Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine--->Myocardial Disease
Page: 1

Question 1#Print Question

A 22-year-old male is admitted to the intensive care unit (ICU) after sustaining a cardiac arrest while playing soccer in a rural area. Cardiopulmonary resuscitation was performed, but no automatic external defibrillator was available; he was intubated in the field because of poor mental status. He is transferred to your tertiary care ICU. Examination reveals an ejection systolic murmur, and he followed commands when sedation was lightened. Transthoracic echocardiography reveals discrete upper septal hypertrophy measuring 18 mm and an elevated left ventricular outflow velocity. He successfully passes a spontaneous awakening trial and spontaneous breathing trial. Unfortunately, at that time, he develops atrial fibrillation, became hypotensive to blood pressures of 94/52, and FiO2 was increased from 0.4 to 0.6 in response to desaturations to the low 80s.

The best treatment for this patient’s atrial fibrillation is:

a. Sotalol
b. Digoxin
c. IV metoprolol
d. Amiodarone
e. Norepinephrine

Question 2#Print Question

A 75-year-old female with prior history of hypertension and hyperlipidemia presents with acute onset chest pain and dyspnea for last 4 hours ago. Physical examination revealed bilateral rales, cool extremities, and diaphoresis. She had no murmurs on auscultation. ECG revealed 1.5-mm ST segment elevations throughout the precordial leads. High-sensitivity troponin was elevated at 100 ng/L. Left coronary angiogram reveals nonobstructive coronary disease and ventriculography shows apical ballooning with sparing of base as well as globally reduced ejection fraction.

Left ventriculography on cardiac catheterization.

On arrival to the ICU she has bibasilar rales with oxygen requirement of 6 L/min via nasal cannula. Blood pressure is 95/48 mm Hg and HR is 122 beats per minute.

Which of the following medications should be avoided at this stage?

a. Diuretics
b. Beta blockers
c. Nitrates
d. Levosimendan

Question 3#Print Question

A 44-year-old female, G1P0, at 36 weeks gestation presents with worsening shortness of breath, lower extremity edema, and fatigue. Vital signs are notable for blood pressure of 84/58 mm Hg, heart rate of 144 beats per minute, respiratory rate 38 breaths per minute, and oxygen saturation of 92% while breathing room air. Examination is notable for 2+ bilateral lower-extremity pitting edema and bibasilar rales extending one-third of the way up bilateral lung fields. Urinalysis shows no protein and indices of renal and hepatic function are normal. Diuretics and afterload reduction with hydralazine and nitrates are started. Echocardiography shows left ventricular dilatation and severe left ventricular dysfunction with ejection fraction of 15%. Cesarean section delivery is performed, but her hemodynamics continue to worsen. Further diagnostic testing including coronary angiography at time of pulmonary artery catheter placement does not reveal alternate etiology, but she is noted to have a cardiac output of 2.1 L/min (cardiac index of 1.3 L/min/m2 ). Unfortunately, her clinical condition worsens and she develops progressive cardiogenic shock refractory to medical therapy including norepinephrine, milrinone, and epinephrine.

The most appropriate next step in management is:

a. Phenylephrine
b. Continue medical management only
c. Urgent mechanical circulatory support
d. Heart transplantation

Question 4#Print Question

A 22-year-old male with no known medical history presents with insidious fatigue, nonproductive cough, and shortness of breath with exertion over the prior 3 weeks. His laboratory test results are notable for an elevated high sensitivity troponin to 60 ng/L, and an NT-proBNP elevated to 2,400 pg/mL. Ejection fraction on transthoracic echocardiogram is noted to be 15% but a normal LV dimension and wall thickness, with no other structural abnormality. He is admitted to the Cardiac ICU for further monitoring and management. You are suspicious for myocarditis. He exhibits no dysrhythmia on telemetry. His symptoms improve with medical management. 

The next best test to confirm a diagnosis is:

a. Viral serologies
b. Endomyocardial biopsy
c. Cardiac MRI
d. Cardiac PET scan

Question 5#Print Question

A 48-year-old male with no known medical history came to the emergency room reporting worsening dyspnea on exertion. ECG is without ischemic changes and high-sensitivity troponin is modestly elevated at 68 ng/L. He is quickly admitted to the cardiac intensive care unit in advanced cardiogenic shock and with recurrent ventricular tachycardia despite diuretics, inodilators, lidocaine, and amiodarone. Emergent myocardial biopsy at time of initiation of mechanical support reveals lymphocytes and multinucleated giant cells. 

Which of the following agents is an appropriate treatment?

a. Azathioprine, cyclosporine, and corticosteroids
c. Corticosteroid monotherapy

Category: Critical Care Medicine--->Myocardial Disease
Page: 1 of 1