Which of the following medications given during the treatment of VF or pulseless VT has no dose maximum?

A 63-year-old African American man with a PMH significant for dyslipidemia presented to the emergency department several days ago with symptoms of an acute stroke. The physician you are working with wants your recommendations on what to send this patient home on for blood pressure control. Current vitals are as follows: BP 138/88 mm Hg, HR 86 beats/min What do you recommend?

Which of the following is an appropriate fibrinolytic dosing regimen for a 78-kg person with STEMI?

What is the initial step in therapy for a stable patient presenting with monomorphic VT?

KE presents with chest pain, nausea, vomiting, and diaphoresis. He is diagnosed with an NSTEMI. Current blood pressure is 92/56 mm Hg and HR is 105 beats/min. Which of these medications should be given to this patient?

A 79-year-old man weighing 80 kg presents to your hospital emergency room with newly discovered AF with rapid ventricular response and is symptomatic with little rate control achieved after initiation of a diltiazem drip. It is decided by the attending physician to proceed with electrical cardioversion. The patient’s wife reports that he underwent a cardiac workup the day before for routine knee replacement surgery. The ECG from that workup is retrieved and shows normal sinus rhythm. What is the next appropriate step in this patient’s care?

A patient experiencing chest pain for a few hours decides to take an SL tablet of NTG. The first tablet provides no pain relief, so EMS is contacted. The patient continued to take the NTG every 5 minutes. The third tablet she took provided relief. How do oral nitrates decrease chest pain?

LC is a 76-year-old woman who presents to ED via EMS to a large academic medical center (with a coronary catheterization laboratory) complaining of sudden onset of diaphoresis and nausea. She states, “About 5 hours ago my chest started hurting and I just don’t feel well.” LC’s weight is 65 kg.

Past medical history: CAD and arthritis

Family history: Father died of acute myocardial infarction at 76 years of age and mother passed away at age 70 from pneumonia

Social history: Does not drink alcohol; smokes 1 pack of cigarettes per week

Medications: ASA 81 mg orally once daily, atorvastatin 40 mg orally at bedtime, conjugated estrogens 0.625 mg orally daily, and celecoxib 200 mg orally daily

Laboratory data: Serum creatinine (SCr) = 1.9 mg/dL, total cholesterol 250 mg/dL, triglycerides 150 mg/dL, high-density lipoprotein (HDL) 40 mg/dL, LDL 130 mg/dL, troponin I = 5.7 ng/mL

Electrocardiogram: ST-segment elevation

Which one of the following is the preferred approach to reperfuse this patient?

CB is a 56-year-old woman who presents with palpitations, dyspnea, and presyncope. An ECG is performed and PVCs are found. CB has a past medical history of hypertension, hyperlipidemia, and postmyocardial infarction 2 years ago. What is the treatment of choice for CB?

PR is an 82-year-old woman who is status post drug-eluting stent placement following presentations with a STEMI. She has a past medical history significant for hypertension, dyslipidemia, and hypothyroidism. She has no known drug allergies. Which of the following is the best choice of long-term antiplatelet therapy?

HB is a 54-year-old African American man who presents to the emergency department with symptoms of left-sided paralysis and visual impairment. He has a PMH significant for hypertension, dyslipidemia, and benign prostatic hyperplasia. MRI of the brain confirms the patient has had an ischemic stroke.

Which of the following medications would be the most appropriate for secondary stroke prevention in HB?

A 72-year-old woman (68 in, 111 kg) is admitted for acute ischemic stroke confirmed by CT of the head. She presents within 1.5 hours of symptom onset and meets all criteria to receive rtPA. The physician asks you what the appropriate dose is for this patient and how to administer it. Your response is:

A patient with an HR of 53 beats/min is complaining of SOB, light-headedness, and has a blood pressure (BP) of 80/58 mm Hg. Transcutaneous pacing is being prepared. What is the first drug and dose that should be administered?

Which antiarrhythmic drug has the potential for causing taste disturbances?

Question 9 of 42

LC is a 76-year-old woman who presents to ED via EMS to a large academic medical center (with a coronary catheterization laboratory) complaining of sudden onset of diaphoresis and nausea. She states, “About 5 hours ago my chest started hurting and I just don’t feel well.” LC’s weight is 65 kg.

Past medical history: CAD and arthritis

Family history: Father died of acute myocardial infarction at 76 years of age and mother passed away at age 70 from pneumonia

Social history: Does not drink alcohol; smokes 1 pack of cigarettes per week

Medications: ASA 81 mg orally once daily, atorvastatin 40 mg orally at bedtime, conjugated estrogens 0.625 mg orally daily, and celecoxib 200 mg orally daily

Laboratory data: Serum creatinine (SCr) = 1.9 mg/dL, total cholesterol 250 mg/dL, triglycerides 150 mg/dL, high-density lipoprotein (HDL) 40 mg/dL, LDL 130 mg/dL, troponin I = 5.7 ng/mL

Electrocardiogram: ST-segment elevation

The physicians are debating on whether LC should receive early oral β-blockers after receiving ASA, ticagrelor, oxygen, nitrates, and morphine. Which of the following vital signs for TS would be conducive for early β-blocker use?

A 68-year-old man with a PMH significant for diabetes mellitus, DVT 5 years ago, and GI bleed 2 weeks ago presents with right-sided weakness and right facial droop that began 2 hours ago. CT of the head confirms ischemic stroke. Home medications include: warfarin 5 mg po daily, pantoprazole 40 mg po daily, and metformin 1000 mg po bid. Pertinent laboratory values on admission include INR 1.4, hemoglobin 14, hematocrit 41, platelets 175,000, and glucose 200 mg/dL. Blood pressure on admission is 160/90 mm Hg.

Which of the following is a relative exclusion criterion for this patient to receive rtPA?

Which of the following statements accurately describes the acute presentation of ischemic stroke?

Which of the following is an appropriate way to counsel patients on taking extended-release dipyridamole plus aspirin therapy?

Which of the following is a common side effect of extended-release dipyridamole plus aspirin?

Which of the following therapies requires routine monitoring of serum creatinine and potassium?

Question 17 of 42

SK is a 68-year-old man who presents to his local physician’s office after eating lunch at a local fast food restaurant. He complains of chest pain with radiation to his jaw. His physician has him chew ASA 325 mg and calls 911. He is transported to the local hospital where electrocardiogram shows ST-segment elevation.

Past medical history: Hypertension, CAD, chronic obstructive pulmonary disease (COPD), stage IV chronic kidney disease, cerebrovascular accident 2 months ago

Family history: Mother died of a stroke at 85 years and father passed away at 75 years in a car accident.

Social history: Smokes 1.5 packs of cigarette per day for 50 years; no alcohol history

Medications: Hydrochlorothiazide 25 mg orally daily, metoprolol tartrate 25 mg orally bid, tiotropium 18 mcg inhaled once daily, albuterol inhaler 1 puff every 6 hours as needed, fluticasone/salmeterol 250/50 mcg inhaled bid

Vital signs: Blood pressure 185/90 mm Hg, heart rate 98 beats/min, respiratory rate 22, O₂ saturation 88%, weight 100 kg

Laboratory data: Unavailable

Allergies: Heparin

Which anticoagulant is the treatment of choice in a STEMI patient that is also dialysis dependent?

Which of the following medications slows depolarization through sodium channel blockade?

Which of the following describes the mechanism of action of clopidogrel?

CS is a 61-year-old white woman who has a PMH significant for hypertension and diabetes mellitus. She presented to the emergency department yesterday with signs and symptoms of an ischemic stroke. CT of the brain confirmed this diagnosis. Which of the following medications would be the most appropriate for secondary stroke prevention in CS?

JL is a 47-year-old man with new onset AF and seasonal allergies. After cardioversion and 4 weeks of anticoagulation, which of the following would be appropriate therapy to prevent thromboembolic complications in JL long-term? ***Hint: Use CHA₂DS₂-VASc to know the score***

A 49-year-old white man with a PMH significant only for osteoarthritis was diagnosed with an ischemic stroke due to an atherosclerotic process several days ago. The patient drinks one to two beers per day and denies smoking. Family history is unremarkable. His current lipid panel is as follows: TC 168 mg/dL, TG 88 mg/dL, HDL 44 mg/dL, LDL 116 mg/dL. Vitals: BP 136/84 mm Hg, HR 78 beats/min. The physician you are working with wants to know if this patient needs to be placed on statin therapy. What do you recommend?

Amiodarone requires substantial safety monitoring during long-term therapy due to its numerous side effects. Which of the following is required to be routinely performed in a patient on long-term amiodarone therapy?

Which of the following medications works by binding to fibrin and subsequently converting plasminogen to plasmin?

G is a 55-year-old man who presents with recurrent complaints of SOB and describes feeling like his heart is racing. An ECG is performed and it is determined that he is in AF with a ventricular rate of 160 beats/min. An evaluation of his LV function concluded that his ejection fraction is 35%. While the patient was still in the examination room, he reports that his symptoms have subsided and a repeat ECG was completed and it was found that the patient was in normal sinus rhythm.

What medication should be prescribed to KG to control his rate?

A nonresponsive patient in ventricular fibrillation has received multiple appropriate defibrillations and epinephrine 1 mg IV twice. Which antiarrhythmic drug can be used next?

You respond with the code team to a patient that is in cardiac arrest. High-quality chest compressions are being given. The patient is intubated and an IV has been started. ECG reveals that the patient is in asystole. The first IV drug and dose to administer is:

A 62-year-old woman is admitted 2 hours after onset of acute stroke symptoms including blurred vision, slurred speech, and right facial droop. CT of the head confirms ischemic stroke. Past medical history is nonsignificant, and the patient takes no medications at home. All laboratory values are within normal limits. Blood pressure is 200/110 mm Hg. Patient meets all other inclusion criteria for rtPA use.

Which of the following is the best option for blood pressure control in this patient?

Which of the following medications given during the treatment of VF or pulseless VT has no dose maximum?

Which of the following antiplatelet/anticoagulant regimens would be recommended for treatment of an NSTEMI patient with a heparin allergy? The patient is going to receive PCI later in the day.

Dofetilide is indicated in which of the following?

Which antiarrhythmic drug is safer to use for maintenance of sinus rhythm in a patient with AF, HF, and an ejection fraction of 15%?

JS is a 78-year-old white woman with a PMH significant for atrial fibrillation, systolic heart failure with an ejection fraction of 35%, and hypertension. She presents to the emergency department with symptoms of right-sided paralysis. She is not able to communicate, but her family member states that the symptoms began approximately 5 hours ago. MRI of the brain confirms the patient has had an ischemic stroke. At home she takes metoprolol 100 mg po bid, lisinopril 40 mg po daily, and furosemide 20 mg po daily. Which of the following medications would be the most appropriate for secondary stroke prevention in JS?

Once the acute phase of myocardial infarction has passed, which of the following therapies is most likely to slow the development of heart failure?

An 81-year-old man with a PMH significant for diabetes, hypertension, and ischemic stroke 3 years ago presents with slurred speech and left-sided weakness that began 3.5 hours ago. NIH stroke score is calculated to be 15. Home medications include lisinopril 40 mg po daily and glipizide 5 mg po bid. Laboratory values are within normal limits and blood pressure is 150/84 mm Hg. The patient weighs 80 kg. Which of the following may be used as initial treatment for ischemic stroke in this patient?

A 65-year-old patient presents with AF and HF. Which of the following is the best choice for pharmacologic cardioversion of AF in this patient?

A 68-year-old man who had a myocardial infarction a year earlier shows premature ventricular beats on his ECG during a routine physical examination. He has not had any symptoms related to this arrhythmia such as dizziness or syncope. What is the best drug therapy for this patient to treat his arrhythmia?

Question 2 of 5

An 84-year-old woman being treated for hypertension, mild heart failure (NYHA class II), and persistent atrial fibrillation is taking several different medications: aspirin, sotalol, diltiazem, metoprolol, captopril, chlorothiazide, and warfarin. Over the past several weeks, she has begun to complain that she is no longer able to take her dog for long walks because she tires easily. She also complains of shortness of breath. The drug-drug interactions most likely contributing to the patient’s recent symptoms are

A 72-year-old patient with heart failure and atrial fibrillation is receiving digoxin. The mechanistic rationale for using digoxin to treat the patient’s arrhythmia is that

What is the rationale for the use of lidocaine in treating a patient with ventricular tachycardia?

What is the mechanism of action of sotalol in preventing ventricular and atrial arrhythmias?

A patient who is taking aspirin has a noncardioembolic stroke. Which action is the most appropriate antiplatelet option for this patient?

A 70-year-old male patient has a history of stroke. Which factor would require intervention?

What is a modifiable risk factor for stroke?

Which statement is correct regarding lipid management in a patient who has a history of stroke?

A patient who was taking aspirin 81 mg daily had a minor stroke and is prescribed clopidogrel. The patient does not have atrial fibrillation. Which statement is correct regarding the combination of aspirin and clopidogrel in this patient?

Which of the following β-blockers are available in both oral and IV formulations? Select all that apply.

RT is a 65-year-old woman who presents with paroxysmal supraventricular tachycardia (PSVT), heart rate (HR) 180 bpm, with a regular rhythm. RT is experiencing mild symptoms and was instructed to bear down as if having a bowel movement with no success. If RT has a narrow QRS interval, what medication(s) is(are) first-line agent(s) to treat this patient? Select all that apply.

A 38-year-old white man with a past medical history (PMH) significant for hypertension, diabetes, and chronic alcoholism comes to your clinic for routine follow-up. His social history is significant for alcohol and tobacco abuse. He currently drinks one case of beer per night and smokes two packs per day. Pertinent laboratory findings are as follows: total cholesterol (TC) 182 mg/dL, triglyceride (TG) 218 mg/dL, low density lipoprotein (LDL) 96 mg/dL, high density lipoprotein (HDL) 52 mg/dL, glucose 146 mg/dL. Current blood pressure (BP) is 158/94 mm Hg and heart rate (HR) is 92 beats per minute (bpm). He is 69-in tall and weighs 232 lb. Which of the following are risk factors for ischemic stroke in this patient? Select all that apply.

PR is a 62-year-old woman who presents to the emergency department (ED) with a non-ST-elevation myocardial infarction (NSTEMI). She has no significant past medical history. Pertinent data includes: blood pressure 125/79 mm Hg, heart rate 75 bpm, serum creatinine (SCr) 1.2 mg/dL, platelet count 142 k/uL, weight 94 kg. She has allergies to penicillin, sulfa, and aspirin. Which of the following regimens are okay to give PR while she waits for her percutaneous coronary intervention (PCI)? Select all that apply.

ST is a 46-year-old man who presents to the emergency department in atrial fibrillation (AF), HR 150 bpm. The resident would like to first initate a rate controlling medication. Which of the following is/are available in both oral and IV preparations? Select all that apply.

Which risk factor should be aggressively targeted to reduce a patient’s risk for stroke?

Which of the following agents is indicated in the setting of non-ST-elevation myocardial infarction (NSTEMI)? Select all that apply.

Which of the following is the correct blood pressure goal recommendation for a 58-year-old woman who just suffered a non-ST-elevation myocardial infarction (NSTEMI) last week?

PR is an 82-year-old woman who is status post drug-eluting stent placement following presentations with an ST-elevation myocardial infarction (STEMI). She has a past medical history significant for hypertension, dyslipidemia, and hypothyroidism. She has no known drug allergies. Which of the following is the best choice of long-term antiplatelet therapy?

Which of the following patients is the best candidate for long-term propafenone therapy for maintenance of sinus rhythm in atrial fibrillation?

A patient experiencing chest pain for a few hours decides to take a SL tablet of nitroglycerine (NTG). The first tablet provides no pain relief, so emergency medical service (EMS) is contacted. The patient continued to take the NTG every 5 minutes. The third tablet she took provided relief. How do oral nitrates decrease chest pain?