.
B. 36 y.o. male with SOB on exertion and fatigue.
C. 49 y.o. female with decreased LOC and central cyanosis.
D. 55 y.o. male with a mild peritonsillar abscess.
Answer: C. 49 y.o. female with decreased LOC and central cyanosis.
Rationale for why the answer is correct: This patient is experiencing an emergency that requires immediate intervention. A decreased LOC would warrant referral to emergency services.
Site for question/rationale: Dr. Seth’s SOB presentation, slide #2 (@0:51 to 1:57)
Question: Which of the following is a Must Not Miss diagnosis for shortness of breath? A. STEMI B. Unstable angina C. Tamponade D. All of the above.
Answer: D. All of the above.
Rationale for why the answer is correct: All of the options are Must Not Miss diagnoses for patient with shortness of breath.
Site for question/rationale: Dr. Seth’s SOB presentation, slide #5 (@ 7:11 to 8:32)
Question: Which of the following would the APRN recognize as false, regarding pulmonary function testing?
A. Spirometry measure flow and volume.
B. Spirometry is best used in children younger the 5 years old
C. Exhalation should last at least 6 seconds in spirometry.
D. Low volume is seen in restrictive lung disease.
Answer: B. Spirometry is best used in children younger the 5 years old.
Rationale for why the answer is correct: Spirometry is difficult to use in children younger than 6 years of age. All other options are correct.
Question: If patient is symptomatic and ECG is normal what test can you do to try and capture what is going on for an extended amount of time as opposed to just a moment which is what an ECG reads?
a) US
b) Echocardiogram
c) Holter monitor
d) Computed tomography angiography
Answer: Holter monitor
Rationale for why the answer is correct: the Holter monitor is an ambulatory ECG that looks for arrhythmias and can be on continuous for 24-48 hours as opposed to regular ECG which just captures a moment.
Site for question/rationale: Cardiac testing lecture Minute 0:42-1:40
Question: What are some of the reasons why you would order a stress test?
a) Pre-op
b) Prior to exercise regimen
c) Rule in/rule out MI with chest pain
d) All of the above
Answer: All of the above
Rationale for why the answer is correct: stress test used in pre-op, prior to test regimen, there are guidelines before someone starts an exercise program if they have not done any exercise and they are over the age of 35, also used to rule in/rule out MI.
Question: Which of the following is a contraindication to stress testing?
a) CHF
b) Angina
c) Aortic stenosis
d) All of the above
Answer: All of the above
Rationale for why the answer is correct: if the patient has any of the following conditions you do not send them for a stress test because they can die: CHF, uncontrolled arrythmias, aortic stenosis, angina, MI, PE, severe pulmonary hypertension, aortic dissection
- Question: Which of the following could you do/look at while doing a right sided heart catheterization?
a) Look at vessels
b) Insert stent
c) Look for blood flow problems
d) Left ventricle ejection fraction
Answer: Look for blood flow problems
Rationale for why the answer is correct: Right sided heart catheterization does not look at the vessels it is used more for diagnostic reasons for other problems, but it will look at blood flow problems, valvular disease on the right side, and diagnose pulmonary hypertension.
Site for question/rationale: Cardiac testing minute 9:22
Question: What is one question you can ask to determine if chest pain is cardiac or muscular?
a) Is your chest pain worse with movement?
b) Does your pain occur after eating?
c) Does drinking milk improve pain?
d) Do you use illicit drugs?
Answer: Is your chest pain worse with movement?
Rationale for why the answer is correct: Knowing if chest pain is worse with movement is one of the big things that will determine if chest pain is cardiac or muscular.
Site for question/rationale: CC shortness of breath lecture Minute 10:49
Question: When ordering diagnostics for a patient with shortness of breath, what tests would you order to rule out acute coronary syndrome?
a) EKG, troponin, BNP
b) CBC
c) BMP
d) ABGs
Answer: EKG, Troponin, BNP
Rationale for why the answer is correct: If you suspect a cardiac cause and you are trying to look at the heart and make sure they are not having a heart attack, they are not in CHF or having some type of arrhythmia that is not letting them get the oxygen moved around to the tissues, you order EKG, troponin, and BNP
Site for question/rationale: CC shortness of breath lecture Minute 13:50
Question: What is one test you can do in a patient with shortness of breath if you are trying to distinguish between a pulmonary and cardiac cause?
a) CBC
b) BMP
c) Peak flow meter with nebulizer treatment
d) oximetry
Answer: Peak flow meter with nebulizer treatment
Rationale for why the answer is correct: If you do a peak flow meter before you give the nebulizer treatment, and then do peak flow meter again after nebulizer treatment, if you can show improvement after nebulizer you can say it is likely pulmonary cause because they wouldn’t be improvement with nebulizer if it was a cardiac cause and will get better if the cause is pulmonary
Site for question/rationale: CC shortness of breath lecture 15:15
Question: Knowing patient has good renal function and you have a positive D-dimer, what is the test of choice to rule out pulmonary embolism?
a) Chest x-ray
b) Computed tomography angiography
c) Ultrasound
d) ECG
Answer: Computed tomography angiography
Rationale for why the answer is correct: if d-dimer positive or you have high suspicion of PE, and patient has good renal function computed tomography angiography is the test of choice to rule out pulmonary embolism. It will also show malignancy, pneumonia, and pulmonary edema.
Site for question/rationale: CC shortness of breath lecture 18:05
Sam had a myocardial infarction six months ago. He presents to the clinic for regular follow-up. When reviewing his 12 lead EKG this morning which finding would not cause alarm?
a) ST segment elevation
b) Peaked T wave
c) Presence of Q wave
d) T wave inversion
Answer: c. presence of Q wave
Rationale for why the answer is correct: A q wave will show up in EKG 8-48 hours an MI has occurred. After they appear, they never go away.
Site for question/rationale: 12 lead EKG, Dr. Stritto, 30:45/1:09:18
The provider may expect a non-pathologic axis deviation on the 12 lead EKG in _____________.
a) Children
b) Tall thin adults
c) Improperly placed leads
d) All the above
Answer: d. all the above
Rationale for why the answer is correct: Children and tall, thin adults exhibit a normal, non- pathologic right axis deviation. Lead placement should always be considered first if there is an axis deviation.
Site for question/rationale: 12 lead EKG, Dr. Stritto, 44:32/ 1:09:18
What serum test is most preferred when patient presents with chest pain and the provider would like to rule out AMI?
a) Troponin T
b) CK-MB
c) CBC
d) Ionized Ca++
Answer: a. Troponin T
Rationale for why the answer is correct: Troponin T proteins rise most quickly after cardiac damage and are specific to cardiac tissue. CK-MB may start changing after several hours. CBC and ionized Ca++ are not specific to cardiac tissue ischemia.
Site for question/rationale: Cardiac Testing, Dr. Seth, 5:30/29:58
- Sue, a 55-year-old female presents to the clinic for annual follow-up, refills, and lab work. She takes Levothyroxine 75mcg po daily for hypothyroidism, Colace 100mg po daily for constipation and HTZ 12.5mg po daily for HTN as prescribed. She Her vitals today are P 70, B/P 140/90, RR 16, O2 sat 99% on RA. She says she feels “great” and walks daily. The provider notices she has been on the same dose of HTN medication for years and it may need adjusting after investigation based on her blood pressure. What test might you order for Sue, along with her annual labs?
a) Referral to cardiology for heart catheterization
b) Troponin T
c) Cardiac Stress Test
d) Transthoracic Echocardiogram (TTE)
Answer: d. Transthoracic Echocardiogram (TTE)
Rationale for why the answer is correct: It is recommended for patients with longstanding HTN to have a TTE to evaluate with increased risk for HF. Especially considering Sue may need a change in her HTN medication regimen. The other tests/ referrals would not be indicated unless Sue is having symptoms of cardiac damage.
A Transesophageal Echocardiogram would be indicated over a TTE in:
a) Children
b) Septic Shock
c) Atrial Fibrillation if a clot is suspected.
d) B & C
Answer: d. B & C
Rationale for why the answer is correct: TEE would be indicated to look at potential vegetation in sepsis and to better visualize a potential embolic source in atrial fibrillation. There is no indication for TEE over TTE for age alone.
Site for question/rationale: Cardiac Testing, Dr. Seth, Slide 11
