CARDIOLOGY FISDAP 2 EXAM REVIEW SOLVED QUESTIONS COMPLETE ANSWERS
GRADED A PLUS
Cardiology Fisdap 2 Revision Handbook 2026/2027
Cardiac Physiology AND Questions and Answers
Verified Solutions Latest Update
Question:
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).
Question:
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.
Question:
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.
Question:
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.
Question:
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).
Question:
A 27-year-old female complains of palpitations. The cardiac monitor reveals a narrow-complex
tachycardia at 180/min. She denies any other symptoms, and states that this has happened to her
before, but it typically resolves on its own. Her blood pressure is 126/66 mm Hg, pulse is 180
beats/min, and respirations are 16 breaths/min. After attempting vagal maneuvers and giving two
doses of adenosine, her cardiac rhythm and vital signs remain unchanged. You should:
Answer:
Transport at once, reassess her frequently, and perform synchronized cardioversion if necessary.
Although the patient is in supraventricular tachycardia (SVT), she remains stable following your
initial efforts to slow her heart rate with vagal maneuvers and adenosine. Her failure to respond to
initial treatment does not automatically make her unstable. Simply transport her, closely monitor her
en route, and be prepared to cardiovert her if she does become unstable (ie, hypotension, altered
mental status, chest pain). Unless specified in your local protocols, pharmacologic therapy beyond
adenosine (ie, calcium channel blockers, amiodarone) is typically not indicated in the field for stable
patients with SVT, although these medications may be given in the emergency department.
However, if your protocols or medical control call for the administration of diltiazem (Cardizem),
the initial dose is 0.25 mg/kg.
Question:
You should interpret the following cardiac rhythm as:
, Answer:
Third-degree AV block. The rhythm is regular, with a ventricular rate of approximately 40 to 50
beats/min. It has wide (greater than 120 ms [0.12 sec]) QRS complexes and more P waves than QRS
complexes. Because there is no relationship between any one P wave to a given QRS complex, this
is a third-degree AV block, also called complete heart block. First- degree AV block is characterized
by P-R intervals that exceed 200 ms (0.20 seconds [5 small boxes]), although there is a consistent
1:1 P- to-QRS ratio; unless ectopic compexes are present, it is usually a regular rhythm.
Second-degree AV block type I is characterized by P- R intervals that progressively lengthen until a
P wave is blocked (not followed by a QRS complex); it is an irregular rhythm. Second- degree AV
block type II, which may be regular or irregular, is characterized by more P waves than QRS
complexes; however, the P- R intervals of the conducted complexes are the same.
Question:
A 49-year-old male complains of generalized weakness that began about a week ago. He is
conscious and alert and is breathing adequately. His blood pressure is 138/78 mm Hg, pulse is 130
beats/min and irregular, and respirations are 14 breaths/min. You administer supplemental oxygen
and apply the cardiac monitor, which reveals atrial fibrillation; a 12-lead ECG tracing reveals the
same. The patient denies any significant medical problems and takes no medications. After
establishing IV access, you should:
Answer:
Administer 0.25 mg/kg of diltiazem and transport for evaluation. In the absence of any significant
medical history, this patient's weakness probably signaled the onset of his atrial fibrillation (A- Fib).
New-onset A-Fib of greater than 48 hours' duration should not be treated with synchronized
cardioversion until the patient is adequately anticoagulated first (ie, Coumadin). Blood can stagnate
in the fibrillating atria, which increases the risk of clot formation; cardioversion may dislodge these
clots, resulting in a stroke, pulmonary embolism, or myocardial infarction. Furthermore, this patient
is hemodynamically stable and is not in need of electrical therapy. Appropriate treatment for a
patient with A-Fib or atrial flutter (A-Flutter) with a rapid ventricular rate (RVR) involves
controlling the ventricular rate with a calcium-channel blocker. Diltiazem (Cardizem) is the most
common drug used for this purpose. The initial dose is 0.25 mg/kg, which may be repeated in 15
minutes in a dose of 0.35 mg/kg. Amiodarone may be used to terminate new-onset A-Fib or
A-Flutter, but is uncommonly given for this purpose in the prehospital setting. Vagal maneuvers and
adenosine are indicated for narrow-complex tachycardias in an attempt to slow the ventricular rate
so you can identify the underlying rhythm. You have already identified this patient's rhythm.
Question:
GRADED A PLUS
Cardiology Fisdap 2 Revision Handbook 2026/2027
Cardiac Physiology AND Questions and Answers
Verified Solutions Latest Update
Question:
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).
Question:
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.
Question:
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.
Question:
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.
Question:
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).
Question:
A 27-year-old female complains of palpitations. The cardiac monitor reveals a narrow-complex
tachycardia at 180/min. She denies any other symptoms, and states that this has happened to her
before, but it typically resolves on its own. Her blood pressure is 126/66 mm Hg, pulse is 180
beats/min, and respirations are 16 breaths/min. After attempting vagal maneuvers and giving two
doses of adenosine, her cardiac rhythm and vital signs remain unchanged. You should:
Answer:
Transport at once, reassess her frequently, and perform synchronized cardioversion if necessary.
Although the patient is in supraventricular tachycardia (SVT), she remains stable following your
initial efforts to slow her heart rate with vagal maneuvers and adenosine. Her failure to respond to
initial treatment does not automatically make her unstable. Simply transport her, closely monitor her
en route, and be prepared to cardiovert her if she does become unstable (ie, hypotension, altered
mental status, chest pain). Unless specified in your local protocols, pharmacologic therapy beyond
adenosine (ie, calcium channel blockers, amiodarone) is typically not indicated in the field for stable
patients with SVT, although these medications may be given in the emergency department.
However, if your protocols or medical control call for the administration of diltiazem (Cardizem),
the initial dose is 0.25 mg/kg.
Question:
You should interpret the following cardiac rhythm as:
, Answer:
Third-degree AV block. The rhythm is regular, with a ventricular rate of approximately 40 to 50
beats/min. It has wide (greater than 120 ms [0.12 sec]) QRS complexes and more P waves than QRS
complexes. Because there is no relationship between any one P wave to a given QRS complex, this
is a third-degree AV block, also called complete heart block. First- degree AV block is characterized
by P-R intervals that exceed 200 ms (0.20 seconds [5 small boxes]), although there is a consistent
1:1 P- to-QRS ratio; unless ectopic compexes are present, it is usually a regular rhythm.
Second-degree AV block type I is characterized by P- R intervals that progressively lengthen until a
P wave is blocked (not followed by a QRS complex); it is an irregular rhythm. Second- degree AV
block type II, which may be regular or irregular, is characterized by more P waves than QRS
complexes; however, the P- R intervals of the conducted complexes are the same.
Question:
A 49-year-old male complains of generalized weakness that began about a week ago. He is
conscious and alert and is breathing adequately. His blood pressure is 138/78 mm Hg, pulse is 130
beats/min and irregular, and respirations are 14 breaths/min. You administer supplemental oxygen
and apply the cardiac monitor, which reveals atrial fibrillation; a 12-lead ECG tracing reveals the
same. The patient denies any significant medical problems and takes no medications. After
establishing IV access, you should:
Answer:
Administer 0.25 mg/kg of diltiazem and transport for evaluation. In the absence of any significant
medical history, this patient's weakness probably signaled the onset of his atrial fibrillation (A- Fib).
New-onset A-Fib of greater than 48 hours' duration should not be treated with synchronized
cardioversion until the patient is adequately anticoagulated first (ie, Coumadin). Blood can stagnate
in the fibrillating atria, which increases the risk of clot formation; cardioversion may dislodge these
clots, resulting in a stroke, pulmonary embolism, or myocardial infarction. Furthermore, this patient
is hemodynamically stable and is not in need of electrical therapy. Appropriate treatment for a
patient with A-Fib or atrial flutter (A-Flutter) with a rapid ventricular rate (RVR) involves
controlling the ventricular rate with a calcium-channel blocker. Diltiazem (Cardizem) is the most
common drug used for this purpose. The initial dose is 0.25 mg/kg, which may be repeated in 15
minutes in a dose of 0.35 mg/kg. Amiodarone may be used to terminate new-onset A-Fib or
A-Flutter, but is uncommonly given for this purpose in the prehospital setting. Vagal maneuvers and
adenosine are indicated for narrow-complex tachycardias in an attempt to slow the ventricular rate
so you can identify the underlying rhythm. You have already identified this patient's rhythm.
Question:
