palpitations. EKG 1a is obtained. She is treated with adenosine, and EKG 1b is obtained. What is the most likely cause of this tachycardia? A. AV reentry using an accessory pathway B. AV nodal reentrant tachycardia C. Atrial tachycardia D. Sinus tachycardia 1a 1b 2. A 47 year old female with a history of alcoholism and schizophrenia is admitted to the hospital with pyelonephritis and started on intravenous ciprofloxacin. She complains of palpitations and one episode of near syncope. EKG 2 is obtained. Which of the following therapies is most appropriate at this point? A. Temporary pacing B. Isoproterenol C. Potassium and magnesium repletion D. Change from intravenous to oral ciprofloxacin E. Atropine 2. 3. A 50 year old smoker with chronic bronchitis treated with beta-2 agonists and theophylline presents with dyspnea. His temperature is 102 F, BP 130/70 mm Hg, and RR is 32 breaths/min; pulse is irregular. There are diffuse wheezes, the nail beds are cyanotic, and the jugular veins are moderately distended. EKG 10 is obtained. What is the EKG diagnosis? Which intervention is most appropriate? A. Digitalization B. Electrical cardioversion C. Oxygen, acetaminophen, and discontinuation of theophylline D. Activated charcoal E. Verapamil, 1 mg/min IV 3 4a. A 60 year old man presents to the emergency room with 3 mm of ST segment elevation in leads V 1 to V 3 . His blood pressure is 120/80 mm Hg, and he is complaining of chest discomfort and is diaphoretic. The rhythm shown in EKG 4a is noted. What is the EKG diagnosis? What immediate intervention is most appropriate? A. Carotid sinus massage B. Intravenous beta blockade C. Intravenous amiodarone D. Electrical cardioversion E. Intravenous procainamide 4a. 4b. Sinus rhythm is restored, he is given thrombolytic therapy, bolused with 1 mg/kg lidocaine, and started on a lidocaine infusion at 2 mg/min. The rhythm shown in EKG 4b is noted. What is the EKG diagnosis? Which intervention is most appropriate? A. Discontinue the lidocaine B. Give additional lidocaine, 0.5 mg/kg IV bolus, and increase the lidocaine to 3 mg/ml C. Change the lidocaine to amiodarone D. Electrical cardioversion E. Observation 4b 5. A 69 year old man has been undergoing evaluation for palpitations. His resting EKG is EKG 5a. A previous echocardiogram and exercise stress test have been normal. He presents to the emergency room with palpitations, and EKG 5b is obtained. On 12-lead monitoring, the rhythm shown in EKG 5c is noted. Which of the following is true? A. This condition rarely results in sudden death B. This arrhythmia is sensitive to adenosine C. This arrhythmia usually responds to calcium channel blockers and beta blockers D. This arrhythmia is amenable to catheter ablation E. All of the above 5a. 5b. 5c. 6. A 55 y/o male with history of alcoholism is pulled out of Lake Michigan after a near- drowning. The following ECG suggests:
A. Hyperkalemia B. Acute myocardial infarction C. Hypothermia D. Left bundle branch block 6. 7. A 64 year old woman with a history of previous myocardial infarction is admitted for chest pain, and noted to have the rhythm seen in EKG 7. Which of the following is the most appropriate treatment? A. Intravenous amiodarone B. Intravenous lidocaine C. Beta blockade D. Intravenous diltiazem E. An electrophysiology consult for implantable defibrillator placement 7 8A. A 74 year old man with a previous history of MI presents with palpitations. EKG 8a is obtained. What is the EKG diagnosis? A. Atrial fibrillation B. Ventricular tachycardia C. Junctional rhythm with premature ventricular contractions D. Sinus rhythm with evidence of acute myocardial infarction 8a. 8B. He has recurrent symptoms, and EKG 8b is obtained. What is the rhythm? A. Atrial fibrillation B. Ventricular tachycardia C. Junctional rhythm with premature ventricular contractions D. Sinus rhythm with evidence of acute myocardial infarction 8b. 9. A 53 year old with no past medical history presents with palpitations and EKG 9. His blood pressure is 105/70 mm Hg, and an echocardiogram reveals normal left ventricular function and wall motion. The most appropriate therapy at this point would be: A. Adenosine for AV node reentrant tachycardia with RBBB B. Emergent cardioversion without sedation C. Intravenous diltiazem for atrial flutter D. Intravenous amiodarone 9. 10A. A 27 year old man with no previous medical history presents with palpitations and EKG 10a. His blood pressure is 100/60 mm Hg. Which of the following is correct? A. IV diltiazem should be started for rate control of supraventricular tachycardia B. IV amiodarone should be started for stable ventricular tachycardia C. IV diltiazem should be given for right ventricular outflow tract tachycardia D. IV amiodarone should be given for atrial fibrillation with WPW syndrome E. Digoxin should be given for rate control of atrial fibrillation 10a. 10b. The patient becomes diaphoretic, and blood pressure drops to 70/40 mm Hg. What is the appropriate next step? A. IV amiodarone B. IV procainamide C. IV lidocaine D. IV diltiazem E. Electrical cardioversion 10c. The patient is converted to sinus rhythm. EKG 10c is obtained. Which of the following is correct? A. The patient is not at increased risk for sudden death B. The patient should undergo catheter ablation C. The patient should have an implantable defibrillator placed D. The patient should have an ICD and a catheter ablation 10c. 10d. The patient has recurrent symptoms and EKG 10d is obtained. What is the most likely etiology of the rhythm? A. Orthodromic reentrant tachycardia (AV reentrant tachycardia) B. AV nodal reentry tachycardia C. Atrial fibrillation D. Atrial tachycardia 10d. 11. A 66 year old with a pacemaker presents with palpitations. Blood pressure is 100/70, and lungs are clear. EKG 11 is obtained. The best course of action at this point would be to: A. Give diltiazem 10 mg IV B. Give lidocaine 100 mg IV C. Put a magnet over the chest D. Sedate and perform electrical cardioversion E. Give amiodarone 150 mg IV 11. 12. A 57 year old woman with history of laxative abuse and recent vomiting has a seizure at home and is transferred to the emergency department. EKG 12 is obtained. The nurse asks which antiarrhythmic agent you wish to choose. What is the best answer? A. Amiodarone B. Procainamide C. Flecainide D. Diltiazem E. None of the above 12.