AEMCA Cardiovascular Emergencies 2 — Questions and Answers
Question 1: A patient presents with crushing chest pain radiating to the left jaw, diaphoresis, and nausea. Which coronary artery is most commonly occluded in an anterior wall MI?
- Right coronary artery
- Left anterior descending artery (Correct answer)
- Left circumflex artery
- Posterior descending artery
Correct answer: Left anterior descending artery
The left anterior descending (LAD) artery supplies the anterior wall of the left ventricle and is most commonly occluded in anterior MI.
Question 2: When applying a 12-lead ECG, which limb lead placement error will invert Lead I and reverse aVR and aVL?
- Swapping RA and LA electrodes (Correct answer)
- Swapping RA and RL electrodes
- Swapping LA and LL electrodes
- Swapping LL and RL electrodes
Correct answer: Swapping RA and LA electrodes
Swapping the right arm (RA) and left arm (LA) electrodes inverts Lead I and reverses the augmented limb leads aVR and aVL.
Question 3: A patient in ventricular fibrillation receives a defibrillation shock. What is the IMMEDIATE next step after the shock is delivered?
- Check the pulse
- Deliver a second shock at higher energy
- Resume CPR for 2 minutes (Correct answer)
- Administer 1 mg epinephrine IV
Correct answer: Resume CPR for 2 minutes
Current AHA guidelines require immediate resumption of CPR for 2 minutes after a defibrillation shock before rhythm and pulse checks.
Question 4: Which ECG finding is most characteristic of hyperkalemia-induced cardiac toxicity?
- Prolonged QT interval
- Peaked (tall, narrow) T waves (Correct answer)
- ST-segment depression in V4-V6
- Prominent U waves
Correct answer: Peaked (tall, narrow) T waves
Hyperkalemia classically causes tall, peaked, narrow T waves as an early sign of cardiac toxicity.
Question 5: A patient with known heart failure presents with severe dyspnea, pink frothy sputum, and SpO2 of 84%. After high-flow oxygen, what is the priority pharmacological intervention?
- Furosemide IV 40–80 mg (Correct answer)
- Metoprolol 5 mg IV
- Adenosine 6 mg rapid IV push
- Amiodarone 150 mg IV over 10 minutes
Correct answer: Furosemide IV 40–80 mg
IV furosemide reduces preload by promoting diuresis and venodilation, directly addressing pulmonary edema in acute decompensated heart failure.
Question 6: During assessment of a pulseless patient, the monitor shows organized electrical activity at 80 bpm. What condition must be considered first?
- Ventricular tachycardia
- Pulseless electrical activity (PEA) (Correct answer)
- Asystole
- Atrial fibrillation with block
Correct answer: Pulseless electrical activity (PEA)
Organized electrical activity without a palpable pulse defines pulseless electrical activity (PEA), requiring CPR and identification of reversible causes.
Question 7: Which reversible cause of PEA is suggested by distended neck veins, absent breath sounds on the left, and tracheal deviation to the right?
- Hypovolemia
- Tension pneumothorax (Correct answer)
- Cardiac tamponade
- Pulmonary embolism
Correct answer: Tension pneumothorax
Tension pneumothorax causes JVD, absent breath sounds on the affected side, and tracheal deviation away from the affected side, and is a reversible cause of PEA.
AEMCA Cardiovascular Emergencies 2
A patient presents with crushing chest pain radiating to the left jaw, diaphoresis, and nausea.
Which coronary artery is most commonly occluded in an anterior wall MI?