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Cardio ER

Total questions: 70

Worksheet time: 35mins

Name
Class
Date
1.

A 54-year-old male presents with sudden, severe chest pain radiating to the back. The pain began abruptly while lifting boxes. BP is 180/100 in the right arm and 145/90 in the left arm. What is the most likely diagnosis?

a)

STEMI

b)

Pulmonary embolism

c)

Aortic dissection

d)

GERD

e)

Pericarditis

2.

Which of the following chest pain characteristics is most consistent with pericarditis?

a)

Worse with exertion and relieved with rest

b)

Sudden onset, tearing, radiates to back

c)

Worse when lying flat, improved when leaning forward

d)

Associated with hemoptysis and dyspnea

e)

Constant, pressure-like pain with diaphoresis

3.

A patient presents with pleuritic chest pain and shortness of breath after a long flight. Vitals: HR 112, RR 24, SpO₂ 89% on RA. What is the best next step?

a)

Administer aspirin

b)

Obtain CTA chest

c)

Perform stress ECG

d)

Start nitroglycerin drip

e)

Order abdominal ultrasound

4.

Which is most associated with stable angina?

a)

Chest pain at rest

b)

Chest pain lasting >30 minutes

c)

Relieved with nitroglycerin and rest

d)

Elevated troponin

e)

Worsening pattern over days

5.

Which of the following causes of chest pain is most likely to present with a widened mediastinum on chest X-ray?

a)

STEMI

b)

Pulmonary embolism

c)

Pneumothorax

d)

Aortic dissection

e)

Costochondritis

6.

A 61-year-old man presents with crushing chest pain radiating to the left arm and jaw for the past 30 minutes. He is diaphoretic and nauseated. ECG shows ST elevations in leads V2–V5. What is the most appropriate next step?

a)

Begin metoprolol and schedule stress test

b)

Administer tPA and send to cath lab next day

c)

Administer aspirin and sublingual nitroglycerin, then activate cath lab

d)

Perform echocardiogram before deciding treatment

e)

Order CT chest to rule out dissection

7.

What ECG finding is most diagnostic for STEMI?

a)

PR segment depression

b)

ST elevation ≥1 mm in two contiguous leads

c)

ST depression and T wave inversion

d)

Q waves in inferior leads

e)

Peaked T waves

8.

Which of the following best describes the pathophysiology of a STEMI?

a)

Coronary vasospasm causing temporary ischemia

b)

Subendocardial ischemia due to supply-demand mismatch

c)

Complete coronary artery occlusion causing transmural infarction

d)

Plaque erosion causing transient platelet aggregation

e)

Microvascular embolization without necrosis

9.

A patient with suspected MI has normal ECG and initial troponin. What is the best next step?

a)

Rule out MI and discharge

b)

Repeat troponin in 6 hours only

c)

Observe and trend high-sensitivity troponins q2h

d)

Administer thrombolytics

e)

Schedule outpatient echocardiogram

10.

Which medication is not routinely given during acute MI management?

a)

A. Aspirin

b)

B. P2Y12 inhibitor (e.g., clopidogrel)

c)

C. Beta-blocker

d)

D. Proton pump inhibitor

e)

E. Heparin

11.

A 72-year-old man presents after a syncopal episode while standing in church. He felt lightheaded and then collapsed. Vitals are normal and EKG shows sinus bradycardia with a first-degree AV block. Which of the following is the most likely cause of his syncope?

a)

Vasovagal syncope

b)

Orthostatic hypotension

c)

Cardiac arrhythmia

d)

Hypoglycemia

e)

Pulmonary embolism

12.

Which feature on history most strongly suggests a cardiac cause of syncope?

a)

Occurs with prolonged standing

b)

Associated with nausea and warmth beforehand

c)

Occurs suddenly without warning during exertion

d)

Associated with emotional stress

e)

Triggered by pain or blood draw

13.

A patient with syncope has this ECG: P waves and QRS complexes occur independently. The ventricular rate is 30 bpm. What is the appropriate next step?

a)

Observation

b)

Atropine trial and discharge

c)

Transcutaneous pacing and admit for pacemaker

d)

Cardioversion

e)

Beta-blocker administration

14.

A 26-year-old healthy woman faints while getting her blood drawn. She felt warm and nauseated beforehand. What is the most appropriate management?

a)

Send for head CT

b)

Place on telemetry

c)

Rehydrate, observe briefly, and reassure

d)

Start metoprolol

e)

Refer for tilt table testing

15.

Which diagnostic test is most appropriate for initial evaluation of syncope in the ED?

a)

Tilt table testing

b)

Holter monitor

c)

Brain MRI

d)

ECG

e)

Echocardiogram

16.

A 70-year-old man presents with worsening dyspnea, orthopnea, and bilateral lower extremity edema. He has an S3 gallop and crackles at the lung bases. BNP is elevated. What is the most appropriate next step?

a)

Oral beta-blocker and discharge

b)

Immediate IV furosemide

c)

IV steroids and albuterol

d)

Subcutaneous heparin

e)

Oral amiodarone

17.

Which of the following is most characteristic of left-sided heart failure?

a)

Jugular venous distension and ascites

b)

Worsening with lying flat and paroxysmal nocturnal dyspnea

c)

Pulsatile liver and ankle swelling

d)

Normal breath sounds but elevated BNP

e)

Polycythemia and hemoptysis

18.

Which lab value is most helpful in supporting a diagnosis of acute decompensated heart failure in the emergency department?

a)

Troponin

b)

Serum lactate

c)

Creatinine kinase

d)

B-type natriuretic peptide (BNP)

e)

D-dimer

19.

Which of the following is the most common cause of CHF in the United States?

a)

Valvular disease

b)

Viral myocarditis

c)

Ischemic heart disease

d)

Hypertrophic cardiomyopathy

e)

Thyroid disease

20.

A 68-year-old woman presents with acute dyspnea, orthopnea, and pink frothy sputum. She has bilateral crackles, an S3 gallop, and elevated jugular venous pressure. CXR shows bilateral perihilar opacities. What is the most appropriate initial management?

a)

Albuterol and corticosteroids

b)

IV furosemide and nitroglycerin

c)

Oral lisinopril and discharge

d)

Broad-spectrum antibiotics

e)

Emergent intubation and tPA

21.

What is the most likely cause of pulmonary edema in a patient with left-sided heart failure?

a)

Increased pulmonary capillary hydrostatic pressure

b)

Decreased oncotic pressure

c)

Lymphatic obstruction

d)

Capillary leak from infection

e)

Aspiration of gastric contents

22.

Which physical exam finding is most specific for cardiogenic pulmonary edema?

a)

Inspiratory wheezing

b)

Dullness to percussion

c)

Basilar crackles and S3 gallop

d)

Whispered pectoriloquy

e)

Asymmetric breath sounds

23.

What is the most appropriate imaging study to determine ejection fraction and evaluate structural causes of heart failure?

a)

Chest X-ray

b)

Cardiac CT

c)

Transthoracic echocardiogram

d)

MRI

e)

Right heart catheterization

24.

A 75-year-old male with known systolic CHF presents with shortness of breath and O2 saturation of 88% on room air. Chest X-ray shows cardiomegaly and Kerley B lines. BNP is elevated. Which of the following is not appropriate in the acute setting?

a)

Oxygen supplementation

b)

Loop diuretics

c)

Sublingual nitroglycerin

d)

IV labetalol

e)

Noninvasive ventilation (BiPAP) if needed

25.

Which chest X-ray finding is most consistent with pulmonary edema due to heart failure?

a)

Hyperinflation with flattened diaphragms

b)

Mediastinal shift

c)

Bilateral perihilar infiltrates with Kerley B lines

d)

Large pleural effusion on one side

e)

Ground-glass opacities without cardiomegaly

26.

A 64-year-old man presents with chest tightness that occurs when climbing stairs and is relieved with rest. ECG is normal, and troponins are negative. What is the most likely diagnosis?

a)

STEMI

b)

Unstable angina

c)

Stable angina

d)

Variant (Prinzmetal) angina

e)

GERD

27.

Which of the following is true regarding unstable angina?

a)

Pain is relieved consistently with rest and nitroglycerin

b)

There is complete occlusion of a coronary artery

c)

Troponins are typically elevated

d)

There is no myocardial necrosis, but symptoms are new or worsening

e)

It is usually provoked only by exertion

28.

Which of the following medications is not part of the acute ED treatment for unstable angina?

a)

A. Aspirin

b)

B. Clopidogrel

c)

C. IV furosemide

d)

D. Nitroglycerin

e)

E. Beta-blockers

29.

What is the first-line outpatient diagnostic study to evaluate a patient with stable angina and normal baseline ECG?

a)

Coronary CTA

b)

Cardiac catheterization

c)

Stress ECG

d)

Chest X-ray

e)

Troponin I

30.

A patient with stable angina and no contraindications is being discharged from the ED. Which of the following is an appropriate long-term medication regimen?

a)

A. Aspirin, beta-blocker, statin, sublingual nitroglycerin

b)

B. Heparin, tPA, PPI

c)

C. Dual antiplatelet therapy, IV nitroglycerin, morphine

d)

D. Amiodarone, lisinopril, metformin

e)

E. Digoxin, warfarin, statin

31.

A 71-year-old man presents with sudden-onset pain in the left leg. On exam, the leg is pale, pulseless, cold to touch, and the patient reports numbness. What is the next best step?

a)

Elevate the leg and apply warm compresses

b)

Start IV heparin and consult vascular surgery

c)

Order Doppler in the morning and monitor pulses

d)

Begin aspirin and statin and discharge

e)

Initiate thrombolytics in the emergency department without imaging

32.

Which of the following is one of the 6 P’s of acute limb ischemia?

a)

Pallor

b)

Pruritus

c)

Petechiae

d)

Pulsus paradoxus

e)

Pitting edema

33.

Which of the following is most likely a cause of embolic acute limb ischemia?

a)

Arterial dissection

b)

Deep vein thrombosis

c)

Atrial fibrillation

d)

Atherosclerotic plaque rupture

e)

Smoking

34.

A bedside Doppler reveals absent arterial signals in the foot. What additional test should be ordered immediately if neurologic deficits are present?

a)

ABI

b)

CT angiography of lower extremity

c)

MRI

d)

D-dimer

e)

Stress test

35.

What is the primary goal of treatment in acute arterial occlusion of the limb?

a)

Manage pain and inflammation

b)

Delay surgery to allow thrombolytics to work

c)

Restore perfusion within 6 hours to prevent irreversible damage

d)

Reduce clot burden with aspirin alone

e)

Control blood pressure and cholesterol

36.

A 72-year-old man with a history of hypertension presents with acute dyspnea, chest pain, and a new harsh systolic murmur radiating to the carotids. He becomes hypotensive and syncopal. Which valvular emergency is most likely?

a)

Mitral regurgitation

b)

Aortic stenosis

c)

Mitral stenosis

d)

Tricuspid regurgitation

e)

Aortic regurgitation

37.

Which of the following cardiomyopathies is most commonly associated with sudden cardiac death in young athletes?

a)

Dilated cardiomyopathy

b)

Restrictive cardiomyopathy

c)

Arrhythmogenic right ventricular cardiomyopathy

d)

Hypertrophic cardiomyopathy

e)

Takotsubo cardiomyopathy

38.

What is the most appropriate initial management for a patient with hypertrophic cardiomyopathy who presents with exertional chest pain and syncope?

a)

Diuretics and IV fluids

b)

Beta-blockers and avoid dehydration

c)

Thrombolytics and aspirin

d)

Cardioversion

e)

ACE inhibitors and nitrates

39.

A patient with suspected acute mitral regurgitation after an inferior MI develops respiratory distress. On exam, there is a holosystolic murmur at the apex radiating to the axilla and bibasilar crackles. What is the best next step?

a)

IV diuretics and discharge

b)

Begin high-dose steroids

c)

Emergent echocardiogram and cardiothoracic consult

d)

Administer adenosine

e)

Prescribe long-acting nitrates

40.

Which of the following is true regarding dilated cardiomyopathy?

a)

Most often caused by genetic sarcomere mutations

b)

Leads to reduced ejection fraction and systolic dysfunction

c)

Characterized by concentric hypertrophy and preserved EF

d)

Manifests with bradycardia and AV block only

e)

Always requires emergent valve surgery

41.

A 42-year-old woman presents with sudden-onset dyspnea and pleuritic chest pain 4 days after returning from a transatlantic flight. She is tachycardic and has an oxygen saturation of 91% on room air. What is the most appropriate next diagnostic step?

a)

Chest X-ray

b)

Troponin and ECG

c)

CT pulmonary angiography (CTA)

d)

Echocardiogram

e)

D-dimer only

42.

Which of the following is a major risk factor for pulmonary embolism?

a)

Chronic asthma

b)

Prolonged immobility

c)

Diabetic ketoacidosis

d)

Smoking marijuana

e)

Iron-deficiency anemia

43.

Which of the following is the most common presenting symptom of pulmonary embolism?

a)

Hemoptysis

b)

Syncope

c)

Pleuritic chest pain

d)

Sudden-onset dyspnea

e)

Fever

44.

What is the initial treatment of a hemodynamically stable patient with confirmed pulmonary embolism and no contraindications?

a)

Oral warfarin only

b)

IV thrombolytics

c)

Subcutaneous low molecular weight heparin or DOAC

d)

Aspirin and clopidogrel

e)

Oxygen and steroids

45.

A patient with PE becomes hypotensive, tachycardic, and hypoxic despite oxygen therapy. What is the next best step in management?

a)

Administer IV steroids

b)

Intubate and observe

c)

Begin IV tPA (thrombolytics)

d)

Start aspirin and repeat CTA

e)

Begin diuretics

46.

A 55-year-old man presents to the ED with a BP of 240/130 mmHg and a complaint of blurry vision and a severe headache. Fundoscopy reveals papilledema. What is the goal of BP reduction in the first hour?

a)

Normalize BP to <120/80 mmHg

b)

Lower BP to <160/100 mmHg immediately

c)

Reduce MAP by no more than 25% in the first hour

d)

Reduce systolic BP to <100 mmHg

e)

Delay BP treatment for 24 hours

47.

Which of the following defines a hypertensive emergency?

a)

BP > 140/90 with headache

b)

BP > 180/120 with no symptoms

c)

BP > 180/120 with evidence of target-organ damage

d)

BP > 160/100 that resolves with rest

e)

BP > 200/100 with family history of hypertension

48.

Which of the following IV medications is most appropriate for acute blood pressure control in hypertensive encephalopathy?

a)

IV metoprolol

b)

IV nicardipine

c)

IV furosemide

d)

IV lisinopril

e)

IV hydralazine

49.

A 32-year-old pregnant woman at 36 weeks presents with a BP of 190/120, headache, and 3+ proteinuria. What is the most appropriate initial agent for BP control?

a)

IV nitroglycerin

b)

IV labetalol

c)

IV nicardipine

d)

Oral atenolol

e)

IV nitroprusside

50.

Which of the following is true regarding hypertensive urgency?

a)

Requires admission for IV medication

b)

Defined by BP >180/120 with neurologic symptoms

c)

No evidence of end-organ damage

d)

Requires MAP reduction of 50% in 1 hour

e)

Treated with IV labetalol and nicardipine

51.

A 67-year-old man with hypertension presents with sudden-onset "tearing" chest pain radiating to his back. On exam, his right arm BP is 190/110 and his left is 160/90. CXR shows a widened mediastinum. What is the best next step in diagnosis?

a)

Chest X-ray only

b)

Cardiac enzymes and ECG

c)

CT angiography of chest and abdomen

d)

Pulmonary angiogram

e)

Echocardiogram only

52.

Which of the following is true regarding aortic dissection?

a)

Always causes hypotension

b)

Type A dissections are managed medically only

c)

Dissections are most often caused by trauma

d)

Beta-blockers should be used before vasodilators

e)

D-dimer is diagnostic

53.

What is the initial treatment goal for a stable ascending aortic dissection (Type A)?

a)

Immediate IV fluids and inotropes

b)

Maintain SBP >160 mmHg for perfusion

c)

HR <60 bpm and SBP 100–120 mmHg with beta-blockers ± nitroprusside

d)

Start oral antihypertensives and refer to vascular surgery

e)

Start aspirin and high-dose statin

54.

Which of the following is an indication for elective repair of an asymptomatic abdominal aortic aneurysm (AAA)?

a)

Diameter >3.0 cm

b)

Diameter ≥5.5 cm in men or growth >0.5 cm in 6 months

c)

Presence of bruit over aorta

d)

BP >160/100 despite medications

e)

Any aneurysm found on screening ultrasound

55.

A 75-year-old man with a known AAA presents with sudden flank pain, hypotension, and a pulsatile abdominal mass. What is the immediate next step?

a)

Stat CT angiogram

b)

IV beta-blockers and observation

c)

Bedside ultrasound and emergent vascular surgery consult

d)

Start broad-spectrum antibiotics

e)

Monitor serial abdominal exams

56.

A 68-year-old male smoker presents with chronic calf pain while walking that resolves with rest. He has diminished dorsalis pedis pulses. What is the most likely diagnosis?

a)

Deep vein thrombosis

b)

Chronic venous insufficiency

c)

Acute limb ischemia

d)

Peripheral arterial disease (PAD)

e)

Cellulitis

57.

Which of the following is the most significant modifiable risk factor for peripheral vascular disease?

a)

Hypertension

b)

Diabetes mellitus

c)

Hyperlipidemia

d)

Smoking

e)

Advanced age

58.

Which of the following is the first-line diagnostic test to assess the severity of chronic arterial insufficiency in a patient with claudication?

a)

CT angiography

b)

Venous duplex ultrasound

c)

Ankle-brachial index (ABI)

d)

Cardiac catheterization

e)

MRI of lower extremities

59.

A patient with PAD is unable to walk more than a block without significant leg pain. What is the first-line pharmacologic therapy to improve symptoms?

a)

Cilostazol

b)

Atorvastatin

c)

Aspirin

d)

Lisinopril

e)

Clopidogrel

60.

Which of the following is true about venous insufficiency as compared to arterial disease?

a)

More commonly causes claudication

b)

Ulcers are typically located on toes

c)

Pain improves with elevation of legs

d)

Pulses are absent

e)

Skin is cool and hairless

61.

A 28-year-old woman presents with palpitations. ECG shows a narrow complex tachycardia at 180 bpm with no visible P waves. She is alert and hemodynamically stable. What is the first-line treatment?

a)

Amiodarone

b)

IV diltiazem

c)

Synchronized cardioversion

d)

Vagal maneuvers followed by IV adenosine

e)

IV metoprolol

62.

A patient presents with palpitations and irregularly irregular rhythm. ECG shows absence of P waves and variable R-R intervals. What is the initial treatment if the patient is stable and in A-fib with rapid ventricular response?

a)

Synchronized cardioversion

b)

IV furosemide

c)

IV diltiazem or metoprolol

d)

Adenosine

e)

Lidocaine

63.

A 68-year-old man collapses at home. EMS finds him pulseless with the monitor showing polymorphic ventricular tachycardia (“twisting of the points”). What is the first-line treatment?

a)

IV amiodarone

b)

IV magnesium sulfate

c)

IV calcium gluconate

d)

IV adenosine

e)

Lidocaine

64.

A 72-year-old man has bradycardia with a HR of 28 bpm. ECG shows complete AV dissociation with wide QRS complexes. BP is 80/40. What is the next best step?

a)

Atropine

b)

Transcutaneous pacing

c)

Adenosine

d)

Observation

e)

Diltiazem

65.

A patient is found unresponsive and pulseless. ECG monitor shows organized electrical activity with no palpable pulse. What is the appropriate management?

a)

Defibrillation

b)

Atropine

c)

Synchronized cardioversion

d)

High-quality CPR and epinephrine

e)

Adenosine

66.

A 48-year-old man presents with chest pressure lasting 15 minutes while walking. It resolved with rest. ECG: Nonspecific ST changes, Troponin: Normal, History: Moderate suspicion for ACS, Risk factors: Smoker, HTN. What is his HEART score?

a)

2

b)

3

c)

4

d)

5

e)

6

67.

Based on the previous patient's HEART score of 5, what is the best next step in management?

a)

Discharge with primary care follow-up

b)

Admit for serial troponins and consider stress testing

c)

Immediate PCI

d)

Thrombolytic therapy

e)

Cardiology follow-up in 1 week

68.

Which component of the HEART score is scored 2 points if the patient has new ST-segment depression?

a)

A. History

b)

B. ECG

c)

C. Age

d)

D. Risk factors

e)

E. Troponin

69.

A 65-year-old woman presents with chest pain at rest. • ECG: Normal • Troponin: Elevated • Risk factors: HTN, diabetes, hyperlipidemia, smoking What is her HEART score?

a)

3

b)

4

c)

5

d)

7

e)

9

70.

For patients with a HEART score of 0–3, what is the recommended disposition?

a)

Cardiology consult and hospital admission

b)

PCI within 24 hours

c)

Stress testing in the ED

d)

Safe for discharge with primary care or cardiology follow-up

e)

Administer tPA and repeat troponin

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