Clinical skills

Question 0

Causes of right axis deviation

Answer 0

RVH (chronic lung disease)
WPW
Anterolateral MI
Left posterior hemiblock

Question 1

Common causes of left axis deviation

Answer 1

Left anterior hemiblock
WPW
Inferior MI

Question 2

Normal p wave

Answer 2

<2.5 blocks in lead ll
Lead l has both positive and negative (biphasic)
Should look the same
Give rise to QRS

Question 3

Peaked P in lead ll

Answer 3

RAH

Question 4

Exaggerated negative deflection of P in V1

Answer 4

LAH

Question 5

Bifid p wave in lead ll

Answer 5

LAH

Question 6

Normal PR interval

Answer 6

0.12-0.2secs

Question 7

Axis in no mans land

Answer 7

Emphysema
Hyperkalaemia
Pacing
Lead transposition

Question 8

Missing p waves

Answer 8

Sick sinus

Question 9

Saw tooth p waves

Answer 9

Atrial flutter

Question 10

One p per QRS but every one different

Answer 10

MAT

Question 11

Neg p in lead ll

Answer 11

Junctional pacemaker (retrograde conduction)

Question 12

First degree block

Answer 12

Long PR interval

Question 13

Second degree type l

Answer 13

Prolonging PR then dropped beat

Question 14

Second degree type ll

Answer 14

Regular PR with dropped beats (pearl necklace)

Question 15

Tall QRS in Vl

Answer 15

RVH

Question 16

Too tall V4-V6

Answer 16

LVH

Question 17

Notched QRS (too wide)

Answer 17

RBBB

LBBB

Question 18

When is there increased risk of VT/Vfib with PVCs? (6)

Answer 18

More than 6 PVCs per min
Multifocal
Bigeminy/trigeminy
Couplets
Runs of VT
R on T

Question 19

ECG signs in ACS

Answer 19

ST elevation / depression
T wave changes
LBBB
L ant hemiblock 
VT
Other

Question 20

ECG signs for ACS must be..

Answer 20

In contiguous leads

Question 21

Big Q waves

Answer 21

Old MI

Question 22

Causes of long QT

Answer 22

Drugs (amiodarone)
Electrolyte abnormalities
Congenital

Question 23

Values for LVH

Answer 23

V6 R>25mm
V1 S>25mm
V1 S + V6 R >35mm
Deepest S + tallest R >45mm

Question 48

Causes of distributive shock

Answer 48

Sepsis Anaphylaxis Neurogenic (spinal injury)

Question 49

Causes of obstructive shock

Answer 49

Massive PE Tension pneumothorax Cardiac tamponade

Question 50

Causes of hypovolaemia shock

Answer 50

Haemorrhage Burns GIT losses

Question 51

Causes of cardiogenic shock

Answer 51

MI Arrhythmias Acute valvular damage Cardiac contusion

Question 52

Stage 1 of shock

Answer 52

Up to 15% blood loss Pallor Normal resp and BP

Question 53

Stage 2 of shock

Answer 53

``` 15-30% blood loss Tachycardia Systolic normal but diastolic increased therefore narrow pulse pressure Sweating Delayed cap refill ```

Question 54

Stage 3 of shock

Answer 54

``` 30-40% blood volume loss Systolic BP 100 or less Tachycardia over 120 Resp rate>30 Altered mental state Sweating + cool pale skin ```

Question 55

Stage 4 of shock

Answer 55

``` Greater than 40% blood loss Systolic 70 or less Tachy of 140 or more and marked tachypnoea Possible coma Absent cap refill Very very pale ```