Basic & Advanced EKG (Exam I) (Assessment Review)

Question 1

In what leads should a p-wave be positive?

Answer 1

• I, II, aVF, V4-V6

Question 2

What should the duration of a p-wave be?

Answer 2

• < 0.12 seconds

Question 3

What should the duration of a PR interval be?

Answer 3

• 0.1 - 0.2 seconds

Question 4

What should the duration of a QRS complex be?

Answer 4

• < 0.12 seconds

Question 5

Elevation/depression of an ST segment by __ mm is clinically relevant

Answer 5

1

Question 6

T-waves should be positive in which leads?

Answer 6

• I, II, V3-V6

Question 7

What does Paroxysmal mean?

Answer 7

Intermittent

Question 8

Venticular ectopy is usually indicative of what?

Answer 8

• K⁺ imbalances

Question 9

What effects do halothane/enflurane have in regards to arrhythmias?

Answer 9

• Halothane & enflurane sensitize the myocardium

Question 10

What arrhythmia in infants can result from sevoflurane?

Answer 10

• Bradycardia (via oculo-cardiac reflex?)

Question 11

What can desflurane cause during induction?

Answer 11

Prolonged QT

Question 12

What two adverse events can occur from local anesthetic injection into the vasculature?

Answer 12

• Severe bradycardia
• Asystole

Question 13

How would excessive intravascular lidocaine be treated?

Answer 13

• Lipid rescue

Question 14

What is the exhaustive list of conditions that can result in perioperative dysrhythmias?

(this card sucks)

Answer 14

• General anesthetics
• Local anesthetics
• Abnormal ABG or electrolytes
• Endotracheal intubation
• Autonomic reflexes
• CVP cannulation
• Surgical stimulation of heart/lungs
• Location of surgery
• Hypoxemia
• Cardiac Ischemia
• Catecholamine excess

Question 15

What anatomic structure (discussed in class) causes dysrhythmias when stimulated during cardiac surgeries?

Answer 15

• Pulmonary arteries

Question 16

What example was given of a surgical location where stimulation results in dysrhythmias?

Answer 16

• Eyes (due to oculo-cardiac reflexes)
• Heart/lungs

Question 17

Where does lead V1 go? V2?

Answer 17

• V1 - 4th ICS, right of sternum
• V2 - 4th ICS, left of sternum

Question 18

Where does lead V3 go?
V4?

Answer 18

• V3 - between V2 and V4
• V4 - 5th ICS, left of sternum

Question 19

Where does lead V5 go?
V6?

Answer 19

• V5 - 5th ICS, left of sternum
• V6 - 5th ICS, left of sternum

Question 20

What wave is the first negative deflection after the p-wave on any lead?

Answer 20

• Q-wave

Question 21

What wave is the first positive deflection after a p-wave?

Answer 21

• R-wave

Question 22

Describe an s-wave.

Answer 22

• Negative deflection below baseline after an R or Q wave.

Question 23

What QRS is denoted by 1 in the figure below?

Answer 23

R

Question 24

What QRS is denoted by 2 in the figure below?

Answer 24

QS

Question 25

What QRS is denoted by 3 in the figure below?

Answer 25

qRs

Question 26

What QRS is denoted by 4 in the figure below?

Answer 26

rS

Question 27

What QRS is denoted by 5 in the figure below?

Answer 27

qR

Question 28

What QRS is denoted by 6 in the figure below?

Answer 28

rSR'

Question 29

1 small box on an EKG strip equals _____.

Answer 29

1mm or 0.04s

Question 30

1 large box on an EKG strip equals ______.

Answer 30

5mm or 0.2s

Question 31

If healthy, both the QRS complex and T-wave should be ______ in leads I, II, & III.

Answer 31

positive.

Question 32

What is the mean electrical axis of the heart?

Answer 32

59°

Question 33

A clockwise shift of the mean electrical axis shift of the heart is indicative of what?

Answer 33

- Right-axis deviation

Question 34

A counter-clockwise shift of the mean electrical axis shift of the heart is indicative of what?

Answer 34

- Left-axis deviation

Question 35

Regarding Lead I, where is the negative terminal connected? How about the positive terminal?

Answer 35

Negative terminal = Right arm Positive terminal = Left arm

Question 36

Regarding Lead II, where is the negative terminal connected? How about the positive terminal?

Answer 36

Negative terminal = Right arm Positive terminal = Left leg

Question 37

Regarding Lead III, where is the negative terminal connected? How about the positive terminal?

Answer 37

Negative terminal = Left arm Positive terminal = Left leg

Question 38

Which lead can be used as the determinant of posterior vs anterior injury?

Answer 38

V2

Question 39

In which precordial lead does the QRS complex have the most magnitude?

Answer 39

V4

Question 40

What mV is denoted by a small box on an EKG strip?

Answer 40

0.1mV

Question 41

What mV is denoted by a large box on an EKG strip?

Answer 41

0.5mV

Question 42

What angle is viewed utilizing aVF?

Answer 42

90°

Question 43

What angle is viewed utilizing aVL?

Answer 43

-30°

Question 44

What angle is viewed utilizing aVR? How does this compare to lead II?

Answer 44

-150° - aVR is essentially opposite lead II. (not exactly though, Lead II's negative terminal is -120°)

Question 45

What are the positive & negative terminals for lead aVR?

Answer 45

Negative = left arm + left leg (+30°) Positive = right arm (-150°)

Question 46

What are the positive & negative terminals for lead aVF?

Answer 46

Negative = left arm + right arm Positive = left leg

Question 47

What are the positive & negative terminals for lead aVL?

Answer 47

Negative = left leg + right arm Positive = left arm

Question 48

What cardiac EKG lead is the least useful in practice but most unique in its position? (this one has a lot of test questions about it)

Answer 48

aVR

Question 49

What is the axis of Lead I?

Answer 49

0°

Question 50

What is the axis of Lead III?

Answer 50

120°

Question 51

What degree change would characterize an extreme axis deviation?

Answer 51

-90° to 180°

Question 52

What would the mV of this QRS complex be?

Answer 52

+1.5mV

Question 53

What would the mV of this QRS complex be?

Answer 53

- 1.0mV ( approximation)

Question 54

Determine the mV of leads I & III and subsequently the degree & axis of deviation noted by these strips.

Answer 54

- Lead I ≈ -2.5mV - Lead III ≈ +1.75mV - Deviation ≈ inbetween +180° & +120° ≈ 170° due to greater Lead I magnitude. **Significant right axis deviation**

Question 55

The EKG strips below are indicative of what pathology?

Answer 55

Right Bundle Branch Block (RBBB)

Question 56

A notched, wide R wave on Lead V6 would likely be indicative of what condition?

Answer 56

- Left Bundle Branch Block (LBBB)

Question 57

A positive current of injury noted on V2 would be indicative of what?

Answer 57

Posterior MI

Question 58

A negative current of injury noted on V2 would be indicative of what?

Answer 58

Anterior MI

Question 59

What axis would be expected with a negative QS deflection in leads I and II and a positive R deflection in Lead III?

Answer 59

Right Axis Deviation

Question 60

What axis would be expected with a negative QS deflection in leads II and III and a positive R deflection in Lead I?

Answer 60

Left Axis Deviation

Question 61

A positive V1 QRS with negative QRS in leads I, II, and III would the resulting axis be?

Answer 61

- Extreme Axis Deviation

Question 62

What block would you expect to present with a right axis deviation?

Answer 62

- Posterior Hemiblock

Question 63

What block would you expect to present with a left axis deviation?

Answer 63

- Anterior Hemiblock

Question 64

What is an MCL1 lead? How is it placed?

Answer 64

- Modified V1 lead - Negative on left arm, positive in 4th ICS right of sternum.

Question 65

What would leads I, III, and III look like with normal axis?

Answer 65

- All + QRS

Question 66

Differentiate physiologic left axis and pathologic left axis deviation.

Answer 66

- Physiologic = (+ Lead I & III) & (+ or isoelectric Lead II) - Pathologic = (+ Lead I) & (- Lead II & III)

Question 67

What is the most common cause of right ventricular hypertrophy?

Answer 67

- **Lung disease**, pulmonary embolus, and pulmonary valve disease.

Question 68

In what situations would you find physiologic left axis deviation?

Answer 68

- Obesity & athleticism

Question 69

Bundle Branch Block diagnosis is dependent on ______. Hemiblock diagnosis is based on _______________.

Answer 69

- time - axis deviation

Question 70

What pertinent anatomical features of the heart are fed via the RCA?

Answer 70

- Inferior & posterior wall - Right ventricle - SA & AV node - Posterior fascicle of LBB

Question 71

What pertinent anatomical features of the heart are fed via the LAD?

Answer 71

- Anterior wall of LV - Septal wall - Bundle of His & BB

Question 72

What severe outcome should you worry about with septal infarct?

Answer 72

Septal rupture

Question 73

What pertinent anatomical features of the heart are fed via the circumflex artery?

Answer 73

- Lateral wall of LV - *SA & AV nodes (?) - Posterior wall of LV *should be RCA, no?*

Question 74

Why is morphine now avoided in MI's?

Answer 74

- Morphine causes histamine release.

Question 75

What percentage occlusion would be assumed with chest pain on exertion?

Answer 75

70 - 85% occlusion

Question 76

What percentage occlusion would be assumed with chest pain at rest?

Answer 76

90% occlusion

Question 77

What percentage occlusion would be assumed with chest pain unrelieved by nitroglycerin?

Answer 77

100% occlusion

Question 78

What should be administered before nitroglycerin with an acute right-sided MI?

Answer 78

fluid bolus

Question 79

Are EKGs better in regards to sensitivity or specificity?

Answer 79

- Specificity (If MI is shown on EKG then its likely an MI) but sensitivity is 50% for EKGs so a negative EKG result doesn't rule out MI.

Question 80

What sign would indicate ischemia?

Answer 80

- Symmetrical inverted T-waves in two or more related leads.

Question 81

What sign would indicate an injury pattern?

Answer 81

- ST segment elevation of more than 1mm in two or more related leads. *most important thing to look for*

Question 82

What sign would indicate infarction?

Answer 82

- Pathologic Q waves ( >40ms wide or ⅓ the depth of r-wave height) coupled with ST elevation.

Question 83

Which leads indicate a true lateral MI? Which would indicate a high lateral?

Answer 83

- True lateral = V5 & V6 - High lateral = I, aVL

Question 84

What is the most commonly seen MI? What is commonly seen with this type of MI? Do you use nitrates?

Answer 84

- Inferior - Bradycardia, hypotension, 1st degree or Mobitz 1 blocks, and nausea. - Caution with nitrates due to RV's being preload dependent w/ inferior MI's

Question 85

What is the most lethal MI? What dysrhythmias are commonly seen with this type of MI? Do you use nitrates?

Answer 85

- Anterior Wall (LAD) - CHB and VF/Vtach - Yes to nitrates.

Question 86

What would cause one to prepare defibrillation pads for a patient undergoing an anterior MI? (other than vfib/vtach)

Answer 86

- Presence of **BBB or hemiblock** whilst undergoing an anterior MI

Question 87

What condition presents with ST elevation on all leads? How is it diagnosed?

Answer 87

- Pericarditis - Patient feels better when they lean forward and there won't be reciprocal ST depression. - Diagnosed via fever, WBCs, hx of IVDU, etc.

Question 88

What condition looks like myocardial infarction on an EKG but can be fatal if thrombolytics are administered?

Answer 88

- Dissecting thoracic aorta aneurysm.

Question 89

What four conditions mimic myocardial infarction in their EKG presentation?

Answer 89

- LBBB - LV hypertrophy - Pericarditis - Thoracic aortic dissection