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cardiac, EKG, CXR videos Flashcards

1
Q

Ninja Nerd EKG Basics: electrical activity generated FROM positive to negative electrode generates what type of deflection on EKG?

A

negative deflection line

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2
Q

Ninja Nerd EKG Basics: electrical activity generated TO positive FROM negative electrode generates what type of deflection on EKG?

A

positive deflection line

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3
Q

Ninja Nerd EKG Basics: electrical activity moving from SA node to AV node generates what type of deflection line in Lead II?

A

positive (upward) deflection line (P wave)

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4
Q

Ninja Nerd EKG Basics: atrial depolarization from SA node to AV node results in what shape in Lead II?

A

P wave

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5
Q

Ninja Nerd EKG Basics: what does the P wave represent?

A

atrial depolarization

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6
Q

Ninja Nerd EKG Basics: what happens at AV node and how is it represented on the EKG?

A

there is a .1 second delay

on the EKG: isoelectric line

we call it PR interval

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7
Q

Ninja Nerd EKG Basics: why is the PR interval very important?

A

it’s important when looking at heart blocks

first, second, third degree heart blocks get jammed up at AV node

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8
Q

Ninja Nerd EKG Basics: which bundle branch actually depolarizes the ventricular septum?

A

the LEFT bundle branch

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9
Q

Ninja Nerd EKG Basics: interventricular septum depolarization manifests itself in what way on EKG?

A

negative deflection called the Q WAVE (but not the pathological kind)

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10
Q

Ninja Nerd EKG Basics: what is the Q wave indicating?

A

septal depolarization

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11
Q

Armando Hasudungan ACS: Two things characterize acute coronary syndrome

A

unstable angina

MI: STEMI and NSTEMI

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12
Q

Armando Hasudungan ACS: describe acute coronary syndrome

A

syndrome in which you have reduction of blood supply to cardiac muscle or loss or total occlusion reducing all blood supply to heart muscle cells

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13
Q

Armando Hasudungan ACS: EKG changes seen over time w/ pts who have suffered a STEMI

A

onset - 12 hrs: peaked T wave –> ST segment elevation

12-24 hrs: ST segment elevation (and may form pathological Q wave), +/- inverted T-wave

1st wk: pathological Q wave, T wave inversion

wk - mo.s: pathological Q wave (sign of previous MI)

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14
Q

Armando Hasudungan ACS: troponin changes with pt having a STEMI

A 
onset = 2-3 hrs (uptodate)
peak = day 2 (video) (24 hrs, PAER)
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15
Q

Armando Hasudungan ACS: CK-MB changes with pt having a STEMI

A 
onset = 3-12 hrs (PAER)
peak = ~24-48 hrs (video)
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16
Q

Armando Hasudungan ACS: what percent of EKG’s may be normal in pts in initial stages of unstable angina?

A

20%

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17
Q

Armando Hasudungan ACS: what area of the heart does the left circumflex artery supply?

A

lateral wall of the heart

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18
Q

Armando Hasudungan ACS: pathophysiology for a STEMI

A

complete occlusion of artery b/c of rupture plaque, no blood supply to myocardium, infarction distally which progresses proximally until transmural infarction, possible damage to papillary muscles may result

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19
Q

Armando Hasudungan ACS: what is the definition of a STEMI?

A

complete occlusion of coronary artery causing an infarction

ST-elevation above J point in 2 contiguous leads

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20
Q

Armando Hasudungan ACS: what is the definition of a NSTEMI?

A

partial occlusion causing ischemia to tissue proximally
plaque rupture thrombosis, but artery not fully occluded

ST depression below J point
t wave inversion or flattening (sometimes)

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21
Q

Medical Basics EKG for Beginners: what components of the EKG do we consider when we are analyzing an EKG?

A 
rate
rhythm
intervals - PR, QRS, QT
axis
ischemia
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22
Q

Medical Basics EKG for Beginners: how many small boxes make up the big boxes in the x axis? how many in the y axis?

A

5 small boxes x 5 small boxes = 1 big box

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23
Q

Medical Basics EKG for Beginners: what is being measured in the x axis? y axis?

A

x axis = time
(1 big box = 0.2 seconds)

y axis = voltage
(1 big box = 0.5 mV)

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24
Q

Medical Basics EKG for Beginners: what are we considering when we evaluate the rhythm?

A

time between R waves, measured by x -axis boxes representing time

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25
Q

Medical Basics EKG for Beginners: which three leads are considered to determine of the axis is normal or abnormal?

A

I, II, aVR

P waves upright in I, II, inverted in aVR

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26
Q

Medical Basics EKG for Beginners: which lead is negative with a normal axis?

A

P wave is inverted in aVR lead

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27
Q

Medical Basics EKG for Beginners: what pathologies may cause left axis deviation?

A

LVH
L anterior fascicular block
inferior MI

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28
Q

Medical Basics EKG for Beginners: what pathologies may cause right axis deviation?

A

RVH
L posterior fascicular block
lateral MI

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29
Q

Ninja Nerd EKG Basics: which leads are left-sided leads?

A

I
aVL
V4-V6

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30
Q

Ninja Nerd EKG Basics: which leads are right-sided leads?

A

III
aVR
V1-V3

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31
Q

Ninja Nerd EKG Basics: what leads look at the inferior wall of the the heart?

A

II
III
aVF

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32
Q

Ninja Nerd EKG Basics: what leads look at lateral wall of L ventricle?

A

I
aVL
V5
V6

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33
Q

Ninja Nerd EKG Basics: what leads look at R ventricle?

A

aVR
V1
V2

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34
Q

Ninja Nerd EKG Basics: what leads look at anteroseptal area of the heart?

A

V1-V4

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35
Q

Ninja Nerd EKG Basics: name precordial chest leads and what plane do they report electrical activity from?

A

V1-V6

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36
Q

Ninja Nerd EKG Basics: what is the cutoff width for deciding if QRS is wide?

A

> 0.12 seconds = wide

but don’t ignore .10 - .12 seconds

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37
Q

Ninja Nerd MASTER EKG video:

what leads do we consider the P waves for whether the rhythm is normal sinus rhythm?

A

are P waves upright in leads I and II, and inverted in aVR?

Is every P wave followed by a QRS?

“yes” to both? good!

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38
Q

Ninja Nerd MASTER EKG video:

what are three differentials for NARROW and REGULAR tachycardia?

A

sinus tach
2:1 atrial flutter
SVT

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39
Q

Ninja Nerd MASTER EKG video:

what are three differentials for NARROW and IRREGULAR tachycardia?

A 
A Fib (MC)
variable A flutter (variable block)
MAT (multifocal atrial tachycardia)
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40
Q

Ninja Nerd MASTER EKG video:

what are four differentials for WIDE and REGULAR tachycardia?

A

VTach
SVT w/ BBB
sinus tach w/ BBB
antidromic WPW

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41
Q

Ninja Nerd MASTER EKG video:

what are three differentials for WIDE and IRREGULAR tachycardia?

A

PMVT = PolyMorphic VTach
AFib w/ WPW
AFib w/ BBB

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42
Q

Ninja Nerd MASTER EKG video:

What’s a J wave?

A

short positive deflection following the down stroke of the R wave producing a fish hook appearance

this is helpful to differentiating benign early depolarization vs STEMI

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43
Q

Ninja Nerd MASTER EKG video:

What are DDx of ST Elevation? (there are 8 listed by the video)

A

STEMI
pericarditis
vasospasm
PE

LV aneurysm
LV hypertrophy
L BBB
benign early repolarization

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44
Q

Ninja Nerd MASTER EKG video:

What are DDx of ST Depression?

A 
NSTEMI
posterior MI
L BBB
LVH w/ strain
reciprocal changes
digoxin toxicity
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45
Q

Ninja Nerd MASTER EKG video:

What are DDx of J Waves?

A

benign early repolarization
hypothermia
hypercalcemia
Brugada syndrome

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46
Q

Ninja Nerd MASTER EKG video:

what are three types of ST segment DEPRESSION? which one is worse?

A

downsloping
horizontal
upsloping

horizontal ST depression can be harbinger of ischemia - don’t send this pt home!

(also, the upsloping in V1-V3 with peaked T waves can mean proximal LAD occlusion)

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47
Q

Ninja Nerd MASTER EKG video:

define ST depression

A

J point/ST segment at least 0.5 mm below isoelectric line in two contiguous leads

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48
Q

Ninja Nerd MASTER EKG video:

four types of T wave abnormalities

A

T-wave inversion
hyperacute T wave
biphasic T wave
flat T wave

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49
Q

Ninja Nerd MASTER EKG video:

when am I most nervous when I see a particular T wave abnormality and what is it?

A

t-wave inversion by itself in aVL - this may be a sign of impending inferior wall MI…so keep getting serial EKGs

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50
Q

Ninja Nerd MASTER EKG video:

what are five DDx for T wave inversion?

A 
LVH strain
increased ICP
PE
BBB
ischemia
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51
Q

Ninja Nerd MASTER EKG video:

what is an normal variant for for T wave inversion?

A

it’s not abnormal to have T wave inversion in V1, V2, or lead III

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52
Q

Ninja Nerd MASTER EKG video:

what are two DDx for hyperacute T wave?

A

vasospasm

early STEMI

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53
Q

Ninja Nerd MASTER EKG video:

what are two DDx for biphasic T wave?

A

ischemia

hyperkalemia

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54
Q

Ninja Nerd MASTER EKG video:

what are two DDx for flat T wave?

A

ischemia

hypOkalemia

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55
Q

Ninja Nerd MASTER EKG video:

what are two reasons the QRS wave is widened? What are the other 4 DDx for wide QRS?

A

BBB
hyperkalemia

(also:  
VTach
WPW
paced rhythm
meds (TCA))
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56
Q

Ninja Nerd MASTER EKG video:
what does it mean if a biphasic T wave is seen in V2 to V3? ESPECIALLY if it is positive deflection followed by negative deflection!

A

sign of proximal LAD occlusion

“Wellens-A criteria”

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57
Q

Ninja Nerd MASTER EKG video:

what does it mean if a biphasic T wave is negatively deflected then positively deflected?

A

think HYPERKALEMIA, and check the potassium

58
Q

Ninja Nerd MASTER EKG video:

what are three DDx for peaked T waves?

A

hyperkalemia
hypermagnesemia
ischemia

59
Q

Ninja Nerd MASTER EKG video:

what are De-Winters T-waves and why do they concern us?

A

De-Winters T-waves are signs of ischemia….they are STEMI equivalent, peaked T waves in V1 to V3 area, plus upsloping ST depression….get scared for proximal LAD occlusion

60
Q

CXR:

four initial checks when looking at a CXR?

A 
RIPE
R = rotation
I = inspiration
P = projection
E = exposure

(not the TB RIPE)

61
Q

CXR: what is the systematic way to move through a CXR?

A 
ABCDE
A = airway
B = breathing
C = cardiology
D = diaphragm
E = everything else (bones, fxs, lytic lesions, etc.)
62
Q

Ninja Nerd MASTER EKG video:

define T wave inversion

A

a depression that is at least 1mm or greater below the isoelectric line

63
Q

CXR: first items to check when reviewing CXR

A 
pt name
DOB
date of XR
where XR taken
see if pt has any previous XRays
64
Q

CXR: how many posterior ribs should you be able to count on a good quality CXR?

A

posterior: 9

65
Q

CXR: how many anterior ribs should you be able to count on a good quality CXR?

A

anterior: 5-6

66
Q

CXR: what medical sign of the heart needs to be carefully considered with seen in an AP film?

A

AP film will make heart look slightly larger than it is

67
Q

CXR: what medical findings may cause the trachea to deviate to the RIGHT?

A

pleural effusion
LEFT pneumothorax
RIGHT collapsed lung

68
Q

CXR: at what level of the thoracic vertebrae is the carina?

A

T4/5

69
Q

CXR: what topographical landmark on the anterior chest is at the level of the carina?

A

sternal angle (angle of Louis)

70
Q

CXR: the four zones of the lungs are:

A

apical
upper
middle
lower

71
Q

CXR: how do you determine if the heart is enlarged on the CXR?

A

make sure the width of the heart is not more than 50% of the width of the thoracic window

72
Q

CXR: Is it normal to see air under the diaphragm?

A

yes, you may see air under the left side of the diaphragm b/c air is in the fundus of the stomach

73
Q

CXR: elements to remember when reading CXR to your attending

A 
confirm pt, DOB, date of XRay
RIPE
ABCDE
say what you see
review positive findings
74
Q

Ninja Nerd MASTER EKG video:

what is a pathological Q wave (three criteria)?

A

1) >0.04 seconds (“very wide”), ORRRRR
2) >2 mm in depth (from isoelectric line), ORRRR
3) >25% of QRS complex height

75
Q

Ninja Nerd MASTER EKG video:
LEFT BBB:
in V1-V2, what do you see (according to Ninja Nerd)?

or V5-V6, what do you see (according to Ninja Nerd)?

A

V1-V2 –> deep big S wave (maybe even a little biphid shape)

V5-V6 –> the ‘M’ shape

76
Q

Ninja Nerd MASTER EKG video:
RIGHT BBB:
in V1-V2, what do you see (according to Ninja Nerd)?

in V5-V6, what do you see (according to Ninja Nerd)?

A

V1-V2 –> R-S-R’ pattern

V5-V6 –> super wide S wave, slurred even

77
Q

Ninja Nerd MASTER EKG video:

where should you NEVER see Q waves? What if you do? What does that mean?

A

V1-V3

seeing Q waves in V1-V3 = pathological Q waves

78
Q

Ninja Nerd MASTER EKG video:

why do we care about pathological Q waves (in other words, what are four DDx for pathological Q waves)?

A

MI (old or new)
PE
LBBB
LVH

79
Q

Ninja Nerd MASTER EKG video:

what is the primary concern for low voltage QRS wave?

A

pericardial effusion is the big concern (esp if there is increased HR and SOB)

(think about reasons why the conduction is not getting through to the electrodes)

80
Q

Ninja Nerd MASTER EKG video:
what are two DDx for poor R wave progression (as you go from V1 to V6)?
in other words “what might a poorly progressive R wave mean”?

A

anterior MI

RVH with strain

81
Q

Ninja Nerd MASTER EKG video:

what is a dominant R wave?

A

it’s a big R-wave in V1, V2, or V3 (R waves are supposed to be small in these leads, and definitely shouldn’t be greater than the S waves!)

82
Q

Ninja Nerd MASTER EKG video:

what are three DDx for dominant R waves in V1-V3 AND there is ST depression and upright T waves?

A

I’m most nervous for POSTERIOR MI, but make sure to r/o:
RBBB
and RVH

83
Q

Ninja Nerd MASTER EKG video:

there are nine DDx for prolonged QT…how many can you name?

A 
antiarrythmics
antibiotics
antipsychotics
antidepressants
antiemetics

ischemia
hypokalemia
hypomagnesemia
hypocalcemia

84
Q

Ninja Nerd MASTER EKG video:

what are four DDx for left axis deviation?

A

L BBB
LVH
inferior MI
hyperkalemia

85
Q

Ninja Nerd MASTER EKG video:

what are four DDx for right axis deviation?

A

R BBB
RVH
anterior MI
VTach

86
Q

Ninja Nerd MASTER EKG video: what are three DDx for EXTREME right axis deviation?

A

extreme RVH
VTach
severe obesity

87
Q

Ninja Nerd MASTER EKG video:

How do we define ST segment elevation?

A

1 mm of elevation from isoelectric line in any two contiguous leads except V2 or V3, where it’s 2 mm of elevation

88
Q

Ninja Nerd MASTER EKG video:

How do we define ST segment depression?

A

if the J point is >= 0.5 mm below isoelectric line in any two contiguous leads

89
Q

Ninja Nerd MASTER EKG video:

what benign condition may be present if we see ST segment elevation (ST-E) and a J wave on the EKG?

A

benign early repolarization (add the proper leads to the question) (??)

90
Q

Ninja Nerd MASTER EKG video:

In which conditions do you see a J wave?

A

benign early repolarization
hypothermia
hyperkalemia
Brugada syndrome

91
Q

Ninja Nerd MASTER EKG video:

where are t wave inversions seen as a normal variant?

A

V1
V2
III

92
Q

Ninja Nerd MASTER EKG video:

how many mm below the isoelectric line have to be T wave inversions to meet criteria of T wave inversion

A

1 mm

93
Q

What is Wellens A criteria? Why is this important?

A

V2/V3 biphasic T waves beginning with a positive deflection followed by a negative deflection

don’t know why it’s important

94
Q

Ninja Nerd MASTER EKG video:

what does R wave progression mean?

A

progressively increasing amplitude of R waves from V1-V6

95
Q

Ninja Nerd MASTER EKG video:

what might you be concerned about if you note a dominant R wave (where the R wave is > than S wave) in V1-V3?

A

posterior MI

RBBB
RVH

96
Q

Ninja Nerd MASTER EKG video:

What is another name for a J wave?

A

Osborn wave

97
Q

Strong Med Lesson 3:

Three ways to assess technical quality of CXR in terms of rotation

A

1) crooked pt?
2) ensure lung apices are visible above clavicles
3) ensure vertebral spinous processes bisect the distance b/w the medial ends of the clavicles

98
Q

Strong Med Lesson 3:

one way to assess technical quality of CXR in terms of adequate inspiration

A

make sure 9-10 posterior ribs are visible

99
Q

Strong Med Lesson 3:

one way to assess technical quality of CXR in terms of exposure/penetration

A

identify thoracic vertebrae

100
Q

Strong Med Lesson 3:

what are three consequences of inadequate inspiration

A

long volume appears falsely low

lung markings are falsely prominent, giving false appearance of pulm edema

cardiac silhouette/mediastinum appear falsely enlarged

101
Q

Strong Med Lesson 3:

what are two consequences of a crooked pt/film

A

costophrenic angles are not visible

gastric air bubble, or intraperitoneal free air, not visible

102
Q

Strong Med Lesson 1:

What determines SHADOW?

A

density
thickness
duration of exposure

103
Q

Strong Med Lesson 1:

short exposures are______

A

UNDERexposed, too bright

104
Q

Strong Med Lesson 1:

long exposures are ____

A

OVERexposed, too dark

105
Q

Strong Med:

which three factors determine exposure?

A

duration of exposure
energy of photons
source-to-image distance

106
Q

Strong Med:

name the fissures, whether visible on xray or not:

A

R Lung L Lung
horizontal oblique
oblique

107
Q

Mr Johnson:

what if you cannot see pleural lines on CXR?

A

nothing, it’s normal

108
Q

Strong Med:

what two characteristics of tissue determine brightness of shadow?

A

density and thickness

109
Q

Strong Med:

what are four aspects of a systematic approach?

A

1 - the less-experienced clinicians need a system
2 - the system should include all aspects of a CXR
3 - the system should be logical and/or easy to remember
4 - always start with the eval of the CXR technical quality

110
Q

Strong Med:

what bones are visible on CXR?

A

ribs
clavicles
vertebral bodies
sternum

111
Q

Strong Med:

what features of the cardiac structures are visible on CXR?

A

RIGHT:
ascending aorta
R pulm artery
R atrium

LEFT:
aortic arch
window
L pulm artery
L atrium
L ventricle
descending aorta
112
Q

Strong Med:

what are the ABCDEF’s of the systematic approach?

A 
A = airways
B = bones & soft tissue
C = cardiac silhouette and mediastinum
D = diaphragm & gastric bubble
E = effusions (i.e. pleural)
F = fields (lung) and findings (lines, tubes, devices)
113
Q

Strong Med Lesson 6:

what size of pneumothorax is classified as “small”?

A

2 cm

114
Q

Strong Med Lesson 6:

define the deep sulcus sign

A

a very pronounced costophrenic angle/sulcus

115
Q

Strong Med Lesson 6:

What is subcutaneous air?

A 
subcutaneous = tissue beneath skin
emphysema = "trapped air"

air that leaks from chest cavity, often found in chest, neck, face; it travels along the fascia

116
Q

Strong Med Lesson 6:

describe how pleural effusion looks on CXR?

A

blunting of posterior costophrenic angle on lateral view

fluid may track up the pleura

117
Q

Strong Med Lesson 6:

define subpulmonic effusion

A

fluid accumulation b/w lung base and diaphragm which does not track up the pleura, does not blunt costophrenic angle

118
Q

Strong Med Lesson 6:

describe how subpulmonic effusions appear

A

1 - diaphragm appears to peak more lateral than normal
2 - diaphragm appears more horizontal than normal
3 - on L: abnormally large distance b/w gastric bubble and lung base
4 - on R: abnormally high horizontal fissure

119
Q

Strong Med Lesson 5:

how do you recognize R ventricular enlargement on lateral CXR?

A

the R ventricle fills the retrosternal space

120
Q

Strong Med Lesson 5:

define double density sign

A

enlarged L atrium stretching over the R atrium

121
Q

Strong Med Lesson 5:

what usually causes the splaying of the carinal angle?

A

lymphadenopathy

122
Q

Strong Med Lesson 5:

what is an “increased AP diameter”

A

COPD barrel chest

123
Q

Strong Med Lesson 5:

what are two signs of pericardial effusion?

A

water bottle sign

oreo cookie sign

124
Q

Strong Med Lesson 5:

what size defines a widened mediastinum?

A

> 8 cm

125
Q

Strong Med 5:

what usually causes widened mediastinum?

A

technical errors, sign of a suboptimal CXR

three of them are:

rotation
poor inspiratory effort
AP view

126
Q

Strong Med Lesson 5:

what usually causes widened mediastinum?

A

technical errors, sign of a suboptimal CXR

three of them are:

rotation
poor inspiratory effort
AP view

127
Q

Strong Med Lesson 5:

what are three causes of hilar enlargement?

A

maliignancy
infection
other

128
Q

Strong Med Lesson 5:

name the four regions of the mediastinum?

A

anterior
superior
middle
posterior

129
Q

Strong Med Lesson 4:

what are three causes that a trachea is deviated in the opposite direction?

A

pleural effusion
large mass
pneumothorax

130
Q

Strong Med Lesson 4:

what are three causes that a trachea is pulled in the ipsilateral direction?

A

collapsed lung (atelectasis)
lobectomy/pneumonectomy
fibrosis

131
Q

Strong Med Lesson 4:

define a cervical rib

A

an extra rib that arises from the 7th cervical vertebrae

132
Q

Strong Med Lesson 4:

what can result from a cervical rib

A

cervical ribs can cause thoracic outlet syndrome

133
Q

Strong Med Lesson 6:

how do loculated pleural effusions look?

A

found in unusual locations that defy gravity

won’t shift when pt lays in lat decubitus position

134
Q

Strong Med Lesson 5:

what is the hilum overlay sign?

A

if pulmonary vessels are visible THROUGH a mass, then

the mass is not in the hilum

(a hilar mass would obscure the pulmonary vessels)

135
Q

Strong Med Lesson 7

what are four reasons for “reduced lung volume” on CXR?

A

poor inspiratory effort
suboptimal timed exposure
restrictive lung disease
subpulmonic effusions

136
Q

Strong Med Lesson 7:

what are two categories of diffuse lung opacities?

A 
alveolar opacities (aka "airspace opacities")
interstitial opacities
137
Q

Strong Med Lesson 7:

what is one reason for cardiogenic pulm edema (causing alveolar opacities)?

A

any cause of congestive heart failure

138
Q

Strong Med Lesson 7:

what are two reasons for NON-cardiogenic pulm edema (causing alveolar opacities)?

A

acute lung injury (ALI)

acute resp distress syndrome (ARDS)

139
Q

Strong Med Lesson 7:

what are two causes of alveolar opacities without edema?

A

multilobar pneumonia

diffuse alveolar hemorrhage

140
Q

Strong Med Lesson 7:

what are three types of interstitial opacities?

A

reticular

nodular

reticulonodular

Directed Study Course_JD (3 decks)

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