PCCN Master Questions with 100%
Complete Solutions, Rated A+
1. Cardiac - cORRECT sOLUTION 1. Cardiac
Pt's EKG shows ST elevation in leads II, III, and aVF. Where is the MI? - cORRECT sOLUTION Inferior wall MI, Right coronary artery
"Reciprocal changes are often seen ini leads I and aVL"
Pt's EKG shows ST elevation in leads V1 and V2. Where is the MI? - cORRECT sOLUTION Septal area, Left Anterior Descending Artery
Pt's EKG shows ST elevation in leads V3 and V4. Where is the MI? - cORRECT sOLUTION Anterior area
Pt has ST elevation in leads V1-V4. Which coronary artery is occluded? - cORRECT sOLUTION Left Anterior Descending Artery
EKG shows: ST segment ELEVATION. What does this indicate? - cORRECT sOLUTION MI or INFARCTION
EKG shows: ST segment DEPRESSION. What does this indicate? - cORRECT sOLUTION Myocardial ISCHEMIA
A sign of necrosis on an EKG would include: - cORRECT sOLUTION Acute ST elevation. abnormal Q wave. Along with acute ST elevation, another indicator of necrosis would be an abnormal
Q wave. If the Q wave appears within about 6 hours of a transmural MI, it is an ominous sign. If the Q wave is more than 0.04 seconds long, it is a sign of necrosis.
In an inferior MI, the Q wave should not exceed 0.03 seconds or it is indicative of necrosis.
EKG shows: Tall peaked T waves and wide QRS What does this indicate? - cORRECT sOLUTION hyperkalemia
EKG shows: Prominent U wave and flat T wave What does this indicate? - cORRECT sOLUTION hypokalemia
EKG shows: PR interval >.2
What does this indicate? - cORRECT sOLUTION 1st degree AV block
EKG shows: Progressive prolongation of PR interval until QRS complex is dropped
What does this indicate? - cORRECT sOLUTION Second degree AV block type 1 or Mobitz (type I)
Difference between 2nd degree AV block type I vs II - cORRECT sOLUTION 2nd
degree AV block type I: PR interval progressively lengthens Mnemonic: (couple is progressively ignoring each other)
2nd degree AV block type II: PR interval remains constant but there is a drop QRS
complex here and there Mnemonic: (couple acts fine then one day, one partner doesn't come home)
EKG shows: No association with P wave and QRS complexes
What does this indicate? - cORRECT sOLUTION 3rd degree AV block aka complete heart block
MEDICAL EMERGENCY
Mnemonic: (couple is divorced, not talking to each other)
Pt with 2nd degree AV block type II with 5s pauses will need... - cORRECT sOLUTION emergent pacing bc these long pauses can cause inadequate perfusion and may lead to cardiac arrest.
How do you tx atrial fibrillation? - cORRECT sOLUTION 3 principles:
1. Rate control (B-blockers / non DHP Ca2+ CB
2. Rhythm control (anti arrhythmic)
3. Stroke prevention (Warfarin)
**If patient is hemodynamically unstable --> direct cardioversion with 100 joules
Which arrhythmia is commonly associated with left-sided heart failure? - cORRECT sOLUTION Atrial Fibrillation bc blood is not moving d/t left ventricular hypertrophy
Sometimes certain medications prolong the QT interval, potentially causing polymorphic ventricular tachycardia. The drug of choice to treat this rhythm is? - cORRECT sOLUTION MAGNESIUM Magnesium acts on the processes by which calcium is transferred both across the cell membrane and within the cell itself. If high doses of Magnesium are given, it may slow AV conduction
The QT interval may be prolonged by use of tricyclic antidepressants, erythromycin (ABX), quinidine (antiarrhythmic) or terfenidine (antihistamine).
Preload vs Afterload - cORRECT sOLUTION Preload: is pressure at end of diastole aka filling of heart
Afterload: the resistance needed to pump blood out of heart aka systole
What does an S3 sound indicate? S4?
Split S1 - cORRECT sOLUTION S3 indicates volume overload aka heart failure
S4 indicates ventricular hypertrophy aka decreased compliance. When ventricles thicken, it is harder to fill adequately, the atria eject more forcefully causing an S4 sound. Split S1 indicates a BBB (bundle branch block) or PVCs
Where is murmur heard in pt with:
Aortic stenosis
Mitral Stenosis
Aortic Regurgitation
Complete Solutions, Rated A+
1. Cardiac - cORRECT sOLUTION 1. Cardiac
Pt's EKG shows ST elevation in leads II, III, and aVF. Where is the MI? - cORRECT sOLUTION Inferior wall MI, Right coronary artery
"Reciprocal changes are often seen ini leads I and aVL"
Pt's EKG shows ST elevation in leads V1 and V2. Where is the MI? - cORRECT sOLUTION Septal area, Left Anterior Descending Artery
Pt's EKG shows ST elevation in leads V3 and V4. Where is the MI? - cORRECT sOLUTION Anterior area
Pt has ST elevation in leads V1-V4. Which coronary artery is occluded? - cORRECT sOLUTION Left Anterior Descending Artery
EKG shows: ST segment ELEVATION. What does this indicate? - cORRECT sOLUTION MI or INFARCTION
EKG shows: ST segment DEPRESSION. What does this indicate? - cORRECT sOLUTION Myocardial ISCHEMIA
A sign of necrosis on an EKG would include: - cORRECT sOLUTION Acute ST elevation. abnormal Q wave. Along with acute ST elevation, another indicator of necrosis would be an abnormal
Q wave. If the Q wave appears within about 6 hours of a transmural MI, it is an ominous sign. If the Q wave is more than 0.04 seconds long, it is a sign of necrosis.
In an inferior MI, the Q wave should not exceed 0.03 seconds or it is indicative of necrosis.
EKG shows: Tall peaked T waves and wide QRS What does this indicate? - cORRECT sOLUTION hyperkalemia
EKG shows: Prominent U wave and flat T wave What does this indicate? - cORRECT sOLUTION hypokalemia
EKG shows: PR interval >.2
What does this indicate? - cORRECT sOLUTION 1st degree AV block
EKG shows: Progressive prolongation of PR interval until QRS complex is dropped
What does this indicate? - cORRECT sOLUTION Second degree AV block type 1 or Mobitz (type I)
Difference between 2nd degree AV block type I vs II - cORRECT sOLUTION 2nd
degree AV block type I: PR interval progressively lengthens Mnemonic: (couple is progressively ignoring each other)
2nd degree AV block type II: PR interval remains constant but there is a drop QRS
complex here and there Mnemonic: (couple acts fine then one day, one partner doesn't come home)
EKG shows: No association with P wave and QRS complexes
What does this indicate? - cORRECT sOLUTION 3rd degree AV block aka complete heart block
MEDICAL EMERGENCY
Mnemonic: (couple is divorced, not talking to each other)
Pt with 2nd degree AV block type II with 5s pauses will need... - cORRECT sOLUTION emergent pacing bc these long pauses can cause inadequate perfusion and may lead to cardiac arrest.
How do you tx atrial fibrillation? - cORRECT sOLUTION 3 principles:
1. Rate control (B-blockers / non DHP Ca2+ CB
2. Rhythm control (anti arrhythmic)
3. Stroke prevention (Warfarin)
**If patient is hemodynamically unstable --> direct cardioversion with 100 joules
Which arrhythmia is commonly associated with left-sided heart failure? - cORRECT sOLUTION Atrial Fibrillation bc blood is not moving d/t left ventricular hypertrophy
Sometimes certain medications prolong the QT interval, potentially causing polymorphic ventricular tachycardia. The drug of choice to treat this rhythm is? - cORRECT sOLUTION MAGNESIUM Magnesium acts on the processes by which calcium is transferred both across the cell membrane and within the cell itself. If high doses of Magnesium are given, it may slow AV conduction
The QT interval may be prolonged by use of tricyclic antidepressants, erythromycin (ABX), quinidine (antiarrhythmic) or terfenidine (antihistamine).
Preload vs Afterload - cORRECT sOLUTION Preload: is pressure at end of diastole aka filling of heart
Afterload: the resistance needed to pump blood out of heart aka systole
What does an S3 sound indicate? S4?
Split S1 - cORRECT sOLUTION S3 indicates volume overload aka heart failure
S4 indicates ventricular hypertrophy aka decreased compliance. When ventricles thicken, it is harder to fill adequately, the atria eject more forcefully causing an S4 sound. Split S1 indicates a BBB (bundle branch block) or PVCs
Where is murmur heard in pt with:
Aortic stenosis
Mitral Stenosis
Aortic Regurgitation
