Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Cardiovascular Disorders--->Imaging and Diagnostic Modalities
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Question 1#Print Question

A 35-year-old-patient with no past medical history comes to the Emergency Department with complaints of several days of fatigue and constant chest pain that is substernal but not radiating, “sharp,” and worsened with inspiration, but seems to improve with sitting forward. He has noticed a 10 lbs unintentional weight gain over the past 2 weeks and significant fatigue. He reports only local travel in the last 2 months and otherwise had a “cold a few weeks ago.” His family history is negative for ischemic heart disease, and he is a nonsmoker and has never used any substances such as cocaine, marijuana, or amphetamines. Examination in the Emergency Department reveals tachycardic heart without gallop or rub, and symmetric 2+ pitting edema to his calves. Initial laboratory test results are notable for an elevated troponin-T and the following ECG:

Which of the following is the BEST imaging modality to diagnose the etiology of his underlying disease?

a. CT Coronary Angiography
b. Cardiac MRI
c. Transesophageal Echocardiogram
d. Cardiac catheterization with ventriculography

Question 2#Print Question

A 65-year-old male presents to the Emergency Department with cough, malaise, and fevers to 39°C. His past medical history is notable for hypertension, diabetes, and a drug-eluting stent placed into his distal right coronary artery 5 years before angina. He has no anginal symptoms at rest. He takes aspirin, atorvastatin, metoprolol, lisinopril, and metformin. Testing with viral panel in the Emergency Department resulted in positive PCR for Influenza A. Electrocardiogram shows:

  • sinus rhythm
  • normal QRS
  • no ischemic changes

and a Troponin-T is <0.01 ng/mL. Over the course of the first 2 hours after presentation, he becomes increasingly hypoxemic, ultimately transferred to the ICU after intubation. His chest radiograph before intubation shows bilateral infiltrates. Oxygenation slowly improves over the next 12 hours. The morning after admission, he is noted to have a short run of wide complex tachycardia. Electrocardiogram shows new left bundle branch block (LBBB). He then continues to have frequent regular wide complex tachycardias, causing hemodynamic instability. Troponin-T now increases to 0.48 ng/mL.

Which of the following is the BEST next step in managing his cardiac status? 

a. Cardiac catheterization
b. Cardiac MRI
c. Transthoracic echocardiogram and serial biomarkers
d. CT Pulmonary Angiogram

Question 3#Print Question

A 68-year-old male with a past medical history of hypertension arrives at the Emergency Department with crushing chest pain. The pain started 1 hour ago and is substernal with radiation to his left shoulder. He is mildly diaphoretic and dyspneic. Vital signs on presentation are notable for:

  • a blood pressure of 110/65 mm Hg
  • heart rate of 100 beats per minute
  • oxygen saturation of 99% on room air

His initial ECG is shown in the figure below:

Which of the following is the next BEST step to evaluate the extent of cardiac damage in this patient?

a. Troponin
b. CK-MB
c. Right-sided ECG leads
d. Posterior ECG leads
e. Right-sided heart catheterization

Question 4#Print Question

A 75-year-old male is brought to the Emergency Department with severe hypotension. He has a past medical history of heart failure with reduced ejection fraction (last EF 24%) and has not been compliant with his diuretics or diet. He has been admitted multiple times in the past year for heart failure exacerbations. On arrival to the Emergency Department, he is cool and minimally responsive with an initial blood bilateral pressure of 70/40 mm Hg. He is started on dobutamine and norepinephrine. On arrival to the ICU, the patient has a right radial arterial line placed without complication. The monitor reports a blood pressure of 65/55 mm Hg. The blood pressure is immediately rechecked manually, and a reading of 80/40 mm Hg is obtained.

Which of the following is the MOST likely reason for this discrepancy?

a. Failure to adequately prime arterial line
b. Patient has severe aortic regurgitation
c. Patient has severe peripheral vascular disease
d. Patient has concurrent sepsis

Question 5#Print Question

A 70-year-old male with past medical history of mild-moderate mitral regurgitation and moderate-severe tricuspid regurgitation, COPD, and secondary pulmonary hypertension presents to the Emergency Department with a fever and new cough. Vitals on presentation are notable for a blood pressure of 80/43, temperature of 38.7°C, and oxygen saturation of 80% on room air, which improves modestly with 6 L oxygen by nasal cannula. Chest radiograph shows multifocal airspace opacities suggestive of pneumonia, but not pulmonary edema. He is transferred to the ICU for intubation. Examination is also notable for cool extremities with +1 symmetric lower extremity edema. In determining whether to administer fluids to this patient to augment his mean arterial pressure, which of the following techniques would be LEAST helpful?

a. Pulmonary Arterial Catheter (PAC)
b. Central Venous Pressure (CVP)
c. Pulse pressure variation
d. Passive leg raise

Category: Critical Care Medicine-Cardiovascular Disorders--->Imaging and Diagnostic Modalities
Page: 1 of 2