IHD

• Which of the following is NOT used to calculate the Framingham risk score?

  A) age

  B) gender

  C) race

  D) total cholesterol / HDL cholesterol

  E) smoker

  C (race)
• A Framingham risk score of >(#)% is considered high risk for ischemic heart disease


  20(%)
• Which of the following lab values, if elevated, is considered a risk factor for ischemic heart disease?

  A) troponin

  B) CRP

  C) ESR

  D) WBC


  B (CRP; >3mcg/ml is considered high risk)
• Which of the following is considered the gold standard for diagnosis of ischemic heart disease?

  A) ECG

  B) stress echocardiogram

  C) cardiac catheterization

  D) stress PET

  C (cardiac catheterization)
• T/F A normal ECG excludes ischemic heart disease


  false (does not exclude IHD or even acute MI)
• Which of the following is a major, non-invasive tool used in the diagnosis of CAD as it measures calcium score to help establish risk?

  A) ECG

  B) stress echocardiogram

  C) cardiac catheterization

  D) CT coronary angiogram


  D (CT coronary angiogram)
• Arterial ______ deposition is intimately associated with vascular injury and atherosclerotic plaque


  calcium (the presence of CACP is a/w atherosclerotic plaque size)
• T/F CACP in the absence of luminal stenosis is a false positive for ischemic heart disease


  false (evidence of coronary atherosclerosis)
• Which of the following tests for ischemic heart disease uses ultrasound to examine the heart and to measure relative pressure differences across valves?

  A) ECG

  B) echocardiogram

  C) cardiac catheterization

  D) CT coronary angiogram


  B (echocardiogram)

  
  

  (gives instantaneous gradient where as catheter gives peak to peak gradient)
• Maximal instantaneous gradient across stenotic valves as measured with an echocardiogram is usually (higher / lower) than the peak to peak gradient measured in the cath lab


  higher
• Which of the following is a low cost test for IHD that tests the functional capacity, a strong predictor of mortality?

  A) Treadmill Stress Test

  B) Graded Exercise Test

  C) Exercise Tolerance Test

  D) Exercise Electrocardiographic Test

  A (Treadmill Stress Test)

  (widely available)
• Which patient should NOT have a treadmill stress test or stress echocardiogram?

  A) initial evaluation in patients with known or suspected CAD

  B) low risk patient with unstable angina, 12 hours after presentation

  C) intermediate risk patient with unstable angina, 2-3 days after presentation

  D) patient with baseline ECG abnormalities such as WPW, >1mm ST depression at rest, or complete LBBB


  D (patient with baseline ECG abnormalities such as WPW, >1mm ST depression at rest, or complete LBBB)

  
  

  (may or may not due screening for asymptomatic patients with DM about to start exercise)
• The treadmill stress test is best used in evaluation of patients with (low / intermediate / high) risk of IHD with atypical history and (low / intermediate / high) risk of IHF with typical history


  intermediate; low
• Which of the following tests evaluates for myocardial ischemia by detecting stress induced systolic regional wall motion abnormalities?

  A) ECG

  B) stress echocardiogram

  C) cardiac catheterization

  D) CT coronary angiogram

  B (Stress Echocardiogram)

  (stress with treadmill, meds, or pacing)
• Stress echocardiograms are limited in patients with poor acoustic windows secondary to:

  A) immunosuppression

  B) paraplegia

  C) COPD

  D) cachexia


  C (COPD or obesity)
• Which of the following medications used for pharmacologic stress tests is selective for A2A receptor agonists responsible for coronary artery vasodilation?

  A) dipyridamole

  B) adenosine

  C) regadenoson

  C (regadenoson)
• Which of the following is NOT a contraindication for cardiac nuclear stress testing?

  A) I-131 therapy within the past 12 wks

  B) allergies to dipyridamole or aminophylline

  C) tobacco use within past 12 hours

  D) active asthma or reactive airway disease

  C (CAFFEINE consumption within past 12 hours)
• Which of the following tests for IHD is the most specific?

  A) treadmill stress test

  B) stress echocardiogram

  C) cardiac nuclear stress testing

  D) ECG

  B (stress echocardiogram, 75-80%)

  (cardiac nuclear stress testing is the most sensitive)
• Which of the following tests for IHD is the most sensitive?

  A) treadmill stress test

  B) stress echocardiogram

  C) cardiac nuclear stress testing

  D) ECG


  C (cardiac nuclear stress testing - 90%)

  (stress echocardiogram is the most specific)
• Which test would be performed in a patient with an acute myocardial infarction?

  A) ECG

  B) stress echocardiogram

  C) cardiac catheterization

  D) stress PET

  C (cardiac catheterization)
• Which test has a 1% risk of abrupt closure (usually occurring in the first 6 months) or in-stent restenosis?

  A) percutaneous coronary intervention

  B) stress echocardiogram

  C) cardiac catheterization

  D) stress PET

  A (percutaneous coronary intervention) (drug eluting stents help prevent in-stent restenosis)
• Which medication used in acute coronary syndrome is a relatively weak antiplatelet aggregation inhibitor yet has significant effect on mortality in MIs, reducing combined endpoint nonfatal MI death by 50%?

  A) ASA

  B) clopidogrel

  C) nitrates

  D) glycoprotein IIb/IIIa inhibitors

  A (ASA)

  (Blocks cyclooxygenase derived thromboxane A2 pathway)
• Which of the following medications used in acute coronary syndrome inhibits the P2Y12 subtype of adenosine diphosphate (ADP) receptor, which prevents platelet activation?

  A) ASA

  B) clopidogrel

  C) nitrates

  D) glycoprotein IIb/IIIa inhibitors

  B (clopidogrel /Plavix) (according to the CURE trial, there was a lower rate of death when treated with both ASA and clopidogrel vs. ASA alone)
• Which of the following medications used for acute coronary syndrome decreases arteriolar and venous tone, reduces preload and afterload, and lowers the oxygen demand of the heart, however should not be used in patients who have taken phosphodiesterase-5 inhibitors such as Cialis or Viagra?

  A) ASA

  B) clopidogrel

  C) nitrates

  D) glycoprotein IIb/IIIa inhibitors

  C (nitrates)
• Which of the following antithrombins should be used for heparin-induced thrombocytopenia?

  A) low molecular weight heparin

  B) unfractionated heparin

  C) direct antithrombins

  D) factor Xa inhibitors

  C (direct antithrombins such as Hirudin or Bivalirudin)

  
  

  (factor Xa inhibitors have a lower risk of causing HIT)
• Which medication used for acute coronary syndrome lowers myocardial oxygen demand through its effect on blood pressure, heart rate, and contractility, reduces risk of MI and relieves symptoms of ischemia and should be given to all patients with acute MI unless presentation complicated by hypotension, bradycardia or cardiogenic shock or in patients with severe reactive airway disease or advanced heart block?

  A) ASA

  B) clopidogrel

  C) beta blockers

  D) glycoprotein IIb/IIIa

  C (beta blockers)
• Which analgesic should be used in for patients with acute coronary syndrome if nitrates are ineffective?

  A) Tylenol

  B) Fentanyl

  C) Morphine

  D) Dilaudid


  C (Morphine 4-8mg)
• A CK (BB/MB/MM) >(#)% indicates an MI

  MB; 5(%)

  (elevates within 4-6 hours and peaks within 18-24hours)
• Which cardiac enzyme is most sensitive and specific for myocardial damage?

  A) CK MB

  B) CK MM

  C) Troponin

  D) myoglobin


  C (Troponin)

  (elevates within 2-4hours and peaks within 7 days)
• Which tumor marker has false positives in the setting of pulmonary embolism, right heart overload, myocarditis?

  A) CK MB

  B) CK MM

  C) Troponin

  D) myoglobin

  C (Troponin)
• What does an elevated troponin without an elevation in myoglobin or CK-MG indicate?

  A) acute onset MI

  B) pericarditis

  C) MI a few days old

  D) MI a few years old


  C (MI a few days old) (troponins stay elevated for 7-10 days)
• Thrombolytics for a STEMI is most beneficial if administered within (#) hours of onset and if the infarct is located (posteriorly / anteriorly / laterally)


  3; anteriorly

  (if cath lab is on site, just go straight to cath lab)
• US guidelines recommend a door to balloon time for primary PCI in STEMI patients of <(#) minutes


  90
• Which intervention for acute coronary syndrome helps acutely support BP, increase coronary perfusion, and reduce cardiac demand?

  A) PCI

  B) LVAD

  C) intra-aortic balloon pump

  D) thrombolytics


  C (intra-aortic balloon pump - bridge to revascularization)

  
• Which of the following is FALSE regarding ischemic heart disease prevention?

  A) consume fish, especially oily fish, twice a week

  B) intake of saturated and trans fats should be limited

  C) the AHA recommends at least 30 minutes of exercise most days of the week

  D) smoking cessation

  E) high intensity statins should be used in patients over 75 with hyperlipidemia

  E (high intensity statins should be used in patients UNDER 75 with hyperlipidemia) (moderate intensity statins for patients over 75)
• Which class of medication is beneficial in cardiac patients with LV dysfunction, MI, or CHF?

  A) ACE-inhibitor

  B) beta blockers

  C) ASA

  D) statins

  A (ACE-inhibitor)
• Which class of medication is beneficial in cardiac patients with systolic / diastolic HF?

  A) ACE-inhibitor

  B) beta blockers

  C) ASA

  D) statins

  B (beta blockers)
• Which of the following is FALSE regarding Takotsubo cardiomyopathy (AKA Broken Heart syndrome)?

  A) Typically presents with chest pain and congestive heart failure with ECG changes classic for acute anterior MI

  B) Cath shows normal CA or minor CAD and classic wall motion abnormality (apical ballooning)

  C) poor prognosis with eventual decompensation

  D) all of the above are true

  C (Prognosis usually good and often wall motion normalizes)
• T/F Patients with permanent pacemakers, who are pacemaker dependent, should have their device evaluated within 3 to 6 months before significant surgical procedures, and also after surgery


  true (potential for interference from cautery in heart surgery with ICDs)
• (bradycardia pacemakers / ICDs) will respond to magnet application with asynchronous pacing at a pre-prescribed rate


  bradycardia pacemakers (Magnet application will affect only the antitachycardia function of an ICD)