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

Question 6# Print Question

A 68-year-old male with a past medical history of coronary artery disease and myocardial infarction requiring three drug-eluting stents presents to the Emergency Department with exertional chest pain. He describes the pain as substernal pressure, without radiation. After his past stents, he attended cardiac rehab and he now walks a few miles per week for exercise. He does not have pain at rest, but over the past months is only able to walk a few minutes when he notices the chest pain with mild dyspnea. The pain resolves when he sits down for a few minutes. He is not able to walk more than half a mile without having significant pain. He feels this is similar to the pain he had before his stents were placed. His ECG is unchanged. His last ECG exercise stress test was 10 years ago, before his stent placements. In evaluating his pain, which of the following is the most appropriate test?

A. Cardiac MRI
B. Transthoracic Echocardiography
C. Technitium-99 Sestamibi Scan
D. Exercise ECG Stress Test


Question 7# Print Question

A 79-year-old female with a past medical history of rheumatoid arthritis, heart failure with reduced ejection fraction (EF 30%), and severe pulmonary hypertension presents to the Emergency Department with fever and dysuria. Vitals on arrival are notable for:

  • blood pressure of 70/48 mm Hg
  • heart rate of 105 beats per minute
  • oxygen saturation of 89% on room air

She has cool extremities, crackles, and significant lower extremity edema. Urinalysis shows significant pyuria with positive nitrite and leukocyte esterase, and significant bacteriuria, and she is started on broad spectrum antibiotics. Laboratory studies are also notable for an NT-proBNP elevated to three times of recent baseline. She is placed on oxygen and her MAP rise to 66 on three vasopressors. Echocardiogram shows a similar EF, with estimated RVSP is 92 mm Hg. Her peripheral O2 venous saturation is 93% on 4 L of nasal cannula. The intensivist decides to place a PAC via the right internal jugular vein. Due to her medical history, which among the following complications is she at the GREATEST risk for?

A. Complete heart block
B. Thromboembolism
C. Misplacement of the catheter into the LA
D. Pulmonary artery rupture


Question 8# Print Question

 A 70-year-old female with a past medical history of iron-deficiency anemia, pulmonary hypertension, and diastolic heart failure presents to the Emergency Department with fever and productive cough. She has also noticed a 10 lb weight gain in the last 2 weeks. Vitals on presentation are notable for:

  • blood pressure of 69/40 mm Hg
  • temperature of 39.0°C
  • heart rate of 130 beats/min
  • oxygen saturation of 85% on room air

Her laboratory test results are notable for an NT-proBNP three times her baseline and a WBC count of 11,000 cells/µL. She is immediately started on broad spectrum antibiotics and transferred to the ICU for mixed shock. Her MAPs remain in the 50s, and she is started on pressor support with limited improvement. Her oxygenation remains poor, and she is intubated for hypoxemic respiratory failure and sedated with propofol. The decision is made to place a pulmonary artery catheter to further guide management. In interpreting her pulmonary artery catheter readings, which of the following in her presentation would lead to an INCREASE in her measured mixed venous oxygen saturation? 

A. Fever
B. Tachycardia
C. Anemia
D. Sedation with propofol




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