Q 1. You are evaluating a patient with a wide-complex tachycardia. The patient has a history of Wolff-Parkinson-White (WPW) syndrome. Which medication is the most effective for treating this patient’s tachycardia?
A.Adenosine
B. Digoxin
C.Diltiazem
D.Procainamide
E. Verapamil
ANSWER. D
Q 2. All of the following are electrocardiographic clues supporting the diagnosis of ventricular tachycardia except
A.capture beats
B. concordance of QRS complex in all precordial leads
C.fusion beats
D.QRS duration during tachycardia shorter than during sinus rhythm
E. RSR' pattern in V1
ANSWER. E
Q 3. A 68-year-old man with a history of myocardial infarction and congestive heart failure is comfortable at rest. However, when walking to his car, he develops dyspnea, fatigue, and sometimes palpitations. He must rest for several minutes before these symptoms resolve. His New York Heart Association classification is which of the following?
A.Class I
B. Class II
C.Class III
D.Class IV
ANSWER. C
Q 4. The husband of a 68-year-old woman with congestive heart failure is concerned because his wife appears to stop breathing for periods of time when she sleeps. He has noticed that she stops breathing for ~10 s and then follows this with a similar period of hyperventilation. This does not wake her from sleep. She does not snore. She feels well rested in the morning but is very dyspneic with even mild activity. What is your next step in management?
A.Electroencephalography
B. Maximize heart failure management
C.Nasal continuous positive airway pressure (CPAP) during sleep
D.Obtain a sleep study
E. Prescribe bronchodilators
ANSWER. B
Q 5. You are caring for a patient with heart rate-related angina. With minor elevations in heart rate, the patient has anginal symptoms that impact his quality of life. On review of a 24-h Holter monitor, it appears that the patient has sinus tachycardia at the time of his symptoms. What is the mechanism for this patient’s arrhythmia?
A.Delayed afterdepolarizations
B. Early afterdepolarizations
C.Increased automaticity
D.Reentry pathway
ANSWER. C
Q 6. Where are the most common drivers of atrial fibrillation anatomically located?
A.Left atrial appendage
B. Mitral annulus
C.Pulmonary vein orifice
D.Sinus venosus
E. Sinus node
ANSWER. C
Q 7. Symptoms of atrial fibrillation vary dramatically from patient to patient. A patient with which of the following clinical conditions will likely be the most symptomatic (e.g., short of breath) if they develop atrial fibrillation?
A.Acute alcohol intoxication
B. Hypertrophic cardiomyopathy
C.Hyperthyroidism
D.Hypothermia
E. Postoperative after thoracotomy
ANSWER. B
Q 8. When deciding whether to initiate anticoagulation for a patient with atrial fibrillation, which of the following factors is least important?
A.Age
B. History of diabetes
C.Mitral stenosis
D.Use of antiarrhythmic medications
E. Hypertension
ANSWER. D
Q 9. Which of the following electrocardiographic findings suggests a focal atrial tachycardia as opposed to an automatic atrial tachycardia (e.g., sinus tachycardia)?
A. Initiation of tachycardia with programmed stimulation
B. One P-wave morphology
C.Slow-onset and termination phase
D.Slowing of the rate with adenosine infusion
ANSWER. A
Q 10. You are seeing a return patient in clinic. The patient is a 76-year-old man with a history of hypertension, remote cerebrovascular accident, diet-controlled diabetes, and congestive heart failure with left ventricular systolic dysfunction (ejection fraction = 30%). The patient reports no new complaints and feels well. On physical examination, you palpate an irregular pulse, and an electrocardiogram verifies atrial fibrillation. The patient does not have a history of atrial fibrillation. You and the patient are interested in a trial of direct current cardioversion (DCCV). What is the appropriate management of anticoagulation for this patient?
A.Initiate warfarin (with goal INR 2.0–3.0) following DCCV only if cardioversion is unsuccessful.
B. Give full-dose aspirin (325 mg daily) 3 weeks prior to DCCV, perform transesophageal echocardiogram (TEE) and DCCV (if not contraindicated), then discontinue aspirin if DCCV is successful.
C.Initiate IV heparin and warfarin, perform transesophageal echocardiogram (TEE) and DCCV (if not contraindicated), then discontinue warfarin if DCCV is successful.
D.Initiate IV heparin, perform TEE and DCCV (if not contraindicated), then continue warfarin for at least 1 month.
ANSWER. D
