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WorksheetsECG Basics and Aortic Aneurysms
Total questions: 106
Worksheet time: 53mins
Which 12-lead ECG set best localizes injury to the anterior wall supplied by the left circumflex or LAD region?
Leads II, III, aVF indicate anterior injury
Leads V7–V9 reflect anterior wall injury
Leads I, aVL, V5, V6 show anterior injury
Leads V1–V4 reflect anterior wall injury
ST-segment elevation most directly indicates which clinical process in myocardial tissue?
Ischemia without infarction
Injury progressing into infarction
Electrolyte imbalance only
Conduction delay at AV node
On a standard ECG grid, what time value does one small box represent for interval measurement?
0.02 seconds per small box
0.04 seconds per small box
0.20 seconds per small box
0.10 seconds per small box
Which description best matches the QRS complex in normal ventricular depolarization?
Duration 0.02–0.06 seconds, tall and broad Q
Duration 0.12–0.20 seconds, inverted deep Q
Duration 0.20–0.40 seconds, wide and deep Q
Duration 0.04–0.12 seconds, narrow and shallow Q
A patient presents with sudden tearing pain radiating to the neck and back, unequal pulses in extremities, and hypotension. Which condition is most likely?
Pulmonary embolism with pleurisy
Abdominal aortic aneurysm rupture
Thoracic aortic aneurysm (dissection)
Acute pericarditis with effusion
Which finding most specifically suggests an abdominal aortic aneurysm (AAA)?
Palpable abdominal pulse with lower left abdominal pain
Epigastric burning relieved by antacids
Chest pain radiating to shoulders with syncope
Sharp pleuritic pain with hemoptysis
Which ECG change is most consistent with myocardial ischemia rather than infarction?
ST-segment depression indicating reduced perfusion
Pathologic Q waves in inferior leads
ST-segment elevation across precordial leads
Tall, peaked T waves in all limb leads
During suspected thoracic aortic dissection, which immediate management priority is most appropriate to reduce risk of rupture?
Aggressive fluid boluses to raise blood pressure
Exercise stress testing to assess ischemia
High-dose morphine and blood pressure control
Early thrombolysis to restore coronary flow
Which factor is a non‑modifiable cardiovascular risk?
Dietary pattern over years
Use of oral contraceptives
Advanced age
Type A personality traits
Which item is most clearly a modifiable cardiovascular risk?
Family history of CVD
Hypercholesterolemia control
Male biological sex
Advanced age
Identify the correct sequence for deoxygenated blood through the heart.
Veins to vena cava to right atrium to tricuspid to right ventricle to pulmonary artery to lungs
Vena cava to left atrium to mitral to left ventricle to pulmonary artery to lungs
Veins to pulmonary veins to left atrium to mitral to left ventricle to aorta to body
Lungs to pulmonary veins to left atrium to tricuspid to right ventricle to aorta
Which pathway correctly describes oxygenated blood leaving the lungs?
Pulmonary veins to right atrium to mitral valve to left ventricle to pulmonary artery
Vena cava to right atrium to tricuspid valve to left ventricle to aorta
Pulmonary arteries to right atrium to tricuspid valve to right ventricle to aorta
Pulmonary veins to left atrium to mitral valve to left ventricle to aortic valve to aorta
Which pacemaker site has the fastest intrinsic rate?
AV node at forty to sixty
Purkinje fibers at fifteen to forty
SA node at sixty to one hundred
Ventricular myocardium at twenty to forty
A junctional escape rhythm typically presents at what rate?
One hundred fifty to two hundred fifty beats per minute
One hundred to one hundred eighty beats per minute
Sixty to one hundred beats per minute
Forty to sixty beats per minute
Which heart rhythm most likely corresponds to a rate of 150–250 beats per minute?
Atrial tachycardia pattern
Accelerated junctional rhythm
Supraventricular tachycardia
Ventricular tachycardia
A patient’s ECG shows SVT at 160 bpm. Which alternative rhythm would be slower yet still tachycardic?
Atrial fibrillation above three hundred
Idioventricular escape at thirty
Junctional tachycardia at one hundred ten
Sinus bradycardia at fifty
Which drug class prevents angiotensin II from binding to its receptors?
Beta blockers reduce beta-1 and sodium
CBBs dilate arteries via calcium blockade
ARBs block angiotensin II receptors
ACE inhibitors block angiotensin II formation
Which ACE inhibitor mechanism is most accurate?
Buffers metabolic acidosis directly
Stops enzyme producing angiotensin II
Blocks alpha and beta receptors
Opens sodium and potassium channels
Which beta blocker effect is correctly stated?
Increase renin-aldosterone secretion
Dilate vessels via endothelial CNP
Stimulate vagal tone and SA node
Decrease beta-1 and block sodium channels
Which calcium channel blocker example fits the list?
Propranolol, acebutolol, labetalol
Amlodipine, nifedipine, nicardipine
Captopril, lisinopril, enalapril
Losartan, valsartan, candesartan
Which natriuretic peptide is released by atrial muscle cells?
BNP from ventricular myocardium
ANP from atrial muscle cells
ANP from endothelial venules
CNP from renal tubular cells
BNP primarily counters which hormonal axis?
Renin–angiotensin–aldosterone
Hypothalamic–pituitary–thyroid
Insulin–glucagon regulation
Sympathetic–parasympathetic balance
Which statement best describes CNP?
Secreted by endothelium, causes vasodilation
Stored in ventricles, raises preload
Released by atria, increases sodium reabsorption
Produced by kidneys, vasoconstricts arterioles
Which drug decreases conduction through the SA node?
Nitro raises conduction via venodilation
Adenosine slows SA node conduction
Atropine suppresses PVCs directly
Amiodarone increases SA node firing
Amiodarone’s mechanism is best summarized as:
Enhances vagal tone to AV node
Blocks calcium, sodium, potassium channels
Stimulates alpha and beta receptors
Buffers acidosis and raises pH
Which agent reduces platelet stickiness?
Morphine promotes platelet adhesion
Heparin increases thrombin activity
Aspirin inhibits platelet aggregation
Mag sulfate activates clotting cascade
Which intervention primarily reduces vagal tone?
Atropine reduces vagal tone
Adenosine increases vagal tone
Verapamil increases vagal tone
Nitrous oxide reduces vagal tone
Which calcium salt supports myocardial contraction by aiding electrical activity?
Magnesium sulfate boosts calcium influx
Calcium gluconate decreases preload
Calcium chloride aids contraction
Sodium bicarbonate increases calcium binding
Which drug limits conversion of prothrombin to thrombin, preventing clots?
Morphine enhances coagulation
Aspirin increases thromboxane A2
Verapamil accelerates fibrin creation
Heparin limits thrombin formation
Labetalol’s key action includes:
Opens calcium channels in myocardium
Blocks beta receptors in heart and vessels
Stimulates alpha receptors in arteries
Inhibits angiotensin-converting enzyme
Which statement about Lasix is accurate?
Diuretic creating osmotic gradient
Antiarrhythmic blocking sodium flux
Vasodilator enhancing nitric oxide
ACE inhibitor lowering angiotensin II
Which vasoconstrictor increases perfusion in shock states?
Morphine decreases preload only
Mag sulfate depresses CNS
Nitro reduces oxygen demand
Dopamine increases perfusion
Epinephrine 1:10 primarily does what?
Blocks beta-1 and sodium channels
Stabilizes cardiac membranes
Stimulates alpha and beta receptors
Buffers metabolic acidosis
Which drug buffers metabolic acidosis?
Sodium bicarbonate buffers acidosis
Amiodarone raises serum bicarbonate
Nitro lowers oxygen demand only
Heparin reduces acidity in blood
Which calcium channel blocker prevents calcium movement across cell membranes?
Adenosine enhances calcium entry
Atropine blocks sodium channels
Dopamine opens calcium channels
Verapamil blocks calcium movement
Which drug for ROSC reduces myocardial oxygen demand and decreases preload?
Morphine decreases demand and preload
Epinephrine decreases preload by venodilation
Nitro increases demand and preload
Levofed reduces preload via diuresis
Which ROSC vasopressor is an adrenal agonist?
Dopamine is an adrenal antagonist
Nitro is a venoconstrictor agonist
Morphine is an adrenal agonist
Levofed is an adrenal agonist
Which emergency drug enhances circulation during CPR?
Epinephrine enhances circulation
Verapamil enhances circulation
Aspirin enhances circulation
Atropine enhances circulation
Which medication is first-line to increase blood pressure in cardiogenic shock when the pump is failing?
Atropine infusion 1mg every 5 minutes
Epinephrine drip 2–10 mcg/min
Nitroglycerin sublingual every 5 minutes
Dopamine drip 2–20 mcg/kg/min
A patient with cardiogenic shock should be positioned for comfort if hemodynamically stable. What additional action is critical because the medication is temporary?
Administer corticosteroids immediately
Provide only oxygen and palliative maneuvers
Begin emergency revascularization and reperfusion
Avoid all fluids for 24 hours
Which finding most specifically indicates increased pulmonary congestion in cardiogenic shock?
Warm extremities with bounding pulses
Normotension without diaphoresis
Dyspnea with lung rales
Bradycardia with regular rhythm
For symptomatic bradycardia, which sequence includes recommended pharmacologic options?
Furosemide, then nitrates, consider ACE inhibitor
Amiodarone, then lidocaine, consider magnesium
Nitro, then aspirin, consider morphine
Atropine, then dopamine drip, consider epinephrine
Arteriosclerosis is best described as which pathologic process?
Degenerative disease of medium and large arteries affecting intima
Narrowing of veins due to lipid emboli
Thickening of arterial walls from calcium deposits
Acute inflammation of coronary arteries causing spasm
Which statement accurately contrasts arthrosclerosis with arteriosclerosis?
Arthrosclerosis is an acute spasm; arteriosclerosis is chronic plaque
Arthrosclerosis is wall thickening from calcium; arteriosclerosis leads to intimal injury
Arthrosclerosis is venous; arteriosclerosis is coronary only
Arthrosclerosis affects the intima; arteriosclerosis affects media
Intermittent claudication with reduced pulses and cold, pale extremities most likely indicates which condition?
Cardiogenic pulmonary edema
Acute coronary artery spasm
Stable venous insufficiency syndrome
Peripheral arterial atherosclerotic disease
Which feature distinguishes unstable angina from stable angina?
Pain only during the three Es: eating, exercise, emotion
Episodes that come and go with rest and nitro relief
Pain lasting longer than 20 minutes or new onset crescendo
Spasm-related pain responding to calcium channel blockers
Prinzmetal’s angina is characterized primarily by which mechanism?
Ruptured atherosclerotic plaque with thrombus
Abnormal spasm of coronary arteries
Fixed stenosis of the left main artery
Microvascular dysfunction only
Which term describes the drug effect that increases myocardial contractile strength?
Chronotropic effect on heart rate
Inotropic effect on contractility
Dromotropic effect on conduction
Vasotropic effect on vessel tone
Cardioversion is best described as which action during organized tachyarrhythmias with a pulse?
High-energy DC shock for fibrillation
Synchronized shock on the R wave
Unsynchronized shock during any wave
Continuous pacing through chest wall
Which rhythm is appropriately treated with synchronized cardioversion?
Sinus bradycardia with poor perfusion
Asystole without perfusion
Perfusing supraventricular tachycardia
Pulseless ventricular tachycardia
Defibrillation aims to terminate ventricular fibrillation primarily by what mechanism?
Stimulating vagal output to slow atrial activity
Boosting sympathetic tone to raise heart rate
Depolarizing myocardium to allow uniform repolarization
Increasing AV nodal conduction velocity
Transcutaneous pacing is most indicated for which patient presentation?
Symptomatic bradycardia not responding to medications
Stable narrow-complex SVT with a pulse
Pulseless ventricular fibrillation requiring shock
Rapid atrial flutter with adequate perfusion
In a bradycardic patient with poor perfusion and pulselessness, which intervention is prioritized?
Proceed to defibrillation promptly
Start transcutaneous pacing slowly
Administer bronchodilators first
Initiate cardioversion immediately
Which autonomic effect is mediated by beta-1 stimulation of the heart?
Reduced atrial conduction and cool extremities
Decreased heart rate and AV conduction
Increased heart rate and contractility
Peripheral vasodilation with warm skin
Why do patients in shock often present with pale, cool, and clammy skin?
Beta-1 mediated bronchodilation increases sweating
Dromotropic drugs reduce cutaneous perfusion directly
Alpha-mediated vasoconstriction shunts blood from skin
Parasympathetic stimulation warms peripheral tissues
Which formula correctly calculates cardiac output using stroke volume and heart rate?
Stroke volume minus heart rate times time
Stroke volume plus heart rate divided by pressure
Heart rate divided by stroke volume times resistance
Stroke volume times heart rate per minute
According to Frank-Starling, what primarily increases stroke volume in a healthy ventricle?
Higher systemic resistance augments ejection fraction
Lower preload reduces ventricular wall tension
Greater ventricular filling increases myofiber stretch
Faster heart rate lengthens diastolic filling time
A normal ventricle ejects about two-thirds of end-systolic blood. What term describes this ejected amount?
End-diastolic volume
Stroke volume amount
Ejection fraction amount
Cardiac reserve volume
If stroke volume is 70 mL and heart rate is 70 bpm, what is the cardiac output?
5.5 L per minute
4.9 L per minute
3.5 L per minute
6.0 L per minute
When stroke volume decreases, which compensatory change helps maintain blood pressure?
Reduced heart rate to prolong filling
Decreased systemic vascular resistance
Increased systemic vascular resistance
Lowered venous return via pooling
Which relationship correctly links blood pressure to cardiac output and systemic vascular resistance?
Blood pressure equals heart rate plus resistance
Blood pressure equals cardiac output times resistance
Blood pressure equals stroke volume divided by resistance
Blood pressure equals stroke volume minus resistance
What is the leading cause of death in the immediate period following a myocardial infarction?
Chronic systolic heart failure
Progressive heart block over weeks
Life-threatening ventricular arrhythmias
Acute pulmonary edema within hours
Which finding most specifically indicates left-sided heart failure rather than right-sided heart failure?
Peripheral edema with ascites and RUQ discomfort
Jugular venous distention and enlarged liver on exam
Blood backing up into lungs causing dyspnea and rales
Most common cause being failure of the opposite ventricle
Which symptom pattern best aligns with right-sided heart failure?
Pink frothy sputum with orthopnea and tachycardia
Acute pulmonary edema with pleuritic chest pain
Peripheral edema, JVD, ascites, possible RUQ pain
Chronic atrial arrhythmias and increased blood pressure
Preload is best defined as which statement?
Amount of blood ejected in one minute of cardiac output
Pressure filled in the ventricle at end of diastole
Resistance the ventricle must overcome to eject blood
Ratio of blood ejected to the ventricle’s filled volume
Which treatment is most appropriate for chest pain due to pulmonary edema in congestive heart failure?
Morphine first to relieve anxiety and vasodilate
Nitroglycerin to vasodilate and reduce work of the heart
Aspirin to reduce platelet stickiness for ischemic pain
Anxiolytics to treat pleuritic pain from pneumonia
A patient reports sharp, stabbing chest pain with sudden dyspnea. Which cause is most consistent?
Pulmonary embolism resulting in pleuritic irritation
Costochondritis producing aching anterior chest
Pericarditis causing dull squeezing heaviness
Gastroesophageal reflux disease with burning pressure
Which statement about afterload is accurate?
It is decreased by increasing venous return like a rubber band
It represents ventricular resistance against which to contract
It equals stroke volume multiplied by heart rate
It is measured by ejection fraction during systole
Which set of symptoms most strongly suggests a cardiovascular chest pain etiology?
Localized aching reproducible with chest wall palpation
Burning gnawing pressure linked to peptic ulcer disease
Sharp stabbing pain from pleural irritation and pneumothorax
Dull pressure, squeezing heaviness with ischemia risk
In the Frank-Starling concept described, what happens when the cardiac muscle is stretched within limits by increased venous return?
Ejection fraction falls to one-third of filled volume
Afterload rises due to systemic vascular resistance
Force of contraction increases, boosting blood ejection
Contraction weakens and stroke volume decreases
Which statement best characterizes cardiogenic shock in advanced cases?
Always resolves once preload is increased
Persists after rhythm or volume issues corrected
Primarily due to allergic bronchospasm
Never related to myocardial infarction
Which mechanical complication can precipitate cardiogenic shock?
Isolated upper airway obstruction only
Simple pleural effusion without symptoms
Uncomplicated musculoskeletal chest pain
Tension pneumothorax or cardiac tamponade
During a 12‑lead ECG evolution toward infarction, which sequence is typical?
Ischemia then injury then infarction
Infarction then ischemia then injury
Ischemia then infarction then resolution
Injury then infarction then ischemia
Which drugs are typical in the history of a patient with hypertension?
Thiazide diuretics, beta blockers, CCBs, ACEIs
Only anticoagulants for stroke prevention
Long‑term steroids and nebulized albuterol
Antibiotics and antitussives exclusively
Which clinical picture most aligns with pneumonia rather than pleurisy?
Pain only with inhalation, friction rub sound
Fever, chills, productive cough, pleuritic chest pain
Chest pain without cough, smoker with dry rub
Isolated pleural inflammation without infection
You assess chest pain using OPQRST. Which component asks about what makes it better or worse?
Provocation and palliation factors
Radiation to other areas
Onset timing description
Quality of pain characteristics
In the diagram showing Serum K (mEq/L) progression, which ECG change is most characteristic of mild hyperkalemia (<6.5 mEq/L)?
Flattened P waves with broad base
Tall T waves with narrow base
Prolonged PR interval with delta wave
ST elevation with reciprocal depression
A patient is started on dopamine at 5 mcg/kg/min. According to dosing guidance, what is the typical titration range for dopamine infusion?
0.5–2 mcg/kg/min titrate
2–10 mcg/kg/min titrate
20–40 mcg/kg/min titrate
10–25 mcg/kg/min titrate
Dobutamine primarily increases cardiac output by which mechanism noted in the material?
Enhancing diastolic filling time
Slowing atrioventricular conduction
Increasing stroke volume
Decreasing systemic vascular resistance
Which statement best distinguishes dopamine from dobutamine in clinical use per the notes?
Dobutamine is a vasopressor without inotropy
Dopamine is a pure beta agonist
Dopamine stimulates alpha and beta receptors
Dobutamine causes marked bradycardia
What ECG criterion helps identify ventricular tachycardia on a 12-lead as described?
Rate >250 with sinus P waves
Rate 60–100 with narrow QRS
Rate 100–250 with regular, bizarre QRS
Irregular rhythm with normal QRS
Which clinical consequence is associated with untreated VT according to the material?
Development of first-degree AV block
Resolution without intervention
Conversion to VFib
Progression to atrial flutter
When differentiating stable versus unstable VT, which parameter is explicitly used?
Serum calcium level
Blood pressure and pulse
Liver function tests
Age and weight
Prehospital pediatric care guidance in the notes warns against administering which drug to pediatrics?
Epinephrine in arrest
Cardizem for SVT
Adenosine for SVT
Lidocaine in VT
Which electrolyte imbalance most commonly causes severe hyperkalemia leading to sine waves and possible asystole?
Hepatic failure causing ammonia accumulation
Renal failure impairing potassium excretion
Hypothyroidism slowing metabolic clearance
Adrenal crisis reducing aldosterone secretion
A patient’s ECG shows wide QRS, left axis deviation, lost ST segment contiguous with a peaked T wave, and flattening P wave. What condition best explains these findings?
Hypermagnesemia causing slowed conduction
Hyperkalemia progressing toward severe levels
Hypocalcemia with prolonged QT interval
Acute myocardial infarction with ST elevation
Which mineral primarily stabilizes cardiac membranes and is often tested when torsades de pointes is suspected?
Magnesium stabilizing membranes and reducing dysrhythmias
Calcium increasing muscle contraction strength
Potassium facilitating conduction and rhythm
Sodium enhancing blood volume and pressure
Which symptom pattern is most typical of myocardial infarction presentations noted in men?
Intermittent mild chest discomfort with no radiation
Severe constant chest pain radiating to back, neck, arms
Isolated palpitations without shortness of breath
Brief dizziness resolved by rest within minutes
After return of spontaneous circulation, what is the recommended target range for induced therapeutic hypothermia?
40–42°C to enhance reperfusion and warming
36–38°C to avoid arrhythmia recurrence
32–36°C to slow metabolism and limit injury
28–30°C to completely suppress metabolism
Which statement about torsades de pointes is most consistent with the provided material?
Associated with low magnesium that worsens dysrhythmias
Improved by sodium loading to raise blood pressure
Triggered by hypercalcemia increasing contraction strength
Primarily due to elevated potassium from dehydration
Which post-ROSC protocol element is correctly matched with its purpose?
Prolonged hypothermia beyond 72 hours to prevent reperfusion
Rapid rewarming to 38°C to enhance oxidative metabolism
Chilled IV fluids and ice packs to 32–36°C for neuroprotection
Warm IV fluids to 37°C to boost cardiac output
Atypical myocardial infarction presentation in females most commonly includes which symptom profile?
Fatigue and lightheadedness without chest pain
Sudden sharp pleuritic pain only
Severe crushing chest pain always present
Isolated epigastric pain after meals
During cardiac arrest, defibrillation should be delivered as early as possible. Which time window corresponds to the electrical phase when success is highest?
Greater than 10 minutes post arrest
Immediately after ROSC is achieved
4 to 10 minutes after arrest
0 to 4 minutes after arrest
Which statement best distinguishes systolic from diastolic blood pressure in terms of cardiac cycle phases?
Systolic is ventricular contraction; diastolic is relaxation
Systolic is atrial filling; diastolic is atrial emptying
Systolic is coronary perfusion; diastolic is ejection
Systolic is valve closure; diastolic is valve opening
In ECG interpretation, which pattern most strongly indicates acute injury consistent with myocardial infarction rather than ischemia alone?
ST-segment elevation in affected leads
T-wave inversion without ST shift
Sinus tachycardia with narrow QRS
Normal ST with prolonged deep Q
According to Poiseuille’s Law, how does blood flow change when vessel radius increases while pressure difference remains constant?
Flow remains unchanged by radius
Flow decreases inversely with radius
Flow increases linearly with radius
Flow increases with radius to the fourth power
A vessel transports 1 mL/min at radius 1 under a fixed pressure gradient. If radius increases to 4, what is the expected flow per minute by Poiseuille’s Law?
256 mL per minute
64 mL per minute
16 mL per minute
4 mL per minute
Which ECG leads best localize an anterior wall myocardial infarction?
Leads V1 and V2
Leads V1, V2, V3, V4
Leads I, aVL, V5
Leads II, III, aVF
An inferior wall myocardial infarction is most commonly supplied by which coronary artery?
Left circumflex artery
Right coronary artery
Posterior descending artery
Left anterior descending artery
Which statement correctly distinguishes transmural from subendocardial myocardial infarction?
Subendocardial involves outer full thickness
Transmural affects inner layer only
Subendocardial involves entire ventricular wall
Transmural involves full myocardial thickness
Which leads are most associated with a septal myocardial infarction?
I and aVL
V1 and V2
II and III
V3 and V4
Lateral wall myocardial infarction typically correlates with occlusion of which artery?
Posterior descending artery
Left anterior descending artery
Left circumflex artery
Right coronary artery
Cor pulmonale is best described as which condition?
Heart failure due to pulmonary disease
Heart failure from primary valvular disease
Right heart failure from congenital shunt
Left heart failure due to hypertension
In COPD-related heart failure, which pathophysiologic change most directly contributes to cor pulmonale?
Systemic arterial hypertension
Pulmonary hypertension
Reduced systemic vascular resistance
Coronary vasospasm
Which cardiac property refers to the pacemaking ability that determines the fastest intrinsic rate in the conduction system?
Afterload
Automaticity
Excitability
Contractility
Match the vocabulary terms with the definition. Not all terms will be used.
When blood leaves this chambers of the heart, it heads to the lungs.
Right Ventricle
Stops blood from flowing back into the ventricles each time they contract.
Semilunar (SL) Valves
Responsible for distributing electrical impulses throughout the heart,
Atrioventricular (AV) Node
This blood vessels splits into two and sends oxygen poor blood to the lungs
Right Atrium
The chamber in the heart that receives oxygenated blood from the lungs.
Left Atrium
