Answer and Explanation 16

16.  The correct answer is B.  Target INR for patients with A-Fib is 2.0-3.0.  It is also target for patients with DVT or PE.  INR of 2.5-3.5 is the target range for patients with valve replacements.

Question 16

16.  Which of the following INR range is ideal for maintaining patients with Atrial Fib?

A.  INR 1.5-2.5

B.  INR 2.0-3.0

C.  INR 2.5-3.5

D.  INR 3.5-4.5

Answer and Explanation 15

15.  The correct answer is A.  Atrial depolarization is represented by the P wave.  The QRS complex is Ventricular Depolarization.  The T wave represents ventricular repolarization.  The U Wave which is rarely seen represents atrial repolarization.

Question 15

15.  Which of the following is the QRS representative of?

A.  Ventricular Re-polarization

B.  Atrial Repolarizaiton

C.  Ventricular Depolarization

D.  Atrial Depolarization

Answer and Explanation 14

14.  The correct answer is B.  The patients heart rate is high and needs to have better rate control.  The patient needs to be anti-coagulated.  Digoxin may be helpful for rate control or the patient had a poor ejection fraction.  This would be tough to manage acutely as an outpatient.  The patient does not need a stress test at this point.  Having the patient valsalva may help with the patients rate but if they do not convert they still need to be anti-coagulated.

Question 14

14.  You are evaluating a patient in your office for palpitations.  You obtain an EKG and find out the patient is in A-Fib with RVR at a rate of 120.  What is the best management option in this situation?

A.   Start the patient on digoxin, teach the patient how to check there pulse and see the patient next week.

B.   Arrange for transfer to the emergency room for IV meds for rate control, anticoagulation, and laboratory evaluation.

C.   Arrange for the patient to have an outpatient stress test.

D.   Have the patient perform a valsalva maneuver

Answer and Explanation 13

13.   The correct answer is D.  Nitroglycerin, Aspirin and Oxygen are all helpful in patients with acute chest pain.  Ativan is only really helpful for chest pain with anxiety component or if it is cocaine induced.

Question 13

13.  Which are the following is not considered a mainstay in treating a patient with acute chest pain?

A.  Nitroglycerin

B.  Aspirin

C.  Oxygen

D.  Ativan

Answer and Explanation 12

12.  The correct answer is A.  This patient has a new onset left bundle branch block and should be treated as a STEMI.  This patient should be evaluated for an emergent cardiac catheterization.  Ativan would not be helpful.  Choice C is not helpful because the patient has not been symptomatic long enough to be positive.  Choice D is incorrect because a dissection does not show any specific EKG abnormality.

Question 12

12.  Your patient is a 53 year old male who comes in with chest pain radiates to left jaw and left arm.  Below is his EKG.  His pain started 20 minutes prior to arrival.  There is no old EKG.  Which of the following is the best action for this patient.



A.  Consult cardiology for an emergent cardiac catheterization.

B.  Give the patient Ativan 1 mg IV

C.   Wait on the patients cardiac enzymes to come back, then make a decision on disposition.

D.  Get a CTA of the Chest to look for dissection which is common in this EKG pattern.

Answer and Explanation 11

11.  The correct answer is D.  Cardizem should be used only when patients who you know do not have any diastolic dysfunction in patients with CHF.  BIPAP would be helpful to correct the patients hypoxemia and respiratory distress.  Bumex would be helpful to help the patient clear her edema as well as reduce the after load.  A nitro drip would help improve her pre load and he beneficial.

Question 11

11.   Your patient is an 82 year old female that come in with shortness of breath, pedal edema, and jugular venous distention.  She has crackles bilaterally in both bases.  Her vital signs are as follows:  HR 120, RR 36, BP 159/83 Sats are 90% on a 100% NRB.  Her EKG demonstrates a sinus tachycardia.  Which of the following is an immediate treatment option?

A.  BIPAP

B.  Nitroglycerin Drip

C.  Bumex IV

D.  Cardizem Drip