Deck 15: 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

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 2

C

Question 3

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.

Answer 3

A

Question 4

A positive stress test implies that

A)Ischemia is present.
B)Ischemia is absent.
C)Infarction is present.
D)Infarction is absent.

Question 5

One MET is equal to

A)3.5 ml O₂/kg/min.
B)35 ml O₂/kg/min.
C)0.35 ml O₂/kg/min.
D)0.035 ml O₂/kg/min.

Question 6

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)Electrolye abnormalities

Question 7

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

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

Question 8

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 9

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 10

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 11

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 12

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 13

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

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

Question 14

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 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

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

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

Question 17

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.

Question 18

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

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

Question 19

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 20

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 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

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 23

To ensure good contact with the skin,what preparation is used at stress test electrode sites?

A)Lotion is applied to the skin,then electrodes are placed on top.
B)Skin is cleaned and degreased with acetone,then abraded to remove the horny layer of epidermis.
C)Skin is cleaned with soap and water,then electrodes are applied.
D)Skin is cleaned,benzoin is applied to the electrode sites,then electrodes are attached.

Question 24

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 25

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 26

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 27

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 28

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 29

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 30

Running on a treadmill is what kind of exercise?

A)Static
B)Isometric
C)Isotonic
D)Isovolumetric

Question 31

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 32

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 33

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)J-point depression.

Question 34

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 35

The most widely known exercise protocol using a treadmill is the

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

Question 36

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 37

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 38

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 39

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 40

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 41

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 42

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 43

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

Question 44

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

Question 45

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 46

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 47

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 48

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 49

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

Question 50

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 51

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

Question 52

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

Question 53

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

Question 54

Attending to activities of daily living averages about 10 METS.

Question 55

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 56

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

Question 57

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

Question 58

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 59

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 60

A MET is a measurement of oxygen consumption.

Question 61

A positive stress test implies that _____ is present.

Question 62

Bayes' Theorem is concerned with the _____ of stress test results.

Question 63

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

Question 64

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