ATRIAL FIBRILLATION

JOHONEY BE JUMAWAN
LEVEL 1- IM RESIDENT CUMC

Source: HARRISON’S PRINCIPLES OF INTERNAL MEDICINE, 20TH EDITION

 IN ADDITION TO AGE AND UNDERLYING
CARDIAC DISEASE, THE FF ARE RISK
FACTORS FOR DEVELOPING AF EXCEPT:
A. OBESITY
B. SLEEP APNEA
C. DIABETES MELLITUS
D. RENAL FAILURE
E. HYPERTENSION
 IN ADDITION TO AGE AND UNDERLYING
CARDIAC DISEASE, THE FF ARE RISK
FACTORS FOR DEVELOPING AF EXCEPT:
A. OBESITY
B. SLEEP APNEA
C. DIABETES MELLITUS
D. RENAL FAILURE
E. HYPERTENSION

pp. 1746
 THE FOLLOWING ARE TRUE
ABOUT AF, EXCEPT:
A. PATIENTS WITH HEART FAILURE HAVE AN INCREASED RISK OF DEVELOPING
AF
B. AF INCREASES THE RISK OF STROKE BY FIVEFOLD & IS ESTIMATED TO BE
THE CAUSE OF 50% OF STROKES
C. AF INCREASES THE RISK OF DEMENTIA AND SILENT STROKES DETECTED BY
MRI
D. AF IS A MARKER FOR OTHER PREDICTORS OF MORBIDITY AND MORTALITY
 THE FOLLOWING ARE TRUE
ABOUT AF, EXCEPT:
A. PATIENTS WITH HEART FAILURE HAVE AN INCREASED RISK OF DEVELOPING
AF
B. AF INCREASES THE RISK OF STROKE BY FIVEFOLD & IS ESTIMATED TO
BE THE CAUSE OF 50% OF STROKES (25%)
C. AF INCREASES THE RISK OF DEMENTIA AND SILENT STROKES DETECTED BY
MRI
D. AF IS A MARKER FOR OTHER PREDICTORS OF MORBIDITY AND MORTALITY

pp 1746
 THE FF ARE ACUTE PRECIPITATING
FACTORS ASSOCIATED WITH AF EXCEPT:
A. HYPERTHYROIDISM
B. ALCOHOL INTOXICATION
C. PULMONARY EMBOLISM
D. ACUTE KIDNEY INJURY
E. MYOCARDIAL INFARCTION
 THE FF ARE ACUTE PRECIPITATING
FACTORS ASSOCIATED WITH AF EXCEPT:
A. HYPERTHYROIDISM
B. ALCOHOL INTOXICATION
C. PULMONARY EMBOLISM
D. ACUTE KIDNEY INJURY
E. MYOCARDIAL INFARCTION

AF ALSO OCCURS IN UP TO 30% OF PATIENTS RECOVERING FROM CARDIAC

SURGERY, ASSOCIATED WITH INFLAMMATORY PERICARDITIS

pp 1746
 PAROXYSMAL AF IS DEFINED BY EPISODES
THAT START SPONTANEOUSLY AND STOP
WITHIN HOW MANY DAYS OF ONSET?
A. 3 DAYS
B. 5 DAYS
C. 7 DAYS
D. 10 DAYS
 PAROXYSMAL AF IS DEFINED BY
EPISODES THAT START SPONTANEOUSLY
AND STOP WITHIN HOW MANY DAYS OF
ONSET?
A. 3 DAYS
B. 5 DAYS
C. 7 DAYS
D. 10 DAYS

pp. 1746
 NEW-ONSET AF THAT PRODUCES SEVERE HYPOTENSION,
PULMONARY EDEMA OR ANGINA SHOULD BE
ELECTRICALLY CARDIOVERTED STARTING WITH HOW
MANY JOULES?

QRS SYNCHRONOUS SHOCK OF

A. 100 J
B. 150 J
C. 200 J
D. 300 J
 NEW-ONSET AF THAT PRODUCES SEVERE
HYPOTENSION, PULMONARY EDEMA OR ANGINA
SHOULD BE ELECTRICALLY CARDIOVERTED
STARTING WITH HOW MANY JOULES?
QRS SYNCHRONOUS SHOCK OF
A. 100 J
B. 150 J
C. 200 J
D. 300 J

pp. 1746
 THE MAJOR SOURCE OF
THROMBOEMBOLISM AND STROKE IN AF IS
FORMATION OF THROMBUS IN:
A. LEFT VENTRICULAR APPENDAGE
B. RIGHT VENTRICULAR APPENDAGE
C. RIGHT ATRIAL APPENDAGE
D. LEFT ATRIAL APPENDAGE
 THE MAJOR SOURCE OF
THROMBOEMBOLISM AND STROKE IN AF
IS FORMATION OF THROMBUS IN:

A. LEFT VENTRICULAR APPENDAGE

B. RIGHT VENTRICULAR APPENDAGE
C. RIGHT ATRIAL APPENDAGE
D. LEFT ATRIAL APPENDAGE

pp. 1747
 WHAT IS THE COMMON PRACTICE FOR
CARDIOVERSION IN PATIENTS WHO HAVE
NOT BEEN ANTICOAGULATED?
(provided they are not at high risk for stroke)

A. CARDIOVERSION WITHIN 24 H OF THE ONSET OF AF

B. CARDIOVERSION WITHIN 48 H OF THE ONSET OF AF
C. CARDIOVERSION ONCE ONSET OF AF EXCEEDS > 48 HRS
D. CARDIOVERSION ONCE ONSET OF AF EXCEEDS > 24 HRS
 WHAT IS THE COMMON PRACTICE FOR
CARDIOVERSION IN PATIENTS WHO
HAVE NOT BEEN ANTICOAGULATED?
(provided they are not at high risk for stroke)

A. CARDIOVERSION WITHIN 24 H OF THE ONSET OF AF

B. CARDIOVERSION WITHIN 48 H OF THE ONSET OF AF
C. CARDIOVERSION ONCE ONSET OF AF EXCEEDS > 48 HRS
D. CARDIOVERSION ONCE ONSET OF AF EXCEEDS > 24 HRS

pp. 1747
 ONE OF THE 2 APPROACHES TO
MITIGATE THE RISK RELATED TO
CARDIOVERSION IS TO ANTICOAGULATE
CONTINUOUSLY FOR HOW MANY WEEKS
BEFORE CARDIOVERSION?
A. 4 WEEKS
B. 2 WEEKS
C. 3 WEEKS
D. 5 WEEKS
 ONE OF THE 2 APPROACHES TO
MITIGATE THE RISK RELATED TO
CARDIOVERSION IS TO ANTICOAGULATE
CONTINUOUSLY FOR HOW MANY WEEKS
BEFORE CARDIOVERSION?
A. 4 WEEKS
B. 2 WEEKS
C. 3 WEEKS
D. 5 WEEKS

pp. 1747
 THE FOLLOWING MEDS CAN BE USED TO
ACHIEVE ACUTE RATE CONTROL IN AF
EXCEPT:
A. NICARDIPINE
B. DIGOXIN
C. CARVEDILOL
D. DILTIAZEM
 THE FOLLOWING MEDS CAN BE USED TO
ACHIEVE ACUTE RATE CONTROL IN AF
EXCEPT:
A. NICARDIPINE
B. DIGOXIN
C. CARVEDILOL
D. DILTIAZEM

pp. 1747
 THESE 2 ARE OFTEN USED IN COMBINATION
FOR PATIENTS WHO HAVE CHRONIC AF:

A. β-ADRENERGIC BLOCKERS & CALCIUM CHANNEL BLOCKERS

B. CALCIUM CHANNEL BLOCKERS AND ACE-INHIBITORS
C. ACE-INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS
D. ANGIOTENSIN RECEPTOR BLOCKERS & β-ADRENERGIC BLOCKERS
 THESE 2 ARE OFTEN USED IN COMBINATION
FOR PATIENTS WHO HAVE CHRONIC AF:

A. β-ADRENERGIC BLOCKERS & CALCIUM CHANNEL BLOCKERS

B. CALCIUM CHANNEL BLOCKERS AND ACE-INHIBITORS
C. ACE-INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS
D. ANGIOTENSIN RECEPTOR BLOCKERS & β-ADRENERGIC BLOCKERS

pp. 1747
 ANTICOAGULATION IS WARRANTED FOR AF
PATIENTS WITH THE FF CONDITIONS
EXCEPT:

A. MITRAL STENOSIS
B. PRIOR HISTORY OF STROKE
C. AORTIC DISSECTION
D. HYPERTROPHIC CARDIOMYOPATHY
 ANTICOAGULATION IS WARRANTED FOR AF
PATIENTS WITH THE FF CONDITIONS
EXCEPT:

A. MITRAL STENOSIS
B. PRIOR HISTORY OF STROKE
C. AORTIC DISSECTION
D. HYPERTROPHIC CARDIOMYOPATHY

pp. 1748
 THE CHA2DS2-VASc SCORE FOR WHICH
ANTICOAGULATION IS RECOMMENDED:

A. > OR = TO 3
B. > OR = TO 2
C. > OR = TO 4
D. > OR = TO 5
 THE CHA2DS2-VASc SCORE FOR WHICH
ANTICOAGULATION IS RECOMMENDED:

A. > OR = TO 3
B. > OR = TO 2
C. > OR = TO 4
D. > OR = TO 5

pp. 1748
 THE FOLLOWING ARE THE MAJOR
OPTIONS FOR ANTICOAGULATION EXCEPT:
A. WARFARIN
B. CLOPIDOGREL
C. RIVAROXABAN
D. DABIGATRAN
 THE FOLLOWING ARE THE MAJOR
OPTIONS FOR ANTICOAGULATION EXCEPT:

A. WARFARIN
B. CLOPIDOGREL
C. RIVAROXABAN
D. DABIGATRAN

pp. 1748
 THE AGENT REQUIRED FOR PATIENTS WITH
RHEUMATIC MITRAL STENOSIS OR
MECHANICAL HEART VALVES:

A. APIXABAN
B. DABIGATRAN
C. WARFARIN
D. HEPARIN
 THE AGENT REQUIRED FOR PATIENTS
WITH RHEUMATIC MITRAL STENOSIS OR
MECHANICAL HEART VALVES:

A. APIXABAN
B. DABIGATRAN
C. WARFARIN
D. HEPARIN

pp. 1748
 THE FF ANTICOAGULANTS HAVE RENAL
EXCRETION AND CANNOT BE USED IN
PATIENTS WITH SEVERE RENAL
INSUFFICIENCY (CrCl <15 mL/min) EXCEPT:
A. DABIGATRAN
B. WARFARIN
C. RIVAROXABAN
D. APIXABAN
 THE FF ANTICOAGULANTS HAVE RENAL
EXCRETION AND CANNOT BE USED IN
PATIENTS WITH SEVERE RENAL
INSUFFICIENCY (CrCl <15 mL/min) EXCEPT:

A. DABIGATRAN
B. WARFARIN
C. RIVAROXABAN
D. APIXABAN

pp. 1748
 A REVERSAL AGENT AVAILABLE
FOR DABIGATRAN:

A. IDARUCIZUMAB
B. VITAMIN K
C. ANDEXANET ALFA
D. FRESH FROZEN PLASMA
 A REVERSAL AGENT AVAILABLE
FOR DABIGATRAN:
A. IDARUCIZUMAB
B. VITAMIN K
C. ANDEXANET ALFA
D. FRESH FROZEN PLASMA

pp. 1749
 WHICH OF THE FF STATEMENTS
ARE TRUE?

A. ASPIRIN AND CLOPIDOGREL ARE SUPERIOR TO WARFARIN FOR STROKE

PREVENTION IN AF
B. ASPIRIN AND CLOPIDOGREL HAVE LESS RISK OF BLEEDING THAN WARFARIN
C. ASPIRIN ALONE IS BETTER THAN COMBINATION OF CLOPIDOGREL + ASPIRIN
FOR STROKE PREVENTION
D. NOTA
 WHICH OF THE FF STATEMENTS
ARE TRUE?
A. ASPIRIN AND CLOPIDOGREL ARE INFERIOR TO WARFARIN FOR STROKE
PREVENTION IN AF
B. ASPIRIN AND CLOPIDOGREL DO NOT HAVE LESS RISK OF BLEEDING THAN
WARFARIN
C. COMBINATION OF CLOPIDOGREL + ASPIRIN IS BETTER THAN ASPIRIN
ALONE FOR STROKE PREVENTION
D. NOTA

pp 1749
 A RHYTHM CONTROL STRATEGY IS
USUALLY SELECTED FOR THE FF
PATIENTS WITH AF, EXCEPT:

A. PATIENTS WITH ASYMPTOMATIC PAROXYSMAL AF

B. PATIENTS WITH RECURRENT EPISODES OF SYMPTOMATIC PERSISTENT AF
C. AF WITH DIFFICULT RATE CONTROL
D. AF RESULTING IN DEPRESSED VENTRICULAR FUNCTION
 A RHYTHM CONTROL STRATEGY IS USUALLY
SELECTED FOR THE FF PATIENTS WITH AF,
EXCEPT:

A. PATIENTS WITH ASYMPTOMATIC PAROXYSMAL AF- SYMPTOMATIC

B. PATIENTS WITH RECURRENT EPISODES OF SYMPTOMATIC PERSISTENT AF
C. AF WITH DIFFICULT RATE CONTROL
D. AF RESULTING IN DEPRESSED VENTRICULAR FUNCTION

pp 1749
 FOLLOWING A 1ST EPISODE OF PERSISTENT
AF, THE FOLLOWING STRATEGIES ARE
REASONABLE EXCEPT:

A. USE OF AV NODAL-BLOCKING AGENTS

B. USE OF ANTICOAGULANTS
C. USE OF ANTIPLATELET
D. CARDIOVERSION
 FOLLOWING A 1ST EPISODE OF PERSISTENT
AF, THE FOLLOWING STRATEGIES ARE
REASONABLE EXCEPT:

A. USE OF AV NODAL-BLOCKING AGENTS

B. USE OF ANTICOAGULANTS
C. USE OF ANTIPLATELET
D. CARDIOVERSION

pp. 1749
 WHICH OF THE FF ARE TRUE OF
ANTIARRHYTHMIC DRUGS?
A. CLASS I SODIUM-CHANNEL BLOCKING AGENTS ARE OPTIONS FOR SUBJECTS
WITHOUT SIGNIFICANT STRUCTURAL HEART DISEASE
B. FLECAINIDE HAS NEGATIVE INOTROPIC AND PROARRHYTHMIC EFFECTS
WHICH WARRANTS AVOIDANCE IN PATIENTS WITH CAD OR HEART FAILURE
C. CLASS III AGENTS (SOTALOL & DOFELITIDE) CAN BE GIVEN TO PATIENTS
WITH CAD OR STRUCTURAL HEART DISEASE
D. ALL OF THE ABOVE
 WHICH OF THE FF ARE TRUE OF
ANTIARRHYTHMIC DRUGS?
A. CLASS I SODIUM-CHANNEL BLOCKING AGENTS ARE OPTIONS FOR SUBJECTS
WITHOUT SIGNIFICANT STRUCTURAL HEART DISEASE
B. FLECAINIDE HAS NEGATIVE INOTROPIC AND PROARRHYTHMIC EFFECTS
WHICH WARRANTS AVOIDANCE IN PATIENTS WITH CAD OR HEART FAILURE
C. CLASS III AGENTS (SOTALOL & DOFELITIDE) CAN BE GIVEN TO PATIENTS
WITH CAD OR STRUCTURAL HEART DISEASE
D. ALL OF THE ABOVE

pp. 1749
 AN AGENT WHICH IS MORE EFFECTIVE IN
MAINTAINING SINUS RHYTHM IN APPROX. 2/3 OF
PATIENTS AND CAN BE GIVEN TO PATIENTS WITH
CAD & HEART FAILURE

A. DRONEDARONE
B. AMIODARONE
C. DOFETILIDE
D. PROPAFENONE
 AN AGENT WHICH IS MORE EFFECTIVE IN MAINTAINING
SINUS RHYTHM IN APPROX. 2/3 OF PATIENTS AND CAN BE
GIVEN TO PATIENTS WITH CAD & HEART FAILURE

A. DRONEDARONE
B. AMIODARONE
C. DOFETILIDE
D. PROPAFENONE

pp. 1749
 WHICH OF THE FF ARE TRUE OF
CATHETER ABLATION IN AF?
A. CATHETER ABLATION INVOLVES CARDIAC CATHETERIZATION,
TRANS(ATRIAL) SEPTAL PUNCTURE & CRYOABLATION TO ABOLISH THE
ABILITY OF TRIGGERING FOCI IN THESE REGIONS TO INITIATE AF
B. ABLATION IS LESS EFFECTIVE IN PATIENTS WITH PERSISTENT AF,
PARTICULARLY LONG-STANDING PERSISTENT AF
C. IN PATIENTS WITH PAROXYSMAL AF, SINUS RHYTHM IS MAINTAINED FOR > 1
YEAR AFTER 1 ABLATION PROCEDURE IN ~60% OF PATIENTS
D. ALL OF THE ABOVE
 WHICH OF THE FF ARE TRUE OF
CATHETER ABLATION IN AF?

A. CATHETER ABLATION INVOLVES CARDIAC CATHETERIZATION, TRANS(ATRIAL)

SEPTAL PUNCTURE & CRYOABLATION TO ABOLISH THE ABILITY OF TRIGGERING
FOCI IN THESE REGIONS TO INITIATE AF
B. ABLATION IS LESS EFFECTIVE IN PATIENTS WITH PERSISTENT AF, PARTICULARLY
LONG-STANDING PERSISTENT AF
C. IN PATIENTS WITH PAROXYSMAL AF, SINUS RHYTHM IS MAINTAINED FOR > 1
YEAR AFTER 1 ABLATION PROCEDURE IN ~60% OF PATIENTS
D. ALL OF THE ABOVE

pp. 1749
 THE FF ARE MAJOR PROCEDURE-RELATED
COMPLICATIONS OF CATHETER ABLATION
EXCEPT:

A. CARDIAC TAMPONADE
B. STROKE
C. VAGUS NERVE PARALYSIS
D. BLEEDING FROM FEMORAL ACCESS SITES
 THE FF ARE MAJOR PROCEDURE-RELATED
COMPLICATIONS OF CATHETER ABLATION
EXCEPT:

A. CARDIAC TAMPONADE
B. STROKE
C. VAGUS NERVE PARALYSIS- PHRENIC NERVE
D. BLEEDING FROM FEMORAL ACCESS SITES
 BASED ON THE CHA2DS2-VASC RISK
ASSESSMENT, WHAT ARE THE ONLY 2 RISK
FACTORS WHICH SCORES 2 POINTS?

A. CHF AND HYPERTENSION

B. AGE 65-75 AND VASCULAR DISEASE
C. STROKE AND FEMALE SEX
D. AGE >/= 75 AND DIABETES MELLITUS
 RISK FACTORS POINTS
C- CONGESTIVE 1
A. CHF AND HYPERTENSION HEART FAILURE
B. AGE 65-75 AND VASCULAR DISEASE H- HYPERTENSION 1
C. DM AND FEMALE SEX A- AGE >/= 75 Y 2
D- DIABETES 1
D. AGE >/= 75 AND STROKE MELLITUS
S- STROKE/TIA, 2
EMBOLUS
V- VASCULAR 1
pp. 1748 DISEASE
A- AGE 65-75 Y 1
SEX- FEMALE 1
-END-