PCCN Master Questions With Answers
1. Cardiac - Answer - 1. Cardiac
Pt's EKG shows ST elevation in leads II, III, and aVF. Where is the MI? - Answer - 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? - Answer - Septal area, Left Anterior
Descending Artery
Pt's EKG shows ST elevation in leads V3 and V4. Where is the MI? - Answer - Anterior area
Pt has ST elevation in leads V1-V4. Which coronary artery is occluded? - Answer - Left Anterior
Descending Artery
EKG shows: ST segment ELEVATION.
What does this indicate? - Answer - MI or INFARCTION
EKG shows: ST segment DEPRESSION.
What does this indicate? - Answer - Myocardial ISCHEMIA
A sign of necrosis on an EKG would include: - Answer - 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? - Answer - hyperkalemia
,PCCN Master Questions With Answers
EKG shows: Prominent U wave and flat T wave
What does this indicate? - Answer - hypokalemia
EKG shows: PR interval >.2
What does this indicate? - Answer - 1st degree AV block
EKG shows: Progressive prolongation of PR interval until QRS complex is dropped
What does this indicate? - Answer - Second degree AV block type 1 or Mobitz (type I)
Difference between 2nd degree AV block type I vs II - Answer - 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? - Answer - 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... - Answer - emergent pacing bc these
long pauses can cause inadequate perfusion and may lead to cardiac arrest.
How do you tx atrial fibrillation? - Answer - 3 principles:
1. Rate control (B-blockers / non DHP Ca2+ CB
,PCCN Master Questions With Answers
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? - Answer - 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? - Answer - 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 - Answer - 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 - Answer - 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
, PCCN Master Questions With Answers
Where is murmur heard in pt with:
Aortic stenosis
Mitral Stenosis
Aortic Regurgitation
Mitral Regurgitation - Answer - Aortic stenosis: Systole
Mitral Stenosis: Diastole
Aortic Regurgitation: Diastole
Mitral Regurgitation: Systole
Mneminic: A for Systolic (bc first)
"Regurgitations" are opposite of stenosis
When pt has acute mitral valve regurgitation, they will have increased pressure in what area of the
heart? - Answer - Increased in left atrial diastolic pressure bc blood is flowing back from the valve.
How does chronic aortic stenosis lead to left ventricular hypertrophy? - Answer - Chronic aortic
stenosis leads to left ventricular hypertrophy bc of increased workload of pumping blood through a
narrow opening. The left atrium can also enlarge but mainly causes left ventricular hypertrophy. The
right ventricle will remain normal for a period of time. That's why LHF happens first then leads to RHF.
Chronic mitral stenosis will cause enlargement in which area? - Answer - Left atria hypertrophy.
In pt with Mitral valve stenosis, their valve thickens, reducing blood flow from left ventricle to left atria.
The pressure in left atria becomes high, causing enlargement overtime, then pt will be at risk for a fib bc
the left atria becomes so thick than it cannot properly contract and just quivers so higher risk for blood
ctot bc the blood isn't moving.
Pt with left atria hypertrophy are at risk for... - Answer - A fib
Left atria becomes so thick that it cannot properly contract and just quivers so higher risk for blood clot
bc blood isn't moving
1. Cardiac - Answer - 1. Cardiac
Pt's EKG shows ST elevation in leads II, III, and aVF. Where is the MI? - Answer - 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? - Answer - Septal area, Left Anterior
Descending Artery
Pt's EKG shows ST elevation in leads V3 and V4. Where is the MI? - Answer - Anterior area
Pt has ST elevation in leads V1-V4. Which coronary artery is occluded? - Answer - Left Anterior
Descending Artery
EKG shows: ST segment ELEVATION.
What does this indicate? - Answer - MI or INFARCTION
EKG shows: ST segment DEPRESSION.
What does this indicate? - Answer - Myocardial ISCHEMIA
A sign of necrosis on an EKG would include: - Answer - 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? - Answer - hyperkalemia
,PCCN Master Questions With Answers
EKG shows: Prominent U wave and flat T wave
What does this indicate? - Answer - hypokalemia
EKG shows: PR interval >.2
What does this indicate? - Answer - 1st degree AV block
EKG shows: Progressive prolongation of PR interval until QRS complex is dropped
What does this indicate? - Answer - Second degree AV block type 1 or Mobitz (type I)
Difference between 2nd degree AV block type I vs II - Answer - 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? - Answer - 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... - Answer - emergent pacing bc these
long pauses can cause inadequate perfusion and may lead to cardiac arrest.
How do you tx atrial fibrillation? - Answer - 3 principles:
1. Rate control (B-blockers / non DHP Ca2+ CB
,PCCN Master Questions With Answers
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? - Answer - 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? - Answer - 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 - Answer - 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 - Answer - 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
, PCCN Master Questions With Answers
Where is murmur heard in pt with:
Aortic stenosis
Mitral Stenosis
Aortic Regurgitation
Mitral Regurgitation - Answer - Aortic stenosis: Systole
Mitral Stenosis: Diastole
Aortic Regurgitation: Diastole
Mitral Regurgitation: Systole
Mneminic: A for Systolic (bc first)
"Regurgitations" are opposite of stenosis
When pt has acute mitral valve regurgitation, they will have increased pressure in what area of the
heart? - Answer - Increased in left atrial diastolic pressure bc blood is flowing back from the valve.
How does chronic aortic stenosis lead to left ventricular hypertrophy? - Answer - Chronic aortic
stenosis leads to left ventricular hypertrophy bc of increased workload of pumping blood through a
narrow opening. The left atrium can also enlarge but mainly causes left ventricular hypertrophy. The
right ventricle will remain normal for a period of time. That's why LHF happens first then leads to RHF.
Chronic mitral stenosis will cause enlargement in which area? - Answer - Left atria hypertrophy.
In pt with Mitral valve stenosis, their valve thickens, reducing blood flow from left ventricle to left atria.
The pressure in left atria becomes high, causing enlargement overtime, then pt will be at risk for a fib bc
the left atria becomes so thick than it cannot properly contract and just quivers so higher risk for blood
ctot bc the blood isn't moving.
Pt with left atria hypertrophy are at risk for... - Answer - A fib
Left atria becomes so thick that it cannot properly contract and just quivers so higher risk for blood clot
bc blood isn't moving
