Cardiology and 12-Lead Interpretation

Question 1

Your patient is having a massive inferior wall MI. What vessel is most likely occluded?

Answer 1

Right Coronary Artery

Question 2

Your patient is in cardiogenic shock and you suspect this patient is having an infarct in their left ventricle (“Widow maker”). What vessel is most likely occluded?

Answer 2

Left Coronary Artery

Question 3

If left without input, a single cardiac cell will contract rhythmically at a steady rate. If two cells are in contact, the first one to contract will in turn stimulate the other to contract. This characteristic of cardiac cells is called:

Answer 3

automaticity

Question 4

T/F: During systole, sodium and calcium move out of the cells.

Answer 4

False

Question 5

T/F: Potassium is primarily an intracellular ion.

Answer 5

True

Question 6

____________ is the amount of blood ejected from the ventricles with each contraction.

Answer 6

Stroke volume

Question 7

What is the formula for determining mean arterial pressure (MAP)?

Answer 7

[(2 x diastolic) + systolic] / 3

Question 8

You are treating a patient complaining of severe chest pain that is made worse when the patient lays flat and is relieved when the patient leans forward. What cardiac condition should you suspect?

Answer 8

Pericarditis

Question 9

T/F: An abdominal aortic aneurysm typically occurs between the renal and inferior mesenteric arteries.

Answer 9

True

Question 10

What is the main risk for morbidity or mortality regarding non-bacterial thrombotic endocarditis (NBTE)?

Answer 10

A clot breaking loose and lodging in the heart or brain.

Question 11

You are treating a 55-year-old male IV drug user and alcoholic. The patient is having excruciating pain in his back, abdominal rigidity, and has a blood pressure of 52/P. What condition should you suspect?

Answer 11

Abdominal Aortic Aneurysm Rupture

Question 12

You are transporting a 78-year-old female who just received a diagnostic heart cath (a major blockage was found). The patient is now being transported to a larger facility for open heart surgery. During transport, the patient has sudden onset of chest pain, severe back pain that progresses down her flank, and is extremely diaphoretic. She tells you that it feels like something “just tore inside me”. You are seeing signs of ischemia in several leads when you perform a 12 lead. What should you suspect?

Answer 12

She is having an aortic dissection caused by her heart cath.

Question 13

What is the target heart rate range and the target systolic blood pressure range for a patient with an abdominal aortic aneurysm (AAA)?

Answer 13

HR of 60 - 80
Systolic BP of 100 - 120

Question 14

T/F: Atropine is typically the medication used for a bradycardic patient with a suspected AAA.

Answer 14

False, an AAA is a contraindication for administering atropine.

Question 15

T/F: Hypertensive urgency is when organ damage occurs as a result of hypertension.

Answer 15

False, hypertensive emergencies are when organ damage occurs as a result of hypertension.

Question 16

Mean arterial pressures should not be lowered more than ____% in the first hour of treatment for patients with hypertensive emergency.

Answer 16

20

Question 17

If blood pressure is lowered too rapidly in a patient with hypertensive emergency, what condition can occur?

Answer 17

watershed stroke

Question 18

T/F: A NSTEMI typically indicates a partial obstruction of the coronary artery.

Answer 18

True

Question 19

T/F: An MI can often present as general malaise and weakness in the elderly without specific cardiac signs and symptoms.

Answer 19

True

Question 20

T/F: All patients who have an MI will develop a “Q” wave.

Answer 20

False

Question 21

Aside from cardiac related events, a CK-MB value may also be elevated in patients with ______________________.

Answer 21

skeletal injuries

Question 22

T/F: Slightly elevated Troponin levels can still be indicative of damage to the heart muscle.

Answer 22

True

Question 23

T/F: High flow oxygen is indicated for all patients with a suspected MI.

Answer 23

False

Question 24

In a hemodynamically unstable cardiogenic shock patient, what intervention should you perform to maintain an adequate heart rate?

Answer 24

Pacing

Question 25

When a cardiac cell is depolarized, _______ charges are on the outside and ________ charges are on the inside of the cell.

Answer 25

negative, positive

Question 26

What is the optimal patient position for obtaining a 12 lead EKG?

Answer 26

supine

Question 27

When obtaining a 12 lead, you decide to place the limb leads on the patient’s trunk. Upon printing out the strip, you should:

Answer 27

note on the strip that the limb leads were placed on the trunk.

Question 28

What are the bipolar leads?

Answer 28

I, II, III

Question 29

T/F: The “P” wave should typically be upright in leads II, III, and aVF and have a duration less than 0.1 seconds.

Answer 29

True

Question 30

An elevation or depression of the ST segment of ____ mm or more above the isoelectric line may be indicative of myocardial injury or ischemia.

Answer 30

1

Question 31

You are treating a 22-year-old female who developed sudden onset chest pain and shortness of breath. You observe “Q” waves in Lead III. What condition should you suspect?

Answer 31

Pulmonary embolus

Question 32

Axis determination can be used to assist in diagnosing which of the following?

a) atrial fibrillation vs atrial tachycardia
b) the presence of hemiblocks
c) myocardial infarction vs angina
d) mitral valve prolapse

Answer 32

b) the presence of hemiblocks

Question 33

T/F: The electrical impulse that travels towards the electrode is seen as a negative inflection on the EKG tracing.

Answer 33

False, it is seen as a positive inflection

Question 34

In regards to axis deviation, what is the axis orientation when you observe upright QRS complexes in leads I, II, and III?

Answer 34

This is a normal axis

Question 35

In regards to axis deviation, what is the axis orientation when you observe upright QRS complexes in lead I, and downward QRS complexes in lead II and III?

Answer 35

This is a pathological left axis

Question 36

T/F: A right axis deviation is a normal finding in pediatrics, but may indicate a posterior hemiblock in adults.

Answer 36

True

Question 37

Which leads look at the inferior surface of the left ventricle?

Answer 37

Leads II, III, and aVF

Question 38

T/F: Acute MI’s cannot be determined if a left bundle branch clock is present.

Answer 38

True

Question 39

T/F: Sodium is the primary extracellular ion.

Answer 39

True

Question 40

Your patient is in Torsades de pointes. Should you expect this patient to be hypokalemic or hyperkalemic?

Answer 40

hypokalemic

Question 41

You are transporting a 75-year-old female with heart failure. You notice on her EKG that she has a prolonged QT interval. She appears to have ST elevation in multiple leads, but her Troponin and CPK are negative. What should you suspect?

Answer 41

Hypocalcemia

Question 42

T/F: If the QRS duration exceeds 0.12 seconds, then there may be a bundle branch block.

Answer 42

True

Question 43

T/F: An anterior MI is usually more massive than an inferior MI because the left anterior descending (LAD) artery is the largest coronary artery so its blockage results in a massive infarct.

Answer 43

True