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EP Exam Review Book Examples

Sample Questions - Page 2 of 3
(Note: Images shown here in color, will appear gray scale in the book)

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LAB VALUES


BLOOD CHEMISTRIES

  1. Sodium
  2. Potassium
  3. Chloride
  4. Total Calcium
  5. Magnesium

371. Match the normal blood chemistry ranges to its electrolyte.

  1. 0.8-1.0 mg/L
  2. 1.5-2.1 mEq/L
  3. 3.5-4.5 mEq/L
  4. 95-105 mEq/L
  5. 135-145 mEq/L

BE ABLE TO CORRECTLY MATCH ALL ANSWERS BELOW:

BLOOD CHEMISTRIES Normal Value
SODIUM 135-145 mEq/L
POTASSIUM (K+) 3.5-4.5 mEq/L
CHLORIDE 95-105 mEq/L
TOTAL CALCIUM 0.8-1.0 mg/L
MAGNESIUM 1.5-2.1 mEq/L

See: Underhill, chapter on "Laboratory Tests" also, Todd, Vol II, Chapter on "Cath Protocol and Preparation" Keywords: blood chemistries pre-cath.

399. To ensure correct patient is being operated on, when a patient is brought to the EP lab you should check all the following EXCEPT:
   a. Check ID band
   b. Check their name
   c. Ask patient date of birth
   d. Ask patient the site of the procedure
   e. Check responses against consent form

ANSWER: b. Checking their name, is not adequate. They must STATE their full name. You are supposed to ask the patient to state their full name, not just say "Are you John Doe?". See JCAHO poster

468. This ECG shows:
EP Exam Review - Ques. 468. This ECG Shows:    a. 1st degree HB
   b. Mobitz I HB
   c. 2nd degree HB type II
   d. Sinus Tachycardia with ST depression

ANSWER: a. 1st degree HB. The P waves are seen in the upper strip as a small deflection at the end of the T wave, way out in front of the QRS. The lower strip more clearly shows the P waves between each QRS. This is similar to an electrogram where you can better understand the P waves (A waves) and their relationship to the surface ECG.

502. The ECG lead labeled #3 on this Hex-axial reference system diagram is lead _______.

EP Exam Review - Ques. 502 - The ECG lead labeled #3 on this Hex-axial diagram is lead____   a. aVR
  b. aVL
  c. aVF
  d. I
  e. II
  f. III

ANSWER: f. EP Exam Review - Ques. 502 - Answer Hex-axial diagramLead III is at 120o in the second quadrant (down and to right) and is a bipolar lead normally positive at the left. leg. Know this reference system. It is essential for axis and lead direction. CORRECTLY MATCHED ANSWERS ARE:

  1. +I   2. +aVL   3. -III   4. -aVF   5. -II   6. +aVR

Note that as you move around the circle the leads alternate between bipolar (I, II, III) and augmented (aVR, aVL, aVF). Also, the top half of the circle is only positive for the aV arm leads. In fact aVR is typically always opposite in direction from most other leads because of its vector polarity. For this reason lead aVR is usually ignored when checking for infarction patterns. See: Braunwald, chapter on ECGs.

533. Which arrhythmia reveals a "jump" in the A2 H2 interval with progressively early atrial extrastimuli as shown in the diagram.

EP Exam Review - Ques. 533 - Which arrhytmia reveals a "jump"…   a. AVRT   b. AVNRT   c. Mobitz 1 AV block   d. Mobitz 2 AV block

ANSWER: b. AVNRT. Cohen says: In AVNRT programmed atrial stimulation (A1A2) typically reveals the presence of a "jump" in which progressive earlier extrastimuli demonstrate a jump in the A2H2 interval indicative of refractoriness in the fast AV nodal pathway. Elimination of the slow pathway (postablation) reveals no evidence of a jump and only a single curve. See, Cohen, chapter on AV-Nodal Reentrant Tachycardia

 

580. While performing incremental pacing on the 14 year old patient below, you should note:

EP Exam Review - Ques. 580 - While performing incemental pacing…

a.
AV Block second degree type I

b.
AV Block second degree type 2

c.
VA Block

d.
CHB


ANSWER: a. AV block second degree type I -Wenckebach.

EP Exam Review - Ans. - 580 - AV block second degree type I

This MD is pacing off the HRA… notice the pacing artifact and the atrial waveform. The S1 Stim on the bottom just shows pacing, not capture. Notice the block occurs in the AV node. You may notice the AV interval get progressively longer until block… this shows the decremental properties of the AV node, unlike accessory pathways which do not decrement. They conduct all or none.

This is a different catheter set up than the previous examples. This is physician preference. This MD also uses an arterial pressure line on the bottom. An arterial pressure is nice to have since some patients do not tolerate rapid pacing. There is about 200 ms delay from V to arterial pulse.

EP Exam Review - Ques. 590 - What term best describes the condution after S2?

 

 

 

 

590. What term best describes the conduction after S2?

  a.  AERP
  b.  VERP
  c.  Infranodal Block
  d.  InfraHisian Block

EP Exam Review - Ans. 590 - Infrashian block

ANSWER: d. Infrahisian block.

When looking for block, don't forget to use the surface EKG. If you had more QRS complexes, you would note group beating suggesting Wenckebach.

Kusumoto teaches us that, "If complete infrahisian block develops, the patient is dependent on automaticity from ventricular tissue, which is notoriously unreliable. For this reason evidence of infrahisian block, even in an asymptomatic patient is an indication for permanent pacing." See: Kusumoto chapter on Bradycardia

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Wes Todd, BS, RCIS.
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