Deck 2: Cardiology

Question 1

Your patient is found sitting on the edge of the bathtub with cool, diaphoretic skin. She states she became lightheaded and nearly "passed out" while vomiting. Your cardiac monitor shows a sinus bradycardia at a rate of 48. Which of the following is most likely?

A) Sick sinus syndrome
B) Use of sympathomimetic medications
C) Disease of the cardiac conduction system
D) Increased parasympathetic tone

Answer 1

Increased parasympathetic tone

Question 2

The pressure in the left ventricle at the end of diastole is called:

A) after.
B) preload.
C) ejection fraction.
D) stroke volume.

Answer 2

preload.

Question 3

The valve between the right atrium and right ventricle is the ________ valve.

A) bicuspid
B) pulmonic
C) tricuspid
D) aortic

Answer 3

tricuspid

Question 4

Public education about cardiovascular disease focuses on:

A) risk factors and signs and symptoms of CVD.
B) CPR and public access defibrillation.
C) CPR and signs and symptoms of CVD.
D) risk factors and public-access defibrillation.

Question 5

For a resting potential in a cardiac cell to exist, there must be an:

A) adequate number of potassium ions inside the cell and sodium ions outside the cell.
B) adequate number of sodium ions inside the cell and potassium ions outside the cell.
C) influx of calcium ions into the cell.
D) ionic equilibrium between the inside and outside of the cell.

Question 6

Which of the following items is most likely to interfere with the function of an implanted cardiac pacemaker?

A) Magnet
B) Cellular telephone
C) Television remote control
D) Hair dryer

Question 7

The first phase of the cardiac cycle is:

A) systole.
B) diastole.
C) contraction.
D) ejection.

Question 8

Typical stroke volume is about ________ of the volume of the left ventricle.

A) one-third
B) one-half
C) two-thirds
D) three-quarters

Question 9

When the ECG paper is traveling at the standard rate of 25 mm/sec, a large box in the horizontal direction equals:

A) 0.08 seconds.
B) 0.12 seconds.
C) 0.20 seconds.
D) 0.24 seconds.

Question 10

Which of the following will occur with an increase in peripheral vascular resistance?

A) Decreased stroke volume
B) Increased ejection fraction
C) Increased preload
D) Decreased afterload

Question 11

Beta-blockers generally have which of the following effects?

A) Increased cardiac conduction
B) Decreased myocardial contractility
C) Vasoconstriction
D) Increased myocardial contractility

Question 12

The presence of inverted T waves on an ECG indicates:

A) myocardial infarction.
B) myocardial necrosis.
C) myocardial ischemia.
D) myocardial injury.

Question 13

Your patient is a 54-year-old male who is unresponsive and cyanotic and has agonal respirations. A "quick look" shows ventricular tachycardia. Which of the following is most important when determining the immediate treatment of this patient?

A) How long he has been "down"
B) Whether he has a pulse
C) Whether he is allergic to lidocaine
D) Whether he has an implanted cardioverter-defibrillator

Question 14

ECG findings associated with hypokalemia include:

A) U waves and flat T waves.
B) U waves and an Osborn wave.
C) an Osborn wave and a "J" wave.
D) flattened T waves and a widened QRS complex.

Question 15

There are 15 small boxes between R waves on an ECG tracing. What is the heart rate?

A) 150
B) 120
C) 100
D) 20

Question 16

The first part of the aorta as it leaves the heart is the:

A) aortic arch.
B) thoracic aorta.
C) descending aorta.
D) ascending aorta.

Question 17

If the stroke volume decreased, which of the following would occur to maintain the blood pressure at its current value?

A) Increased heart rate and increased peripheral vascular resistance
B) Decreased heart rate and decreased peripheral vascular resistance
C) Increased heart rate and decreased peripheral vascular resistance
D) Decreased heart rate and increased peripheral vascular resistance

Question 18

Blood entering the left atrium arrives via the:

A) bicuspid valve.
B) superior and inferior vena cava.
C) pulmonary vein.
D) pulmonary artery.

Question 19

The proportion of the left ventricular volume that is pumped out of the heart during systole is the:

A) ejection fraction.
B) stroke volume.
C) preload.
D) afterload.

Question 20

Which of the following risk factors has been proven to increase the risk of cardiovascular disease?

A) Oral contraceptive use
B) Type A personality
C) Stress
D) Lack of exercise

Question 21

A 35-year-old male is complaining of a headache, blurred vision, nausea, and vomiting. He has a history of hypertension but is noncompliant with his medications. His pupils are equal and reactive, his skin is warm and dry, and his breath sounds are clear and equal bilaterally. HR = 122, BP = 202/138, RR = 12, SaO₂ = 99%. In addition to monitoring his cardiac rhythm, administering oxygen, and starting an IV at a KVO rate, which of the following is most appropriate?

A) Labetalol, IV
B) Diazepam, IV
C) Nitroglycerin, SL
D) Morphine, IV

Question 22

Elastic and smooth muscle fibers are primarily found in the tunica ________ of blood vessels.

A) collateralus
B) media
C) adventitia
D) intima

Question 23

While monitoring a patient's cardiac rhythm, you note that there is no electrical activity after a PQRST complex for a period equal to exactly three of the previous R-R intervals. This is most accurately described as:

A) sinus arrest.
B) sinus pause.
C) sinus arrhythmia.
D) sinus block.

Question 24

A 48-year-old male is sitting upright in bed in respiratory distress. He describes an acute onset of difficulty breathing and chest pain during the night that has been worsening for the past 3 hours. He also complains of nausea. Pain is described as a substernal pressure radiating to his left shoulder. Physical examination reveals cool, diaphoretic skin and rales on auscultation bilaterally. Medical history includes two prior myocardial infarctions. Medications include Zestril and metoprolol. HR = 132, BP = 140/100, RR = 25, SaO₂ = 92%. Which of the following is NOT indicated?

A) Adenosine
B) Enalapril
C) Morphine
D) Nitroglycerin

Question 25

Which of the following endocrine substances acts as a marker for congestive heart failure?

A) BNP
B) Angiotensin
C) ACTH
D) Troponin

Question 26

You have administered a medication to a patient, resulting in a decreased speed of cardiac impulse conduction. This drug is most accurately described as having a ________ effect.

A) negative dromotropic
B) negative chronotropic
C) positive dromotropic
D) positive chronotropic

Question 27

Which of the following most accurately describes the etiology of Wolff-Parkinson-White syndrome?

A) Presence of an accessory conduction pathway
B) Idiopathic
C) Increased automaticity
D) Shifting supraventricular pacemaker sites

Question 28

A 67-year-old male is unconscious, is sitting in a chair, and has agonal respirations. His wife states that he was up all night with difficulty breathing and chest discomfort but would not go to the hospital. Physical examination reveals pink, frothy sputum in the airway; cold, diaphoretic skin; and rales audible without a stethoscope. HR = 108, BP = 74 mmHg by palpation, RR = 4, SaO₂ = 82%. The monitor shows sinus tachycardia. Which of the following is the highest priority when treating this patient?

A) Immediate transport
B) Determining whether the patient has a Do Not Resuscitate order
C) Dopamine infusion
D) Intubation

Question 29

You have administered a drug with potent beta-1 effects. Which of the following effects should you most anticipate?

A) Smooth muscle relaxation
B) Peripheral vasoconstriction
C) Increased heart rate
D) Peripheral vasodilation

Question 30

To detect life-threatening cardiac dysrhythmias, the paramedic must view the ECG in ________ lead(s).

A) two
B) one
C) three
D) twelve

Question 31

The difference between apical and peripheral pulse rates that results from decreased cardiac output when the atria fail to contract is known as:

A) pulsus paradoxus.
B) pulse deficit.
C) pulsus alternans.
D) paroxysmal pulse pressure.

Question 32

PSVT is least likely to occur secondary to:

A) stress.
B) Wolff-Parkinson-White syndrome.
C) myocardial infarction.
D) ingestion of caffeine.

Question 33

Which of the following most accurately differentiates cardioversion from defibrillation?

A) Cardioversion is timed to be synchronous with the patient's R wave.
B) Cardioversion requires fewer than 100 joules.
C) The electrical stimulation of cardioversion travels at a slower rate through the myocardium.
D) Cardioversion cannot be used in patients who have a pulse.

Question 34

The total duration of ventricular depolarization is represented by the ________ on the ECG.

A) QRS duration
B) QT interval
C) PQ interval
D) R-R interval

Question 35

Which of the following is most characteristic of right heart failure?

A) JVD, peripheral edema, and pulmonary edema
B) Rales, cough productive of blood-tinged sputum
C) Ascites, peripheral edema, and cyanosis
D) JVD, peripheral edema, and liver and spleen engorgement

Question 36

Measures to treat cardiogenic shock include all of the following EXCEPT:

A) reducing stroke volume.
B) increasing the contractile force.
C) improving preload.
D) reducing peripheral resistance.

Question 37

The anterior surface of the heart is best viewed by ECG leads:

A) II, III, and aVF.
B) V₁-V_4.
C) I and aVL.
D) aVR, aVL, and aVF.

Question 38

Which of the following statements concerning Q waves on the ECG is most accurate?

A) Q waves are not a normal finding on the ECG.
B) The absence of a Q wave is a significant pathophysiological finding.
C) A Q wave is significant if it is 0.04 or more seconds wide.
D) A Q wave is only significant in the presence of chest pain.

Question 39

________ is a drop in systolic blood pressure of more than 10 mmHg with inspiration.

A) Electrical alternans
B) Pulsus alternans
C) Pulse deficit
D) Pulsus paradoxus

Question 40

Which of the following is the most likely result of increased pulmonary artery pressure?

A) Increased left ventricular workload and cor pulmonale
B) Increased right ventricular workload and cor pulmonale
C) Decreased right atrial workload and right ventricular hypertrophy
D) Increased left ventricular workload and congestive heart failure

Question 41

The heart sound produced by the closing of the aortic and pulmonary valves is:

A) S4.
B) S2.
C) S3.
D) S1.

Question 42

A junctional escape beat occurs when:

A) the AV junction becomes irritable and temporarily overrides the SA node.
B) there is a conduction block between the SA node and AV node.
C) there is an accessory pathway that causes reentry of the impulse at the AV node.
D) the rate of the SA node is slower than that of the AV node.

Question 43

The most common cause of death resulting from myocardial infarction is:

A) end-organ failure.
B) inadequate tissue perfusion.
C) heart failure.
D) dysrhythmia.

Question 44

Which of the following ECG findings is least anticipated in a patient experiencing an acute myocardial infarction?

A) Osborn wave
B) ST elevation
C) ST depression
D) QRS greater than 0.12 seconds

Question 45

Which of the following is the least likely cause of PEA?

A) Hypertension
B) Hypovolemia
C) Cardiac tamponade
D) Tension pneumothorax

Question 46

Signs and symptoms of decreased tissue perfusion secondary to cardiogenic shock include all of the following EXCEPT:

A) altered mental status.
B) cold, diaphoretic skin.
C) constricted pupils.
D) tachypnea.

Question 47

The base of the heart lies at the level of the ________ rib.

A) first
B) third
C) second
D) fourth

Question 48

Myocardial ischemia may result in:

A) J waves.
B) ST segment depression.
C) QRS duration greater than 0.12 seconds.
D) inverted P waves.

Question 49

A 64-year-old female is alert and oriented, in moderate respiratory distress, and complaining of chest pain. She describes an acute onset of right-sided chest pain that radiates across her chest. Physical examination reveals cold, diaphoretic skin; lung sounds with crackles bilaterally; JVD; and peripheral edema. Medical history includes hypertension, prior myocardial infarction, and heart failure. HR = 128, BP = 86/56, RR = 26, SaO₂ = 92%. Which of the following is appropriate in the prehospital treatment of this patient?

A) Dopamine
B) Nitroglycerin
C) Amiodarone
D) Morphine

Question 50

Which of the following is NOT considered a modifiable risk factor for coronary heart disease?

A) Stress
B) Gender
C) Obesity
D) Diet

Question 51

Auscultation of an S₃ is associated with:

A) mitral valve prolapse.
B) increased force of atrial contraction.
C) aortic stenosis.
D) congestive heart failure.

Question 52

Which of the following occurs during depolarization of a cardiac cell?

A) Sodium moves out of the cell.
B) The cell becomes relatively more positively charged.
C) Potassium moves into the cell.
D) The cell becomes negatively charged.

Question 53

An ECG monitor is useful for:

A) determining cardiac output.
B) detecting the total electrical activity within the heart.
C) determining stroke volume.
D) evaluating the effectiveness of cardiac contractions.

Question 54

Your patient is a 58-year-old female who is confused and dyspneic. Her daughter called EMS because the patient complained of a fluttering sensation in her chest, followed a few minutes later by chest pain and an acute onset of confusion. She is pale and diaphoretic without a palpable radial pulse. The monitor shows a narrow complex rhythm at a rate of 180. Which of the following is most appropriate?

A) Valsalva maneuver
B) IV adenosine
C) Immediate synchronized cardioversion
D) IV diltiazem

Question 55

Which of the following rhythms requires transcutaneous pacing?

A) Supraventricular tachycardia
B) Junctional tachycardia
C) Sinus bradycardia
D) Symptomatic third-degree AV block

Question 56

Your patient is a 32-year-old female, 30 weeks' pregnant, complaining of shortness of breath and palpitations. She is alert and oriented, though anxious; her skin is cool and moist, and her radial pulse is weak and rapid, but regular. HR = 180, BP = 100/72, RR = 24. The monitor shows supraventricular tachycardia. After applying oxygen by nonrebreather and starting an IV of normal saline, which of the following is most appropriate?

A) 150 mg of amiodarone
B) Transport without further intervention
C) 6 mg of adenosine
D) 2 mg of Versed and cardioversion beginning at 50 joules

Question 57

Which of the following is affected by a properly working pacemaker?

A) Automaticity
B) Stroke volume
C) Cardiac rhythm
D) Ejection fraction

Question 58

Excessive preload over time would lead to:

A) decreased capacity of the left ventricle.
B) strengthening of the left ventricle.
C) increased ejection fraction of the left ventricle.
D) weakening of the left ventricle.

Question 59

Release of acetylcholine at the neuroeffector junction would result in a(n):

A) increase of both sympathetic and parasympathetic tone.
B) positive dromotropic effect.
C) negative chronotropic effect.
D) positive inotropic effect.

Question 60

Which of the following most accurately describes a Valsalva maneuver?

A) Firmly pressing the carotid artery against the transverse process of the vertebra behind it
B) Asking the patient to bear down as if to move his bowels with his nose and mouth closed
C) Digital rectal stimulation
D) Immersing the face in cold water

Question 61

The amount of resistance that must be overcome by the left ventricle during systole is called:

A) stroke volume.
B) preload.
C) cardiac output.
D) afterload.

Question 62

The mitral valve is also known as the ________ valve.

A) pulmonic
B) right atrioventricular
C) left atrioventricular
D) tricuspid

Question 63

Which of the following is least likely to be associated with the pain of acute myocardial infarction?

A) Pain described as sharp
B) Discomfort lasting longer than 30 minutes
C) Radiation to arms and neck
D) Pain reproducible with palpation

Question 64

Pharmacological interventions initiated by prehospital care providers in the treatment of congestive heart failure may include all of the following EXCEPT:

A) dopamine.
B) atropine.
C) furosemide.
D) nitroglycerin.

Question 65

The QRS complex represents:

A) ventricular depolarization.
B) atrial repolarization.
C) atrial depolarization.
D) ventricular repolarization.

Question 66

Common chief complaints and symptoms associated with cardiac disease include all of the following EXCEPT:

A) dyspnea.
B) syncope.
C) chest pain.
D) vertigo.

Question 67

You have begun transcutaneous pacing of a 52-year-old male who is in third-degree heart block. He was initially unresponsive to all stimuli, with a pulse of 32, blood pressure 60 by palpation, and a respiratory rate of 12. Which of the following is least helpful when determining the effectiveness of transcutaneous pacing?

A) Evidence of mechanical capture
B) Increased level of consciousness
C) Evidence of electrical capture
D) Increased blood pressure

Question 68

Signs and/or symptoms of a dissecting thoracic aneurysm include all of the following EXCEPT:

A) hypotension.
B) chest pain.
C) palpable pulsating mass.
D) difficulty breathing.

Question 69

An accelerated junctional rhythm has a rate between ________ and ________.

A) 40, 60
B) 20, 40
C) 100, 150
D) 60, 100

Question 70

Cardioversion can be used to treat all of the following rhythms EXCEPT:

A) ventricular tachycardia with a pulse.
B) rapid atrial fibrillation.
C) ventricular fibrillation.
D) supraventricular tachycardia.

Question 71

Which of the following is most commonly associated with multifocal atrial tachycardia?

A) Acute myocardial infarction
B) Digitalis toxicity
C) Pulmonary disease
D) Use of cocaine, amphetamines, or caffeine

Question 72

A 48-year-old male is complaining of chest pain that he describes as dull, located substernally, but radiating to his neck. He rates the pain a 6 on a scale of 1 to 10 and complains of nausea and lightheadedness. His skin is cool and diaphoretic. HR = 96, BP = 124/82, RR = 14, SaO₂ = 97%. The 12-lead ECG is nondiagnostic. In addition to oxygen, an IV of normal saline at a keep open rate, and transport to the emergency department, which of the following would be most appropriate?

A) Nitroglycerin, morphine, and furosemide
B) Reassurance that likely his condition is not cardiac in nature
C) Nitroglycerin
D) Aspirin, nitroglycerin, and morphine

Question 73

Paramedics use all of the following interventions to treat congestive heart failure EXCEPT:

A) sitting the patient upright.
B) decreasing patient anxiety.
C) administering oxygen
D) administering fluid bolus to treat hypotension.

Question 74

Your patient in atrial fibrillation has a heart rate of 108 on the monitor, but her radial pulse is 88. The patient is experiencing:

A) paradoxical pulse.
B) pulsus obliterans.
C) pulse deficit.
D) pulsus alternans.

Question 75

Stroke volume × heart rate × systemic vascular resistance =

A) blood pressure.
B) ejection fraction.
C) cardiac output.
D) end-diastolic pressure.

Question 76

A 63-year-old male is alert and oriented, complaining of dizziness. He describes an acute onset of dizziness and near-syncope that has lasted for 15 minutes. He is also experiencing substernal chest pain radiating to his jaw, as well as nausea and weakness. Physical examination reveals cool, diaphoretic skin; delayed capillary refill; and mild crackles to the bases bilaterally. He has no significant medical history, but he takes 325 mg of aspirin a day. HR = 220, BP = 88/52, RR = 16, SaO₂ = 92%. Which of the following should be done first?

A) Start an IV of normal saline
B) Synchronized cardioversion
C) Oxygen by nonrebreathing mask
D) Administer 0.4 mg of nitroglycerin sublingually

Question 77

Your patient is a 73-year-old male who is sitting in a recliner, cyanotic, pulseless, and apneic. The patient's skin is cool and dry. The patient's wife last saw him an hour and a half ago. Which of the following should you do first?

A) Check for rigor mortis.
B) Start CPR.
C) Attach the monitor/defibrillator.
D) Inform the patient's wife that he is dead and nothing can be done for him.

Question 78

Claudication is significant because it:

A) leads to glaucoma when left untreated.
B) indicates the presence of atherosclerosis.
C) results from inadequate coronary artery perfusion.
D) results in inadequate cerebral perfusion.

Question 79

The lead to the left of the sternum at the fourth intercostal space is:

A) V₁.
B) V₂.
C) V₃.
D) V₄.

Question 80

Poiseuille's law specifically states that blood flow through a vessel is directly proportional to the ________ of the vessel's radius.

A) fourth power
B) third power
C) square
D) tenth power