Conducting pre-procedural activities

Question 1

A Holter monitor is used to assess what?

Answer 1

Frequency and severity and arrhythmias

Question 2

When draping a patient for a PPM, the technologist will drapes which area?

Answer 2

drapes the area that has been disinfected for use

Question 3

Where is the primary source of airborne bacteria?

Answer 3

opening the procedure room door

Question 4

When handling sterile items it is important to keep the equipment where?

Answer 4

within the sterile field

Question 5

What influences the shelf life of a sterile package?

Answer 5

number of packaging layers

Question 6

The patient is presenting for a Bi-V ICD implant has a baseline O2 saturation of 84%, which does not improve with O2 therapy. How should the patient be sedated?

Answer 6

The patient should not be sedated

Question 7

A patient is taken off Coumadin for one week prior to RF ablation procedure. The INR yields a value of 3. What should the next step be?

Answer 7

Send the patient home and repeat the INR at a later date

Question 8

What is the acceptable K+ levels for a patient undergoing an EP study?

Answer 8

3.5-5.4

Question 9

Prior to starting the case, after explaining the procedure to the patient as well as identifying risks and potential complications, permission is given to proceed with the study. This is known as what?

Answer 9

informed consent

Question 10

The patient is arriving for their pacemaker implant is complaining of itching and feeling warm. The IV ancef was started by the floor nurse approx. 20 mins ago. What immediate action should be taken?

Answer 10

Stop the Ancef drip and notify the physician

Question 11

What class drug is amiodarone?

Answer 11

Class III

Question 12

Which medication markedly increases the refractory period?

Answer 12

Amiodarone

Question 13

Which TVP adjustment would change the unit from the demand mode to asynchronous?

Answer 13

decrease sensitivity

Question 14

The best description of cardiac thresholds for a single chamber implantable device?

Answer 14

the minimum amount of mA required to elicit a response

Question 15

What is the unit for resistance?

Answer 15

Ohms

Question 16

Hysteresis is used for what?

Answer 16

promote intrinsic conduction

Question 17

What happens to impedance when the lead is fractured?

Answer 17

increases

Question 18

Class I antiarrhythmic _________________ velocity and _______________ refractory periods.

Answer 18

decrease, increase

Question 19

If the ICD conductor is fractured by how much will the impedance increase?

Answer 19

250 Ohms or 30%

Question 20

Where should a patient carry their cellphones when they have a device?

Answer 20

In the contralateral pocket or in their pant pockets

Question 21

What does low impedance reading mean during a follow up visit post PPM?

Answer 21

possible lead insulation break

Question 22

The physician orders Ibutilide 1 mg IV. What aspect of patient monitoring should you adjust?

Answer 22

QT interval

Question 23

During monitoring of a RF ablation procedure, you observe the catheter temperature reach 100 C. What is your next action?

Answer 23

Alert the physician and stop the ablation delivery because of potential coagulum

Question 24

What are the MOST common catheter positions for performing an initial VT study?

Answer 24

HRA, HIS, RVOT and RVA

Question 25

In order to help facilitate the induction of AVNRT, is it customary to use which drug via IV?

Answer 25

Isuprel

Question 26

During open-irrigated ablation, the pump alarm beeps. You should do what action next?

Answer 26

turn off the pump and notify the physician to turn flow off to patient

Question 27

During RF ablation, a high impedance reading continually shuts off the RF generator. What should your first troubleshooting attempt be?

Answer 27

Check the patient ground is secure

Question 28

Which blood test is likely to be performed prior to removing an arterial sheath in a heparinized patient?

Answer 28

ACT

Question 29

What test should be ordered to after a subclavian venous puncture?

Answer 29

chest x-ray

Question 30

Circulation distal to the femoral artery is best assessed by __________ pulses.

Answer 30

dorsalis-pedis

Question 31

Post procedure, an arterial line is to be discontinued. The final ACT is 450 seconds. The previous ACT was 320 seconds, with no heparin given since then. The next logical step would be to do what?

Answer 31

repeat the ACT

Question 32

``` The following prerequisites describe which type of tachycardia mechanism? Two pathways (A&B) must be connected One pathway must be conduct more slowly The slower pathway must have a shorter effective refractory period ```

Answer 32

Re entry

Question 33

During phase 2 of the action potential, there is a slow influx of which ion?

Answer 33

Calcium

Question 34

Give an example of Class Ia antiarrhythmic

Answer 34

procainamide

Question 35

Where is the maximum conduction delay?

Answer 35

N-regional cells of the AV node

Question 36

Repetetive delivery of 8 atrial beats at the same cycle length followed by 9th beat which is delivered with a progressively shorter coupling interval describes which pacing protocol?

Answer 36

Decremental atrial pacing

Question 37

What is the most common mechanism for tachycardias?

Answer 37

Reentry

Question 38

What does burst pacing protocol consist of?

Answer 38

sequence of fixed pacing train

Question 39

What is the most important cause of non-cardiac syncope ?

Answer 39

vagal hypersensitivity syndromes

Question 40

What is the mA of the stimulator conventionally set at?

Answer 40

2x diastolic threshold

Question 41

What is the formula for cSNRT?

Answer 41

cSNRT = SNRT-SCL

Question 42

How is retrograde conduction defined?

Answer 42

Conduction from the ventricle to the atria

Question 43

In a patient with a resting baseline sinus cycle length (SCL) of 623 msec and a sinus node recovery time (SNRT) of 2122 msec, Calculate the cSNRT.

Answer 43

1499 msec

Question 44

What is the heart rate in BPM for a patient with a tachycardic rate of 320 msec?

Answer 44

188 BPM

Question 45

What is the name of the ridge tissue in front of the inferior vena cava?

Answer 45

The Eustasian ridge

Question 46

What would be necessary for a patient with symptomatic 1st degree AVB with HIS purkinje disease?

Answer 46

PPM

Question 47

Carotid massage is performed on a patient presenting with syncope. What arrhythmia would you expect?

Answer 47

SVT and VT (could be SVT with aberrancy)

Question 48

With the exception of a local stimulus of above normal strength, which refractory period describes the time during repolarization in which the longest coupling interval (S1, S2) of input into a tissue fails to produce capture?

Answer 48

Effective

Question 49

You have induced tachycardia in a patient who did not have an V-A block with adenosine. The tachycardia has a V-A of 180 ms. Suddenly, the patient develops LBBB and the V-A increases to 220ms. What does the patient most likely have?

Answer 49

a left-sided AP

Question 50

What causes a delta wave?

Answer 50

Antegrade AP conduction pre-exciting the ventricular tissue

Question 51

What is the equation for corrected QT?

Answer 51

QTc = QT / √R-R interval

Question 52

Tall peaked T waves on a 12 lead ECG is associated with what?

Answer 52

hyperkalemia

Question 53

What are the proper high/low pass filter for intracardiac electrograms in Hertz?

Answer 53

30/500

Question 54

What are the proper high/low pass filter for electrocardiogram in Hertz?

Answer 54

0.5/100

Question 55

what is the most common site for idiopathic VT?

Answer 55

RVOT

Question 56

How is the left atrium activated simultaneously with the right atrium?

Answer 56

Bachman's Bundle

Question 57

What is a specific complication to PVI?

Answer 57

atrioesophageal fistula

Question 58

You are assisting with a PPM generator change on a pacemaker dependent patient. The doctor attaches the new generator leads, but no pacing occurs until the generator is placed in the pocket. Why did this happen?

Answer 58

The generator is unipolar

Question 59

A properly functioning RV apical pacing lead should produce what kind of morphology on the surface ECG?

Answer 59

LBBB morphology

Question 60

What is the normal range for pacemaker impedance?

Answer 60

300-1200 Ohms

Question 61

What is the most important consideration when selecting a site for a peripheral IV in a patient undergoing a device implant?

Answer 61

planned side of implant

Question 62

What is the usual result of moving the ground patch closer to the site of RF energy?

Answer 62

a decrease in impedence

Question 63

In an effective RF burn, the impedance should follow what pattern?

Answer 63

decrease initially, then increase and stabilize

Question 64

What safety checks should be performed prior to using a TVP for pacing?

Answer 64

check date of last battery change

Question 65

Class I recommendations for the extraction of a chronic pacing and defibrillation leads include what risk factor?

Answer 65

An occult (mysterious) infection for which no source can be found and for which the pacing system is suspected

Question 66

After injecting 15cc of Omnipaque into the CS visualization, the patient's O2 saturation falls from 98% to 90% on 2L of O2 via nasal cannula and he begins to wheeze. What is the most likely cause?

Answer 66

An allergic to iodine

Question 67

During a cryoablation for atrial tachycardia near the bundle of HIS, a patient goes into complete heart block. What would the next logical step be?

Answer 67

stop ablation and wait for conduction to return

Question 68

What are the four structures, outline the triangle of Koch?

Answer 68

Tendon of Todaro, HIS bundle, septal leaflet of tricuspid annulus, coronary sinus os

Question 69

What nerve drapes itself over the right atrial appendage and affects diaphragmatic motion?

Answer 69

phrenic nerve

Question 70

What vessel normally supplies blood to the SA and AV node?

Answer 70

RCA

Question 71

What is the most common site of triggers for a. fib?

Answer 71

pulmonary veins

Question 72

What best describes the appropriate protocol for testing the pacing capture threshold of a newly implanted lead?

Answer 72

Decreasing the pulse voltage from 5V until the capture is lost

Question 73

What does magnet application do to the defibrillator Reed switch?

Answer 73

Disables shocking therapies and goes to asynchronous pacing

Question 74

Which of the following is likely to happen during the lead maturation process?

Answer 74

Encapsulation of the electrode with fibrin tissue

Question 75

A 12-lead EKG of VT with a positive QRS in Lead I and negative QRS in aVF indicates what axis deviation?

Answer 75

Left axis deviation