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Self-Assessment Questions

Cardiology

Coronary Artery Disease: Review Questions

Beth R. Malasky, MD

Dr. Malasky is a Clinical Assistant Professor of Medicine and a Cardiologist with the Native American Cardiology Program, University of Arizona Health Sciences Center, Tucson, AZ.


Choose the single best answer for each question.

Questions 1 through 4 refer to the following case study.

A 60-year-old man with hypertension, dyslipidemia, and a 20-year history of diabetes mellitus goes to the emergency department because of a 1-month history of cough, increasing dyspnea, abdominal bloating, and orthopnea requiring him to sleep sitting up. He reports that his cough is productive of green sputum. He has had some lower extremity edema over the past week but reports no chest pain. He is in rapid atrial fibrillation, with a ventricular rate of 140 bpm. His blood pressure is 120/75 mm Hg, temperature is 38.6°C (101.5°F), and oxygen saturation is 86% on room air. He has absent breath sounds one third of the way up on the right side and rales halfway up, bilaterally. His jugular venous pressure is elevated to the angle of the jaw, and he has an enlarged liver with hepatojugular reflux.

1. Which of the following is NOT an appropriate intervention for this patient?
  1. Administer a low-dose beta-blocker, intravenously
  2. Administer flecainide
  3. Administer heparin, furosemide, and oxygen
  4. Load with digoxin, intravenously
  5. Perform cardioversion
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2. The patient receives appropriate therapy and converts spontaneously to sinus tachycardia at a rate of 120 bpm. Electrocardiography reveals Q waves in the inferior leads, poor R wave progression in the anterior precordium, and nonspecific ST and T wave changes. Chest radiography reveals pulmonary edema with an effusion on the right side. At this time, which of the following is NOT an appropriate diagnostic evaluation?

  1. Monitor serial cardiac enzyme levels to rule out myocardial infarction
  2. Monitor on telemetry and follow electrolyte levels
  3. Obtain sputum for Gram stain and blood cultures
  4. Perform echocardiography
  5. Perform stress test with nuclear imaging
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3. The patient’s troponin I level is elevated to 14 ng/mL, with a normal proportion of creatine kinase­MB isoenzymes. Echocardiography reveals severely decreased left ventricular (LV) function with multiple segmental wall motion abnormalities and an ejection fraction of 20%. There is dilation of the left ventricle and left atrium, moderate mitral regurgitation, and moderate tricuspid regurgitation, with an estimated pulmonary artery pressure of 70 mm Hg. The patient is placed on heparin, low-dose dopamine, and an aggressive diuretic regimen. He loses 10 kg (22 lb) during the next 48 hours and is finally able to lie flat. Which of the following is the most appropriate test to perform next?
  1. Cardiac catheterization
  2. Cardiac magnetic resonance imaging
  3. Dobutamine echocardiography
  4. Electron beam computed tomography
  5. Stress test
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4. The patient has severe 3-vessel coronary artery disease and is referred for bypass surgery. The surgeons are concerned about his severely decreased LV function. Which of the following tests will NOT help predict improvement in cardiac function and survival after revascularization?

  1. Dobutamine echocardiography
  2. Electron beam computed tomography
  3. Fluorodeoxyglucose positron emission tomography
  4. Persantine sestamibi imaging
  5. Rest-rest thallium
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