Flashcards for Midterm Exam

Question

Normal Mg⁺

Answer 1

1.5-2.5 meq/L

Answer 2

280-300 mOsm

Answer 3

1. Assess adequacy of dialysis 2. Metabolic acidosis with high AG 3. **Hyperk**alemia (hypok w/ dialysis) 4. **Hyperglyc**emia (if insulin resistant) 5. **Hypermag**nesemia 6. **Hypona**tremia (hyper is rare) 7. **Hypoca**lcemia (unclear etiology) 8. **Hypoalb**uminemia (esp. w/ dialysis)

Answer 4

Tall T waves ST depression Wide QRS

Answer 5

Peaked or flattened T waves Prolonged PR & QT

Answer 6

Prolonged QT

Answer 7

elbow flexion = C5, C6 elbow extension = C6, C7, C8

Answer 8

C7, C8, T1

Answer 9

C8, T1, ulnar nerve

Answer 10

C8, T1, median nerve

Answer 11

L4, L5, S1

Answer 12

L4, L5, S1, S2

Answer 13

* Phenelzine * Isocarboxazid * Selegiline * Brofaromine * Befloxatone * Iproniazid * Moclobemide

Answer 14

Disease modifying therapy/ immunomodulator for MS Side Effects: flu-like symptoms, hepatotoxicity, myelosuppression, depression

Answer 15

Disease modifying therapy/ immunomodulator for MS Side Effects: GI discomfort, infections

Answer 16

Disease modifying therapy/ immunomodulator for MS Side Effects: well tolerated

Answer 17

Disease modifying therapy/ immunomodulator for MS Side Effects: Leukoencephalopathy, hepatotoxicity

Answer 18

Disease modifying therapy/ immunomodulator for MS Side Effects: bradycardia, hepatoxicity

Answer 19

Disease modifying therapy/ immunomodulator for MS Side Effects: neutropenia, hepatotoxicity

Answer 20

Immunosuppresant drug for MS Side Effects: severe myelosuppression and cardiac toxicity-- reduced EF--heart failure

Answer 21

1. Ibuprofen 2. Indomethacin 3. ASA 4. Cox-2 Inhibitors 5. DVT preventative therapy

Answer 22

II, III, avF

Answer 23

I, avL, V5-V6

Answer 24

+ electrode placed directly over R atrium; corresponds to septal wall (LAD)

Answer 25

+ electrode placed just anterior to the AV node; corresponds to septal wall (LAD)

Answer 26

+ electrode placed over ventricular septum; corresponds to anterior wall (LAD)

Answer 27

+ electrodes placed over lateral surface of L ventricle; corresponds to lateral wall of heart (circumflex)

Answer 28

* LBBB * Chronic HTN * Aortic stenosis * Aortic insufficiency * Mitral regurgitation

Answer 29

1. PE 2. Pulm HTN 3. COPD 4. Cor pulmonale 5. Acute bronchospasm

Answer 30

Large R wave in V1 and gets progressively smaller in V2, V3, V4

Answer 31

Large S wave in V1 and larger R wave in V5 * Depth (in mm) of S in V1, plus height of R in V5 if \>35 mm = LVH

Answer 32

T wave inversion or ST segment depression

Answer 33

ST segment elevation (\>1 mm)

Answer 34

Q waves which are \>1 small box or 1/3 size of QRS

Answer 35

Infarction (old MI)

Answer 36

Normal, healthy pt; no systemic dz

Answer 37

Mild to moderate systemic dz, well-controlled, no functional limitations

Answer 38

Severe systemic dz, functional limitation

Answer 39

Severe systemic dz that is a constant threat to life

Answer 40

Moribund pt, not expected to survive (+/- surgery)

Answer 41

Pt declared brain dead; harvesting organs for donation

Answer 42

* 10-30% pts develop **GI hemorrhage** * High incidence of **Hep B&C** (multiple transfusions) * **Anorexia, N/V** * **Ascites** w/ dialysis * **Hypersecretion** of gastric acid **+ delayed emptying** (autonomic neuropathy)

Answer 43

Effects altered due to: * **Anemia** * **Decreased** serum **protein** * **Fluid retention** = *change Vd for MR's* * **Electrolyte** abnormalities = *pts more prone to dig toxicity* * Abnormal **cell membrane** activity Drugs eliminated by the kidneys unchanged are **_CONTRAINDICATED_** * **_Gallamine, phenobarbital, LMWH_** \*\*\*LMWH is cleared by the kidneys and NOT removed during dialysis = prolonged duration and r/f bleeding!

Answer 44

1. Blood Urea Nitrogen (10-20 mg/dL) 2. Plasma creatinine (0.7-1.5 mg/dL) * GFR can decreased 50% without rise in plasma creatinine. Not accurate indicator, especially in elderly 3. Creatinine clearance\*\* (110-150 mL/min)

Answer 45

_Chronic Kidney Disease (CKD)_ = GFR \< 60 mL/min/1.73m2 for 3 months _Chronic Renal Failure (CRF)_ = GFR 15 mL/min/1.73m2 _ESRD_ = Loss of renal function for 3 months or more (Diabetes accounts for ½ of cases & HTN for ¼. Polycystic 10%-genetic autosomal dominant) _Acute Kidney Injury (AKI)_ = Sudden decreased function/UOP

Answer 46

1. Oliguria 2. Fluid overload 3. Hyperkalemia 4. Severe acidosis 5. Metabolic encephalopathy 6. Pericarditis 7. Coagulopathy 8. Refractory GI symptoms 9. Drug toxicity

Answer 47

* Diffusion of solutes between blood and dialysis solution remove metabolic wastes and restore buffers to the blood * Need vascular access * AV fistula = cephalic vein anastomosed to radial artery * Jugular or femoral vein for emergency access

Answer 48

* General rule: scheduled doses of drugs are administered after dialysis * Low-molecular weight, water-soluble, non-protein bound drugs are readily cleared by dialysis

Answer 49

* Uremic Encephalopathy * Asterixis * Myoclonus * Lethargy * Confusion * Seizures * Coma * Autonomic Neuropathy * Peripheral Neuropathy _S/P Dialysis_ * **Disequilibrium syndrome** (dialysis related) transient CNS disturbance after rapid ↓ in ECF osmolality compared w/ ICF osmolality * **Dementia**

Answer 50

1. **Anemia** typical **Hgb = 6-8 g/dL** * ↓ erythropoietin and RBC production and ↓ cell life span * GI blood loss, hemodilution, bone marrow suppression * Excess PTH replaces bone marrow w/ fibrous tissue * Most pts tolerate anemia well (exception CAD) * ↑ 2,3- DPG (diphosphoglycerate) + metabolic acidosis = favors Right shift 2. **Impaired platelets (**qualitative) = prolonged bleeding time 1. ↓ plt factor III activity 2. ↓ adhesiveness & aggregation 3. **Impaired WBC** function = infections 4. Release of **defective von Willebrand factor\***\* 5. Dialysis = Residual **anticoagulation vs** promotion of **hypercoagulable** state 6. **Hypocomplementemia** w/ dialysis

Answer 51

Renal Tubular Function = reflects concentrating ability of kidney vs nephron function (GFR) * Urine Specific Gravity (1.003-1.030) * Urine Osmolarity (38-140 mOsm/L)

Answer 52

* Normal BUN = 10-20 mg/dL * Varies _inversely w/GFR_ & **directly w/protein catabolism** * \> 50 mg/dL is indicative of ↓GFR (in pts w/ nml diets) * The most common cause of ↑BUN is CHF 2^◦ to reabsorption of BUN *(RAAS is on high)* * BUN is **_not_** a sensitive index bc urea clearance also depends on urea production * **BUN can be abnormal** despite a *normal GFR* due to: * High protein diet * GI bleed * Febrile illness

Answer 53

* Plasma Cr is a specific indicator of GFR (plasma Cr is freely filtered but not reabsorbed) * **8-17 hr lag time** after change in GFR before ↑ Cr levels are seen * Suggestive [but not indicative] of Acute Renal Failure * Usually 50% ↑ in plasma Cr reflects a corresponding ↓ in GFR * Skeletal muscle = source of Cr (more muscle mass = higher baseline Cr) * Elderly pt: Cr levels stay normal/constant d/t: * ↓ muscle mass and GFR * *If CR ↑ in elderly, may be indicative of renal failure*

Answer 54

Creatinine Clearance approximates GFR 24 hr collection most accurate although 2 hr tests also helpful 100-120 mL/min = Normal 60-100 mL/min = ↓ Renal Reserve 40-60 mL/min = Mild Renal Impairment 25-40 mL/min = Moderate Insufficiency \< 25 mL/min = Renal Failure \< 10 mL/min = ESRD

Answer 55

male: 4.6-6.2 million/mm³ female: 4.2-5.4 million/mm³

Answer 56

Male = 13.5-18 g/dL Female = 12-16 g/dL

Answer 57

male = 40-54% female = 38-47%

Answer 58

5,000-10,000/mm³

Answer 59

150,000-400,000 cell/mm³

Answer 60

90-120 sec

Answer 61

160-350 mg/dL

Answer 62

* If **regional** anesthesia is planned need **coag panel**!!!! * **↑ bleeding** despite **normal PT, PTT** * **Bleeding Time** best screening test * Important cause of coagulation issues- **release of defective von Willebrand factor** * Rx: * **Desmopressin (0.3-0.4 mg/kg over 30 min)** * **Cryoprecipitate 10 units IV over 30 min** * Blood warmer set up and ready to go

Answer 63

**EKG** * Hyper or hypokalemia * HyperK (Concern above 5.0) → Tall T waves, ST depression, wide QRS * HypoK → peaked or flattened T waves, prolonged PR & QT * Hypocalcemia → Prolonged QT * Ischemia * Conduction blocks * LVH **Echocardiography** * Hypertrophy * Ventricular EF * Wall motion abnormalities * Pericardial fluid

Answer 64

* CXR *(look for butterfly wings, enlarged heart)* 1. Fluid status 2. Determine presence of HTN related CV disease 3. Pericardial effusion 4. **Uremic pneumonitis** * ABG – hypoxia and acid/base status especially if dyspnea noted on exam

Answer 65

* Place tips of index finger just in front of the tragus of ear - ask patient to open mouth. * Fingertips should drop into joint spaces as mouth opens. * Check for smooth range of motion, swelling/tenderness. * Snapping & clicking normal * Ask pt to open & close mouth, protrude & retract (jutting the jaw forward), & perform side to side motion.

Answer 66

* Flexion = Touch chin to chest * Extension= Look up at ceiling * Rotation= Turn head to each side looking directly over shoulder * Lateral Bending = Tilt head touching ear to shoulder ## Footnote *\*Might have to do awake fiberoptic intubation if they can’t tolerate.*

Answer 67

(adduction, abduction, flexion, extension, internal & external rotation) 1. Abduct the arms to shoulder level. 2. Raise arms vertical position above head palms facing each other. 3. Place both hands behind the neck with elbows out to the side. 4. Place both hands behind the small of the back.

Answer 68

* Thoracic Outlet Syndrome- compression of brachial plexus and subclavian vessels near the 1st rib * Be certain pt can work or sleep w/ arms elevated over head before putting arms beside head (prone positioning)

Answer 69

Ask pt. to bend and straighten elbow (flexion and extension) With arms at sides and elbows flexed instruct pt. to turn palms up (supination) and palms down (pronation)

Answer 70

* **Concentrate on ROM that can impact positioning** * Flexion – supine pt. bends each knee to chest/abdomen * Abduction – supine pt. stabilize anterior superior iliac spine and abduct the extended leg until the iliac spine moves = limit! \*Perform this test if placing in lithotomy position or if pt at r/f hip issues (OA, etc.)

Answer 71

* Mental status (awake, alert, oriented X3) * Speech (clear speech, slurred) * Cranial nerves (don’t do on every pt) * Gait (Parkinson’s gait) * Motor function (note where we are starting from and document so we can note any changes or exacerbations post-op) * Sensory function

Answer 72

1 = Olfactory (smell)

Answer 73

2 = Optic (sight – confrontation test; pupillary rxn to light)

Answer 74

3 = Oculomotor (pupillary rxn to light; extraocular movements)

Answer 75

4 = Trochlear (extraocular movements) 6 = Abducens (extraocular movements)

Answer 76

5 – Trigeminal Ask pt to clench their teeth as you palpate temporal and masseter muscles Check sensation in areas circled Corneal reflex (cotton ball)

Answer 77

7 – Facial Ask pt to: * Raise both eyebrows * Close eyes tightly so you can’t open them * Frown, Smile * Show teeth * Puff out both cheeks

Answer 78

11 – Spinal Accessory * Ask pt. to turn head to each side against your hand * Ask pt to shrug both shoulders upward against your hand – trapezii strength

Answer 79

8 – Acoustic (hearing) 9 – Glossopharyngeal and 10 – Vagus (voice hoarseness?, gag reflex, AHH- palate should rise symmetrically) 12 – Hypoglossal (tongue movement, ask them to move tongue side to side)

Answer 80

* Test flexion and extension and compare symmetry * Grade on 0-5 scale 0. No muscular contraction detected 1. Barely detectable 2. Active movement with gravity eliminated 3. Active movement against gravity 4. Active movement against gravity with some resistance 5. Active movement against gravity with full resistance

Answer 81

* Glasgow Coma Scale – defines neurologic function impairment * Eyes open - Never(1)- Spontaneous (4) * Best Verbal Response None (1) – Oriented (5) * Best Motor Response None (1) - Obeys commands (6) * Mortality closely related to initial score * Scores 8 or less considered severe (coma)- will require intubation and controlled ventilation for ICP & airway control

Answer 82

* Suppression or dz of pituitary-adrenal axis will prevent pt from responding to stress of surgery appropriately * Any pt who has received corticosteroid therapy (suppression of pituitary-adrenal axis) for at least 1 month in the past 6-12 months needs supplementation periop * 2 possible regimens * 100 mg Hydrocortisone pre-op, intra-op and post-op * 25 mg Hydrocortisone pre-op + 100mg IV gtt over 12-24 hrs

Answer 83

* Immunosuppressant used in **MS**, Ankylosing Spondylitis (**AS**) and **RA** * Immuno-suppression, anemia, thrombocytopenia, pulmonary, renal, hepatic toxicity * **CBC** * **Chem**istry Panel * Consider **PFTs** and **LFTs** if history warrants

Answer 84

* These pts are generally on **immunosuppressive** meds * Any recent history of illness or infection? * Take extra care with infection prevention * **Which meds** are they taking and how often? * **Steroids** in the past year???? * *Be ready to give stress dose* * **Remission vs exacerbation** intervals * *If in middle of exacerbation, perhaps delay elective surgery* * Severity and nature of symptoms * **Respiratory** status * Previous **triggers****** DOCUMENT PRE-EXISTING DEFICITS * Paralysis (assess for motor strength) * Sensory disturbances (assess along dermatomes) * Autonomic disturbances (resting HR, orthostatic hypotension) * Visual impairment (cranial nerve check) * Seizures (meds) * Emotional Disturbances Counsel pt regarding increased r/f relapse w/ surgery

Answer 85

* Document **time course** of dz * Precipitating factors * Onset of symptoms * Dz Progression (worsening, stable, improving) * Document severity and current state of symptoms * **Facial paralysis** – bulbar involvement (what other concerns might you have here????) protecting airway * Difficulty **swallowing** – pharyngeal muscle weakness * Impaired **ventilation** – current ventilatory support required (vent settings) * Decreased **deep tendon reflexes**– lower motor nerves * Extremity **paresthesias** * **Pain** – headache, backache, muscle tenderness + note meds helpful for pain control * **ANS DYSFUNCTION!!!!!**! * Review ICU flow sheets for **VS** trends * **Vasoactive med**ication history for HTN and hypotension (ex. vasopressors, B-Blockers) * ECG, any recent arrhythmias? * Inquire w/nurse/patient regarding tolerance of position changes

Answer 86

* **Age of diagnosis**, recent exacerbations and hospitalizations * Current and past **symptoms** (ex. oculogyric crisis (eyes stuck in one position), when? How long did it last? What helped?) * **ANS** symptoms (orthostatic BPs) * History of **Pergolide** therapy? CV function—cv testing might be needed * **Temp** regulation issues? * **Pulmonary** status optimized? *(CXR, maybe won’t tolerate exercise bc of motor disability—hard to use as gauge for cv and pulm function, so may need pft if concerned)* * Dysphagia and/or dyspnea * Pulmonary infection * Continue **current med regimen** and note side effects * Levodopa -what happens if the patient misses a dose? * Anticholinergics and MAO’s? * Note the **natural ROM** for positioning * Deactivate deep brain stimulators before electrocautery

Answer 87

* Natural ROM for positioning and laryngoscopy * Baseline motor strength & sensation in applicable areas * Medication regimen (ex. pt on high dose opioids), what drugs improve pain, what has been ineffective? * Consider potential for operative blood loss * CBC * Type and Cross

Answer 88

* Evaluate for co-existing **vasculitis, aortitis, aortic insufficiency, pulm fibrosis** * Evaluate for severity of **kyphosis (difficult airway)** * SpO2, ECG, ECHO, CXR, PFTs * CBC, BUN/Creatinine * D/c NSAIDs at least 2 day pre-op * May have **positioning challenges** *(Eval normal ROM)* * ROM joints (esp. sacroiliac) * Pain mgt. hx. * ECG (cardiac conduction) * PFT (fibrosis) * Meds (NSAIDS, methotrexate, etc.)

Answer 89

* Determine level of lesion * Acute or Chronic? * **_Acute_** 1. Fluid and Blood Status 2. CBC, Type and Cross, Chem 7 3. ECG/ Chest X-ray 4. Vasopressor requirement? 5. Ventilatory support (current vent settings)? 6. Associated injuries? * **_Chronic_** 1. History of **autonomic dysreflexia**? What initiated it? 2. Old OR/ICU records helpful – **response** to vasopressors, tracheal suctioning 3. **Ventilatory reserve** – level of lesion 4. Assessment of **skin** integrity 5. Positioning – note normal **ROM**

Answer 90

* History of recent TIA or CVA ↑ r/f peri-operative stroke * Optimal time for subsequent elective surgery after stroke is controversial * Ensure optimization has occurred * Emboli – PFO (patent foramen ovale) corrected? * A-fib 1-3 months anticoagulation therapy * Carotid bruit noted on exam? * Ask pt about TIA symptoms (be aggressive w/ questioning!) * Consider carotid doppler ultrasound study - refer vascular surgeon

Answer 91

* **Mechanism** of injury or illness * **Location**, size, and time course of lesion * **CT/MRI** report (secondary edema, hydrocephalus?) * Level of consciousness (**LOC**) * **ICP** status (current symptoms of headache, N/V, bradycardia, HTN, etc.) * Evaluate **CV** status * Consider **cranial nerve** assessment * Consider muscle strength and sensation assessment * Review **current meds** and treatments * Endocrine status (pituitary tumors) * Fluid status * CBC * T&C * Electrolyte panel * ECG * +/- Echo * Review current **ventilatory status** (vent settings and ABG results; CXR)? * Note **baseline VS** and set BP parameters * Continue current meds * Steroids or anticonvulsants, for example

Answer 92

* Type of seizure activity; typical length, frequency, severity, & recovery period * Hx of status epilepticus (how long did it last, how was it treated, were treatments effective) * Precipitating/causative factors (ETOH withdrawal, brain tumor) * Pharmacologic Therapy * Testing directed based on meds - CBC, plt, electrolyte panel common * Routine levels of anticonvulsants unnecessary in pts w/ good seizure control * Cancel elective surgery until seizure disorder optimized by neurologist

Answer 93

* Note natural **ROM** (arthritis) * Note neuromuscular strength, cranial and peripheral neuropathies * Note mentation (CNS involvement) * Fluid and electrolyte status – Chemistry Panel * Hematologic – CBC, PT/PTT and INR * **Skin** – note existing rashes (not to be confused with allergic reactions peri-op) * **Distal extremities**- Raynaud’s common - pulse ox readings difficult * Renal Function – glomerulonephritis, proteinuria, albumin level, chemistry panel * **CV** status – Echo, CV consult, pericarditis? Conduction abnormalities?, CHF, valvular dysfunction? * **Pulm** status – PFT’s (restrictive pattern) * **GI** – prone to N/V?

Answer 94

* Note dose amount, frequency, timing of last dose, side effects, etc. * Drugs that affect **coagulation** status * Ibuprofen * Indomethacin * ASA * Cox-2 Inhibitors * DVT preventative therapy * Immunosuppressive therapy * **Steroids** * **Optimized** by PCP or rheumatologist?

Answer 95

* Focus areas: airway, neuro, pulm, CV * Note Natural ROM * TMJ – limited mouth opening (awake fiberoptic intubation) * Atlanto-axial joint – lateral neck radiograph or MRI * Cricoarytenoid arthritis – hoarseness, pain on swallowing, dyspnea, stridor, laryngeal tenderness * Individualized airway plan based on findings * Dyspnea is often a sign of cardiac ischemia in this population * PFTS and ABG if suspect lung involvement (restrictive pattern) * ECHO, ECG (cardiac conduction) especially if cardiac involvement suspected * Consider effect of meds: ASA, NSAIDS, methotrexate, immunosuppressive drugs and steroids * Balance preference to continue meds with anti-coagulation and immunosuppressive characteristics

Answer 96

* Note Natural ROM– focus on key problem areas * *If you note hip involvement and you’re doing lithotomy position, might do hip assessment from earlier* * Meds for pain relief, what works/doesn’t work, last dose, etc.

Answer 97

* Note degree of skeletal muscle weakness, progression of dz * Note med history * Cholinesterase inhibitors * Steroids * Immunosuppressive therapy

Answer 98

* Note progression of dz, natural ROM, muscle strength * Delayed gastric motility * Ventilatory status (PFT, cough strength) * Cardiac – ECG, perhaps ECHO

Answer 99

* Cardiopulmonary assessment – ECHO (valve assessment) * TMJ at risk * High PTX risk (avoid nitrous)

Answer 100

* Tracheal deviation or compression * Difficulty breathing (sign of airway obstruction) * Dysphagia * SOB * **Preop airway assessment, cervical ROM, cervical X-ray, ENT consult** * Radiation to head and neck→ permanent tissue fibrosis * Carotid artery dissection * Hypothyroidism * Difficult ventilation/intubation May not be recognized on physical exam

Answer 101

* Anterior mediastinal masses can obstruct the great vessels (aorta, PA, PV, SVC), heart, trachea, and bronchi. * C/o dysphagia, dyspnea, wheezing, coughing (especially when recumbent)→SVC compression/syndrome, which leads to… * JVD * Facial, neck, chest edema, ↑ ICP, airway compromise * Fiberoptic intubation

Answer 102

Special anesthetic considerations: * Review imaging to determine if alternate airway management plan should be used * Plan for **difficult a/w** * Question pt regarding **dysphagia & difficulty breathing** (signs of airway obstruction) swallowing, voice changes * Surgical blood loss can be significant: **T&C, CBC** * Lack of access to airway during case: special equipment (securing ETT) * Hypercalcemia related to METS: check **calcium** level * Alcohol-induced liver dz: check **LFTs** * Chronic smoking hx: **PFTs, pulm toilet, inhalers** * May need **nutritional therapy** preop * May need **invasive monitoring**- esp A-line

Answer 103

1. Spinal cord compression— * urinary/bowel incontinence * peripheral neuropathies * gait disturbances 2. Cardiac tamponade— * muffled heart tones * elevated JVD, distended neck veins * progressive dyspnea 3. Neutropenia sepsis—may present with low-grade fever or none, cough, arthralgia 4. CNS metastasis—headaches, visual disturbances, balance/gait disturbances, confusion, n/v 5. Tumor lysis syndrome— * ↑ uric acid, K+, & phos levels * Most often seen 12-72 hrs post chemo tx for hematologic malignancy 6. SVC syndrome—obstruction of SVC * Swelling of hands, neck face, dyspnea, cough

Answer 104

* Poor IV access * At risk for lymphedema- avoid IVs and BP cuff on surgical arm * Check type of chemotherapy for complications

Answer 105

* May be aspiration risk- give preop aspiration risk prophylaxis (no Reglan) * May be dehydrated from colon prep and/or obstruction- preop IV fluid * May need T&S or T&C

Answer 106

* Robotic surgeries * Special positioning (steep Trendelenburg)

Answer 107

* Associated CAD * Pulmonary insufficiency after lung tissue resection * Potential for massive blood loss during surgical resection * Special equipment needed * **Preoperative PFTs, DLCO, VO2 max, CXR, ABGs, O2sat** * **? Cardiac stress testing** * **HCT/Hbg, T&C**

Answer 108

* Broad QRS: \>120 ms * RSR’ pattern in V1-V3 * Rabbit ears for RBBB * Wide, slurred S wave in lateral leads (I, aVL, V5-V6)

Answer 109

WPW, LVH, BBB

Answer 110

\< 0.12 sec with progressive increased amplitude in V1-V6

Answer 111

* ST segments and T waves * Directed opposite to the main vector of the QRS complex * ST elevation and upright T waves with negative QRS complex * ST depression and inverted T wave with positive QRS complex

Answer 112

* Normal vector of depolarization is from base to apex and endocardium to epicardium. * When this vector is not directed in this usual direction it is referred to as axis deviation. * To evaluate for axis deviation, examine the direction of the R wave deflection in lead I & aVF. * Axis deviation can occur w/ ventricular hypertrophy, conduction block, or physical change in position of heart. * Vectors tend to point towards areas of hypertrophy and away from areas of injury (MI)

Answer 113

•Normal axis has + R wave deflections in both lead I & aVF

Answer 114

* Left axis deviation has a + R wave deflection in lead I but – R wave deflection in aVF * Leaving each other = Left axis deviation

Answer 115

* Right axis deviation has a – R wave deflection in lead I but + R wave deflection in aVF * Reaching each other = Right axis deviation

Flashcards for Midterm Exam

(155 cards)