ITE Cardiology Practice Exam

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• Preoperative evaluation for a patient with a suspected CIED should include which step?
• If electromagnetic interference is likely during a procedure and the patient has a device-dependent CIED, what is the recommended action?
• The QTc threshold used to define prolongation in this context is greater than how many milliseconds?
• Lusitropy refers to which aspect of cardiac function?
• In a patient with multiple risk factors, which factor among the listed is most likely to have increased myocardial oxygen demand during a procedure?
• Which is an advantage of centrifugal pumps over roller pumps in cardiopulmonary bypass circuits?
• Which statement best describes vasopressin's relation to dobutamine in cardiogenic shock?
• Which are the three main determinants of myocardial oxygen demand?
• Which patient scenario would most likely benefit from continuing or initiating perioperative beta-blocker therapy according to guidelines?
• The SA node is supplied by which artery in about 60% of cases?
• What is the normal central venous pressure (CVP) range?
• Diltiazem mechanism and indications.
• Which statement correctly identifies high-risk dental procedures requiring endocarditis prophylaxis?
• In a patient with severe aortic stenosis, which induction agent is preferred to maintain hemodynamics?
• In elderly patients undergoing anesthesia, which statement is most likely true compared to younger patients?
• Which agents decrease CMR and increase CBF but do so to a lesser extent than volatile anesthetics?
• What is the primary hemodynamic benefit of ventricular hypertrophy?
• In stable SVT management, which pharmacologic regimen is described?
• Which imaging modality is more sensitive for detecting the acute phase of stroke?
• In the Revised Cardiac Risk Index, which factor is considered high-risk type of surgery?
• Perioperative anemia is associated with increased risk of mortality; mortality risk is especially high when hemoglobin is below which level?
• Which ECG lead configuration is preferred for intraoperative ischemia monitoring and rhythm surveillance?
• What best describes the windsock effect in thoracic aortic aneurysm stent deployment?
• What is the approximate elimination half-life of Nesiritide?
• Negative lusitropy is best described as what?
• Hypercapnia causes what change in cerebral circulation?
• Which perioperative management strategy is commonly used for pacemaker-dependent patients to mitigate EMI from electrocautery equipment?
• Which feature improves defibrillation success when using a biphasic defibrillator?
• In LV hypertrophy, the ventricle is more dependent on atrial contraction to maintain LVEDV.
• Nitroglycerin is best described as which mechanism of action relevant to acute coronary syndromes?
• In dual-chamber pacing, the second spike indicates what?
• Hypovolemic shock results in decreased preload and what pattern of systemic vascular resistance?
• What is the most common complication of cardiac surgery or induction as described in the material?
• Which statement about endocarditis prophylaxis indications is accurate?
• Which statement best summarizes the coagulation pathways?
• In the context of air embolism terminology, VAE stands for which condition?
• Administration of epinephrine increases contractility. On the Frank-Starling curve for a normally functioning ventricle, this results in which shift?
• Mannitol is contraindicated in which condition due to the risk of increasing intravascular volume?
• Which is NOT a recognized side effect of amiodarone?
• Which treatment is used for severe digoxin toxicity?
• In the mid-esophageal two-chamber view (60-90 degrees), which left ventricular wall is typically the anterior wall?
• In right ventricular infarction, which therapy should be avoided due to preload reduction and potential hemodynamic compromise?
• In Wolff-Parkinson-White syndrome with SVT, which agent is safe to treat through the accessory pathway?
• Labetalol pharmacology describes which profile?
• Regional anesthesia can reduce afterload. How does this affect mitral valve prolapse and its murmur?
• In cardiogenic pulmonary edema, alveolar flooding tends to occur more in which part of the lungs?
• On CVP tracing, which pattern is characteristic of tricuspid stenosis?
• In serotonin syndrome, which medication is used as treatment?
• Which medication decreases digoxin plasma levels?
• In tamponade management, which step is most appropriate for stabilization when the patient is unstable?
• In the perioperative management of congenital LQTS, which action is recommended?
• Which of the following is NOT a Revised Cardiac Risk Index variable?
• Fenoldopam is a dopamine D1 receptor agonist that increases renal perfusion and diuresis without alpha or beta activity. Which statement best describes its hemodynamic profile?
• Inodilator therapy can differ from milrinone in what regard?
• What is a commonly cited threshold for aneurysm repair in both abdominal and thoracic aneurysms?
• During laparoscopic surgery, pneumothorax would most likely present with which combination of findings?
• Which autonomic change does the carotid sinus reflex produce?
• In a pacemaker-dependent patient with a dual-chamber device, which ECG pattern represents sequential atrial and ventricular pacing?
• Which ECG finding is typical of hyperkalemia?
• Intraoperative bradycardia in a heart transplant recipient with minimal blood loss: what is the most appropriate intervention to increase heart rate?
• Fondaparinux has been shown to decrease the risk of DVT/PE compared with LMWH, but at the cost of which adverse effect?
• Compared with open repair, endovascular repair of the descending thoracic aorta generally results in which outcome?
• Cardiogenic shock is associated with which hemodynamic profile?
• Which factors are part of the common pathway?
• Electrical cardioversion is typically reserved for patients with which presentation of atrial fibrillation?
• Which class of medications is associated with acquired LQTS?
• How should the IABP be timed during the cardiac cycle?
• In massive intracardiac venous air embolism, what is the most direct cause of cardiovascular collapse?
• Which medications should be used with caution in inferior wall ischemia or when complete heart block is a concern?
• Which change increases myocardial oxygen supply?
• Which AV block type is typically treated with a permanent pacemaker?
• Which pad positions are considered reasonable and effective for defibrillation?
• Obstructive shock presents with which hemodynamic pattern?
• In an ECG, a large R wave in lead V1 should prompt consideration of which diagnosis?
• Coronary artery air occlusion occurs when air moves from the venous to the arterial circulation, typically via which mechanism?
• Which statement correctly matches the three coagulation pathways?
• What is the effect of inotropic agents that increase contractility on the ventricular function curve?
• Which of the following conditions can increase blood pressure in the operating room?
• Prothrombin time (PT) evaluates which coagulation pathways?
• Which of the following is a risk factor for sudden death in congenital LQTS?
• Inheritance pattern of congenital LQTS is typically autosomal dominant or recessive.
• Tachycardia and peripheral vasoconstriction in response to reduced cardiac output serve what purpose?
• In heart transplant recipients, which autonomic innervation is absent at baseline?
• Diffusion-weighted imaging in acute ischemia reveals cytotoxic edema as which type of signal?
• Which statement about HiTT is true?
• According to ACC/AHA guidelines, patients with no active cardiac conditions and functional capacity greater than 4 METs generally require what regarding preoperative cardiac testing?
• Which statement about the intra-aortic balloon pump (IABP) curve is true?
• Which agent is NOT typically used for acute intraoperative hypertension due to its long-acting effect?
• Which reflex is characterized by bradycardia and vasodilation in response to myocardial ischemia with an empty ventricle?
• Which CVP pattern is typical of cardiac tamponade?
• Which of the following is commonly included in the initial management of cardiogenic pulmonary edema?
• Which perioperative agent is considered the gold standard for DVT/PE prophylaxis due to its balance of efficacy and bleeding risk?
• Approximately how much air and carbon dioxide can result in a fatal air lock during venous gas embolism?
• In the setting of AV block, which statement best describes third-degree (complete) heart block?
• A patient on selegiline (MAOI) requires a perioperative vasopressor. Which agent should be avoided?
• In acute pericardial tamponade requiring emergent intervention, which therapy is least appropriate?
• Inferior wall myocardial infarction with ST elevations in leads II, III, aVF and right-sided lead V4R is most commonly due to occlusion of which artery?
• Which finding defines severe preeclampsia?
• In about 15% of patients, which artery gives rise to the PDA, leading to a left-dominant circulation?
• Mobitz type II AV block is defined by which finding?
• Which of the following statements about non-specific ST-segment depression is true?
• Capnography can yield false-negative readings in which scenario?
• In left ventricular diastolic dysfunction due to hypertrophy, what is the main hemodynamic consequence?
• Which induction agent is described as having less cardiac depressant effects and preserving spontaneous ventilation?
• Which equation correctly defines LV wall tension T?
• What is a potential neurologic complication of thoracic endovascular aortic repair related to spinal perfusion?
• Which mechanism best describes how PEEP improves oxygenation?
• Which description correctly characterizes the pharmacologic profile of labetalol?
• Regarding defibrillation pad placement, which statement is true?
• In mitral valve prolapse with regurgitation, which hemodynamic change should be avoided to prevent worsening prolapse?
• Which scenario increases the CBF/CMR ratio more when MAC is around 0.8?
• Which statement about left ventricular anterior wall imaging in transesophageal echocardiography is true?
• High-dose thrombin time (HiTT) specifically tests the effect of heparin on thrombin by measuring what process?
• In a patient with suspected right ventricular infarction, the first-line treatment to optimize preload is a saline bolus. Which option represents this initial intervention?
• Before cardioversion for atrial fibrillation lasting more than 48 hours, which test is used to rule out cardiac thrombus?
• What is the normal range for cardiac index (CI)?
• What is the correct order of the heart's electrical nodes?
• On an arterial pressure tracing with an intra-aortic balloon pump, the arrow indicates which phase?
• Luxury perfusion is defined as which combination?
• What is a key perioperative goal for LQTS patients?
• Coronary blood flow occurs primarily during which phase of the cardiac cycle?
• In cardiac arrest resuscitation, what is the initial action?
• Which electrolyte correction is part of digoxin toxicity management?
• During cardiac arrest, which receptor activation is most important to improve coronary and cerebral perfusion when using epinephrine?
• Which medication is used prophylactically to prevent eclampsia in patients with preeclampsia?
• Which of the following is NOT observed immediately after aortic cross-clamping?
• Milrinone effect on left ventricular diastolic pressure (LVDP) as described in the material?
• Under the Frank-Starling mechanism, what is the effect of increasing venous return on stroke volume?
• Which is listed as a possible intraoperative cause of hypertension?
• In healthy patients undergoing non-cardiac surgery, which transfusion strategy has not been shown to improve morbidity and mortality?
• Which is considered the first-line long-term management for most patients with congenital LQTS?
• Which statement describes the effect of perioperative beta-blockade as per guidelines?
• What is the role of positive end-expiratory pressure (PEEP) in preventing venous air embolism?
• For synchronized cardioversion of PSVT or Atrial Flutter, what is the initial energy setting?
• Sodium nitroprusside (SNP) has which of the following properties?
• In malignant hyperthermia, which intervention is used to correct metabolic acidosis?
• When prosthetic valve dysfunction is suspected in a patient with a mechanical valve, which imaging modality is the initial investigation of choice?
• Ischemic preconditioning is characterized by which of the following features?
• Atenolol is described as which of the following?
• Spinal drainage may be considered in which scenarios during or after aortic procedures?
• Which of the following pacemaker modes is asynchronous, pacing at a fixed rate without sensing?
• In the mid-esophageal two-chamber view, which wall is typically supplied by the right coronary artery?
• In unstable SVT, what is the initial energy setting for synchronized cardioversion?
• Which factor is NOT considered a high-risk factor for infective endocarditis prophylaxis?
• Nicardipine is best described as which type of vasodilator and what is its main hemodynamic effect?
• Immediately after delivery in a patient with preeclampsia, sudden dyspnea and hypoxemia are most likely due to which mechanism?
• Which condition requires cardiology evaluation before elective non-cardiac surgery?
• Which laboratory finding is typically elevated in neuroleptic malignant syndrome?
• Milrinone has which primary actions?
• Distributive shock is typically characterized by which combination of vascular resistance and cardiac output?
• Vasopressin deficiency leads to which condition?
• Tolvaptan is a vasopressin receptor type 2 antagonist used to treat which condition?
• Which statement best describes the hemodynamic and respiratory effects of fentanyl when used for induction?
• A cannon a wave on a central venous pressure tracing is a sign of which condition?
• In which scenario is IABP indicated?
• Which medication can increase digoxin levels and toxicity by altering plasma concentration?
• Before surgery in a patient with multiple cardiovascular risk factors, which test is commonly indicated to assess carotid disease?
• In heart failure with preserved ejection fraction (HFpEF), which statement is true?
• During treadmill stress testing, which factor is the largest determinant of myocardial oxygen demand?
• Which type of shock is associated with low systemic vascular resistance and elevated cardiac output?
• Which method is used for secondary confirmation of endotracheal tube placement?
• Which ECG finding is commonly associated with subarachnoid hemorrhage and may indicate morbidity if persistent?
• In the described two-chamber TE view, which structure may be seen in cross-section?
• What is a consequence of left ventricular hypertrophy on diastolic function?
• Which volatile anesthetic is most associated with inducing ischemic preconditioning?
• Paced P-wave morphology depends on atrial lead location. Which statement is most accurate?
• Which test evaluates the anticoagulant effect of high-dose heparin and assesses the intrinsic and final common pathway?
• Which reflex is responsible for sudden bradycardia and hypotension after a high spinal or epidural anesthetic block?
• Which statement best describes malignant hyperthermia?
• Which volatile anesthetic is most associated with ischemic preconditioning?
• Atrial contraction contributes to ventricular filling by approximately what percentage in a normal heart?
• What is the typical minimum duration of dual antiplatelet therapy after a bare-metal stent implantation?
• Which dental procedure is high-risk and requires endocarditis prophylaxis?
• Patients with obstructive sleep apnea are more likely to have which hemoglobin trend?
• In DOO mode during surgery, which scenario can trigger ventricular tachycardia or ventricular fibrillation?
• Which change decreases myocardial oxygen demand?
• In a patient taking sildenafil for erectile dysfunction, which intraoperative medication would be contraindicated due to risk of severe hypotension?
• Why do centrifugal cardiopulmonary bypass circuits require flowmeters on the arterial limb?
• Which combination is not considered appropriate for perioperative atrial fibrillation?
• Which syndrome includes deafness?
• Milrinone is best described as which type of agent?
• Which maneuver BEST helps avoid the windsock effect when deploying a thoracic aortic aneurysm stent?
• In anesthesia management of mitral regurgitation, which combination best describes the hemodynamic goals?
• Which statement best characterizes heart failure with reduced ejection fraction (HFrEF)?
• In most individuals, which artery supplies the SA node?
• Which set of clinical risk factors for coronary disease is listed as relevant in perioperative considerations?
• Multifocal atrial tachycardia is defined by heart rate > 100 and how many distinct P-wave morphologies in the same lead?
• Which statement best describes autonomic innervation of a transplanted heart?
• Which reflex involves carotid body chemoreceptors sensing hypoxemia and hypercapnia to raise sympathetic activity?
• Right ventricular ischemia on CVP tracing may show which configuration on the waveform?
• How does an intra-aortic balloon pump help in cardiogenic pulmonary edema?
• Which medication is most commonly used to terminate an acute paroxysmal SVT by AV nodal blockade?
• Which is part of acute management of congenital LQTS?
• Which statement correctly describes ST-segment elevation in ischemia?
• In trauma with TBI and hypotension with high urine output, which vasopressor is first-line?
• Which symptom is associated with digoxin toxicity?
• Propofol has what cardiovascular effects during anesthesia?
• ACT can be prolonged by which factors?
• In LV hypertrophy, increasing wall thickness reduces wall tension.
• Concentric left ventricular hypertrophy reduces LV wall tension according to the law of Laplace. If arterial pressure P and ventricle radius r remain constant and wall thickness h doubles, what happens to wall tension T?
• What is the most common primary cardiac tumor in adults?
• Which reflex is triggered by traction or pressure on the eye, often causing bradycardia during ocular surgery?
• Which statement correctly describes myocardial hibernation?
• Which scenario is MOST likely to cause harm in a patient with a pacemaker in DOO mode during pacing?
• Which symptom differentiates serotonin syndrome from neuroleptic malignant syndrome?
• Which finding best indicates cardiac tamponade?
• Which modality is best for detecting a pericardial effusion?
• Which reflex is associated with impending herniation and a triad of hypertension, bradycardia, and abnormal breathing?
• What is the most common primary cardiac tumor in children?
• In pacemaker terminology, what does the term 'inhibition' refer to?
• Endovascular aneurysm repair compared with open repair typically shows which outcome?
• What is the most important determinant of myocardial oxygen supply-demand balance?
• Which vasopressor is preferred to maintain systemic vascular resistance and coronary perfusion in a patient with aortic stenosis during anesthesia?
• Which statement about the Frank-Starling curve is correct?
• Endovascular repair is recommended for which condition?
• In cardiogenic shock with low cardiac index and MAP around 75 mmHg, which vasoactive agent is preferred initially?
• Which finding is typical of cardiac tamponade?
• Congenital long QT syndrome is primarily caused by mutations in which cellular components?
• What is the effect of vasodilators such as ACE inhibitors or nitroglycerin on ventricular function in relation to filling pressures?
• What effect does adenosine have on the heart, and for what condition is it first-line therapy?
• In a stable atrial fibrillation patient with a history of severe COPD or diabetes mellitus, which class of drug is preferred for rhythm control?
• Which QRS morphology is commonly seen with ventricular pacing?
• Which electrolyte disturbances can worsen LQTS?
• A hypertensive patient experiences sudden intraoperative hypertension and tachycardia after the omission of which medication?
• Which ECG lead provides the highest sensitivity for detecting myocardial ischemia?
• Which medication increases digoxin sensitivity without changing its plasma level?
• Which statement best describes the effect of furosemide on preload and filling pressures?
• What is the effect of volatile anesthetics on CBF and CMR at MAC less than 1?
• Which gene associations correspond to LQT1, LQT2, and LQT3 respectively?
• Beck's triad for cardiac tamponade includes which combination?
• Ventricular pacing on ECG shows which sequence?
• What is the purpose of a biventricular pacemaker (cardiac resynchronization therapy)?
• Which method is quickest and most reliable to confirm proper placement of a central venous line prior to dilation?
• In a pacemaker-dependent patient undergoing surgery, which perioperative strategy is commonly used to minimize electromagnetic interference?
• Which of the following is a natural defense mechanism that helps the heart tolerate ischemia?
• In a denervated transplanted heart, how does the heart's output respond to circulating catecholamines?
• What does atrial pacing look like on ECG?
• Phenylephrine is an alpha-1 agonist that causes vasoconstriction and increased blood pressure. The rise in blood pressure is attributable to increased systemic vascular resistance and what other mechanism?
• Cardiogenic pulmonary edema following an anterior wall myocardial infarction is most likely due to which mechanism?
• What is the primary method used to confirm endotracheal tube placement at the bedside?
• What is the recommended location of the intra-aortic balloon pump distal tip?
• In concentric LV hypertrophy, which diastolic parameter is most affected?
• Unstable SVT with hypotension or symptomatic: which action constitutes the initial management step?
• In the LV wall tension equation T = (P*r)/(2h), which variable represents the ventricular radius?
• An old myocardial infarction (MI) is defined as MI occurring more than 30 days prior to surgery. How is it categorized?
• Where is the most common location for the right ventricular pacing lead?
• What percentage of patients with congenital LQTS mutations manifest symptoms such as recurrent syncope or cardiac arrest?
• Which scenario increases the cerebral blood flow to cerebral metabolic rate (CBF/CMR) ratio the most?
• What is a typical normal ACT value?
• Vasopressin in cardiogenic shock is a V1 receptor agonist that increases vascular tone and is adjunctive, but lacks inotropy.
• Which positioning is associated with increased risk of intraoperative hypotension due to decreased venous return?
• In a patient with low CI, decreased urinary output, elevated lactate, and hypotension, which vasopressor is preferred?
• In the wall tension formula T = (P × r) / (2h), which variables in the numerator affect T when increased?
• Which statement describes typical stable angina?
• For a patient with a bare-metal coronary stent, how long should aspirin therapy be continued perioperatively?
• What ACT range is typically used as a mark of adequate anticoagulation prior to bypass?
• Which of the following is a Revised Cardiac Risk Index variable?
• Roller pumps in cardiopulmonary bypass are more likely to cause which complication compared with centrifugal pumps?
• The hallmark ECG finding of congenital long QT syndrome is prolongation of the QT interval.
• Which statement accurately describes pacemaker leads?
• Pericardial constriction on CVP tracing is characterized by which pattern?
• Which test is used to assess intrinsic and common pathways at low heparin doses (<1 U/mL)?
• Which statement best describes LV hypertrophy's effect on ventricular compliance?
• For penicillin-allergic patients requiring endocarditis prophylaxis, which regimen is commonly used?
• In inferior-wall myocardial infarction with complete heart block, which artery is most commonly implicated?
• According to the formula T = (P × r) / (2h), which variables determine wall tension?
• Defibrillation using large 4.3 cm electrodes can cause tissue damage; what is a potential risk?
• Which statement correctly describes an intra-aortic balloon pump effect on afterload and coronary perfusion?
• Nesiritide is a recombinant form of human brain natriuretic peptide (BNP). Which statement best describes its clinical effects?
• Oversizing a thoracic aortic stent-graft can lead to which complication?
• Approximately how many mL/kg of air can cause a fatal air lock?
• The most common location of a myxoma, the most common primary cardiac tumor in adults, is which chamber of the heart?
• Activated partial thromboplastin time (aPTT) is used to assess which coagulation pathway, and what happens at heparin concentrations greater than 1 U/mL?
• Which test correlates with heparin concentrations and is unaffected by hemodilution or hypothermia?
• Which condition is an indication for permanent pacemaker placement?
• For a patient with a permanent pacemaker scheduled for knee replacement, what is the BEST preoperative step?
• For a patient with a DDD pacemaker undergoing surgery with EMI, what is a potential risk if EMI is interpreted as R waves?
• What is the windsock phenomenon?
• Which is the primary pharmacologic treatment for malignant hyperthermia?
• Which medication may be used to blunt intense sympathetic responses intraoperatively (bolus plus infusion)?
• For a patient with aortic stenosis undergoing anesthesia, which pre-induction strategy helps reduce the risk of hypotension?
• Which statement best describes defibrillation versus cardioversion?
• Tolvaptan may cause hypotension due to diuresis and is not the drug of choice in patients with which condition?
• Which intraoperative condition is described as causing hypotension by decreasing venous return?