Question 1

Which of the following are not used as stressors in cardiac stress testing?

Accepted Answer

Noradrenaline is not used as a stressor in cardiac stress testing. The stressors used are
•Physical stressors: treadmill or bicycle
•Increased coronary flow: dipyridamole (Persantine), adenosine
•Increased myocardial O2 demand: dobutamine (ß1-selective agonist)

Question 2

Which of the following statement is correct about junctional premature beat?

Accepted Answer

The correct statement about junctional premature beat is that there is no P wave preceding the premature QRS complex. In junctional rhythm the origin of impulse is near AV node; a normal P wave is not seen. Sometimes, a retrograde P wave may be seen which represents atrial depolarization moving backward from the AV node into the atria.

Question 3

"Ashman phenomenon" is associated with which of the following arrhythmias?

Accepted Answer

"Ashman phenomenon" is associated with atrial fibrillation. Ashman phenomena presents as wide QRS complexes due to aberrancy which may occur following a long short R-R cycle sequence.

Question 4

The nurse records the ECG of a patient presenting with complaints of sudden onset palpitation with ventricular rate of about 200/ minute. ECG shows paroxysmal supraventricular tachycardia. Which of the following drugs the nurse should prepare if this patient is not responding to vagal maneuvers?

Accepted Answer

The nurse should prepare adenosine if the patient is not responding to vagal maneuvers. Adenosine is the first choice in acute paroxysmal supraventricular tachycardia, if unresponsive to vagal maneuvers. If no response, try metoprolol, digoxin, verapamil; DC shock if signs of cardiogenic shock, angina, or CHF.

Question 5

Which of the following statements are true about primary Raynaud's phenomena versus secondary Raynaud's phenomena?

Accepted Answer

The true statement about primary Raynaud's phenomena versus secondary Raynaud's phenomena is secondary Raynaud's phenomena is associated with many diseases while primary Raynaud's phenomena is an inherited condition.

Question 6

Which of the following is not a histopathologic finding in hypertrophic cardiomyopathy?

Accepted Answer

Fluid in the intramyocardial space is not a histopathologic finding in hypertrophic cardiomyopathy. Histopathologic findings in hypertrophic cardiomyopathy are myocardial fiber disarray, myocyte hypertrophy, and interstitial fibrosis.

Question 7

Which of the following is not a part of major criteria of the modified Jones criteria for diagnosis of rheumatic fever?

Accepted Answer

Polyarthralgia is not a part of major criteria of the modified Jones major criteria for diagnosis of rheumatic fever. The major criteria of the modified Jones criteria includes :
•Pancarditis
•Polyarthritis
•Sydenham's chorea
•Erythema marginatum
•Subcutaneous nodules

Question 8

A nurse records the ECG of a patient presenting with chest pain. The ECG shows ST elevation in precordial leads. Which of the following diagnosis is unlikely?

Accepted Answer

If the ECG shows ST elevation the unlikely diagnosis is subendocardial infarction. Causes of ST segment elevation:
•Early repolarization (normal variant)
•Acute MI
•Post MI
•Prinzmetal's angina (coronary vasospasm)
•Acute pericarditis
•Ventricular aneurysm
•LBBB

Question 9

A patient presents with chest pain in emergency department was diagnosed to have acute myocardial infarction. What is the goal of treatment in this patient?

Accepted Answer

The goal of treatment in a patient of acute myocardial infarction is to minimize the infarct and prevent complication. The goal of treatment in patients of acute myocardial infarction is to minimize the amount of infarcted myocardium and prevent complications.

Question 10

A 62-year male patient presents to emergency with severe acute chest pain. After looking at which of the following ECG findings, should the nurse prepare for thrombolytic therapy?

Accepted Answer

After looking at the ECG showing 2 mm ST elevation in leads V1 and V2 the nurse should prepare for thrombolysis. Following are the indications for thrombolytic therapy for a patient presenting with acute chest pain:
•At least 0.5 hours of ischemic cardiac pain and
•Any of the following ECG changes thought to be of acute onset
•at least 1 mm of ST elevation in at least two limb leads
•at least 1 mm of ST elevation in at least two adjacent precordial leads
•new onset complete BBB
•Presentation within 12 hours of symptom onset

Question 11

Which one of the following is an absolute contraindication for thrombolytic therapy in acute myocardial infarction?

Accepted Answer

Aortic dissection is the absolute contraindication for thrombolytic therapy which is the likely diagnosis in a 70-year old hypertensive male with acute chest pain, ST elevation in leads II, III and aVF and new diastolic murmur in the left lower sternal region.

Question 12

All of the following group of drugs improve the survival in congestive heart failure as shown by many studies except

Accepted Answer

Nitrates do not improve the survival in patients of congestive heart failure. The drugs which offer mortality benefit to the patients of cardiac failure are: spironolactone, ACE inhibitor, Angiotensin receptor blocker and beta-blockers. Nitrates are used for symptom control but do not increase survival.

Question 13

A patient presenting to emergency room was diagnosed to have acute myocardial infarction. Which of the following measures should the nurse be prepared to take in the emergency room?

Accepted Answer

The nurse should be prepared to take the following measures in emergency room are: ECASA 325 mg chewed stat, oxygen, sublingual nitroglycerine, morphine for pain relief, sedation, venodilation and ß blockers to reduce heart rate if not contraindicated.

Question 14

In a patient of mitral stenosis which of the following is not true?

Accepted Answer

All patients with mitral stenosis will not have atrial fibrillation although about 80% patients of mitral stenosis suffer from atrial fibrillation.

Question 15

Which of the following is not an indication of surgery in patients with mitral stenosis?

Accepted Answer

Atrial fibrillation is not an indication of surgery in patient of mitral stenosis. The indications of surgery in mitral stenosis are: MV area <1.0 cm2 with symptoms, NYHA class III or IV, worsening pulmonary hypertension, infective endocarditis, systemic embolization, unacceptable lifestyle limitations due to symptoms.

Question 16

Which of the following statements are not true about secondary Raynaud's phenomena?

Accepted Answer

The statement that secondary Raynaud's phenomenon is a hereditary disease which runs in families is not true about secondary Raynaud's phenomenon. Primary Raynaud's or Raynaud's disease is typically an inherited condition, exacerbated by smoking, with a hormonal component. However, Raynaud's syndrome, or secondary Raynaud's is associated with numerous environmental factors and diseases. Those most often associated include scleroderma, lupus, rheumatoid arthritis, eating disorders, atherosclerosis, Buerger's disease, and drugs such as beta-blockers, cytotoxins, cyclosporin, ergotamine, or sulfasalazine. Additionally, occupational hazards including exposure to vibrating equipment, vinyl chloride and cold as well as other comorbid conditions like hypothyroidism, cryoglobulinemia, cancer and reflex sympathetic dystrophy have also been associated with secondary Raynaud's phenomenon.

Question 17

Jones criteria are for diagnosis of which of the following diseases?

Accepted Answer

Jones criteria is for diagnosis of rheumatic fever. Nowadays the criteria has been modified and known as modified Jones criteria.
Modified Jones criteria:
Major criteria
•Pancarditis
•Polyarthritis
•Sydenham's chorea
•Erythema marginatum
•Subcutaneous nodules
Minor criteria
•Previous history of rheumatic fever or rheumatic heart disease
•Polyarthralgia
•Increased ESR or c-reactive protein (CRP)
•Increased pr interval (first degree heart block)
•Fever

Question 18

What is the overall goal of management of metabolic syndrome?

Accepted Answer

The overall goal is to reduce an individual's risk of developing cardiovascular disease and development of type II diabetes. Metabolic syndrome is a constellation of symptoms and signs that put a person at risk for developing cardiovascular and type II diabetes.

Question 19

Which of the following recommendations the nurse should suggest a person who has been diagnosed to have metabolic syndrome?

Accepted Answer

The nurse should recommend a patient of metabolic syndrome to maintain proper lipid levels, maintain proper blood pressure levels, maintain proper glucose levels, and maintain proper albumin excretion and creatinine levels. Other recommendations are to maintain proper diet and exercise, avoid smoking and tobacco use, lose excess weight,

Question 20

Which of the following pharmacologic agents are not used for treatment of metabolic syndrome?

Accepted Answer

Antibiotics are not used for treatment of metabolic syndrome. Pharmacologic agents used to treat metabolic syndrome include lipid-lowering agents, antihypertensives, anticoagulants and diabetic agents such as oral agents and insulin.

Quiz 1: Cardiac Medicine