Self Assessments Week1-4

Question 1

In atrial flutter, the QRS complexes:
Select one:

a. always occur in a regular ratio such as 2:1, 3:1 etc.
b. always occur in a 1:1 ratio
c. always occur in a variable ratio
d. occur in a regular or variable ratio

Answer 1

d. occur in a regular or variable ratio

Question 2

A non-conducted PAC has:
Select one:

a . no P wave
b. a normal P wave in time with the rhythm
c. an early P wave that may be buried in the preceding T wave
d. a P wave after the QRS

Answer 2

c. an early P wave that may be buried in the preceding T wave

Question 3

When there is a wavy baseline and P waves are not identifiable, how can you tell the rhythm is atrial fibrillation as opposed to a sinus or junctional rhythm
with artifact?
Select one:

a. the QRS complexes are in a regular pattern
b. there is electrical interference
c. the QRS complexes are in an irregular pattern
d. there are PACS

Answer 3

c. the QRS complexes are in an irregular pattern

Question 4

Choose the strip with the PVC(s).
Select one:

Answer 4

Question 5

Choose the rhythm(s) that an AED (automated external defibrillator) will shock:
Select one :

a. ventricular fibrillation and ventricular tachycardia
b. ventricular fibrillation
c. asystole
d. ventricular fibrillation and atrial fibrillation

Answer 5

a. ventricular fibrillation and ventricular tachycardia

Question 6

Atrial fibrillation:
Select one:

a. is irregularly irregular
b. speeds up and slows down rhythmically
c. is regular
d. is irregular with a pattern
e. is always faster than 100 bpm

Answer 6

a. is irregularly irregular

Question 7

The rhythm is:
Select one:

a. ventricular fibrillation
b. asystole
c. ventricular tachycardia
d. paced ventricular rhythm

Answer 7

a. ventricular fibrillation

Question 8

The rhythm in the following ECG is:
Select one:

a. junctional bradycardia
b. atrial bradycardia
c. bradycardic sinus arrhythmia
d. atrial fibrillation with slow ventricular response

Answer 8

a. junctional bradycardia

Question 9

Retrograde (upward) depolarization of the atria causes a P wave in Lead II to look:
Select one:

a. normal
b. tall and pointy
c. wide
d. inverted

Answer 9

d. inverted

Question 10

The normal range for a PR interval measurement is:
Select one:

a . 1-2 seconds
b. .20 - .34 seconds
c. .12 - . 20 seconds
d. .20 - .24 seconds

Answer 10

c. .12 - . 20 seconds

Question 11

Which of these images show sinus arrhythmia?

Answer 11

Question 12

Calculate the QRS width in the following image.

Select one:
* a. .2 seconds
* b. .08 seconds
* c. .12 seconds
* d. .8 seconds

Answer 12

• b. .08 seconds

Question 13

Calculate the heart rate (choose closest answer) of the following image.
Select one:

a. 75 bpm
b. 60 bpm
c. 50 bpm
d. 90 bpm

Answer 13

a. 75 bpm

Question 14

Label the images using the following choices:
QS
QRS
RSR’
R
RS
QR

Answer 14

a. R
b. RS
c. RSR’
d. QS
e. QR
f. QRS

Question 15

Calculate the QRS axis for the following ECG:

a. +150
b. +60
c. +40
d. +80

Answer 15

c. +40

Question 16

Lead III records from:
Select one:

a. RA to LA
b. RA to LL
c. LA to LL
d. LA to RA

Answer 16

c. LA to LL

Question 17

If lead I and lead _ have a predominantly positive QRS (more above baseline than below), axis falls within the normal quadrant.
Select one:

a. II
b. III
c. AVF
d. AVR

Answer 17

a. II

Question 18

There is significant artifact in several limb leads on the ECG you are recording. Out of leads I, Il and III lead I has the least artifact. From which limb electrode are you getting the most
interference?
Select one:

a. RA
b. LA
c . RL
d. LL

Answer 18

d. LL

Question 19

Which lead records in the opposite direction as most of the vectors in the heart are travelling?
Select one:

a. AVL
b. Lead II
c. AVR
d. Lead III

Answer 19

c. AVR

Question 20

On ECG paper, one large box (5mm) represents. time on the horizontal axis.
Select one:

a. .04 seconds
b. .20 seconds
c. .24 seconds
d. .5 seconds

Answer 20

b. .20 seconds

Question 21

Calculate the PR interval the following image.

Select one:
a. .2 seconds
b. .08 seconds
c. .12 seconds
d. .8 seconds

Answer 21

c. .12 seconds

Question 22

In AV blocks, the atrial rhythm:
Select one:

• a. is normal and regular
• b. fails to generate some P waves
• c. is totally irregular
• d. fails to generate every second P wave

Answer 22

a. is normal and regular

Question 23

In 3rd degree AV block, how do QRS complexes exist?
Select one:

a. impulses from the atria occasionally permeate the AV node to reach the ventricles
b. the junction or ventricles create their own impulses through the mechanism of an “escape” rhythm
c. impulses from the atria permeate the AV node after every second P wave
d. Impulses from the atria pass through the AV node but create wide QRS complexes due to bundle branch block

Answer 23

b. the junction or ventricles create their own impulses through the mechanism of an “escape” rhythm

Question 24

A bundle branch block causes symptoms of:
Select one:

a. shortness of breath
b. chest pain
c. numbness in fingers
d. none of the above

Answer 24

d. none of the above

Question 25

Calculate the atrial rate in this 6 second strip (select closest answer). Select one: * a. 40 bpm * b. 80 bpm * c. 90 bpm * d. 100 bpm

Answer 25

d. 100 bpm

Question 26

Match the following descriptions with; Regular P wave rhythm, regular QRS rhythm, not related to each other Constant PRI with 1 QRS to every 2 P waves Progressively prolonging PRI with dropped QRS complexes in a pattern, Constant PRI with dropped QRS complexes in a pattern or no Prolonged and constant PRI 1st degree AV block 2nd degree AV block type 1 2nd degree AV block type 2 2:1 AV block 3ra degree AV block

Answer 26

1st degree AV block → Prolonged and constant PRI, 2nd degree AV block type 1 → Progressively prolonging PRI with dropped QRS complexes in a pattern, 2nd degree AV block type 2 → Constant PRI with dropped QRS complexes in a pattern or not, 2:1 AV block → Constant PRI with 1 QRS to every 2 P waves 3ra degree AV block → Regular P wave rhythm, regular QRS rhythm, not related to each other

Question 27

Match the features most often associated with aberrant supraventricular beats vs. ventricular origin beats. Width 0.12 to 0.14 seconds → Width 0.12 t o 0.16 seconds → Long-short interval precedes the beat → Associated with atrial fibrillation → Common with very early PACs → Associated with previous myocardial damage → RBBB morphology 80%-90% of the time → P wave in front of it, often with prolonged PRI → No associated P wave or retrograde P wave buried in T wave → Called wide and bizarre → Large discordant T wave →

Answer 27

Width 0.12 to 0.14 seconds → aberrant supraventricular beats, Width 0.12 t o 0.16 seconds → ventricular origin beats, Long-short interval precedes the beat → aberrant supraventricular beats, Associated with atrial fibrillation → aberrant supraventricular beats, Common with very early PACs → aberrant supraventricular beats, Associated with previous myocardial damage > ventricular origin beats, RBBB morphology 80%-90% of the time → aberrant supraventricular beats, P wave in front of it, often with prolonged PRI → aberrant supraventricular beats, No associated P wave or retrograde P wave buried in T wave → ventricular origin beats, Called wide and bizarre → ventricular origin beats, Large discordant T wave → ventricular origin beats

Question 28

RVH is most often caused by: Select one: * a. Pulmonary hypertension * b. RBBB * c. Myocardial infarction * d. Chronic atrial flutter

Answer 28

a. Pulmonary hypertension

Question 29

Why is the QRS wide in a bundle branch block? Select one: * a. the rhythm is ventricular in origin * b. there are PVCs because of the block to the ventricles * c. due to an escape rhythm * d. due to cell to cell transmission

Answer 29

d. due to cell to cell transmission

Question 30

Identify the type of block/pause: Select one: a. 2nd degree AVB, Mobitz II b. Sinus block c. 1st degree AVB d . Sinus arrest

Answer 30

d . Sinus arrest

Question 31

Recognize the image shown. Select one: * a. Second degree AV block type 1 (Wenckebach) * b. Second degree AV block type 2 (Classical) * c. Third degree AV block * d. Sinus rhythm with non-conducted PACs

Answer 31

* a. Second degree AV block type 1 (Wenckebach)

Question 32

In RBBB, which lead shows an RSR' pattern? Select one: * a. Lead I * b. Lead AVF. * c. Lead V1 * d. Lead V6

Answer 32

c. Lead V1

Question 33

If a patient with an otherwise normal ECG has a left posterior fascicular block (aka posterior hemiblock) what axis will be seen? Select one: * a. normal * b. left * c. right * d. extreme right/indeterminate

Answer 33

c. right

Question 34

Match the hypertrophy or enlargement with the ECG criteria for lead V1. Right ventricular hypertrophy → Right atrial enlargement → Left atrial enlargement → Left ventricular hypertrophy → Deep S wave Biphasic P wave with taller proximal portion Increased RS ratio Biphasic P wave with wider terminal portion

Answer 34

Right ventricular hypertrophy → Increased RS ratio, Right atrial enlargement → Biphasic P wave with taller proximal portion, Left atrial enlargement → Biphasic P wave with wider terminal portion, Left ventricular hypertrophy → Deep S wave

Question 35

Left bundle branch block criteria includes a wide slurred S wave in Lead 1. Select one: TRUE or FALSE

Answer 35

FALSE

Question 36

Josephson's sign is a notch near the nadir of the S wave in V1 that favours ventricular origin. Left bundle branch block has notching of the R wave in leads I, AVL, V5 and/or V6. When P waves are difficult to locate, as is often the case in tachycardias we need to rely on these morphology related clues to help differentiate between SVT with aberrancy and VT if the QRS is wide. VT often has precordial concordance whereas bundle branch blocks do not. VT often has ERAD. VT often has A-V dissociation and capture beats. In orthodromic AVRT, the patient has W W and the signal travels antegrade through the AV node and retrograde through the accessory pathway. What is the rhythm seen in the ECG? Select one: a. Sinus tachycardia with LBBB and LVH X b. Monomorphic ventricular tachycardia c. Polymorphic ventricular tachycardia d. Antidromic AVRT e. Orthodromic AVRT

Answer 36

d. Antidromic AVRT

Question 37

The rhythm which is most likely to precipitate transient aberrancy is: Select one : * a. Wandering atrial pacemaker * b. Atrial fibrillation * c. Atrial flutter * d. Ventricular tachycardia

Answer 37

b. Atrial fibrillation

Question 38

What is the rhythm in the following ECG? Look closely at the morphology of QRS complexes in lead I and at the regularity. Select one: * a. Polymorphic VT * b. Atrial fibrillation with RBBB * c. SVT with RBBB aberrancy * d. Atrial fibrillation with WPW * e.. Monomorphic VT with capture beats

Answer 38

d. Atrial fibrillation with WPW

Question 39

Choose the ECG with left bundle branch block.

Answer 39

Question 40

Aberrant beats are: a. artifact b. supraventricular in origin, early, wide QRS c. ventricular in origin, late, wide QRS d. supraventricular in origin, early, narrow QRS

Answer 40

b. supraventricular in origin, early, wide QRS