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Principles of Anesthesia II (Fall 2024) Grayson/Andy's Cards > Basic & Advanced EKG (Cornelius REVIEW) Exam 1 > Flashcards

Basic & Advanced EKG (Cornelius REVIEW) Exam 1 Flashcards

1
Q

In a normal ECG, the P-wave should be positive in which of the following leads? (Select 6)

A) Lead I
B) Lead II
C) Lead aVR
D) Lead aVF
E) Lead V4
F) Lead V5
G) Lead V6

A

A) Lead I
B) Lead II
D) Lead aVF
E) Lead V4
F) Lead V5
G) Lead V6

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2
Q

What should the duration of a p-wave be?

A
  • < 0.12 seconds
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3
Q

What should the duration of a PR interval be?

A
  • 0.1 - 0.2 seconds
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4
Q

What should the duration of a QRS complex be?

A
  • < 0.12 seconds
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5
Q

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

A

1

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6
Q

In which of the following leads should the P-wave normally be positive?

A) I, II, aVR, V4-V6
B) I, II, aVF, V4-V6
C) II, III, aVF, V1-V3
D) I, aVL, aVF, V1-V3

A

B) I, II, aVF, V4-V6

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7
Q

What does the term “paroxysmal” refer to in a medical context?

A) Continuous and steady
B) Gradual onset and persistent
C) Intermittent
D) Slow progression and constant

A

C) Intermittent

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8
Q

Ventricular ectopy is most commonly indicative of which of the following imbalances?

A) Sodium (Na+)
B) Potassium (K+)
C) Calcium (Ca2+)
D) Magnesium (Mg2+)

A

B) Potassium (K+)

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9
Q

What effect do halothane and enflurane have on the myocardium?

A) They reduce myocardial sensitivity to arrhythmias
B) They increase myocardial contractility
C) They sensitize the myocardium, increasing the risk of arrhythmias
D) They have no effect on the myocardium

A

C) They sensitize the myocardium, increasing the risk of arrhythmias

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10
Q

Which arrhythmia can occur in infants as a result of sevoflurane administration?

A) Tachycardia
B) Atrial fibrillation
C) Bradycardia
D) Ventricular fibrillation

A

C) Bradycardia
(via oculo-cardiac reflex?)

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11
Q

What arrhythmia-related effect can desflurane cause during induction?

A) Bradycardia
B) Prolonged QT interval
C) Shortened PR interval
D) Atrial fibrillation

A

B) Prolonged QT interval

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12
Q

Two adverse events that can occur from local anesthetic injection into the vasculature are __ and __ .

A) Hypertension and tachycardia
B) Seizures and hyperventilation
C) Severe bradycardia and asystole
D) Hypotension and respiratory depression

A

C) Severe bradycardia and asystole

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13
Q

How is excessive intravascular lidocaine typically treated?

A) Sodium bicarbonate
B) Epinephrine
C) Lipid rescue
D) IV fluids

A

C) Lipid rescue

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14
Q

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

(this card sucks)

A
  • 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
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15
Q

Which anatomic structure, when stimulated during cardiac surgeries, is most likely to cause dysrhythmias?

A) Aorta
B) Pulmonary arteries
C) Left atrium
D) Coronary arteries

A

B) Pulmonary arteries

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16
Q

Which of the following surgical locations, when stimulated, can result in dysrhythmias? (Select 3)

A) Eyes
B) Heart
C) Kidneys
D) Lungs
E) Liver

A

A) Eyes (due to oculo-cardiac reflexes)
B) Heart
D) Lungs

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17
Q

Where does lead V1 go? V2?

A
  • V1 - 4th ICS, right of sternum
  • V2 - 4th ICS, left of sternum
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18
Q

Where does lead V3 go?
V4?

A
  • V3 - between V2 and V4
  • V4 - 5th ICS, left of sternum, midclavicular line
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19
Q

Where does lead V5 go?
V6?

A

V5 - 5th ICS, left anterior axillary or between V4-V6
V6 - 5th ICS, left mid axillary

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20
Q

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

A) T wave
B) S wave
C) Q wave
D) R wave

A

C) Q wave

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21
Q

What is the first positive deflection after the P-wave on an ECG?

A) Q wave
B) S wave
C) R wave
D) T wave

A

C) R wave

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22
Q

What is the characteristic of an S-wave on an ECG?

A) A positive deflection after the P-wave
B) A negative deflection below the baseline after an R or Q wave
C) A positive deflection after the Q wave
D) A flat line following the R wave

A

B) A negative deflection below the baseline after an R or Q wave

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23
Q

What QRS is denoted by 1 in the figure below?

A

R

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24
Q

What QRS is denoted by 2 in the figure below?

A

QS

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25
Q

What QRS is denoted by 3 in the figure below?

A

qRs

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26
Q

What QRS is denoted by 4 in the figure below?

A

rS

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27
Q

What QRS is denoted by 5 in the figure below?

A

qR

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28
Q

What QRS is denoted by 6 in the figure below?

A

rSR’

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29
Q

1 small box on an EKG strip equals _____.

A

1mm or 0.04s

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30
Q

1 large box on an EKG strip equals ______.

A

5mm or 0.2s

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31
Q

If healthy, both the QRS complex and T-wave should be __ in leads I, II, & III.
A) Positive
B) Negative
C) Biphasic
D) Flattened

A

A) Positive

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32
Q

What is the mean electrical axis of the heart?

A

59°

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33
Q

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

A
  • Right-axis deviation
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34
Q

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

A
  • Left-axis deviation
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35
Q

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

A

Negative terminal = Right arm
Positive terminal = Left arm

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36
Q

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

A

Negative terminal = Right arm
Positive terminal = Left leg

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37
Q

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

A

Negative terminal = Left arm
Positive terminal = Left leg

38
Q

Which ECG lead is typically used to determine whether an injury is posterior or anterior?

A) Lead I
B) Lead III
C) Lead V2
D) Lead aVL

A

C) Lead V2

39
Q

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

A) V1
B) V2
C) V3
D) V4

A

D) V4

40
Q

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

A

0.1mV

41
Q

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

A

0.5mV

42
Q

What angle is viewed utilizing aVF?

A

90°

43
Q

What angle is viewed utilizing aVL?

A

-30°

44
Q

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

A

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

45
Q

What are the positive & negative terminals for lead aVR?

A

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

46
Q

What are the positive & negative terminals for lead aVF?

A

Negative = left arm + right arm
Positive = left leg

47
Q

What are the positive & negative terminals for lead aVL?

A

Negative = left leg + right arm
Positive = left arm

48
Q

Which cardiac EKG lead is considered the least useful in practice but is the most unique in its position?

A) Lead I
B) Lead V2
C) Lead aVR
D) Lead aVL

(this one has a lot of test questions about it)

A

C) Lead aVR

49
Q

What is the axis of Lead I?

A

0°

50
Q

What is the axis of Lead III?

A

120°

51
Q

What degree change would characterize an extreme axis deviation?

A

-90° to 180°

52
Q

What would the mV of this QRS complex be?

A

+1.5mV

53
Q

What would the mV of this QRS complex be?

A
  • 1.0mV ( approximation)
54
Q

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

A
  • Lead I ≈ -2.5mV
  • Lead III ≈ +1.75mV
  • Deviation ≈ inbetween +180° & +120° ≈ 170° due to greater Lead I magnitude. Significant right axis deviation
55
Q

The EKG strips below are indicative of what pathology?

A

Right Bundle Branch Block (RBBB)

Look at V1, find J point, then trace backwards if pointing up or down

56
Q

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

A
  • Left Bundle Branch Block (LBBB)
57
Q

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

A

Posterior MI

58
Q

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

A

Anterior MI

59
Q

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

A

Right Axis Deviation

60
Q

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

A

Left Axis Deviation

61
Q

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

A
  • Extreme Axis Deviation
62
Q

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

A
  • Posterior Hemiblock
63
Q

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

A
  • Anterior Hemiblock
64
Q

What is an MCL1 lead?
How is it placed?

A
  • Modified V1 lead
  • Negative on left arm, positive in 4th ICS right of sternum.
65
Q

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

A
  • All + QRS
66
Q

What characterizes physiologic left axis deviation on an ECG?

A) (+ Lead I) & (- Lead II & III)
B) (+ Lead I & III) & (+ or isoelectric Lead II)
C) (- Lead I) & (+ Lead II & III)
D) (+ Lead I) & (+ Lead II & III)

A

B) (+ Lead I & III) & (+ or isoelectric Lead II)

67
Q

What characterizes pathologic left axis deviation on an ECG?

A) (+ Lead I) & (- Lead II & III)
B) (+ Lead I & III) & (+ or isoelectric Lead II)
C) (- Lead I) & (+ Lead II & III)
D) (+ Lead I) & (+ Lead II & III)

A

A) (+ Lead I) & (- Lead II & III)

68
Q

Which of the following are common causes of right ventricular hypertrophy? (Select 3)

A) Lung disease
B) Pulmonary embolus
C) Pulmonary valve disease
D) Aortic stenosis
E) Coronary artery disease

A

A) Lung disease
B) Pulmonary embolus
C) Pulmonary valve disease

69
Q

In which of the following situations would you most likely find physiologic left axis deviation? (Select 2)

A) Obesity
B) Hypertension
C) Athleticism
D) Mitral valve prolapse
E) Pulmonary embolus

A

A) Obesity
C) Athleticism

70
Q

Bundle Branch Block diagnosis is dependent on ____.
Hemiblock diagnosis is based on ___.

A
  • time
  • axis deviation
71
Q

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

A
  • Inferior & posterior wall
  • Right ventricle
  • SA & AV node
  • Posterior fascicle of LBB
72
Q

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

A
  • Anterior wall of LV
  • Septal wall
  • Bundle of His & BB
73
Q

What severe outcome should you worry about with septal infarct?

A

Septal rupture

74
Q

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

A
  • Lateral wall of LV
  • *SA & AV nodes (?)
  • Posterior wall of LV

should be RCA, no?

75
Q

Why is morphine now avoided in MI’s?

A
  • Morphine causes histamine release.
76
Q

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

A

70 - 85% occlusion

77
Q

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

A

90% occlusion

78
Q

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

A

100% occlusion

79
Q

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

A

fluid bolus

80
Q

Are EKGs better in regards to sensitivity or specificity?

A
  • 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.
81
Q

What sign would indicate ischemia?

A
  • Symmetrical inverted T-waves in two or more related leads.
82
Q

What sign would indicate an injury pattern?

A
  • ST segment elevation of more than 1mm in two or more related leads.

most important thing to look for

83
Q

What sign would indicate infarction?

A
  • Pathologic Q waves ( >40ms wide or ⅓ the depth of r-wave height) coupled with ST elevation.
84
Q

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

A
  • True lateral = V5 & V6
  • High lateral = I, aVL
85
Q

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

A
  • 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
86
Q

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

A
  • Anterior Wall (LAD)
  • CHB and VF/Vtach
  • Yes to nitrates.
87
Q

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

A
  • Presence of BBB or hemiblock whilst undergoing an anterior MI
88
Q

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

A
  • Pericarditis
  • Patient feels better when they lean forward and there won’t be reciprocal ST depression.
  • Diagnosed via fever, WBCs, hx of IVDU, etc.
89
Q

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

A
  • Dissecting thoracic aorta aneurysm.
90
Q

What four conditions mimic myocardial infarction in their EKG presentation?

A
  • LBBB
  • LV hypertrophy
  • Pericarditis
  • Thoracic aortic dissection

Principles of Anesthesia II (Fall 2024) Grayson/Andy's Cards (24 decks)

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