Acute CHF
The following ECG indicates:
(A) Acute inferior infarct (STEMI)
(B) Acute lateral infarct (STEMI)
(C) Acute anteroseptal infarct (STEMI)
(D) Acute anterior infarct (STEMI)
(A) Acute inferior infarct (STEMI)
A 73 year old woman is hospitalized for pulmonary embolism. After treatment with heparin, she is transitioned to oral warfarin to continue as an outpatient. She is required to go for routine monitoring of her prothrombin time (PT), partial thromboplastin time (PTT), and INR. Assuming therapeutic dosing levels which of the following laboratory results is most likely to be found in this patient?
Elevated PT/INR only
Elevated PTT only
Elevated PT/INR and PTT
Normal PT/INR and PTT
3. Elevated PT/INR and PTT
A 31-year-old man was involved in a severe automobile accident and suffered laceration of the left primary bronchus. The damaged primary bronchus:
(A)Has a larger diameter than the right primary bronchus
(B)Often receives more foreign bodies than the right primary bronchus
(C)Gives rise to the eparterial bronchus
(D)Is longer than the right primary bronchus
(E)Runs under the arch of the azygos vein
(D)Is longer than the right primary bronchus
A 72 year old man presents to the emergency room with chest pain of seven hours duration. ECG shows ST-segment depressions in leads II, III, and aVF. Creatinine kinase is 350 U/L (normal <150) and troponin I is 2.1 ng/mL (normal <0.01). During evaluation in the emergency room, the pateint develops ventricular fibrillation and dies. Which of the following is the most likely finding at autopsy?
Subepicardial myocardial necrosis
Subendocardial myocardial necrosis
Transmural myocardial necrosis
Normal myocardium
2. Subendocardial myocardial necrosis
What kind of food is Monterey Jack?
Cheese
A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition?*
Which of the following lab values is most likely to be lowered by administration of alteplase?
D-Dimer
Fibrinogen
PT
aPTT
2. Fibrinogen
A 67-year-old woman comes to the emergency department because of a 4-month history of fatigue, shortness of breath with exertion, and dizziness. She has a history of atrial fibrillation and had a single-chamber pacemaker placed five years ago after an episode of syncope. Her pulse is 66/min and blood pressure is 98/66 mm Hg. An x-ray of the chest is shown. The x-ray confirms termination of the pacemaker lead in which of the following structures?
Superior Vena Cava
Left Ventricle
Right Ventricle
Left Atrium
Right Atrium
3. Right Ventricle
A 62-year-old man presents for evaluation of chest pain. Five weeks ago he had an inferior myocardial infarction treated with drug-eluting stent implantation to his right coronary artery. Over the past 24 hours, he has noted chest pain different from the pain during his infarction. The pain is mid-sternal, sharp, and worse when he lies flat or takes a deep breath. He reports missing one dose of clopidogrel two nights ago but otherwise, he has been compliant with his medications. Temperature is 100.5°F. Blood pressure, pulse, and physical exam are within normal limits. Labs show a white blood count of 13,000/ml (normal <11,000). The patient's ECG is seen below. What is the likely diagnosis?
Anterolateral wall MI
Inferior wall MI
Lateral wall MI
Pericarditis
3. Lateral wall MI
What’s the tallest building in the world?
Burj Khalifa
All of the following lead to dilation of the coronary artery except:
(A) Adenosine
(B) Endothelium derived hyperpolarizing factor (EDHF)
(C) Endothelin 1
(D) Nitric oxide (NO)
(C) Endothelin 1
A 32 year old man is evaluated in the hematology clinic for excessive bleeding. After discussing the patient's medical history, it is decided to perform laboratory testing. The patient's blood is mixed with calcium and silica, and the time required for the blood to clot is measured. Which of the following factors is directly activated by the addition of silica into the sample?
Factor VII
Factor VIII
Factor X
Factor XI
Factor XII
5. Factor XII
A 27-year-old patient with Marfan syn-drome has an aneurysm of the aortic arch. This may compress which of the following structures?
(A)Right vagus nerve
(B)Left phrenic nerve
(C)Right sympathetic trunk
(D)Left recurrent laryngeal nerve
(E)Left greater splanchnic nerve
(D)Left recurrent laryngeal nerve
A 55-year-old man was walking up his driveway to get his mail when he began to have substernal, crushing chest pain. He rates the pain a 7/10 and states that his left arm and jaw also hurt. The patient called 911 after he became very sweaty, short of breath, and nauseated. Paramedics on scene were able to obtain and transmit a 12-lead ECG to your facility. The ECG is seen below. In what vessel do you expect to find an occlusion?
Left anterior descending
Right marginal branch of the RCA
Posterior descending artery
AV nodal branch
1.Left anterior descending
There’s a country name that ends with the letter Q, what is it?
Iraq
All of the following are advantages of Nuclear Perfusion Imaging except
1. Can localize disease
2. Non-ionizing radiation exposure
3. Extent and severity of ischemia can be objectively quantified
4. LV ejection fraction can be automatically calculated
2. Non-ionizing radiation exposure
A 75-year-old man is found dead in his bedroom at home. Prior to death, he had a history of hypertension well-controlled on amlodipine. He also had hyperlipidemia treated with atorvastatin. He was physically active taking 1 to 2 mile walks each day. There is no history of mental illness or drug use. The family requests an autopsy. No alcohol or illicit substances are found. The brain is normal for the patient’s age. Which of the following cardiac findings is most likely?
Severe left ventricular concentric hypertrophy
Right ventricular hypertrophy
Atherosclerosis
Fibrosis of the HIS-Purkinje system
Left atrial enlargement
3. Atherosclerosis
A.) Decreased duration of the myocardial action potential
B.) Significantly reduced myocardial contraction force
C.) Fixed obstruction of the left ventricular outflow tract
D.) Marked noncompliance of the left ventricular wall
E.) Severe narrowing of the left anterior descending artery
D.) Marked noncompliance of the left ventricular wall
A 45-year-old male presents to the emergency room with chest pain. He reports that over the past 6 months he has not been able to maintain his usual exercise routine because he would get very short of breath and would develop severe chest pain so he stopped going to the gym, and his symptoms were better. You learn from his chart that he was a heavy smoker (2 pack/day) from 18-41 when his kids finally convinced him to quit. His chest pain developed about an hour ago, but when it did not resolve like normal, he had his wife drive him to the emergency room. You order an ECG, troponin test and CK test. What do you expect to from these tests if your patient is suffering from Unstable Angina resulting from partial occlusion of the left anterior descending (LAD) artery?
ST depressions, elevated CK and troponin
ST elevations, normal CK and troponin
ST depressions, normal CK and troponin
ST elevations, elevated CK and tropoin
3. ST depressions, normal CK and troponin
What animal has fingerprints that are nearly identical to humans?
Koalas
The following chest x-ray indicates which stage of congestive heart failure (CHF)?
(A) Stage 0
(B) Stage 1
(C) Stage 2
(D) Stage 3
A 62-year-old man with a history of hypertension and hyperlipidemia presents to the emergency room with chest pain. For the past two weeks, he has noticed pressure-like discomfort in his chest. Symptoms first occurred when climbing stairs in his home. The past few days, symptoms developed when walking across his bedroom. This morning he noticed symptoms while sitting at the breakfast table, prompting him to call 911. ECG is within normal limits. Serial blood measurements of creatine kinase and troponin are normal. Which of the following is the most likely diagnosis?
Stable angina
Unstable angina
Non-ST-Elevation myocardial infarction
ST-Elevation myocardial infarction
Coronary vasospasm
2. Unstable angina
A 71-year-old man with hypertension comes to the physician for a follow-up examination. Cardiovascular exam shows the point of maximal impulse to be in the mid-axillary line. A transthoracic echocardiogram shows concentric left ventricular hypertrophy with a normal right ventricle. Which of the following is the most likely underlying mechanism of this patient's ventricular hypertrophy?
accumulation of glycogen
Accumulation of protein fibrils
Deposition of endomyocardial collagen
Accumulation of sarcomeres in parallel
Infiltration of T lymphocytes
4. Accumulation of sarcomeres in parallel
A 62-year-old man with a history of diabetes and hypertension present to the emergency room complaining of chest pain. The pain is dull, substernal, and has been present on and off for the past 6 hours. ECG shows ST-segment depressions in leads V2, V3, V4, and V5. Blood work reveals creatinine kinase of 500 I/L (normal<150) and troponin I of 1.1 ng/mL (normal <0.01). Which of the following is the most likely finding at coronary angiography?
Thrombotic 100% Occlusion
75% obstruction by calcified plaque
50% obstruction by calcified plaque
95% occlusion by ruptured plaque with thrombus
Coronary vasospasm
4. 95% occlusion by ruptured plaque with thrombus
How fast is the earth spinning? (in MPH)
1000 MPH