Paramedica exam (Cardio)

Damage to the cardiac electrical condution system caused by an acute myocardial infarction Most commonly results in?
A) severe tachycardia
B) acute bundle branch block.
C) ventricular arrhythmias.
D) bradycardia or heart block.

The appropriate dosing regimen for epinephrine in cardiac arrest is?
A) 1 mg of a 1:10,000 solution every 3 to 5 minutes.
B) 0.1 mg/kg of a 1:10,000 solution every 3 minutes.
C) 10 ml of a 1:1,000 solution every 3 to 5 minutes.
D) 1 ml of a 1:10,000 solution every 3 to 5 minutes.

You are performing CPR on an 80-year-old woman whose cardiac arres was witnessed by her husband. Several intubation attempts have been unsuccessful, but ventilations with a bag-mask device are producing adequate chest rise. IV access has been obtained and 1 mg of epinephrine has been administered. The cardiac monitor displays a narrow QRS complex rhythm at a rated of 70 beats/minutes. according to the patients husband, she has had numerous episodes of diarrhea over the past 24 hours and has not had much of an appetite. The MOST appropriate next action should be to?
A) assess the rhythm and pulse after 3 minutes of CPR.
B) continue CPR and administer crystalloid fluid boluses.
C) administer 50% dextrose for presumed hypoglycemia.
D) administer 1 mg of atropine while CPR is ongoing.

Which of the following mechanisms causes hypertension?
A) Arteriosclerosis results in increased elasticity of the arteries, causing vasodilation and increased arteriolar capacity.
B) Atherosclerotic plaque narrows one or more of the coronary arteries, resulting in increased cardiac perfusion.
C) Increased afterload stimulates the Frank-Starling reflex, which raises the pressure behind the blood leaving the heart.
D) Heart rate that is persistenly above 80 Beats/min causes an increase in cardiac output and a resultant increase in blood pressure.

A Patient with orthopnea:
A) experiences dyspnea during periods of exertion.
B) experiences worsened dyspnea while lying down.
C) sleeps in a recliner due to severe right heart failure.
D) prefers a semisitting position to facilitate breathing.

The point of macimal impulse (PMI) usually can be felt on the:
A) left lateral chest, in the midaxillary line, at the fourth intercostal space.
B) left anterior chest, in the midaxillary line, at the fifth intercostal space.
C) medial aspext of the chest, just below the third intercostal space.
D) left anterior chest, in the midclavicular line, at the fifth intercostal space.

The ability of the heart to vary the degree of it contraction without stretching is called:
A) contractility.
B) automaticity.
C) Frank-Starling effect.
D) chronotropy.

It is MOST important to evaluate a cardiac arrhythmia in the context of the:
A) width of the QRS complex.
B) patient's overall condition.
C) patient's heart reate.
D) patient's medical history.

Immediate treatment for a patient with an acute myocardial infarction involves:
A) giving oxygen via nonrebreathing mask.
B) elevating the patient's legs 6 to 12 inches.
C) reducing myocardial oxygen demand.
D) administering up to 3 doses of nitroglycerin.

Which of the following clinical findings is LEAST suggestive of left side heart failure?
A) Shortness of breath
B) Crackles in the lungs
C) an S₃ gallop
D) Sacral edema

What is the approximate maximum dose of lidocaine for a 200 pound patient?
A) 350 mg
B) 275 mg
C) 325 mg
D) 300 mg

Repolarization begins when:
A) the sodium and calcium channels close.
B) calcium ions slowly enter the cardiac cell.
C) the inside of the cell returns to a positive charge.
D) potassium ions rapidly escape from the cell.

Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction?
A) 58 year old diabetic woman
B) 60 year old man with anxiety
C) 71 year old woman with hypertension
D) 49 year old obese man

Which of the following statements regarding the right side of the heart is MOST correct?
A) The right side of the heart is a low pressure pump.
B) The right side of the heart pumps blood through the pulmonary veins.
C) It pumps against the high resistance of the pulmonary circulation.
D) It receives blood exclusively from the venae cavae.

Infarctions of the inferior myocardial wall are MOST often caused by:
A) blockage of the left coronary artery.
B) occlusion of the right coronary artery.
C) acute spasm of the circumflex artery.
D) a blocked left anterior descending artery.

Death in the prehospital setting following an acute myocardial infarction is MOST often the result of:
A) myocardial rupture.
B) ventricular fibrillation.
C) cardiogenic shock.
D) asystole.

The numerous connectins among the arterioles of the various coronary arteries, which allow for the development of alternate routes of blood flow if a larger coronary artery is blocked, are called:
A) the coronary sinus.
B) cardiac myocytes.
C) collateral circulation.
D) coronary microcirculation.

A prolonged Q-T interval indicates that the heart:
A) is experiencing an extended refractory period, making the ventricles more vulnerable to arrhythmias.
B) has a shorter than normal refractory period, increasing the likelihood of severe bradycardia.
C) has a shortened refractory period and may be caused by factors such as hypocalcemia or pericarditis.
D) is depolarizing too quickly, which significantly increases the potential for reenty in the AV junction

Common complaints in patients experiencing an acute coronary syndrome (ACS) include all of the following EXCEPT:
A) chest pain
B) fatigue
C) palpitations
D) headache

The downslope of the T wave:
A) represents a vulnerable period during which a strong impulse could cause depolarization, resulting in a lethal arrhythmia.
B) represents a state of absolute ventricular refractoriness in which another impulse connot cause depolarization.
C) is the strongest part of ventricular depolarization and is often the origin of dangerous ventricular arrhythmias.
D) is the point of ventricular repolarization to which a defibrillator is synchronized to deliver electrical energy.

A major complication associated with atrial fibrillation is:
A) a profound increase in the atrial kick.
B) pulmonary congestion and hypoxemia.
C) clot formation in the bivrillating atria.
D) a significant reduction in atrial filling.

The duration of the QRS complex should be less than:
A) 0.12 seconds.
B) 0.10 seconds.
C) 0.14 seconds.
D) 0.16 seconds.

The heart's anatomic location is MOST accurately described as being:
A) submediastinal.
B) hemithoracic.
C) supradiaphragmatic.
D) retrosternal.

A 17 year old man complains of palpitations and light headedness that began suddenly about 20 minutes ago. his blood pressure is 118/74 mm Hg, heart rate is rapid and regular, respirations are 18 breath per minute. The cardiac monitor reveals a narrow QRS complex tachycardia at 180 beats/min. As you are applying supplemental oxygen, the cardiac rhytm spontaneously converts to a sinus rhythm. Closer evaluation of his rhythm reveals a rapid up slope to the R wave immediately after the end of the P wave. Which of the following statements regarding this scenario is most correct?
A) The patient's ECG abnormality is called an Osborn Wave.
B) This patient likely has Wolff-Parkinson-White syndrome.
C) In this patient, there is a delay in ventricular depolarization.
D) The ECG abnormality is caused by failure of the AV node.

Common signs of left-sided heart failure include all of the following, EXCEPT:
A) hypertension.
B) hypotension.
C) tachycardia.
D) confusion.

In Contrast to the right side of the heart, the left side of the heart:
A) is a high- pressure pump that sends blood through the pulmonary circulation and to the lungs.
B) drives blood out of the heart against the relatively high resistance of the systemic circulation.
C) is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta.
D) drives blood out of the heart against the relatively low resistance of th pulmonary circulation.

You respond to the scene of an assault, where a 20 year old man was struck in the chest with a steel pipe. Your assessment reveals that the patient is unresponsive, apneic, and pulseless. the most appropriate next intervention is to.
A) immediately assess the patient's cardiac rhythm.
B) look for evidence of a pericardial tamponade.
C) give 2 minutes of 15 compressions and 2 breaths.
D) perform 5 cycles of well-coordinated CPR.

Which of the following differentiates an atrial rhythm from a sinus rhythm?
A) Tachycardia
B) Dissociated P waves
C) Varying shapes in P waves
D) Profound bradycardia

The MOST common cause of cardiac arrest in adult patients is:
A) electrocution.
B) an arrhythmia.
C) acute myocardial infarction.
D) respiratory failure.

Supraventricular tachycardia (SVT) is MOST accurately defined as:
A) any tachycardic rhythm with a heart rate greater than 130 beats/min and absent P waves.
B) a tachycardic rhythm originating from a pacemaker site above the level of the ventricles.
C) an irregular tachycardic rhythm that originates just below the atrioventricular junction.
D) a regular tachycardic rhythm between 150 and 180 beats/min with P waves buried in the QRS complexes.

Cardiac related chest pain is often palliated by:
A) mild exercise.
B) exertion.
C) stress.
D) nitroglycerin.

To increase myocardial contractility and heart rate and to relax the bronchial smooth muscle, you must give a drug that:
A) stimulates beta-1 and beta-2 receptors.
B) blocks beta-1 and beta-2 receptors.
C) blocks beta receptores and stimulates alpha receptors.
D) stimulates beta-2 and alpha receptors.

Stable angina:
A) typically subsides within 10 to 15 minutes.
B) occurs after a predictable amount of exertion.
C) usually requires both rest and nitroglycerin to subside.
D) is characterized by sharp chest pain rather than pressure.

Jugular venous distention in a patient sitting at a 45^o angle:
A) is not clinically significant.
B) suggests left side heart failure.
C) indicates right heart compromise.
D) is a sign of reduced preload.

The area of conduction tissue in which electrical activity arises at any given time is called the:
A) myocyte.
B) sinus node.
C) pacemaker.
D) bundle of His.

You receive a call to a residence for a 44 year old man who is "ill." The patient, who receives dialysis treatments three times a week, tells you that he has missed his last two treatments because he was not feeling well. As your partner takes the patient's vitals signs, you apply the ECG, which reveals a sinus rhythm with tall T waves. the 12 lead ECG reveals a sinus rhythm with inverted complexes in lead VR. On the basis of your clinical findings, you should be most suspicious that the patient is:
A) hypernatremic.
B) hypocalcemic.
C) having an acute MI.
D) hyperkalemic.

Premature ventricular complexes (PVCs) that originate from different sites in the ventricle:
A) will appear differently on the ECG.
B) are also called fusion PVCs.
C) produce a palpable pulse.
D) are called unifocal PVCs.

In a patient with left heart failure and pulmonary edema:
A) an acute myocardial infarction or chronic hypertension causes the left ventricle to pump against decreased afterload, resulting in hypoperfusion.
B) diffusely collapsed alveoli cause blood from the right side of the heart to bypass the alveoli and return to the left side of the heart.
C) increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli.
D) the right atrium and ventricle pump against lower pressures, resulting in the systemic pooling of venous blood.

You are dispatched to a grocery store for a 39 year old woman with a severe headache. The patient advises you that her headache, which was present when she woke up this morning,k is located in the back of her head. She is conscious and alert, with a blood pressure of 194/112 mm Hg, pulse of 100 beats/min and strong, and respirations of 14 breaths/min and regular. She denies a history of hypertension or any other significant medical problems. The closest appropriate facility is located 15 miles away. You should:
A) administer supplemental oxygen, start an IV line of normal saline at a keep open rate, and transport.
B) administer oxygen as tolerated, give up to 5 mg of morphine intramuscularly, and transport proptly.
C) start an IV line of normal salin, give her 0.4 mg of sublingual nitroglycerin, and transport at once.
D) give high flow oxygen, establish vascular access, begin transport, and administer labetalol en route.

Patients with a heart rate greater than 150 beats/min usually become unstable because of:
A) increased right atrial preload.
B) an increase in the atrial kick.
C) reduced ventricular filling.
D) a significantly reduced afterload.

In contrast to stable angina, unstable angina:
A) is less frequent but is associated with more pain.
B) indicates that myocardial necrosis has occured.
C) occurs following periods of strenuous exertion.
D) often awakens the patient from his or her sleep.

The right atrium, right ventricle, and part of the left ventricle are supplied by the:
A) left main coronary artery.
B) circumflex artery.
C) right coronary artery.
D) left anterior descending artery.

A woman found her 48 year old husband semiconscious on the couch. As she is escorting you to the patient, she tells you that he had an episode of chest pain the day before but refused to go to the hospital. The patient is responsive to pain only and is markedly diaphoretic. His blood pressure is 70/50 mm Hg, pulse is 140 beats/min and thready, and respirations are 28 breaths/min and shallow. The cardiac monitor reveals sinus tachycardia in lead II and a 12 lead ECG reveals signs of myocardial injury. your should:
A) place the patient in a semi fowler position to facilitate breathing, administer oxygen via nonrebreathing mask, begin transport, establish vascular access en route, and administer 20 ml/kg fluid boluses to improve his blood pressure.
B) start an IV line, administer 5 mg of midazolam, intubate the patient's trachea, ventilate him at a rate of 15 breaths/min, begin transport, and start a dopamine infusion at 5 micrograms/kg/min en route to the hospital.
C) keep the patient in a supine position, insert a nasal airway, assist his ventilations with a bag-mask device, begin transport, establish vascular access en route, consider a 100-200 ml saline bolus, and start an infusion of dopamine.
D) elevate the patient's legs, ventilate him with a bag-mask device, begin transport, establish access en route, administer 6 mg of adenosine to slow his heart rate, and begin an infusion of epinephrine to increase his blood pressure.

A 56 year old man complains of chest tightness, shortness of breath, and nausea. During your assessment, you note that he appears confused. He is profusely diaphoretic, and has a blood pressure of 98/68 mm Hg and a rapid radial pulse. The cardiac monitor reveals a wide QRS complex tachycardia at a rate of 200 beats.min. After administering high-flow oxygen, your should:
A) establish vascular access and administer 150 mg of amiodarone over 10 minutes.
B) obtain a 12 lead ECG tracing to determine the origin of his tachycardic rhythm.
C) establish IV access, consider sedation, and perform synchronized cardioversion.
D) attempt to slow his heart rate with vagal maneuvers and then start an IV line.

A patient in cardiogenic shock without cardiac arrhythmias will benefit MOST from:
A) supplemental oxygen.
B) a high dose vasopressor infusion.
C) a 250 mL bolus of a crystalloid solution.
D) rapid transport to an appropriate hospital.

Acute Coronary syndrome (ACS) is a term to describe:
A) acute chest pressure or discomfort that subsides with rest or nitroglycerin.
B) any group of clinical symptoms consistent with acute myocardial ischemia.
C) a sudden cardiac rhythm disturbance that causes a decrease in cardiac output.
D) a clinical condition in which patients experience chest pain during exertion.

In contrast to a patient with asthma, a patient with left-sided heart failure:
A) is typically a younger patient with a history of a recent upper respiratory infection.
B) presents with a dry, nonproductive cough and diffuse wheezing in all lung fields.
C) Experiences acute weight gain and takes medication such as digoxin and a diuretic.
D) presents with a hyperinflated chest, use of accessory muscles, and expiratory wheezing.

You have applied the defibrillator pads to a pulseless and apneic 60 year old woman and observe a slow, wide QRS complex rhythm. Your next action should be to:
A) immediately begin CPR.
B) check the carotid pulse.
C) attempt cardiac pacing.
D) assess breathing effort.

Hypertensive disease is characterized by:
A) persistent elevation of the diastolic pressure.
B) a diastolic blood pressure above 90 mm Hg.
C) constant fluctuation in the systolic blood pressure.
D) a systolic blood pressure greater than 140 mm Hg.

a 70 year old man called 9-1-1 becuase of generalized weakness. When you arrive at the scene, you find the patient seated in his recliner. He is conscious and alert and is breathing without difficulty. Your physical exam reveals tenderness to his right upper abdominal quadrant, edema to his ankles, and distended jugular veins. The patient tells you that he takes Vasotec for hypertension and Maxide for his swollen ankles. His vital signs are stable. The MOST appropriate treatment for this patient includes:
A) oxygen, cardiac monitoring, an IV line at a keep open rate, and transport.
B) High flow oxygen, vascular access, 1 mg/kg of furosemide, and transport.
C) an IV of D₅W, 0.4 mg of sublingual nitroglycerin, ECG, and transport.
D) 12 Lead ECG acquisition, vascular access, 4 mg of morphine, and transport.

In contrast to coarse ventricular vibrillation, fine ventricular fivrillation indicates that:
A) The cardiac cells temporarily have adequate energy stores.
B) energy reserves of the cardiac cells have been expended.
C) a perfusing rhythm is not possible following defibrillation.
D) the arrhythmia is more likely to respond to defivrillation.

A patient with cardiogenic pulmonary edema and shock should be positioned:
A) supine with the legs elevated.
B) in a semi-Fowler's position.
C) in a lateral recumbent position.
D) in the Trendelenburg position.

The administration of dopamine or any other vasopressor drug requires:
A) an electromechanical infusion pump.
B) online medical control approval.
C) careful titration and blood pressure monitoring.
D) concomitant crstalliod fluid boluses.

a Loud S₃ heart sound, when heard in older adults,often signifies:
A) emphysema.
B) heart failure.
C) valve repture.
D) pulmonary hypertension.

You have just performed synchronized cardioversion on a patient with unstable ventricular tachycardia. Upon reassessment, you note that the patient is unresponsive, apneic, and pulseless. you should:
A) perform 5 cycles of CPR, reassess the cardiac rhythm, and defivrillate if needed.
B) ensure that the synchronizer is off, defibrillate, and immediately begin CPR.
C) increase the energy setting on the defibrillator and repeat the cardioversion.
D) desynchronize the defivbrillator, defibrillate one time, and check for a pulse.

The MOST common cause of right sided heart failure is:
A) long- standing emphysema.
B) acute pulmanary embolism.
C) left sided heart failure.
D) pulmonary hypotension.

A 56 year old man presents with an acute onset of chest pressure and diaphoresis. He has a history of hypertension and insulin dependent diabetes. His airway is patent and his breathing is adequate. You should:
A) administer high flow oxygen.
B) acquire a 12 lead ecg tracing.
C) obtain baseline vitals signs.
D) establish vascular access.

When assessing a patient's 12 lead ECG, it is MOST important to remember that:
A) an unremarkable 12 lead ECG rules out an acute MI.
B) the 12 lead alone should be used to guide your treatment.
C) it may take hours for changes to appear on the ECG.
D) the ECG's analysis of the rhythm is more accurate than yours.

Cardiogenic shock occurs when:
A) left ventricular ejection fraction is less than 50%.
B) blood backs up into the pulmonary circulation.
C) more than 40% of the left ventricle has infarcted.
D) any condition causes an increase in atrial preload.

Injury to the inferior wall of the myocardium would present with:
A) ST segment depression in leads V₅, V₆, and AVL.
B) T wave inversion in leads V₁ through V₄.
C) pathologic Q waves in leads V₄ and V₅.
D) ST segment elevation in leads II, III, and AVF.

When monitoring a patient's cardiac rhythm, it is MOST important to remember that:
A) the ECG does not provide data regarding the patient's cardiac output.
B) many patients with acute myocardial infarction experience asystole.
C) a heart rate below 60 beats per minute must be treated immediately.
D) the presence of a QRS complex correlates with the patient's pulse.