Cardiology Fisdap 2 Questions with VERIFIED Answers (Guaranteed
Success)
Q1: ECG indicators of Wolff-Parkinson-White (WPW) syndrome include:
Answer: Short PR intervals, delta waves, and QRS widening. Wolff-Parkinson-White (WPW) syndrome
is a condition in which accessory pathways—called the bundle of Kent—bypass the atrioventricular
(AV) node, causing the ventricles to depolarize earlier than normal (preexcitation). Because the normal
delay at the AV node does not occur, the PR intervals in patients with WPW are usually less than 0.12
seconds (120 ms). When conduction occurs down the AV node and simultaneously along the bundle of
Kent in an anterograde fashion, the two waves of depolarization meet (fusion). This manifests on the
ECG as a delta wave—slurring or notching at the beginning of the QRS complex—which may cause QRS
widening. The bundle of Kent is a potential site for a reentry circuit because it allows continued
transmission of an electrical impulse from the atria to the ventricles. Therefore, patients with WPW are
prone to reentry tachycardias—most notably, AV reentry supraventricular tachycardia (SVT).
Q2: Sudden cardiac arrest in the adult population is MOST often secondary to:
Answer: A cardiac dysrhythmia. Most cases of sudden cardiac arrest (SCA) in the adult population are
secondary to a cardiac dysrhythmia, usually ventricular fibrillation (V-Fib). This fact underscores the
criticality of early defibrillation. Respiratory failure is the most common cause of cardiac arrest in the
pediatric population.
,Q3: After performing synchronized cardioversion on an unstable patient with a wide-complex
tachycardia, you look at the monitor and see coarse ventricular fibrillation. The patient is
unresponsive, apneic, and pulseless. You should:
Answer: Start CPR, ensure the synchronize mode is off, and defibrillate. If a patient develops
ventricular fibrillation (V-Fib) or pulseless ventricular tachycardia (V-Tach) following synchronized
cardioversion, immediately begin CPR (even if it's just for a short period of time), ensure that the
monitor/defibrillator is not in synchronize mode, and defibrillate as soon as possible. CPR should be
ongoing as the defibrillator is charging in order to avoid unnecessary delays in performing chest
compressions. The synchronize mode must be turned off prior to defibrillation or the device will not
deliver a shock; this is because there are no R waves to synchronize with in V-Fib. Vascular access (IV or
IO), advanced airway management, and pharmacologic therapy should be performed during the
2-minute cycles of CPR; they are not an immediate priority during early cardiac arrest.
,Q4: A 70-year-old man presents with an acute onset of confusion, slurred speech, and left side
weakness. According to his daughter, he has high blood pressure and has had several "small strokes"
over the past 6 months. Your partner applies supplemental oxygen; assesses his vital signs, which are
stable; and assesses his blood glucose level, which reads 35 mg/dL. You attempt to perform the
Cincinnati Prehospital Stroke test, but the patient is unable to understand your instructions. After
establishing IV access, you should:
Answer: Administer 50% dextrose, monitor his cardiac rhythm, protect his impaired extremities, and
transport. This patient's clinical presentation and his history of hypertension and transient ischemic
attacks (TIAs) suggest acute ischemic stroke. However, his blood glucose level (BGL) is significantly low
and must be treated. Untreated hypoglycemia may cause irreversible brain damage or death.
Appropriate treatment for this patient involves administering 50% dextrose (consider giving 12.5 g) and
then reassessing his BGL to determine the need for additional glucose. Because the patient is confused,
and because some patients with acute ischemic stroke lose protective airway reflexes, oral glucose
should be avoided. He may not be able to swallow it, which may result in aspiration. Further treatment
includes protecting his impaired extremities from injury, monitoring his cardiac rhythm, and
transporting him to the hospital. Notify the receiving facility early. Aspirin should be avoided in the
prehospital setting for patients with signs and symptoms of a stroke. A CT scan of the head must be
performed first to rule out intracranial hemorrhage.
, Q5: Which of the following clinical presentations is MOST consistent with an acute ischemic stroke
involving the left cerebral hemisphere?
Answer: Dysarthria, confusion, right side hemiparesis, left side facial droop. Acute ischemic strokes
represent approximately 75% of all strokes. Each cerebral hemisphere controls functions on the
contralateral (opposite) side of the body; therefore, sensory and motor deficits (ie, hemiparesis,
hemiparalysis) are observed on the side of the body opposite the stroke. However, because the facial
nerves do not decussate (cross as they leave the cerebral cortex, move through the brainstem, and
arrive at the spinal cord), facial droop is typically observed on the ipsilateral (same) side as the stroke.
Pupillary changes, if present, will also occur on the same side as the stroke because of optic nerve
crossover in the brain. Other common signs of acute ischemic stroke include dysarthria (slurred
speech), dysphasia (difficulty speaking or understanding), aphasia (inability to speak or understand),
and mental status changes. In contrast to acute ischemic stroke, acute hemorrhagic stroke (caused by a
ruptured cerebral artery) typically presents with more ominous signs, which include a sudden, severe
headache that is followed by a rapid decline in level of consciousness. Because bleeding is occurring
within the brain, intracranial pressure increases, resulting in signs such as decorticate (flexor) or
decerebrate (extensor) posturing, asymmetric or bilaterally dilated pupils, and Cushing's triad
(hypertension, bradycardia, abnormal respiratory pattern).
Success)
Q1: ECG indicators of Wolff-Parkinson-White (WPW) syndrome include:
Answer: Short PR intervals, delta waves, and QRS widening. Wolff-Parkinson-White (WPW) syndrome
is a condition in which accessory pathways—called the bundle of Kent—bypass the atrioventricular
(AV) node, causing the ventricles to depolarize earlier than normal (preexcitation). Because the normal
delay at the AV node does not occur, the PR intervals in patients with WPW are usually less than 0.12
seconds (120 ms). When conduction occurs down the AV node and simultaneously along the bundle of
Kent in an anterograde fashion, the two waves of depolarization meet (fusion). This manifests on the
ECG as a delta wave—slurring or notching at the beginning of the QRS complex—which may cause QRS
widening. The bundle of Kent is a potential site for a reentry circuit because it allows continued
transmission of an electrical impulse from the atria to the ventricles. Therefore, patients with WPW are
prone to reentry tachycardias—most notably, AV reentry supraventricular tachycardia (SVT).
Q2: Sudden cardiac arrest in the adult population is MOST often secondary to:
Answer: A cardiac dysrhythmia. Most cases of sudden cardiac arrest (SCA) in the adult population are
secondary to a cardiac dysrhythmia, usually ventricular fibrillation (V-Fib). This fact underscores the
criticality of early defibrillation. Respiratory failure is the most common cause of cardiac arrest in the
pediatric population.
,Q3: After performing synchronized cardioversion on an unstable patient with a wide-complex
tachycardia, you look at the monitor and see coarse ventricular fibrillation. The patient is
unresponsive, apneic, and pulseless. You should:
Answer: Start CPR, ensure the synchronize mode is off, and defibrillate. If a patient develops
ventricular fibrillation (V-Fib) or pulseless ventricular tachycardia (V-Tach) following synchronized
cardioversion, immediately begin CPR (even if it's just for a short period of time), ensure that the
monitor/defibrillator is not in synchronize mode, and defibrillate as soon as possible. CPR should be
ongoing as the defibrillator is charging in order to avoid unnecessary delays in performing chest
compressions. The synchronize mode must be turned off prior to defibrillation or the device will not
deliver a shock; this is because there are no R waves to synchronize with in V-Fib. Vascular access (IV or
IO), advanced airway management, and pharmacologic therapy should be performed during the
2-minute cycles of CPR; they are not an immediate priority during early cardiac arrest.
,Q4: A 70-year-old man presents with an acute onset of confusion, slurred speech, and left side
weakness. According to his daughter, he has high blood pressure and has had several "small strokes"
over the past 6 months. Your partner applies supplemental oxygen; assesses his vital signs, which are
stable; and assesses his blood glucose level, which reads 35 mg/dL. You attempt to perform the
Cincinnati Prehospital Stroke test, but the patient is unable to understand your instructions. After
establishing IV access, you should:
Answer: Administer 50% dextrose, monitor his cardiac rhythm, protect his impaired extremities, and
transport. This patient's clinical presentation and his history of hypertension and transient ischemic
attacks (TIAs) suggest acute ischemic stroke. However, his blood glucose level (BGL) is significantly low
and must be treated. Untreated hypoglycemia may cause irreversible brain damage or death.
Appropriate treatment for this patient involves administering 50% dextrose (consider giving 12.5 g) and
then reassessing his BGL to determine the need for additional glucose. Because the patient is confused,
and because some patients with acute ischemic stroke lose protective airway reflexes, oral glucose
should be avoided. He may not be able to swallow it, which may result in aspiration. Further treatment
includes protecting his impaired extremities from injury, monitoring his cardiac rhythm, and
transporting him to the hospital. Notify the receiving facility early. Aspirin should be avoided in the
prehospital setting for patients with signs and symptoms of a stroke. A CT scan of the head must be
performed first to rule out intracranial hemorrhage.
, Q5: Which of the following clinical presentations is MOST consistent with an acute ischemic stroke
involving the left cerebral hemisphere?
Answer: Dysarthria, confusion, right side hemiparesis, left side facial droop. Acute ischemic strokes
represent approximately 75% of all strokes. Each cerebral hemisphere controls functions on the
contralateral (opposite) side of the body; therefore, sensory and motor deficits (ie, hemiparesis,
hemiparalysis) are observed on the side of the body opposite the stroke. However, because the facial
nerves do not decussate (cross as they leave the cerebral cortex, move through the brainstem, and
arrive at the spinal cord), facial droop is typically observed on the ipsilateral (same) side as the stroke.
Pupillary changes, if present, will also occur on the same side as the stroke because of optic nerve
crossover in the brain. Other common signs of acute ischemic stroke include dysarthria (slurred
speech), dysphasia (difficulty speaking or understanding), aphasia (inability to speak or understand),
and mental status changes. In contrast to acute ischemic stroke, acute hemorrhagic stroke (caused by a
ruptured cerebral artery) typically presents with more ominous signs, which include a sudden, severe
headache that is followed by a rapid decline in level of consciousness. Because bleeding is occurring
within the brain, intracranial pressure increases, resulting in signs such as decorticate (flexor) or
decerebrate (extensor) posturing, asymmetric or bilaterally dilated pupils, and Cushing's triad
(hypertension, bradycardia, abnormal respiratory pattern).
