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Year 3 Skills > ECG quizzes > Flashcards

ECG quizzes Flashcards

1
Q
A
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2
Q

Are the complexes for the rhythms narrow or broad?

  • Sinus rhythm [a]
  • Atrial tachycardia [b]
  • Ventricular tachycardia [c]
  • Supraventricular tachycardia [d]
  • Left Bundle Branch Block [e]
  • Right Bundle Branch Block [f]
  • Ventricular ectopic [g]
  • Nodal rhythm [h]
  • Wolff Parkinson White [i]
  • First degree heart block [j]
  • Second degree heart block (Mobitz 1) [k]
  • Second degree heart block (Mobitz 2) [l]
  • Third degree heart block with ventricular escape [m]
A
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3
Q

What is the rate?

A

100 +/- 11%

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4
Q

What is the rhythm ana axis?

A

sinus rhythm

normal axis

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5
Q

What is the rate, rhythm and axis?

A

75 +/- 10%

sinus

normal

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6
Q

The ECG comes from a 52 year old man complains of chest pain on exertion. He complains that the pain gets worse as he climbs a hill (especially when carrying shopping), but that the pain settles if he sits down for 10 minutes. As you know, is 12 lead ECG shows a rate of 70 bpm, in sinus rhythm with a normal axis. What is the diagnosis as evidenced by the ECG (at rest)?

What is the diagnosis if he has chest pain on exertion?

A

normal

angina

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7
Q

This man’s resting ECG is normal, and you thus suspect chronic stable angina, where he gets chest pain on exertion, which is relieved by rest. What test does he need to prove this diagnosis?

A

He needs an exercise test, or an exercise induced ECG. This is where a 12 lead ECG is performed while he is having strenuous exercise.

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9
Q

What is the rate, rhythm and axis?

A

140+/- 10%

sinus

normal

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10
Q

This ECG is taken at peak exercise in a patient with chronic stable angina. What does it show?

A

ST depression in leads II, III and aVF

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11
Q

ST depression in leads II, III and aVF is consistent with which of the following:

A.anterior myocardial infarction

B.inferior ischaemia

C.anterior ischaemia

D.inferior myocardial infarction

A

B

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12
Q

This ECG shows ST depression in II, III and aVF during exertion. This is consistent with inferior ischaemia, also known as chronic stable angina. What is the likely pathology behind this finding:

A.complete left coronary artery occlusion

B.partial left coronary artery occlusion

C.complete right coronary artery occlusion

D.partial right coronary artery occlusion

A

D.partial right coronary artery occlusion

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13
Q

Consider this ECG, and what the patient will complain of. Describe the rhythm of this ECG.

A

irregular

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14
Q

The ECG shows the irregularly irregular pulse of atrial fibrillation with a rapid ventricular response (also known by some as “fast” atrial fibrillation). Which of the following are likely to be true in this 70 year old man with arthritis who is otherwise fit and well, but is now in casualty complaining of palpitations and breathlessness at rest.

  • a.Heparin must be started intravenously.
  • b.Aspirin must be started orally.
  • c.Digoxin is a useful drug, and should be started intravenously.
  • d.Simvastatin is a useful drug
  • e.Sublingual GTN is likely to help
A

Digoxin is a useful drug, and should be started intravenously.

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16
Q

What is the diagnosis?

A.ST elevation in leads II, III and aVF

B.ST elevation in leads V2 to V6

C.Wenkebach’s phonomenon

D.Atrial Fibrillation

E.ST depression in leads V2 to V6

F.Left Bundle Branch Block

G.Right Bundle Branch Block

H.ST depression in leads II, III and aVF

I.Complete heart block

A

D

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21
Q

What protocol is followed in an exercise induced ECG?

A

The Protocol commonly used is the “Bruce” protocol, where the exercise gets more strenuous every 3 minutes.

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28
Q

Why is digoxin a good drug for AF? What else would you give the patient?

A

Digoxin slows the ventricular response by increasing the block at the AV node. This helps the palpitations, and reduces the inappropriate tachycardia.

Patients with atrial fibrillation can be started on warfarin to prevent strokes and digoxin to slow down the heart rate. Digoxin will lock the patient in “slow” atrial fibrillation, which is reasonable in a patient who does not need a large cardiac output, for example to play tennis or sport. In casualty one would normally give the first two doses of digoxin intravenously, and then switch to oral, although in the non-compromised patient, you might consider oral digoxin alone. One should also consider the option of cardioverting the patient back to sinus rhythm.

29
Q

Which one of the following regarding this ECG is true?

a. The complexes are narrow.
b. The pulse is irregular.
c. The diagnosis is atrial fibrillation.
d. The diagnosis is left bundle branch block.
e. The diagnosis is right bundle branch block.

A

The diagnosis is left bundle branch block.

30
Q

Why is this a left bundle branch block and not a RBBB?

A

In right bundle branch block, the double R wave is seen best in V1 or V2. This is not the case here.

Since the left bundle is blocked, the right ventricle contracts before the left one, and there are thus two overlapping R waves, resulting in a broad complex. The double R waves are most easily seen in lead II, and less clearly in lead V5.

31
Q

What is the axis?

A

Left axis deviation

32
Q

In left bundle branch block…?

a. The P wave is usually abnormal.
b. Atrial fibrillation is common
c. The ST segments are not interpretable, and the diagnosis of acute myocardial infarction is difficult.
d. Patients usually need urgent thrombolysis.
e. Patients usually need urgent cardioversion.

A

The ST segments are not interpretable, and the diagnosis of acute myocardial infarction is difficult.

34
Q

What is the diagnosis?

  • A.ST elevation in leads II, III and aVF
  • B.ST depression in leads V2 to V6
  • C.ST elevation in leads V2 to V6
  • D.Complete heart block
  • E.Left Bundle Branch Block
  • F.Atrial Fibrillation
  • G.Wenkebach’s phonomenon
  • H.ST depression in leads II, III and aVF
  • I.Right Bundle Branch Block
A

ST elevation in leads II, III and aVF

Careful inspection shows ST elevation in the inferior leads.

36
Q

This ECG shows ST elevation in II, III and aVF as well as V6. This is consistent with inferior infarction. There is also apparent ST depression in leads V1 to V3, but this is in fact inverted ST elevation, so that there is POSTERIOR extension of this inferior infarction. What is the likely pathology behind this finding?

A

D.complete right coronary artery occlusion

38
Q

What is the diagnosis?

  • A.Complete heart block
  • B.ST elevation in leads V2 to V6
  • C.ST elevation in leads II, III and aVF
  • D.Left Bundle Branch Block
  • E.ST depression in leads II, III and aVF
  • F.Right Bundle Branch Block
  • G.ST depression in leads V2 to V6
  • H.Atrial Fibrillation
  • I.Wenkebach’s phonomenon
A

AF - patient with atrial fibrillation with a rapid ventricular response.

39
Q

What does this ECG show?

  • A.Complete heart block
  • B.ST elevation in leads V2 to V6
  • C.ST elevation in leads II, III and aVF
  • D.Left Bundle Branch Block
  • E.ST depression in leads II, III and aVF
  • F.Right Bundle Branch Block
  • G.ST depression in leads V2 to V6
  • H.Atrial Fibrillation
  • I.Wenkebach’s phonomenon
A

Careful inspection shows ST elevation in the inferior leads (V2-V6)

41
Q

This ECG shows ST elevation in V2 to V6. This is consistent with anterior infarction. What is the likely pathology behind this finding?

A

complete left coronary artery occlusion

42
Q

“In LBBB The ST segments are not interpretable, and the diagnosis of acute myocardial infarction is difficult.”

Why?

A

Because depolarisation of the ventricle is not normal, repolarisation is also affected, and the ST segments are usually abnormal. Thus it is difficult to make a diagnosis of ST elevation or ST depression in the presence of left bundle branch block.

44
Q

ST elevation in leads II, III and aVF is consistent with which of the following:

A.inferior myocardial infarction

B.anterior ischaemia

C.inferior ischaemia

D.anterior myocardial infarction

A

Inferior myocardial infarction

46
Q

How do you manage a complete right coronary artery occlusion?

A

Complete right coronary artery occlusion is an emergency and can be confirmed by angiography and immediately, treated by primary (emergency) angioplasty or coronary artery bypass grafting. Where this is not available, immediate thrombolysis is required.

49
Q

ST elevation in leads V2-V6 is consitent with which of the following?

  • A.anterior ischaemia
  • B.inferior myocardial infarction
  • C.inferior ischaemia
  • D. anterior myocardial infarction
A

anterior myocardial infarction

Year 3 Skills (3 decks)

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