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SAEM - Cardiovascular
Terms in this set (19)
A 23-year-old male presents after a syncopal episode. EKG findings include normal sinus rhythm, a short PR interval (less than 0.12 seconds), QRS duration of 0.11 seconds, and the presence of a "delta wave" (a slurred upstroke to the QRS complex). What condition most likely caused the syncopal episode?
A. Vasovagal reaction
B. Wolff-Parkinson-White syndrome
C. Brugada syndrome
Of the options below, the therapy best for symptomatic 3rd degree heart block is:
D. transcutaneous pacer
A 54 year old female presents with palpitations. She is otherwise asymptomatic. EKG shows atrial fibrillation. Vital signs are HR 130-150, BP 148/78, RR 16, T 36.7. What management intervention is most important to accomplish next?
A. Pharmacologic ventricular rate control
B. Radiofrequency ablation
An 8 year old female presents with a regular, narrow-complex SVT. You diagnose AV nodal reentrant tachycardia. Which pharmacologic agent would be most appropriate for initial management?
The answer is B. "Adenosine, a purinergic blocking agent that causes acute and transient AV nodal blockade, is the drug of choice for acute termination of AVNRT. Multiple studies have shown that adenosine is nearly 100 percent effective in terminating AVNRT."
A 65 year old male presents to the emergency department with chest pain. Cardiac monitoring shows a wide complex tachycardia. Past medical history is significant only for hypertension. His BP is 100/66, HR 144, RR 24, and T. 37.5. In addition to ongoing chest pain, he reports dyspnea. His level of consciousness is mildly decreased. Management should proceed on the assumption that he has what abnormal rhythm?
A. Wolff-Parkinson-White syndrome with retrograde conduction
B. Ventricular tachycardia
C. Sinus tachycardia with LVH
D. Supraventricular tachycardia with aberrancy
The answer is B. "Unstable patients with a wide-complex tachycardia should be treated as if ventricular tachycardia is present. "
The best treatment, of the options below, for a patient with second degree AV block Mobitz Type II is:
A. transvenous pacing
Where are the normally dominant pacemaker cells of the heart found?
A. bundle of His
B. accessory pathway of Kent
C. atrioventricular node
D. sinoatrial node
A 22 year old female presents to the emergency department with a "funny feeling" in
her chest. She has had similar episodes but never lasting as long as the current
episode (3-hour duration). Her heart rate is 200, blood pressure is 128/68, respiratory rate is 20 and her pulse oximetry is 96%. Her EKG is shown in the Figure. The best treatment option for this patient is:
(narroq complex regular tachy)
The answer is B. The rhythm shown in the EKG is a narrow complex regular
tachycardia. It could also be described as a supraventricular tachycardia (SVT). The
first-line treatments of stable SVT are vagal maneuvers or adenosine. Unstable SVT
(such as that causing hypotension, heart failure, or myocardial ischemia) should be
R ventricular ischemia EKG?
The EKG's demonstration of ST-segment elevation in V4R (right-sided lead V4) is highly suggestive of right-ventricular ischemia/infarction.
The answer is A. The EKG reveals right bundle-branch block. RBBB are characterized by a prolonged QRS duration, a terminal R wave in V1 and a slurred S wave in leads I and V6. Frequently, an RSR', or "rabbit ears" pattern can also be seen in the precordial leads.
A 40 year old male presents to the emergency department complaining of severe ankle pain after inverting the foot during a soccer game. The triage nurse records the following vital signs: temperature 98.8, pulse 94, respiratory rate 18, BP 188/118. Which of the interventions below is the most appropriate step to take in response to the blood pressure assessment?
A. Ignore the blood pressure since the patient is asymptomatic other than having ankle pain
B. Order an antihypertensive agent to be given in the emergency department because the patient will be discharged with a prescription for one
C. Administer a sublingual antihypertensive agent since the patient probably only has an ankle sprain and will not need an intravenous line
D. Establish intravenous access in order to optimize the onset of action of parenteral antihypertensive medications
E. Take measures to relieve pain and recheck the blood pressure
The blood pressure at which malignant hypertension is defined as present is:
A. an elevated arterial pressure associated with end organ damage
B. an elevated arterial pressure that exceeds the patient's baseline by 33%
C. diastolic blood pressure of 110 or greater
D. systolic blood pressure of 170 or greater
E. systolic blood pressure of 180 or greater
Which of the ocular findings below is associated with hypertension?
A. retinal nevus
B. Roth spots
C. cherry red spot
D. arterio-venous nicking
E. increased cup-to-disk ratio
With regard to targets for therapy of elevated blood pressure identified during an emergency department visit, which of the following is generally true?
A. Patients with hypertensive urgencies are preferably treated with sublingual
nifedipine, as compared with intravenous agents
B. Patients with hypertensive urgencies should have blood pressure normalized (for age) within an hour
C. The target systolic pressure for patients with acute aortic dissection is an absolute number rather than a percent pressure reduction
D. Patients with hypertensive emergencies should have blood pressure normalized (for age) within an hour or less
E. Patients with hypertensive emergencies should have mean arterial blood pressure lowered by 50% within 50 minutes
A 40 year old female presents to the emergency department complaining of a few days of headaches, excessive sweating, anorexia, heat intolerance and palpitations. She has also been having upper respiratory symptoms over the past week. She is found to have a blood pressure of 170/106 and an EKG, urinalysis, fundoscopic examination, serum creatinine, and neurological evaluation are negative. What is the next step in the evaluation/management?
A. Schedule a clonidine suppression test to evaluate for pheochromocytoma
B. Administer sublingual nifedipine while the work-up continues
C. Obtain a medication history
D. Perform CT scan of the abdomen
E. Avoid sublingual or intravenous therapy in the ED and prescribe an oral beta-blocker
Labetalol differs from propanolol in that labetalol is:
A. characterized by an elimination half-life of minutes rather than hours
B. selective for the alpha2-adrenergic receptor
C. a mixed alpha1-agonist and beta-antagonist
D. an alpha-and beta antagonist
E. a mixed alpha-antagonist and beta-agonist
A previously healthy 25 year old female arrives at the emergency department with 3 days of headache, nausea, palpitations, and diaphoresis. She initially presented 2 days ago to the hospital's walk-in clinic, where her blood pressure was found to be moderately elevated. At her clinic visit, the initial evaluation for end-organ damage was negative. In the emergency department, assessment of tests sent from the clinic visit is noteworthy for a normal TSH, normal head CT scan, and markedly elevated urine metanephrine levels. If this woman were to require emergency department therapy for hypertension, which of the following agents should be AVOIDED:
A. calcium channel blocker
D. alpha-adrenergic receptor blocker
E. beta-adrenergic receptor blocker
In a patient with malignant hypertension, the patient's blood pressure should be reduced to what value in the initial 2 hours of treatment?
A. 120/80 mm Hg
B. 100/70 mm Hg
C. 90/60 mm Hg
D. 75% of the pretreatment mean arterial pressure (MAP)
E. 50% of the pretreatment MAP
You need to treat an adult with no past medical history, who presents with a hypertensive emergency. You have access to all of the following agents. Which of the following is the preferred agent and initial dose?
A. labetolol IV 0.2-1.0 mg/kg bolus
B. metoprolol PO 10 mg
C. clonidine PO 0.1 mg
D. hydralazine IM 0.1-0.2 mg/kg
E. esmolol IV 100-500 mic/kg load
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