An acute ST-elevation myocardial infarction, regardless of the degree of coronary artery atherosclerosis, is mainly
the result of:
a. plaque formation
b. coronary artery spasm
c. ventricular fibrillation
d. thrombotic occlusion
e. ventricular aneurysm
d. thrombotic occlusion
- The symptoms associated with an acute myocardial infarction usually last:
a. more than 12 hours
b. 5 to 15 minutes
c. more than 20 minutes
d. more than 60 minutes
e. more than 6 hours
c. more than 20 minutes
- Which of the following is the most typical result of acute right coronary artery occlusion?
a. ventricular tachycardia
b. acute pulmonary edema
c. sinus tachycardia
d. anterior wall infarction
e. inferior wall infarction
e. inferior wall infarction
- Which one of the following is least important when taking a focused prehospital history in a patient with an acute
coronary syndrome?
a. last meal
b. events prior to the episode
c. allergies
d. medications
e. smoking history
e. smoking history
- In the setting of AMI, all of the following define the high risk patient except one:
a. shock
b. heart rate of 100 BPM or more
c. blood pressure of 100 mm Hg or less
d. pulmonary edema (crackles more than 1/2 way up)
e. atrial fibrillation
e. atrial fibrillation
- Each of the following bedside findings is associated with congestive heart failure in the setting of
an acute myocardial infarction, except:
a. crackles and wheezes
b. tachycardia
c. cool, diaphoretic skin
d. third heart sound
e. friction rub
e. friction rub
- Each of the following is a correct guideline for placing chest electrodes on a patient, except:
a. the interspaces are below the corresponding ribs
b. V4, 5 and 6 are in a straight line
c. the sternal angle is at the level of the second rib
d. V1 and V2 are parasternal
e. the interspaces are above the corresponding ribs
e. the interspaces are above the corresponding ribs
- The proper calibration for a 12 Lead ECG is 1 mV. This is equal to a height of:
a. 20 small boxes
b. 1 small box
c. 5 small boxes
d. 10 small boxes
e. 15 small boxes
d. 10 small boxes
- Each of the following is a correct statement regarding the use of aspirin, except:
a. should be chewed for rapid effect
b. prevents clot formation
c. promotes bleeding
d. lyses blood clots
e. decreases platelet stickiness
d. lyses blood clots
- Each of the following is a correct statement regarding nitroglycerin, except:
a. headache is a side effect
b. hypotension is a side effect
c. bleeding is a side effect
d. reduces cardiac work
e. improves coronary blood flow
c. bleeding is a side effect
- Morphine sulfate can cause all of the following, except:
a. decreased platelet stickiness
b. nausea and vomiting
c. hypotension
d. respiratory depression
e. reduced cardiac work
a. decreased platelet stickiness
- Each of the following is a contraindication (exclusion criterion) for fibrinolytic therapy, except:
a. recent stroke
b. recurrent ventricular tachycardia
c. recent cervical disc surgery
d. suspected aortic dissection
e. active internal bleeding
b. recurrent ventricular tachycardia
- Which of the following patients is not a candidate for fibrinolytic therapy:
a. 55 y/o male with jaw pain and 1.5mm of
ST elevation in V4, V5 and V6
b. 51 y/o female with upper abdominal pain and
1.5mm of ST elevation in leads II, III and aVF ST elevation in leads I and aVL
c. 70 y/o male with severe substernal chest pain
and LBBB
d. 45 y/o male with chest pain and RBBB
e. 66 y/o female with acute dyspnea and 2mm of
d. 45 y/o male with chest pain and RBBB
- What is your interpretation of the electrocardiogram shown above?
a. left bundle branch block
b. early repolarization
c. acute inferior wall infarction
d. acute anterior wall infarction
e. acute pericarditis
d. acute anterior wall infarction
- What is your interpretation of the electrocardiogram shown above?
a. acute anterior wall infarction
b. acute inferior wall infarction
c. left bundle branch block
d. acute inferolateral wall infarction
e. early repolarization
a. acute anterior wall infarction
- What is your interpretation of the electrocardiogram shown above?
a. old inferior wall infarction
b. acute anterolateral wall infarction
c. anterior wall subendocardial injury
d. left bundle branch block
e. acute inferior wall infarction
e. acute inferior wall infarction
- What is your interpretation of the electrocardiogram shown above?
a. acute pericarditis
b. anterior wall subendocardial injury
c. acute inferior wall infarction
d. left ventricular hypertrophy
e. ventricular pacemaker
c. acute inferior wall infarction
- What is your interpretation of the electrocardiogram shown above?
a. ventricular pacemaker
b. left bundle branch block
c. anterior wall subendocardial injury
d. acute inferior wall infarction
e. right bundle branch block
b. left bundle branch block
- What is your interpretation of the electrocardiogram shown above?
a .ventricular pacemaker
b. left bundle branch block
c. anterior wall subendocardial injury
d. acute inferior wall infarction
e. right bundle branch block
a .ventricular pacemaker
CHIEF COMPLAINT: 62 yr. male accountant with severe chest pain of 1 hour duration
HISTORY: PAIN: ADDITIONAL:
Provocation: none - awakened Symptoms (other): short of breath
Quality: crushing Allergies: Penicillin
Region: substernal Medications: Nuprin, 1 aspirin daily
Radiation: left shoulder Past History: mild arthritis
Relief: none Last Meal: 7 hrs. ago
Severity: 9/10 Events Prior: sleeping
Time: 1 hr.
VITAL SIGNS: Pulse: 95 BP: Lt. 180/100 Other: anxious, diaphoretic
Resp: 24 Rt. 170/100
INITIAL MANAGEMENT: oxygen / IV started / rhythm strip
ADDITIONAL PHYSICAL: recheck BP: Lt. - 150/90 Rt. - 150/90
- What is your interpretation of the patient’s ECG?
a. left bundle branch block
b. early repolarization
c. acute inferior wall infarction
d. acute anterior wall infarction
e. acute pericarditis
d. acute anterior wall infarction
CHIEF COMPLAINT: 62 yr. male accountant with severe chest pain of 1 hour duration
HISTORY: PAIN: ADDITIONAL:
Provocation: none - awakened Symptoms (other): short of breath
Quality: crushing Allergies: Penicillin
Region: substernal Medications: Nuprin, 1 aspirin daily
Radiation: left shoulder Past History: mild arthritis
Relief: none Last Meal: 7 hrs. ago
Severity: 9/10 Events Prior: sleeping
Time: 1 hr.
VITAL SIGNS: Pulse: 95 BP: Lt. 180/100 Other: anxious, diaphoretic
Resp: 24 Rt. 170/100
INITIAL MANAGEMENT: oxygen / IV started / rhythm strip
ADDITIONAL PHYSICAL: recheck BP: Lt. - 150/90 Rt. - 150/90
- What is your additional management? Choices: NTG, ASA, Morphine, Lasix, Fluids
a. ASA and morphine
b. NTG, ASA, morphine
c. NTG and morphine
d. NTG, morphine and lasix
e. NTG, morphine and fluids
b. NTG, ASA, morphine
CHIEF COMPLAINT: 62 yr. male accountant with severe chest pain of 1 hour duration
HISTORY: PAIN: ADDITIONAL:
Provocation: none - awakened Symptoms (other): short of breath
Quality: crushing Allergies: Penicillin
Region: substernal Medications: Nuprin, 1 aspirin daily
Radiation: left shoulder Past History: mild arthritis
Relief: none Last Meal: 7 hrs. ago
Severity: 9/10 Events Prior: sleeping
Time: 1 hr.
VITAL SIGNS: Pulse: 95 BP: Lt. 180/100 Other: anxious, diaphoretic
Resp: 24 Rt. 170/100
INITIAL MANAGEMENT: oxygen / IV started / rhythm strip
ADDITIONAL PHYSICAL: recheck BP: Lt. - 150/90 Rt. - 150/90
- Is this patient a candidate for fibrinolytic therapy?
a. Yes
b. No
a. Yes
CHIEF COMPLAINT: 58 yr. female administrative assistant with shortness of breath of 45 minutes duration
HISTORY: PAIN: ADDITIONAL:
Provocation: none known Symptoms (other): shortness of breath, can’t lie down
Quality: mild fullness Allergies: aspirin
Region: chest Medications: Tylenol for arthritis
Radiation: none Past History: heart murmur since teens
Relief: none Last Meal: 2 hrs. ago - breakfast
Severity: 2/10 Events Prior: meeting with “the boss”
Time: 45 min.
VITAL SIGNS: Pulse: 82 BP: Lt. 150/80 Other: anxious, diaphoretic, dyspnea
Resp: 30 Rt. 150/80
INITIAL MANAGEMENT: oxygen / IV started / rhythm strip
ADDITIONAL PHYSICAL: crackles both lower lung fields, S3 and S4 apex
- What is your interpretation of the patient’s ECG?
a. early repolarization
b. acute anterolateral infarction
c. anterior wall subendocardial injury
d. left bundle branch block
e. acute inferior wall infarction
e. acute inferior wall infarction
CHIEF COMPLAINT: 58 yr. female administrative assistant with shortness of breath of 45 minutes duration
HISTORY: PAIN: ADDITIONAL:
Provocation: none known Symptoms (other): shortness of breath, can’t lie down
Quality: mild fullness Allergies: aspirin
Region: chest Medications: Tylenol for arthritis
Radiation: none Past History: heart murmur since teens
Relief: none Last Meal: 2 hrs. ago - breakfast
Severity: 2/10 Events Prior: meeting with “the boss”
Time: 45 min.
VITAL SIGNS: Pulse: 82 BP: Lt. 150/80 Other: anxious, diaphoretic, dyspnea
Resp: 30 Rt. 150/80
INITIAL MANAGEMENT: oxygen / IV started / rhythm strip
ADDITIONAL PHYSICAL: crackles both lower lung fields, S3 and S4 apex
- What is your additional management? Choices: NTG, ASA, Morphine, Lasix, Fluids
a. ASA and morphine
b. NTG, ASA, morphine
c. NTG and morphine
d. NTG, morphine and lasix
e. NTG, morphine and fluids
d. NTG, morphine and lasix
