, Paramedic FISDAP Advanced Prep: Master
Cardiovascular Emergencies & Advanced ECG
Interpretation Practice Questions
Subject: Paramedic FISDAP Exam – Cardiovascular Emergencies, Advanced
ECG Interpretation, and Hemodynamic Management
Question 1: A 62-year-old male presents with acute substernal chest pressure radiating to the left
jaw. His 12-lead ECG shows 3mm ST-segment elevation in leads V3 and V4, and 2mm ST
elevation in lead V2. Which coronary artery is most likely occluded, and what is the primary
hemodynamic risk?
A) Right Coronary Artery (RCA); development of high-degree AV block.
B) Left Anterior Descending (LAD) artery; development of left ventricular pump failure or
cardiogenic shock.
C) Left Circumflex (LCx) artery; development of papillary muscle rupture.
D) Left Main Coronary Artery; development of severe right ventricular infarction.
Correct Answer: B) Left Anterior Descending (LAD) artery; development of left ventricular
pump failure or cardiogenic shock.
Explanation: ST elevation in leads V2-V4 indicates an anteroseptal myocardial infarction, which
is classically associated with LAD occlusion. The LAD supplies the majority of the left ventricle;
therefore, massive infarction leads to significant reduction in ejection fraction, increasing the
risk of cardiogenic shock. RCA occlusion typically presents with inferior leads (II, III, aVF) and
potential AV blocks, while LCx occlusion usually presents with lateral leads (I, aVL, V5, V6).
Question 2: You are treating a patient in symptomatic wide-complex tachycardia with a pulse.
The rhythm appears to be a monomorphic ventricular tachycardia. Following the appropriate
ACLS algorithm, you prepare for synchronized cardioversion. What is the precise physiological
rationale for synchronization rather than immediate unsynchronized defibrillation?
A) To deliver the electrical impulse during the absolute refractory period to prevent conversion
to VF.
B) To deliver the electrical impulse during the ventricular repolarization phase to avoid the
vulnerable period (R-on-T phenomenon).
C) To allow the pacemaker cells in the SA node to reset their intrinsic firing rate.
, D) To ensure the electrical current coincides with the QRS complex to avoid delivering energy
during the T-wave.
Correct Answer: D) To ensure the electrical current coincides with the QRS complex to
avoid delivering energy during the T-wave.
Explanation: Delivering a high-energy shock during the relative refractory period (which
corresponds to the T-wave) can precipitate Ventricular Fibrillation (R-on-T phenomenon).
Synchronization ensures the energy is delivered during ventricular depolarization (the R-wave),
thereby avoiding the vulnerable period.
Question 3: A patient exhibits a "Delta wave" on a 12-lead ECG, indicating Wolff-Parkinson-
White (WPW) syndrome. If this patient develops an orthodromic AVRT, which medication is
strictly contraindicated, and why?
A) Adenosine, because it is ineffective in re-entrant tachycardia.
B) Amiodarone, because it has no effect on accessory pathways.
C) Diltiazem or Verapamil, because they block the AV node, forcing conduction down the
accessory pathway and potentially accelerating the ventricular rate.
D) Procainamide, because it is only indicated for sinus tachycardia.
Correct Answer: C) Diltiazem or Verapamil, because they block the AV node, forcing
conduction down the accessory pathway and potentially accelerating the ventricular rate.
Explanation: In patients with pre-excited tachyarrhythmias (especially atrial fibrillation with
WPW), AV nodal blocking agents like calcium channel blockers or beta-blockers can cause
unopposed conduction down the accessory bundle. This can lead to a dangerously rapid
ventricular response, potentially triggering ventricular fibrillation.
Question 4: During your assessment of a patient with suspected cardiogenic shock, you note
distended neck veins, clear lung sounds, and hypotension. What is the most likely diagnosis, and
what intervention is contraindicated?
A) Left ventricular failure; contraindication: fluid boluses.
B) Right ventricular infarction; contraindication: nitroglycerin.
C) Pulmonary embolism; contraindication: aspirin.
D) Tension pneumothorax; contraindication: positive pressure ventilation.
Correct Answer: B) Right ventricular infarction; contraindication: nitroglycerin.
Cardiovascular Emergencies & Advanced ECG
Interpretation Practice Questions
Subject: Paramedic FISDAP Exam – Cardiovascular Emergencies, Advanced
ECG Interpretation, and Hemodynamic Management
Question 1: A 62-year-old male presents with acute substernal chest pressure radiating to the left
jaw. His 12-lead ECG shows 3mm ST-segment elevation in leads V3 and V4, and 2mm ST
elevation in lead V2. Which coronary artery is most likely occluded, and what is the primary
hemodynamic risk?
A) Right Coronary Artery (RCA); development of high-degree AV block.
B) Left Anterior Descending (LAD) artery; development of left ventricular pump failure or
cardiogenic shock.
C) Left Circumflex (LCx) artery; development of papillary muscle rupture.
D) Left Main Coronary Artery; development of severe right ventricular infarction.
Correct Answer: B) Left Anterior Descending (LAD) artery; development of left ventricular
pump failure or cardiogenic shock.
Explanation: ST elevation in leads V2-V4 indicates an anteroseptal myocardial infarction, which
is classically associated with LAD occlusion. The LAD supplies the majority of the left ventricle;
therefore, massive infarction leads to significant reduction in ejection fraction, increasing the
risk of cardiogenic shock. RCA occlusion typically presents with inferior leads (II, III, aVF) and
potential AV blocks, while LCx occlusion usually presents with lateral leads (I, aVL, V5, V6).
Question 2: You are treating a patient in symptomatic wide-complex tachycardia with a pulse.
The rhythm appears to be a monomorphic ventricular tachycardia. Following the appropriate
ACLS algorithm, you prepare for synchronized cardioversion. What is the precise physiological
rationale for synchronization rather than immediate unsynchronized defibrillation?
A) To deliver the electrical impulse during the absolute refractory period to prevent conversion
to VF.
B) To deliver the electrical impulse during the ventricular repolarization phase to avoid the
vulnerable period (R-on-T phenomenon).
C) To allow the pacemaker cells in the SA node to reset their intrinsic firing rate.
, D) To ensure the electrical current coincides with the QRS complex to avoid delivering energy
during the T-wave.
Correct Answer: D) To ensure the electrical current coincides with the QRS complex to
avoid delivering energy during the T-wave.
Explanation: Delivering a high-energy shock during the relative refractory period (which
corresponds to the T-wave) can precipitate Ventricular Fibrillation (R-on-T phenomenon).
Synchronization ensures the energy is delivered during ventricular depolarization (the R-wave),
thereby avoiding the vulnerable period.
Question 3: A patient exhibits a "Delta wave" on a 12-lead ECG, indicating Wolff-Parkinson-
White (WPW) syndrome. If this patient develops an orthodromic AVRT, which medication is
strictly contraindicated, and why?
A) Adenosine, because it is ineffective in re-entrant tachycardia.
B) Amiodarone, because it has no effect on accessory pathways.
C) Diltiazem or Verapamil, because they block the AV node, forcing conduction down the
accessory pathway and potentially accelerating the ventricular rate.
D) Procainamide, because it is only indicated for sinus tachycardia.
Correct Answer: C) Diltiazem or Verapamil, because they block the AV node, forcing
conduction down the accessory pathway and potentially accelerating the ventricular rate.
Explanation: In patients with pre-excited tachyarrhythmias (especially atrial fibrillation with
WPW), AV nodal blocking agents like calcium channel blockers or beta-blockers can cause
unopposed conduction down the accessory bundle. This can lead to a dangerously rapid
ventricular response, potentially triggering ventricular fibrillation.
Question 4: During your assessment of a patient with suspected cardiogenic shock, you note
distended neck veins, clear lung sounds, and hypotension. What is the most likely diagnosis, and
what intervention is contraindicated?
A) Left ventricular failure; contraindication: fluid boluses.
B) Right ventricular infarction; contraindication: nitroglycerin.
C) Pulmonary embolism; contraindication: aspirin.
D) Tension pneumothorax; contraindication: positive pressure ventilation.
Correct Answer: B) Right ventricular infarction; contraindication: nitroglycerin.
