Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Cardiovascular Disorders--->Arrhythmias and Pacemaker
Page: 2

Question 6# Print Question

A 67-year-old man with peripheral vascular disease is about to undergo transmetatarsal amputation and lower extremity skin grafting. The patient had a recent diagnosis of ischemic cardiomyopathy (LVEF 25%) and a latest generation implantable cardioverter defibrillator (ICD) placed a few months ago. The patient is pacemaker dependent 99% of the time according to the recent outpatient ICD interrogation. The surgeon is urging you to quickly bring the patient into the operating room, not worry about the ICD, and promises to avoid any electrocautery. 

Which of the following statements is MOST correct?

A. Applying a magnet for the duration of the case or obtaining an EP consultation before the case is the standard of care for all surgical patients
B. Proceed with the case as requested, ensure that a magnet and TCP equipment are readily available, and insist that only brief bipolar electrocautery bursts are used if any
C. Use of harmonic scalpel confers a similar risk of electromagnetic interference as monopolar and bipolar electrocautery
D. A magnet application onto the ICD will reliably deactivate antitachycardia pacing and defibrillation
E. A magnet application onto the ICD will reliably switch the pacemaker into an asynchronous mode

Question 7# Print Question

A 75-year-old male suffered an acute myocardial infarction (AMI) while driving his car resulting in a head-on collision with an incoming driver. He suffered multiple rib fractures causing a pneumohemothorax and pericardial tamponade and is he being rushed in the operating room for exploration. In the operating room, you note that the patient has intermittent sinus arrest. The surgeon is placing atrial and ventricular pacing wires and is asking you how you would like to pace the patient now that the surgical portion of the case is over.

Which of the following statements is MOST accurate?

A. VOO is the preferred pacing mode for this patient
B. DOO confers less risk of R-on-T phenomenon compared with VOO
C. R-on-T phenomenon is impossible in VVI pacing
D. R-on-T phenomenon is impossible in DDD pacing
E. AAI is a reasonable pacing mode for this patient

Question 8# Print Question

You are called to bedside in the ICU to a 73-year-old female admitted with urosepsis and non-ST elevation myocardial infarction for evaluation of arrhythmia on telemetry. Her 12-lead ECG reveals intermittent torsades de pointes (TdP) and the patient is hemodynamically stable.

Which of the following statements is MOST correct?

A. Magnesium sulfate is the first-line agent in sustained TdP
B. Amiodarone prolongs QT interval and is considered low risk for TdP
C. Sotalol and verapamil are safe nodal blocking agents for patients at risk for TdP
D. Haloperidol, methadone, erythromycin, and procainamide are safe in patients at risk for TdP
E. Hyperkalemia is a risk factor for TdP

Question 9# Print Question

A 75-year-old male with AMI was admitted to the intensive care unit (ICU). Initially hemodynamically and respiratory stable, the patient’s heart rhythm suddenly changed into what appears to be a supraventricular tachycardia with a heart rate of 180 beats/min. The resident asks for your help and suggests administering lidocaine for the patient’s arrhythmia. As you discuss the plan at the bedside, the patient suddenly becomes unresponsive and ventricular tachycardia (VT) is noted on the telemetry. 

Which of the following statements is MOST correct regarding the next steps in the patient’s management?

A. Amiodarone use improves survival of in-hospital cardiac arrest
B. Prophylactic lidocaine and high-dose amiodarone administration for the prevention of VT after AMI may increase mortality
C. Lidocaine administration is associated with increased survival when given prophylactically after return of spontaneous circulation in adults with ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest
D. Lidocaine for VF/pVT leads to worse long-term survival when compared with amiodarone
E. Lidocaine administration is efficacious for the treatment of supraventricular tachycardia

Question 10# Print Question

An 83-year-old male with a history of ischemic cardiomyopathy, systolic heart failure (LVEF 24%), and combined pacemaker and ICD for cardiac synchronization therapy (CRT-D) underwent coronary artery bypass graft (CABG) surgery three days ago. He still has atrial and ventricular epicardial pacing wires in place. He is now urgently admitted to the ICU with acute decompensation of his heart failure and volume overload. On transthoracic echocardiogram, his LVEF is reduced to 15% and the patient’s heart rhythm shows frequent alternating runs of AF/atrial flutter (HR 110s) and monomorphic VT (HR 100s). During these episodes, the patient becomes lightheaded because of mild hypotension.

Which of the following statements about the next steps in management is MOST accurate?

A. Overdrive pacing is not efficacious for breaking postoperative atrial flutter in patients that underwent heart surgery
B. Biatrial but not right atrial pacing reduces the incidence of AF after CABG
C. Epicardial overdrive pacing is contraindicated in patients with monomorphic VT
D. Procainamide is recommended as initial treatment of patients with stable sustained monomorphic VT
E. Verapamil and diltiazem are safe choices for patients with VTs and myocardial dysfunction

Category: Critical Care Medicine-Cardiovascular Disorders--->Arrhythmias and Pacemaker
Page: 2 of 2