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| 1 |
John Smith comes into the ER complaining of chest pain. His blood pressure is 72/48, pulse 32. He is in a sinus rhythm. Based upon the rate, what is this arrhythmia?  |
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Normal Sinus Rhythm
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Sinus Bradycardia |
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Sinus Tachycardia |
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Sinus Dysrhythmia |
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| 2 |
Mr. Smith is a 52 year old executive who is a diabetic and slightly overweight. He reports that he smokes 1 pack per day. He states that the chest pain began suddenly and feels like "an elephant is sitting on his chest". He is pale, diaphoretic, and has cyanotic lips. He states that he has also had some nausea. What would be the pathophysiologic reason for his nausea?
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increased pCO2 and vasodilation of arterial tree to maximize blood flow to the gastrointestinal tract |
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reflex stimuation of vomiting centers by pain fibers as well as vasovagal stimulation |
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neurogenic response to lack of blood supply |
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decreased alpha adrenergic activity in the arteriolar walls |
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| 3 |
What predisposing factors place Mr. Smith at risk for a myocardial infarction? |
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Age, diabetic, weight, cigarette smoker, probable high stress job, & sex |
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Age, sex, diabetic, & probable high stress job |
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Sex, weight, diabetic, & cigarette smoker |
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Diabetic, weight, age, & sex |
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| 4 |
Mr. Smith is diagnosed with an inferior myocardial infarction. Mr. Smith is diagnosed with an inferior myocardial infarction. Which cardiac artery is usually affected with this infarction site? 
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Circumflex Artery
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Left Anterior Artery |
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Right Coronary Artery |
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RCA or dominant distal left circumflex |
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| 5 |
Based upon this diagram, what part of the heart is affected with an Inferior myocardial infarction:  |
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A |
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B |
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C |
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| 6 |
Infarcted tissue is: |
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Found in the hypoxic zone in the heart |
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Functional however the response of the myocardial fibers are slower than normal |
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Electrically silent |
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Indicated by elevated T waves on an EKG |
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| 7 |
What potentially life-threatening dysrhythmia would you be watchful for if Mr. Smith had an anterior MI? |
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Atrial fibrillation |
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Heart Block |
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Ventricular fibrillation |
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Ventricular dysrhythmia |
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| 8 |
Based upon Mr. Smith's lab studies, the physician suspects that this infarct extends through the entire thickness of the myocardium and involves a large area.
What type of infarction did Mr. Smith have? |
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Transmural |
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Subendocardial |
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Subepicardial |
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| 9 |
An intramural infarction would be located: |
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Within the middle of the muscular wall |
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In the innermost layer of the ventricular wall, just below the endocardium |
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On the back wall of the heart muscle |
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In the atrial septal wall |
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| 10 |
What lab study is most specific for acute myocardial infarction? |
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elevated sedimentation rate |
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elevated blood sugar |
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elevated levels of creatine kinase-MB |
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elevated levels of creatine kinase-BB |
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| 11 |
Based upon your knowledge of the vascular causes of myocardial infarction, which vascular cause do you think Mr. Smith would have? |
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Spasm of the coronary artery.  |
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Blockage of the coronary artery.  |
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| 12 |
After the occlusion of the coronary artery, within ____ minutes hypoxic injury and tissue necrosis begins. |
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10 |
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12 |
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30 |
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20 |
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| 13 |
Gross changes to the myocardium may not be visible for hours, but electrical changes are usually visible via the EKG within ______. |
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20 minutes |
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1 minute |
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1 hour |
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3-4 hours |
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| 14 |
Mr.Smith's pain is difficult to control. He continues to complain of chest pain and feeling "impending doom". His blood pressure remains low despite attempts to support it with fluids and medications. His monitor pattern changes to this arrhythmia:
 and he looses consciousness. This tachyarrhythmia is a serious, life threatening event. What is it? |
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Atrial fibrillation |
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Atrial flutter |
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Ventricular fibrillation |
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Ventricular tachycardia |
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| 15 |
What are the cardiovascular outcomes of this rhythm? |
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Increased cardiac output resulting in a sudden increase in blood pressure |
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Marked decrease in cardiac output that left untreated will result in loss of conciousness and further cardiovascular collapse |
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Propulsion of a microclot into the cardiac vasculature which will generally lodge in the pulmonary arteries |
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Coronary artery spasm resulting in micro-hemorrhages which extend to the cerebral tissue |
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