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Theoretical Self-control tests (Only one answer is always correct)
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Theoretical Self-control tests (Only one answer is always correct)

1. Statements about electrocardiography method…All are true except:

A. ECG must always be corresponded with the patient’s general condition and clinical features of pathological state.

B. To understand electrocardiography, one must know definite electrophysiological principles. 

C. Some drugs, infections, fear, exercise, and shock may alter the ECG-grams.

D. ECG changes can not occur without structural abnormalities.

E. ECG is a quick and non-invasive, inexpensive and effective diagnostic tool.

2. Notable findings towards the knowledge of electrocardiography came from many scientists...All are true except:

A. Goldberger.

B. Wilson.

C. Strazhesko.

D. Einthoven.

E. Landsteiner.

3. The electrical system of the heart include several formations...All are true except:

A. Atrioventricular node.

B. Bundle of His.

C. Assmann-Redeker node.

D. Sinoatrial node.

E. Purkinje fibers.

4. It is important to understand some basic electrophysiological definitions...All are true except:

A. Peristaltic activity.

B. Automaticity.

C. Cardiac action potential.

D. Conduction.

E. Refractoriness.

5. In our time electrocardiograph is an extremely sensitive instrument which includes the following main parts...All are true except:

A. Galvanometer.

B. Recorder printer.

C. Amplifier.

D. Microprocessor.

E. Sensing electrodes.

6. Recording rules...All are true except

A. The patient must lie down and relax.

B. Calibrate the record with the 1 mV signal.

C. Record the six standard leads three or four complexes are sufficient for each.

D. Connect up the limb electrodes, making certain that they are applied to the correct limb.

E. Record the three unipolar chest leads.

7. There are some types of leads are widely used in currently clinical practice...All are true except :

A. Unipolar chest leads (V1, V2, V3, V4, V5 and V6).

B. Standard leads (I, II, III).

C. Additional leads (S1, S2, S3, S4).

D. Unipolar limb leads (aVL, aVF, aVR).

E. Tetrapolar ventricular leads (T, R, M).

8. There are the five waves distinguished in the record in norm...All are true except:

A. Q.

B. V.

C. T.

D. R.

E. S.

9. Characteristics of the P wave...All are true except:

A. P wave is the first component of the normal ECG.

B. Normally, it has an amplitude not more than 2.5 small divisions. Its duration is within 0.1 sec (2.5 small divisions).

C. The impulse that makes the P wave originates in sinoatrial node and in the atriums.

D. It represents the beginning of ventricular repolarization.

E. It is usually upright in most leads but can be variable in leads 3 and V1, negative in aVR.

10. Characteristics of the normal Q wave...All are true except:

A. Wide and deep Q may indicate a pronounced dystrophy of myocardium.

B. Amplitude < 25% the amplitude of the R.

C. In healthy person’s duration of Q < 0.03 s.

D. The usual transitional zone from Q>R in the right chest leads to R>Q in the left chest unipolar leads places near V3.

E. In leads II, V1, V2 and V3 is absent in norm.

11. Characteristics of the ST segment...All are true except:

A. ST segment represents the beginning of ventricular repolarization.

B. ST segment starts on the isoelectric line, except in V1 and V2 where it may be elevated (not >1 mm).

C. Most often ST deviation is a sign of myocardial ischemia, pericarditis, and pulmonary embolism.

D. The normal ST arches gently in the direction of the T wave and should not remain exactly horizontal.

E. In norm duration consists between 0.12 and 0.20 s.

12. The analysis of ECG one must carry out in next order...All are true except:

A. Determination the recording paper rate.

B. Evaluation the quality of ECG registration (may be presents of different hindrances).

C. Checking the amplitude of control milliwolt.

D. Testing the blood pressure.

E. Interpretation of the ECG formations.

13. Interpretation of the ECG include…All are true except:

A. Determination of the cardiac rhythm pacemaker site.

B. Estimation of the conductivity.

C. Determination of the electrical axis of the heart.

D. Calculation of the pulse rate.

E. Measurement of the ECG amplitude.

14. ECG signs of normal sinus rhythm…All are true except:

A. The relationship of the P wave and the QRS complex: all P waves are followed by the QRS complex.

B. The conduction to the ventricles is 1:1 (equal quantity of P waves and QRS complexes).

C.  P waves amount are larger than QRS complexes.

D. Constant and normal duration of P wave, PQ interval, QRS complex.

E. The SA node is pacemaker. Heart rate: 60-90 beats per minute.

15. Altered automaticity of the sinoatrial node include...All are true except:

A. Sinoatrial block.

B. Sinus arrhythmia.

C. Sinus tachycardia.

D. Sick sinus syndrome.

E. Sinus bradycardia.

16. Abnormalities of conduction function of heart...All are true except

A. Paroxysmal tachycardias.

B. Sinoatrial block.

C. Atrioventricular block.

D. Wolf-Parkinson-White syndrome.

E. Intraventricular block.

17. ECG signs of sinus tachycardia...All are true except:

A. Regular rhythm.

B. Normal QRS duration.

C. Prolonged PQ interval.

D. Heart rate more than 90 per minute.

E. T wave with normal size and configuration.

18. Sick sinus syndrome can result in many abnormal heart rhythms (arrhythmias)...All are true except:

A. Wolf-Parkinson-White syndrome.

B. Sinus bradycardia.

C. May also be associated with tachycardias.

D. Sinus node exit block.

E. Sinus arrest.

19. ECG signs of sick sinus syndrome...All are true except:

A. Heart rate may be fast or slow, or alternate between fast and slow.

B. Normal QRS duration and shape, although it may vary with change in rhythm.

C. QT interval may vary slightly, but usually within normal limits.

D. T wave with normal size and configuration.

E. Regular rhythm.

20. ECG signs of idioventricular rhythm...All are true except:

A. Heart rate is usually nearly 20 to 40 bpm.

B. P wave is absent.

C. QRS complex wide and bizarre configuration, duration exceeds 0.12 seconds.

D. T wave is abnormal, its deflection usually occurs in the opposite direction from that of the QRS complex.

E. PQ interval is shorter than 0.12 seconds.

21. Features of arrhythmia called wandering pacemaker...All are true except:

A. QRS complex wide and deformed.

B. QT interval may vary slightly, but usually within normal limits.

C. Slight irregular rhythm.

D. Size and configuration of P wave change because of the changing pacemaker site. The P wave may also be absent or inverted or may follow the QRS complex.

E. It occurs when the natural cardiac pacemaker site shifts between the SA node, the atria, and the AV node.

22. ECG signs of parasystolic rhythm...All are true except:

A. QT interval may be lengthened in ventricular parasystolic beats.

B. P wave may change in configuration or may not be visible in a junctional or ventricular parasystolic beat.

C. Irregular rhythm as a result of parasystolic beats.

D. Parasystolic beats are uniform, do not show fixed coupling, and occur at regular intervals.

E. Heart rate is usually nearly 20 to 40 bpm.

23. What arrhythmia may be in situation identifying normal QRS duration and shape? All are true except:

A. Idioventricular rhythm.

B. Sinoatrial block.

C. Sinus bradycardia.

D. Sinus arrhythmia.

E. Wandering pacemaker.

24. ECG signs of premature atrial complexes…All are true except:

A. PR interval is normal or prolonged because the AV junction is often partially refractory when the premature impulse enters it.

B. Wide and deformed QRS complex.

C. Occur as single or repetitive events and have unifocal or multifocal origins.

D. The ectopic P wave is often hidden in the ST-T wave of the preceding beat.

E. After premature atrial complex, there is a pause before the next sinus beat. This is usually incomplete compensatory pause.

25. ECG signs of ventricular extrasystoles...All are true except:

A. Premature QRS is prolonged and deformed.

B. The ectopic P wave is often hidden in the ST-T wave of the preceding beat.

C. P wave before premature beat is absent.

D. After premature complex the complete compensatory pause is present.

E. Irregular rhythm as a result of extrasystole beats.

26. The main events in myocardium during premature ventricular beats...All are true except:

A. Originating in an ectopic ventricular focus.

B. Retrograde conduction.

C. Atrioventricular block.

D. If the first normal impulse reaches the ventricles, they are still in the refractory period following depolarization from the ectopic focus.

E. The second succeeding impulse from the SA node produces a normal beat.

27. The requirements for initiating re-entry mechanism include...All are true except:

A. Electrophysiologic ununiformity.

B. Altered automaticity due to sinus node arrest.

C. Unidirectional block in one pathway.

D. Slow conduction over an alternative pathway, allowing time for the initially blocked pathway to recover excitability.

E. Re-excitation of the initially blocked pathway to complete a loop of activation.

28. Automatic pacemaker activity can be observed due to activity of...All are true except:

A. Fibers of the atrioventricular junction.

B. Purkinje fibers.

C. Fibers of sympathetic system.

D. Specialized atrial fibers.

E. Fibers of His bundle.

29. Triggered activity has been observed in atrial, ventricular, and His-Purkinje tissue under conditions such as...All are true except:

A. Digitalis intoxication.

B. Hypercalcemia.

C. Increased local catecholamine concentration.

D. Hypokalemia.

E. Early repolarization syndrome.

30. ECG signs of atrial paroxysmal tachycardia...All are true except:

A. P wave is replaced by multiply F wave.

B. Ventricular rate varies from 140 to 220 beats per minute.

C. Regular rhythm.

D. P wave is abnormal (more often is inverted).

E. QRS shape and duration is normal.

31. ECG signs of ventricular paroxysmal tachycardia...All are true except:

A. P wave is usually absent.

B. QRS duration is normal, but shape is changed with every constriction.

C. QRS is usually prolonged more than 0.12 seconds and deformed.

D. Regular ventricular rhythm.

E. QT interval is lengthened or immeasurable.

32. The alarming symptoms of ventricular paroxysmal tachycardia include...All are true except:

A. Pain in chest and retrosternal region.

B. Dizziness.

C. Severe palpitation in rest.

D. Shortness of breath.

E. Headache.

33. ECG signs of atrial flutter...All are true except:

A. Ventricular rate varies nearly 110 beats per minute, but atrial rate is 220-400 bpm.

B. P wave is replaced by multiply F wave usually at a ratio of 2:1 (2 F – 1 QRS) but sometimes 3:1 or more.

C. PQ (or PR) is prolonged and more than 0.24 seconds.

D. QRS shape and duration is normal.

E. T wave is distorted by F wave.

34. ECG signs of atrial fibrillation…All are true except:

A. Ventricular response is irregularly irregular and may be fast (HR >100 bpm, indicates inadequate rate control), moderate (HR = 60-100 bpm), or slow (HR <60 bpm, indicates excessive rate control, AV node disease, or drug toxicity).

B. A polymorphic tachycardia associated with the long-QT syndromes characterized by phasic variations in the polarity of the QRS complexes around the baseline. Ventricular rate is often >200 bpm and ventricular fibrillation is a consequence.

C. QRS complexes have relatively normal configuration.

D. Instead P wave irregular undulations of varying shape and amplitude, which are best seen in right leads.

E. The shape of QRS complex changes every contraction.

35. Diagnostic signs of ventricular fibrillation…All are true except:

A. Ventricular response is irregularly irregular and may be fast (HR >100 bpm), moderate (HR = 60-100 bpm), or slow.

B. There is no cardiac output.

C. This rhythm usually results in death unless it is quickly converted by drugs or electrical defibrillation.

D. ECG is bizarre, with absence of the characteristic P, Q, R, S, T waves.

E. It shows irregular waves of varying amplitude and shape occurring 250 to 500 times per minute.

36. In order to weigh up the clinical significance of conduction abnormalities, the physician must assess...All are true except:

A. Risk of progression to complete block.

B. Electrophysiological and homodynamic stability.

C. Site of conduction disturbance.

D. Previous physical exertion.

E. Probability of arising subsidiary escapes rhythms.

37. ECG signs of sinoatrial block (stage II)...All are true except:

A. T wave is normal.

B. Rhythm is regular except for pauses.

C. P wave is absent during a pause, but normal configuration.

D. QRS shape and duration is normal.

E. P wave is absent.

38. ECG signs of second-degree atrioventricular block Mobitz I...All are true except:

A. QRS shape and duration is normal.

B. Rhythm is regularly irregular.

C. Heart rate is normal or slow.

D. PQ (or PR) is longer with every contraction progressively until a P wave goes without a QRS complex. The PR interval in cardiac cycle after the nonconducted is shorter than the interval previous it.

E. PQ is prolonged and more than 0.24 sec., constant.

39. ECG signs of third-degree AV block...All are true except:

A. PQ interval is absent because atria and ventricles beat independently of one another.

B. PQ is prolonged and more than 0.24 s., constant.

C. QRS duration depends of the source of the ventricular rhythm and may be normal or prolonged.

D. T wave may be normal or altered by the early P wave.

E. Atrial rate is normal, but ventricular rhythm ranges from 21 to 40 beats per minute.

40. Diagnostic ECG signs of complete right bundle brunch block...All are true except:

A. Heart rhythm and rate not change.

B. P wave is distorted by the next “M-shaped” QRS complex.

C. P wave has normal shape and duration.

D. QRS duration is more than 0.11 s. It is deformed and “M”-shaped in right chest leads (V1, V2).

E. T wave may be occurred in the direction opposite that of the QRS complex.

41. Diagnostic ECG signs of complete left bundle brunch block...All are true except:

A. Axis may be normal or demonstrate left axis deviation.

B. QRS is deformed and M-shaped in right chest leads (V1, V2).

C. QRS duration is more than 0.11 s. In lead  V1 wide, mainly negative rS complex is present, but V5 and V6  show a wide positive bizarre R wave, without Q wave.

D. T wave may be occurred in the direction opposite that of the QRS complex; also ST wave often shows essential displacement up or downward.

E. Heart rhythm and rate not change.

42. ECG signs of Wolff-Parkinson-White syndrome...All are true except:

A. P wave has normal shape and duration.

B. Heart rate more often not changes, except when supraventricular tachycardia develops.

C. PR interval is shorter than 0.12 s.

D. Duration of ventricular complex is greater than 0.10 sec., delta-wave is present in ascendant part of R

E. PQ is prolonged and more than 0.24 s., constant.

43. What arrhythmias we can occur more often in patients with preexcitation syndromes? All are true except:

A. Paroxysmal atrial tachycardia.

B. Atrioventricular block.

C. Ventricular fibrillation.

D. Paroxysmal nodal tachycardia.

E. Atrial fibrillation.

44. ECG signs of right ventricular hypertrophy...All are true except:

A. PR interval is normal.

B. Right axis deviation of +110 degrees.

C. P wave is higher than 2.5 mm, sharp, especially in leads II, III, and V1.

D. P wave with normal duration and configuration.

E. Tall R in V1, deep S in V5 and V6. The RS proportion exceeds 1 in the right leads and gradually becomes less than 1 as the precordial pattern is extolled in leads V4 through V6.

45. The exercise test is useful in looking for markers of myocardial ischemia...All are true except:

A. Blood pressure response.

B. Typical repolarization (ST segment and T wave) changes due to myocardial ischemia.

C. Tromboembolic syndrome.

D. Arrhythmia syndrome.

E. Chronotropic response.

46. Left ventricular enlargement may occur in association with...All are true except:

A. Valve damages.

B. Systemic arterial hypertension.

C. Cardiosclerosis.

D. Hypertrophic cardiomyopathy.

E. Chronic obstructive bronchitis.

47. Statements about cardiosclerosis...All are true except:

A. Commonly different arrhythmias are occurred.

B. It is acute disease due to blood supply interruption.

C. Left ventricular hypertrophy is developed.

D. It is a form of ischemic heart disease due to permanent chronic oxygen supply insufficiency of myocardial muscle.

E. Two forms of cardiosclerosis are distinguished: diffuse (atherosclerotic disease of heart) and postinfarction.

48. The ECG is useful to localize the site of ischemia and infarction. Some leads depict anteroseptal, anterolateral and anterior areas of the heart...All are true except:

A. V1.

B. V2.

C. V3.

D. aVF.

E. I.

49. ECG signs of pulmonary embolism...All are true except:

A. T inversion over the right chest leads.

B. QRS complexes are prolonged and deformed.

C. S1Q3T3 pattern is common and useful.

D. Sinus tachycardia.

E. P – pulmonale.

50. Many medications can cause changes in ECG...All are true except:

A. Digitalis.

B. Phenothiazines.

C. Tetracycle antidepressants.

D. Potassium-sparing diuretics.

E. Dihydropyridine calcium channel blockers.

Answer keys to the tests

Question number

Right answer

1

D

2

E

3

C

4

A

5

D

6

E

7

E

8

B

9

D

10

D

11

E

12

D

13

D

14

C

15

A

16

A

17

C

18

A

19

E

20

E

21

A

22

E

23

A

24

B

25

B

26

C

27

B

28

C

29

E

30

A

31

B

32

E

33

C

34

B

35

A

36

D

37

E

38

E

39

B

40

B

41

B

42

E

43

B

44

C

45

C

46

E

47

B

48

D

49

B

50

E



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