PCCN Master Questions with Complete Answers 100% Correct 2023

PCCN Master Questions with Complete Answers 100% Correct 2023 1. Cardiac 1. Cardiac Pt's EKG shows ST elevation in leads II, III, and aVF. Where is the MI? 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? Septal area, Left Anterior Descending Artery Pt's EKG shows ST elevation in leads V3 and V4. Where is the MI? Anterior area Pt has ST elevation in leads V1-V4. Which coronary artery is occluded? Left Anterior Descending Artery EKG shows: ST segment ELEVATION. What does this indicate? MI or INFARCTION EKG shows: ST segment DEPRESSION. What does this indicate? Myocardial ISCHEMIA A sign of necrosis on an EKG would include: 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? hyperkalemia EKG shows: Prominent U wave and flat T wave What does this indicate? hypokalemia EKG shows: PR interval .2 What does this indicate? 1st degree AV block EKG shows: Progressive prolongation of PR interval until QRS complex is dropped What does this indicate? Second degree AV block type 1 or Mobitz (type I) Difference between 2nd degree AV block type I vs II 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? 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... emergent pacing bc these long pauses can cause inadequate perfusion and may lead to cardiac arrest. How do you tx atrial fibrillation? 3 principles: 1. Rate control (B-blockers / non DHP Ca2+ CB 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? 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? 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 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 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 Where is murmur heard in pt with: Aortic stenosis Mitral Stenosis Aortic Regurgitation Mitral Regurgitation 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? Increased in left atrial diastolic pressure bc blood is flowing back from the valve.