CEP Cardiac Care & Emergency Pharmacology 2 — Questions and Answers
Question 1: A patient in ventricular fibrillation does not respond to the first defibrillation attempt. What is the next immediate action?
- Administer amiodarone 300 mg IV and resume CPR
- Increase defibrillator energy and shock again immediately
- Resume CPR for 2 minutes before the next shock (Correct answer)
- Administer epinephrine 1 mg IV before the next shock
Correct answer: Resume CPR for 2 minutes before the next shock
After a failed defibrillation, CPR should be resumed immediately for 2 minutes before reassessing rhythm and delivering another shock.
Question 2: Which electrolyte abnormality is most commonly associated with Torsades de Pointes?
- Hyperkalemia
- Hypomagnesemia (Correct answer)
- Hypercalcemia
- Hypernatremia
Correct answer: Hypomagnesemia
Hypomagnesemia is the most common electrolyte disturbance causing Torsades de Pointes by prolonging the QT interval.
Question 3: A patient presents with a heart rate of 180 bpm with a narrow QRS and no P waves visible. The patient is hemodynamically stable. What rhythm is most likely?
- Atrial flutter with 2:1 block
- Wolff-Parkinson-White syndrome
- Supraventricular tachycardia (SVT) (Correct answer)
- Ventricular tachycardia
Correct answer: Supraventricular tachycardia (SVT)
SVT presents with a regular narrow-complex tachycardia around 150-220 bpm where P waves are often hidden in the T wave.
Question 4: A 60-year-old male takes metoprolol daily and presents with a HR of 34 bpm and hypotension. Which medication is contraindicated?
- Calcium chloride
- Glucagon
- Epinephrine
- Atropine (Correct answer)
Correct answer: Atropine
Atropine is unlikely to be effective in beta-blocker overdose bradycardia because the block occurs downstream of the muscarinic receptor; glucagon or calcium are preferred.
Question 5: During a cardiac arrest, when should the first dose of amiodarone be given?
- Before the first defibrillation
- After the first defibrillation and a 2-minute CPR cycle
- After the third defibrillation attempt (Correct answer)
- After epinephrine has been given twice
Correct answer: After the third defibrillation attempt
Amiodarone 300 mg IV is administered after the third defibrillation attempt in refractory VF/pVT per AHA guidelines.
Question 6: A patient with an acute MI develops a new right bundle branch block and hypotension. Which intervention takes priority?
- Transcutaneous pacing
- IV fluid bolus
- Immediate transport for PCI (Correct answer)
- Adenosine 6 mg rapid IV push
Correct answer: Immediate transport for PCI
New RBBB with hemodynamic compromise in the setting of acute MI indicates a large infarction requiring immediate percutaneous coronary intervention.
Question 7: Nitroglycerin is contraindicated in which of the following clinical scenarios?
- Anterior STEMI with hypertension
- Inferior STEMI with suspected right ventricular infarction (Correct answer)
- NSTEMI with chest pain at rest
- Stable angina with systolic BP of 140 mmHg
Correct answer: Inferior STEMI with suspected right ventricular infarction
Nitroglycerin is contraindicated in right ventricular infarction because preload reduction can cause severe hypotension in a preload-dependent RV.
CEP Cardiac Care & Emergency Pharmacology 2
A patient in ventricular fibrillation does not respond to the first defibrillation attempt.
What is the next immediate action?