Deck 17: Diagnostic Electrocardiography

Question 1

A MET is a

A)measurement of energy absorption during exercise.
B)measurement of oxygen consumption during exercise.
C)method of exercise.
D)pharmacologic agent used in stress testing.

Answer 1

B

Question 2

A relative contraindication is one that means

A)don't do the test under any circumstances.
B)don't do the test unless the benefits outweigh the risks.
C)do the test as soon as possible.
D)do the test only if the patient's other relatives have had the same problem also.

Answer 2

B

Question 3

If the stress test is negative and the angiogram reveals normal coronary arteries,the stress test is said to have been a

A)true positive.
B)false positive.
C)true negative.
D)false negative.

Answer 3

C

Question 4

Which of the following is an absolute contraindication to stress testing?

A)Myocardial infarction less than 48 hours old
B)Mild to moderate aortic stenosis
C)Uncontrolled tachyarrhythmias or bradyarrhythmias
D)Electrolyte abnormalities

Question 5

For submaximal testing,what percentage of the target heart rate must be attained?

A)65%
B)85%
C)70%
D)100%

Question 6

Bayes' theorem has to do with

A)the sensitivity and specificity of the stress test results.
B)which patients will be predicted to complete the maximal stress test.
C)the predicted cardiac output during exercise stress testing.
D)the predicted workload of a treadmill versus a bicycle stress test.

Question 7

The specificity of a stress test represents the number of patients with

A)proven coronary artery disease who tested positive on the stress test.
B)normal coronary arteries who tested positive on the stress test.
C)proven coronary artery disease who tested negative on the stress test.
D)normal coronary arteries who tested negative on the stress test.

Question 8

A positive stress test implies that

A)ischemia is present.
B)ischemia is absent.
C)infarction is present.
D)infarction is absent.

Question 9

Thallium-201 enters the heart in much the same way as which ion?

A)Sodium
B)Magnesium
C)Chloride
D)Potassium

Question 10

Which of the following is a relative contraindication to stress testing?

A)Known left main coronary artery disease
B)Acute pulmonary embolus
C)MI less than 48 hours old
D)Symptomatic severe aortic stenosis

Question 11

Which of the following is NOT an indication for stress testing?

A)To diagnose coronary artery disease
B)To evaluate patients with symptoms of exercise-induced arrhythmias
C)To evaluate patients after coronary bypass surgery
D)To evaluate asymptomatic individuals with no CAD risk factors

Question 12

The inability of the heart to increase its rate adequately with exercise is called

A)inotropic reserve.
B)chronotropic reserve.
C)inotropic incompetence.
D)chronotropic incompetence.

Question 13

The J-point is the point at which the

A)P wave and PR segment join together.
B)PR segment and QRS complex join together.
C)QRS complex and ST segment join together.
D)ST segment and T wave join together.

Question 14

13 METs is

A)the oxygen consumption of a person sitting down resting.
B)The level most adults can reach with exertion.
C)the level at which cardiac arrest occurs.
D)almost always associated with significant cardiac ischemia.

Question 15

If the stress test is positive but an angiogram reveals normal coronary arteries,the stress test is said to have been a

A)true positive.
B)false positive.
C)true negative.
D)false negative.

Question 16

How much must a coronary artery be narrowed for the stress test to be positive?

A)35%
B)60%
C)75%
D)90%

Question 17

The target heart rate for a 60-year-old man having a stress test is

A)280.
B)160.
C)190.
D)220.

Question 18

Which of the following is an indication for stress testing?

A)To evaluate asymptomatic individuals with no CAD risk factors
B)To evaluate individuals with noncardiac chest discomfort
C)To evaluate individuals with severe aortic stenosis
D)To evaluate the prognosis and functional capacity after an MI

Question 19

If the stress test is positive and an angiogram reveals coronary artery disease,the stress test is said to have been a

A)true positive.
B)false positive.
C)true negative.
D)false negative.

Question 20

The sensitivity of a stress test represents the number of patients with

A)proven coronary artery disease who tested positive on the stress test.
B)normal coronary arteries who tested positive on the stress test.
C)proven coronary artery disease who tested negative on the stress test.
D)normal coronary arteries who tested negative on the stress test.

Question 21

The "gold standard" for determining the presence of coronary artery disease is the

A)exercise stress test.
B)MUGA scan.
C)thallium stress test.
D)angiogram.

Question 22

A double product greater than 25,000 indicates that

A)an acceptable level of exercise has been achieved during the stress test.
B)the patient has ischemia and the test must be stopped.
C)the stress test is positive for coronary artery disease.
D)there is 2.5 mms of ST segment elevation in three or more leads.

Question 23

A true positive stress test is one in which the stress test is ________ and the angiogram is ________.

A)positive,positive
B)positive,negative
C)negative,positive
D)negative,negative

Question 24

Which of the following is NOT an indicator of an abnormal stress test?

A)Development of a new U wave,or inversion of a pre-existing U wave,during or after exercise
B)ST depression of at least 1-1.5 mm at 0.08 seconds after the J-point
C)ST segment elevation
D)Exercise-induced PACs

Question 25

The patient's target heart rate is 180,but he develops severe chest pain,shortness of breath,and diaphoresis at a heart rate of 135.What should be done?

A)Continue the test until the target heart rate is reached.
B)Stop the test immediately.
C)Continue the test until the heart rate reaches 153,which will be the 85% needed for a valid test.
D)Give the patient a nitroglycerin tablet sublingually and then continue the test.

Question 26

On the morning of the stress test,it is important that the patient

A)eat a big meal for energy.
B)fast for 12 hours to avoid nausea during the test.
C)semi-fast for four hours before the test.
D)eat as usual.

Question 27

If the stress test is negative but the angiogram reveals coronary artery disease,the stress test is said to have been a

A)true positive.
B)false positive.
C)true negative.
D)false negative.

Question 28

All pharmacologic stress tests involve the use of

A)a treadmill to induce stress.
B)medications to induce stress the way exercise would.
C)an arm ergometer to induce stress.
D)radioactive medications to determine tissue perfusion.

Question 29

Running on a treadmill can be used in ALL BUT

A)pharmacologic stress tests.
B)Bruce protocol stress tests.
C)Naughton protocol stress tests.
D)modified Bruce protocol stress tests.

Question 30

The most widely known exercise protocol using a treadmill is the

A)Kattus protocol.
B)Naughton protocol.
C)Bruce protocol.
D)Cornell protocol.

Question 31

To imply ischemia,ST depression of 1.5 mm is required for

A)upsloping ST depression.
B)horizontal ST depression.
C)downsloping ST depression.
D)all the above.

Question 32

The most common methods of stress testing include which of the following?

A)Arm ergometer and treadmill
B)Bicycle ergometer and stair-stepper
C)Treadmill and bicycle ergometer
D)Stair-stepper and arm ergometer

Question 33

Which type of ST segment depression is the most indicative of coronary artery disease?

A)Upsloping
B)Horizontal
C)Downsloping
D)J-point depression

Question 34

If the ST segment drops 3 mm during exercise,it is evidence of

A)old MI.
B)myocardial ischemia.
C)J-point elevation.
D)ventricular tachycardia.

Question 35

Which of the following is NOT a reason to terminate an exercise stress test?

A)Blood pressure drop of more than 10 mm Hg along with severe chest pain
B)Sustained ventricular tachycardia
C)Decreasing amplitude of the QRS complex and T waves
D)EKG machine malfunction

Question 36

The point at which the QRS complex and ST segment join together is called the

A)Q wave.
B)R-point.
C)S wave.
D)J-point.

Question 37

Which of the following is NOT a reason to terminate a stress test?

A)Patient's request
B)ST segment elevation
C)Falling blood pressure
D)Shortening of the PR interval

Question 38

Respiratory rate and heart rate should do what with exercise?

A)Respiratory rate increases,heart rate decreases.
B)Respiratory rate and heart rate both increase.
C)Respiratory rate decreases,heart rate increases.
D)Respiratory rate and heart rate both decrease.

Question 39

Ischemia is recognized by

A)ST depression of 1-1.5 mm at the J-point.
B)ST elevation of 1-1.5 mm at 80 milliseconds after the J-point.
C)ST depression of 1-1.5 mm at 80 milliseconds after the J-point.
D)T wave inversion 80 milliseconds before the J-point.

Question 40

For purposes of ischemia evaluation,the baseline of the EKG is at the

A)ST segment.
B)PR segment.
C)TP segment.
D)J-point.

Question 41

Stress testing is intended to

A)trigger sustained ventricular tachycardia.
B)produce ST segment elevation.
C)produce a drop in blood pressure more than 10 mm Hg.
D)increase the patient's heart rate.

Question 42

Signal-averaged EKGs are used to uncover

A)early potentials,which can be useful in predicting the risk of potentially dangerous ventricular arrhythmias.
B)early potentials,which can be useful in predicting the risk of potentially dangerous atrial arrhythmias.
C)late potentials,which can be useful in predicting the risk of potentially dangerous atrial arrhythmias.
D)late potentials,which can be useful in predicting the risk of potentially dangerous ventricular arrhythmias.

Question 43

Mr.Jackson has periods of sudden,unexpected syncope.What kind of Holter monitoring system would be best?

A)Patient-activated event monitor
B)Either an arrhythmia-activated event monitor with a memory loop recorder or a continuous recorder
C)Continuous recorder
D)Any type of system would be adequate.

Question 44

One benefit of signal-averaged EKGs is that they

A)require only a few seconds to complete.
B)are "cleansed" of background noise.
C)do not require patients to lie down or hold still.
D)require less preparation than a standard 12-lead EKG.

Question 45

A patient is thought to be experiencing sporadic ST segment abnormalities.Which type of monitoring device would be most appropriate for this patient?

A)Event monitor
B)SAEKG
C)Holter monitor
D)Ergometer

Question 46

The patient who has a mild dizzy spell while Holter monitoring is in effect should

A)activate the event marker button and document the symptoms in his or her diary.
B)proceed to the nearest hospital for immediate Holter analysis.
C)call 911 for an ambulance for transport to the emergency department.
D)take the Holter off when the dizzy spell passes,as the monitoring is now complete.

Question 47

The Holter scanner finds that the 24-year-old patient's rhythm changes to sinus bradycardia with a heart rate of 54 during the sleep hours.The Holter technician should

A)immediately notify the physician about this alarming discovery.
B)know this is normal and continue scanning for significant abnormalities.
C)call the patient and tell him or her to come to the office immediately to see the physician.
D)know this is abnormal,but decide it can wait until the physician routinely checks the Holter recordings.

Question 48

Which protocol for treadmill exercise testing is used most often for testing post-MI patients just prior to hospital discharge?

A)Bruce protocol
B)Modified Bruce protocol
C)Naughton protocol
D)Modified Naughton protocol

Question 49

Holter monitoring is a(n)

A)ambulatory electrocardiographic recording.
B)rhythm strip recorded over two hours.
C)method of stress test interpretation.
D)method of stress test recording.

Question 50

Stress testing is a diagnostic procedure done to determine the likelihood of

A)CAD.
B)ventricular arrhythmias.
C)myocardial ischemia.
D)myocardial infarction.

Question 51

The patient's blood pressure was 120/80 at rest.During the stress test,it has fallen to 90/50 and he is cold and clammy.What is the appropriate course of action?

A)Stop the test immediately.
B)Stop for a minute,then resume at a slower pace.
C)Continue as is.
D)Slow the pace to let the patient recover,then speed it back up to the previous level.

Question 52

If your patient develops a first-degree AV block during her stress test,you should

A)stop the test immediately.
B)continue,but watch the rhythm cautiously.
C)stop the test and send the patient for a permanent pacemaker.
D)back the stage to the previous level.

Question 53

Which of the following would be considered a negative Holter?

A)A Holter that reveals tachycardias but not bradycardias
B)A Holter that reveals no ST changes
C)A Holter that reveals bradycardias but not tachycardias
D)A Holter that reveals ST segment elevations

Question 54

Your patient has developed very mild chest discomfort during her treadmill stress test.She denies other symptoms and her blood pressure is stable.There are no EKG changes.What is the correct course of action?

A)Stop the test immediately.
B)Continue but watch cautiously.
C)Stop the test,assess the patient more fully,and then restart if everything is OK.
D)Back down to the next lowest stage of the test.

Question 55

Your patient took his routine beta-blocker medication this morning just before his stress test.What effect would this likely have on the results?

A)True positive
B)True negative
C)False positive
D)False negative

Question 56

A stress test lets the medical team determine how a patient responds to

A)increased myocardial oxygen demand.
B)severe hypertension.
C)decreased myocardial oxygen demand.
D)severe hypotension.

Question 57

The patient's symptoms and EKG during a stress test provide vital information regarding

A)the patency of the patient's pulmonary arteries.
B)the presence of ventricular arrhythmias.
C)the patency of the patient's coronary arteries.
D)the presence of AV blocks.

Question 58

Which of the following medications would most likely be administered during a pharmacologic stress test?

A)Atenolol
B)Verapamil
C)Adenosine
D)Nitroglycerin

Question 59

Mrs.Johnson has developed a severe headache and blurred vision while having a stress test.Her blood pressure is extremely elevated.The correct course of action would be to

A)slow the treadmill to let the blood pressure and symptoms subside.
B)continue the test.
C)terminate the test immediately.
D)ask the patient if she wants to stop or continue,and do as she requests.

Question 60

Mr.Johnson has been on the treadmill only five minutes and is in stage II of the Bruce protocol.He now complains of extreme fatigue but no chest pain.His skin is cold and clammy.He is nowhere near his target heart rate.What course of action is indicated?

A)Coax him into continuing.
B)Stop the test.
C)Back the treadmill to stage I to let him recover.
D)Advance to stage III.

Question 61

A positive stress test implies that ________ is present.

Question 62

If the stress test is positive but the angiogram is negative,the stress test is said to be a false positive.

Question 63

Chronotropic incompetence is the inability of the heart to increase its rate with exercise.

Question 64

A true positive stress test is one in which the stress test is ________ and the angiogram is ________.

Question 65

Holter monitoring is the gold standard for determining the presence of myocardial ischemia.

Question 66

An EKG is done every five minutes during a stress test.

Question 67

Attending to activities of daily living averages about 10 METS.

Question 68

Thallium-201 is a radioisotope used to identify areas of poor myocardial perfusion.

Question 69

Upsloping ST depression is highly indicative of an MI in progress.

Question 70

The stress test should be terminated only if the patient passes out.

Question 71

A MET is a measurement of oxygen consumption.

Question 72

Bayes' theorem is concerned with the ________ of stress test results.

Question 73

Thallium-201 enters the heart in much the same way as the ion ________.

Question 74

If the pretest probability of coronary artery disease is high but the stress test is negative,the test result is likely to be a ________ negative.

Question 75

The most commonly used device for exercise stress testing is the arm ergometer.