Exam

Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
1) Approximately ________ percent of Canadians are believed to have some form of cardiovascular 1) _______
disease.
A) 25 B) 75 C) 60 D) 50 E) 80

2) Which of the following is NOT considered a modifiable risk factor for coronary heart disease? 2) _______
A) gender
B) smoking
C) psychosocial tension
D) obesity
E) diet

3) Which of the following is NOT a risk factor of cardiovascular disease? 3) _______

A) hypertension
B) exercise
C) heredity
D) hypercholesterolemia
E) carbohydrate intolerance

4) The thick middle tissue layer of the heart is the: 4) _______

A) endocardium.
B) epicardium.
C) endometrium.
D) pericardium.
E) myocardium.

5) The amount of blood ejected by the heart in one cardiac contraction is known as: 5) _______
A) cardiac cycle.
B) cardiac output.
C) preload.
D) stroke volume.
E) ejection fraction.

6) The pressure in the ventricle at the end of diastole is known as: 6) _______
A) afterload.
B) stroke volume.
C) end-systole volume.
D) ejection fraction.
E) preload.

7) The interval from the end of one cardiac contraction to the end of the next is known as: 7) _______
A) diastole.
B) the ejection fraction.
 C) the cardiac cycle.
D) systole.
E) the heart beat.

8) Increased venous return to the heart results in greater preload and thus: 8) _______
A) increased heart rate.
B) less myocardial stretch.
C) greater afterload.
D) greater stroke volume.
E) lesser stroke volume.

9) The structure that supplies blood to the left ventricle, the interventricular septum, and the heart's 9) _______
conduction system is the:
A) right coronary artery.
B) posterior descending artery.
C) marginal artery.
D) left coronary artery.
E) posterior ascending.

10) Place the cardiac electrical pathway in order from beginning to end. 10) ______

1. AV node
2. internodal pathways
3. bundle of His
4. SA Node
5. Purkinje fibers
6. right bundle branch
A) 1, 2, 4, 6, 3, 5
B) 1, 3, 2, 4, 5, 6
C) 4, 2, 1, 3, 6, 5
D) 4, 3, 1, 5, 6, 2
E) 4, 6, 1, 3, 5, 2

11) The ventricular syncytium contracts: 11) ______

A) from inferior to superior.
B) from lateral to medial.
C) from right to left.
D) from left to right.
E) from superior to inferior.

12) The intrinsic rate of the ________ is 40-60 beats per minute. 12) ______
A) bundle of His
B) AV Node
C) SA node
D) Purkinje system
E) right bundle branch
13) The structures that conduct electrical impulses from the SA node to the AV junction are the: 13) ______
A) bundle of His.
B) Purkinje fibers.
C) internodal pathways.
D) the bundle of branches.
E) septal fibers.

14) The delay in conduction at the AV node is due to the: 14) ______
A) natural blocks within the internodal pathways.
B) need to allow the atria to fill.
C) intrinsic rate of the AV node.
D) collection of electrical impulses from the internodal pathways at the AV junction.
E) slow depolarization of the atria.

15) A cell's capability to self-depolarize is known as: 15) ______

A) conductivity.
B) dromotropy.
C) contractility.
D) excitability.
E) automaticity.

16) The ability of cardiac cells to propagate the electrical impulse from one to another is known as: 16) ______
A) automaticity.
B) conductivity.
C) excitability.
D) dromotropy.
E) contractility.

17) The ion that is moved out of the cell during cardiac depolarization is: 17) ______
A) calcium.
B) potassium.
C) thallium.
D) sodium.
E) magnesium.

18) During depolarization of the cardiac cells, the interior of the cell becomes: 18) ______
A) saturated with potassium.
B) positively charged.
C) saturated with chloride.
D) saturated with magnesium.
E) negatively charged.

19) All of the following electrolytes affect cardiac function EXCEPT: 19) ______
A) Ph+. B) Cl-. C) Mg+. D) K+. E) Ca++.
20) According to ________, the more the myocardial muscle is stretched, the greater its force of 20) ______
contraction will be.
A) Boyle's Law
B) Henry's Law
C) Dalton's Law
D) Starling's Law
E) Poiseuille's Law

21) The cardiac contractile force is called: 21) ______

A) ejection fraction.
B) inotropy.
C) syncytium.
D) chronotropy.
E) dromotropy.

22) The BEST position to evaluate a patient for jugular vein distention is at a ________ angle. 22) ______
A) 25 degree B) 45 degree C) 75 degree D) 60 degree E) 90 degree

23) The point on the chest wall where the heartbeat can best be heard or felt is known as the: 23) ______
A) systolic site.
B) apical evaluation location.
C) point of maximum impulse.
D) ventricular auscultory site.
E) cardiac auscultation location.

24) S4 is heard: 24) ______

A) immediately before S1.
B) only in patients with an ejection fraction less than 50%.
C) immediately after S2.
D) as a click before S3.
E) between S2 and S3 in the patient with COPD.

25) The heart sound heard by closure of the AV valves is: 25) ______
A) S5. B) S1. C) S2. D) S3. E) S4.

26) The heart sound heard by closure of the aortic and pulmonary valves is: 26) ______
A) S4. B) S2. C) S3. D) S1. E) S5.

27) Which heart sound is associated with congestive heart failure? 27) ______
A) S4 B) S2 C) S5 D) S3 E) S1

28) Scenario: In evaluating the history of a patient's chest pain, you note that the patient experiences dec reased
dyspnea 28) ___
when ___
sitting
upright.
This is
known
as:
A) paroxysmal nocturnal dyspnea.
B) tachypnea.
C) bradypnea.
D) orthopnea.
E) apnea.

29) All of the following findings during a focused assessment of the cardiac patient might indicate 29) ______
cardiac compromise EXCEPT:
A) syncopal episode.
B) extremity edema.
C) constricted pupils.
D) palpitations.
E) nausea and/or vomiting.

30) The rationale for ECG monitoring is to: 30) ______

A) determine stroke volume.
B) evaluate pulse strength.
C) evaluate the effectiveness of cardiac contractions.
D) evaluate the heart's electrical system for abnormalities.
E) determine cardiac output.

31) The upward deflection on the ECG paper in lead II represents: 31) ______
A) precordial impulse.
B) isoelectric impulse.
C) artifact.
D) positive impulse.
E) negative impulse.

32) A positive deflection on the ECG tracing paper indicates: 32) ______
A) the presence of necrotic tissue.
B) the electrical impulse is moving toward the positive electrode.
C) that there is no electrical impulse.
D) the electrical impulse is traveling perpendicular to the lead.
E) the electrical impulse is moving toward the negative electrode.

33) The QRS complex represents: 33) ______

A) the delay at the AV junction.
B) ventricular depolarization.
C) ventricular repolarization.
D) atrial depolarization.
 E) atrial repolarization.

34) The time an impulse takes to travel from the atria to the ventricles is known as the: 34) ______
A) QT interval.
B) S-T segment.
C) P-R interval.
D) QRS interval.
E) TU interval.

35) A normal QRS complex lasts: 35) ______

A) between 0.06 and 0.28 seconds
B) between 0.33 and 0.42 seconds.
C) between 0.08 and 0.42 seconds.
D) between 0.04 and 0.12 seconds.
E) between 0.12 and 0.20 seconds.

36) The absolute refractory period is from the: 36) ______

A) beginning of the P wave to the QRS complex.
B) beginning of the QRS complex to the apex of the T wave.
C) beginning of the P wave to the apex of the T wave.
D) end of the QRS complex to the apex of the T wave.
E) end of the P wave to the beginning of the T wave.

37) Changes in the S-T segment might indicate any of the following EXCEPT: 37) ______
A) inotropy. B) ischemia. C) necrosis. D) infarct. E) injury.

38) When the ECG paper is traveling at 25 mm/sec, a large box in the horizontal direction indicates: 38) ______
A) 0.04 seconds.
B) 1 millivolt positive deflection.
C) 0.20 seconds.
D) 1 millivolt negative deflection.
E) 0.50 seconds.

39) When the ECG paper is traveling at 25 mm/sec, an upward deflection on the vertical axis of 2 39) ______
large boxes indicates a:
A) negative deflection of 0.5 mV.
B) negative deflection of 1.0 mV.
C) positive deflection of 1.0 mV.
D) negative deflection of 2.0 mV.
E) positive deflection of 2.0 mV.

40) Einthoven's triangle is formed by the: 40) ______

A) modified chest leads.
B) bilpolar leads.
C) augmented leads.
 D) precordial leads.
E) multiaxial leads.

41) In a lead II tracing the positive electrode is located on the: 41) ______
A) left leg.
B) right arm.
C) right leg.
D) left arm.
E) Angle of Louis.

42) The purpose of the precordial leads is to evaluate the: 42) ______
A) right atrium and septum.
B) right atrium and right ventricle.
C) left ventricle and septum.
D) right ventricle and septum.
E) left atrium and septum.

43) Scenario: A 72-year-old male is complaining of difficulty breathing. You attach him to the ECG 43) ______
and notice a rhythm of 42 with corresponding pulse, a P-R interval of 0.16, and normal R-R
intervals. This patient's MOST likely rhythm is:
A) sinus bradycardia.
B) sinus dysrhythmia.
C) atrial flutter.
D) atrial fibrillation.
E) accelerated IVR.

44) Scenario: A 72-year-old male is complaining of difficulty breathing. You attach him to the ECG 44) ______
and notice a rhythm of 42 with corresponding pulse, a P-R interval of 0.16, and normal R-R
intervals. Vitals are blood pressure of 98/52, respirations of 42. The patient also states that he
feels very nauseated and dizzy. Treatment for this patient should include:
A) adenosine 6 mg.
B) Isuprel 2-10 mcg/min.
C) epinephrine 1:1000 0.3 mg.
D) epinephrine 1:10,000 1 mg.
E) atropine 0.5 mg.

45) Which of the following can a single lead indicate? 45) ______
A) the presence of an infarct
B) the location of an infarct
C) the quality or presence of pumping action
D) chamber enlargement
E) the heart rate

46) All of the following are typical causes of cardiac dysrhythmia EXCEPT: 46) ______
A) cardiac contusion.
B) hypothermia.
 C) metabolic acidosis.
D) atelectasis.
E) myocardial ischemia.

47) Which of the following is NOT recommended to use when evaluating an ECG strip? 47) ______
A) analyze the T wave
B) analyze the QRS complex
C) analyze the rate
D) analyze the P-R interval
E) analyze the P waves

48) Scenario: You encounter a patient with a normal P-R interval, a QRS duration of 0.08, and a R-R 48) ______
interval of 0.48 seconds. This patient is in:
A) atrial flutter.
B) sinus tachycardia.
C) supraventricular tachycardia.
D) ventricular tachycardia.
E) atrial fibrillation.

49) Scenario: A 16-year-old female is crying and hysterical after breaking up with her boyfriend. She 49) ______
fainted prior to EMS arrival and is presently A&Ox4 with vitals of BP 112/72, P 96 and irregular,
and R of 36 crying. After placing her on the cardiac monitor, you note that she has a normal P-R
interval, QRS duration, and T waves. It is safe to assume that her ECG is:
A) sinus bradycardia.
B) sinus tachycardia.
C) sinus dysrhythmia.
D) sinus arrest.
E) atrial fibrillation.

50) Scenario: A 62-year-old male fainted while going to the bathroom. His current vitals are blood 50) ______
pressure, 108/64; pulse 62, and irregular; and respirations, 24. His ECG displays an irregular
rhythm with normal P-R interval and QRS complex. The MOST likely cause of the patient's
syncopal episode is:
A) paroxysmal syncitial arrest.
B) AV-node ischemia.
C) excessive vagal tone.
D) fibrotic disease.
E) digitalis toxicity.

51) Scenario: EMS is called to the scene of an 82-year-old male with a history of cardiac 51) ______
complications. After placing him on the monitor, you note that the rhythm is slightly irregular
with normal QRS complexes, but each P wave is different. This rhythm is:
A) accelerated IVR.
B) wandering atrial pacemaker.
C) sinus arrest.
D) sinus dysrhythmia.
E) runs of PACs.
52) Scenario: A patient with a history of bronchitis and emphysema is suffering from adult 52) ______
respiratory distress syndrome. ECG monitoring shows a tachycardic rhythm of 132 with varying
P-R intervals and irregular P waves. The ECG is:
A) accelerated sinus dysrhythmia.
B) atrial fibrillation.
C) sinus tachycardia.
D) multifocal atrial tachycardia.
E) atrial flutter.

53) Scenario: A healthy female is being transported for preterm labor contractions. Per protocol, she 53) ______
is lying slightly tilted on her left side, is on oxygen via nonrebreather mask, and an IV of normal
saline is established at TKVO. You place her on the ECG and notice an underlying normal sinus
rhythm with occasional early beats. Upon closer examination, you note that the early beats have
different P waves than the underlying rhythm, a normal QRS complex, and they occur about two
times per minute. This ectopic rhythm is:
A) PVC. B) PJC. C) PPC. D) PSC. E) PAC.

54) Scenario: Your patient is complaining of shortness of breath with a respiratory rate of 36. After 54) ______
applying oxygen via nonrebreather, you place the ECG. Lead II shows P-P intervals of 0.20
seconds and R-R intervals of 0.80 seconds. The rhythm is regular and conduction appears to be
4:1. This ECG indicates:
A) sinus dysrhythmia.
B) atrial fibrillation.
C) wandering pacemaker.
D) 3rd-degree AV block.
E) atrial flutter.

55) Which ECG is characterized by a P-R interval greater than 0.20 and a normal QRS duration? 55) ______
A) 2nd-degree Type II AV block
B) complete AV block
C) 2nd-degree Type I AV block
D) 1st-degree AV block
E) 3rd-degree AV block

56) An ECG rhythm that has no correlation between P waves and QRS complexes is known as a: 56) ______
A) 2nd-degree AV Block Type II.
B) 2nd-degree AV Block Type I.
C) 3rd-degree AV Block.
D) wandering atrial pacemaker
E) 1st-degree AV Block.

57) Scenario: A patient presents with a normal sinus rhythm with occasional ectopic beats. The 57) ______
ectopic beats appear with absent P waves and a normal QRS complex. The ectopic beat is a
premature ________ contraction.
A) atrial
 B) Purkinje
C) bundle
D) ventricular
E) junctional

58) A junctional escape rhythm originates from the: 58) ______

A) bundle of His when the intrinsic fibers are firing too fast.
B) Purkinje system when the SA node is firing at a slower rate than the Purkinje system.
C) SA node when the AV node is firing at a slower rate than the SA node.
D) Purkinje system when the AV node is firing at a slower rate than the Purkinje system.
E) AV node when the SA node is firing at a slower rate than the AV node.

59) A junctional tachycardia rhythm with a rate of 150 may be identified as: 59) ______
A) sinus tachycardia.
B) supraventricular tachycardia.
C) junctional fibrillation.
D) atrial flutter.
E) ventricular tachycardia.

60) An ECG shows a heart rate of 90, with no P waves, and QRS duration of 0.10. This rhythm is: 60) ______
A) atrial tachycardia.
B) accelerated junctional rhythm.
C) atrial flutter.
D) supraventricular tachycardia.
E) accelerated IVR.

61) Which of the following rules is appropriate for determining a ventricular escape rhythm? 61) ______
A) P waves inverted
B) QRS duration greater than 0.12
C) pacemaker site at the SA node
D) P-R interval of 0.16
E) rate greater than 60

62) Scenario: A patient has a complete AV dissociation, occasional beats that appear without a P 62) ______
wave, and a QRS complex of 0.24. The ectopic beat is a:
A) PJC.
B) PVC.
C) atrial ectopic beat.
D) PAC.
E) junctional ectopic beat.

63) As a rule, when a patient has PVCs, treatment should be initiated when: 63) ______
A) PVC's occur at least four times per minute.
B) chest pain is present.
C) the patient is in good health.
D) P-on-R phenomenon occurs.
 E) PACs occur with the PVCs.

64) An example of polymorphic VT is: 64) ______

A) ventricular fibrillation.
B) torsades de pointes.
C) supraventricular tachycardia.
D) ventricular flutter.
E) atrial fibrillation.

65) Which of the following ECGs is NOT due to an AV Block? 65) ______
A) infranodal
B) Wenckebach
C) Mobitz II
D) atrial tachycardia
E) atrial flutter

66) Scenario: A healthy 16-year-old male suffers a syncopal episode on the football practice field. 66) ______
ECG evaluation shows tachycardia with a normal P-R interval, QRS of 0.20, and a delta wave.
The ECG is best described as:
A) 2nd-degree heart block Type II.
B) Wolff-Parkinson-White syndrome.
C) ventricular fibrillation.
D) ventricular tachycardia.
E) hyperkalemia syndrome.

67) A disorder in which conduction of all supraventricular beats through the ventricles is delayed is: 67) ______
A) aberrant conduction.
B) complete heart block.
C) AV dissociation.
D) bundle branch block.
E) post-excitation syndrome.

68) Scenario: You are called to the scene of a possible drowning at a local pool. Upon arrival, you 68) ______
discover that lifeguards have removed the patient from the pool and are performing rescue
ventilations since the patient has a pulse. Upon placing the monitor, you discover a rapid
rhythm at 200 beats per minute, no P waves, and a QRS complex of 0.16. Management should
consist of:
A) cardioversion 100 joules.
B) procainamide 25 mg/min.
C) lidocaine 1.5 mg/mg.
D) amiodarone 150 mg.
E) defibrillation 200 joules.

69) All of the following might cause of pulseless electrical activity EXCEPT: 69) ______
A) electrocution.
B) tension pneumothorax.
 C) hypoxemia.
D) hypovolemia.
E) cardiac tamponade.

70) Enhanced automaticity resulting in a retrograde impulse may be due to: 70) ______
A) digitalis necrosis.
B) dysrhythmias.
C) ectopic beats.
D) ectopic foci.
E) aberrant reentry pathways.

71) A classic change in the ECG complex for a patient suffering from hypothermia is the: 71) ______
A) P wave.
B) Q wave
C) delta wave.
D) U wave.
E) J wave.

72) Tall, peaked T waves in the precordial leads on an ECG indicate: 72) ______
A) hyperkalemia.
B) hyperthermia.
C) hypernatremia.
D) hyperglycemia.
E) hypoglycemia.

73) An inverted T wave or depressed S-T segment typically indicates: 73) ______
A) an old injury.
B) cardiac ischemia.
C) a normal response to increased preload.
D) a delay in conduction through the internodal pathways.
E) necrotic tissue damage.

74) Which of the following lead combinations can be used to evaluate the right ventricle on the ECG 74) ______
tracing?
A) V1 and V2
B) V5 and V6
C) II, III, and aVF
D) V3 and V4
E) I and aVL

75) Which of the following lead combinations can be used to evaluate the inferior (diaphragmatic) 75) ______
side of the heart on the ECG tracing?
A) II, III, and aVF
B) aVR
C) II, aVR, and V6
D) I and aVL
 E) V5 and V6

76) Given an abnormal ECG, the first thing that should be treated is the: 76) ______
A) Q-T interval.
B) rhythm.
C) rate.
D) blood pressure.
E) patient.

77) Scenario: Your patient is a 22-year-old male with tachycardia, but no other symptoms. Which of 77) ______
the following is the BEST pharmaceutical intervention?
A) atropine
B) oxygen
C) nitro
D) dopamine
E) adenosine

78) Scenario: A 24-year-old female is complaining of chest pain and difficulty breathing. She has 78) ______
been up for three days studying for finals and has been taking ephedrine supplements to help
her stay awake and alert. She also admits to drinking 12 Mountain Dew soft drinks in the past
day. Vitals are BP 80/40, P 180 carotid, and R 42. She is very pale and lethargic. The ECG shows a
narrow QRS complex with regular R-R intervals, no discernable P or T waves at 200 beats per
minute. The BEST treatment for this patient would include:
A) cardioversion at 100 joules.
B) adenosine 6 mg rapid IVP.
C) verapamil 2.5 mg slow IVP.
D) defibrillation at 200 joules.
E) vagal manoeuvers.

79) Scenario: A 52-year-old male patient is experiencing chest pain and shortness of breath. Vitals 79) ______
are blood pressure 108/64, pulse 50 and irregular, and respirations 36. ECG shows an irregular
ventricular rhythm and a P-R interval that becomes progressively longer ending in a
nonconducted QRS complex. Which of the following regimens is indicated for this patient?
A) IV, O2, adenosine 6 mg
B) IV, O2, procainamide 25 mg/min
C) IV, O2, lidocaine 1.5 mg/kg
D) IV, O2, atropine 0.5 mg
E) IV, O2, verapamil 2.5 mg

80) Scenario: A patient is experiencing severe chest pain and is hemodynamically unstable. ECG 80) ______
shows a ventricular rate of 40. P-R interval is 0.24 and is constant for conducted QRS complexes.
However, every 4th P wave does not conduct a QRS. Immediate management for this patient
should include:
A) atropine 1 mg.
B) adenosine 6 mg.
C) synchronized cardioversion at 100 joules.
D) lidocaine 1 mg/kg.
 E) transcutaneous pacing.

81) Scenario: A patient involved in a motor vehicle accident is semiconscious. Vitals are blood 81) ______
pressure of 102/64, pulse of 120, respirations of 24. ECG shows a sinus tachycardia with
bigeminy. Which of the following treatments is appropriate?
A) carotid sinus massage
B) immediate cardioversion at 100 joules
C) lidocaine 1 mg/kg
D) vagal manoeuvers
E) immediate defibrillation at 200 joules

82) Scenario: You are called to the scene of a 52-year-old male who is unconscious. The patient's 82) ______
wife states that he has a cardiac history and takes Pronestyl regularly and that he has been
taking her erythromycin for a cold and Seldane for seasonal allergies. ECG shows a polymorphic
ventricular tachycardia. The BEST treatment for this patient should include:
A) adenosine 6 mg.
B) sodium bicarbonate 1 mEq/kg.
C) procainamide 20 mg/min.
D) lidocaine 1 mg/kg.
E) magnesium sulfate 1-2 grams over 2 minutes.

83) Scenario: You are managing a patient in the ED with symptomatic bradycardia and multifocal 83) ______
PVCs. Suddenly your patient slumps unconscious and goes into ventricular fibrillation. You
check your defibrillator/monitor and all connections. You then confirm that your patient is
pulseless. After activating the code team, your next action would be to:
A) administer Lidocaine 1.5 mg/kg.
B) perform transcutaneous pacing.
C) administer procainamide 25 mg/min.
D) cardiovert at 200 joules.
E) defibrillate at 200 joules.

84) Scenario: While managing your patient in ventricular fibrillation, the monitor shows asystole. 84) ______
You confirm in two leads. Your next action is to:
A) administer Epinephrine 1:10,000.
B) administer adenosine 6 mg.
C) defibrillate at 360 joules.
D) cardiovert at 100 joules.
E) begin CPR.

85) Which of the following procedures is NOT considered a vagal maneuver? 85) ______
A) forced expiration against a closed glottis
B) carotid sinus massage
C) Valsalva manoeuvre
D) precordial thump
E) bearing down
86) Prior to performing carotid sinus massage, the paramedic MUST auscultate for: 86) ______
A) carotid bruits.
B) wheezing.
C) rhonchi.
D) apical heart tones.
E) pneumomediastinum.

87) Scenario: A 22-year-old female has just finished jogging 5 miles. She is complaining of a "funny" 87) ______
feeling in her chest. Physical exam reveals a weak, rapid pulse, normal breath sounds, and no
trauma. Vitals are blood pressure, 112/68; pulse, 144; and respirations, 32. She denies drug use.
ECG findings show a rapid rhythm with no discernable P waves and a QRS duration of 0.08.
Which of the following treatments should be attempted first?
A) adenosine 6 mg
B) vagal manoeuvers
C) verapamil 2.5 mg
D) cardioversion at 100 joules
E) defibrillation at 200 joules

88) Which of the following rhythms requires transcutaneous pacing? 88) ______
A) symptomatic 3rd-degree AV block
B) supraventricular tachycardia
C) junctional tachycardia
D) ventricular fibrillation
E) sinus bradycardia

89) By adjusting the ________, the paramedic can increase the milliamps delivered until capture is 89) ______
obtained when pacing a heart rate.
A) voltage selector
B) synchronizer selector
C) joules selector
D) rate selector
E) output selector

90) Implanted pacemakers that sense and fire only when the heart rate drops below a set rate are 90) ______
known as:
A) AV sequential pacemakers.
B) fixed-rate pacemakers.
C) drop-rate pacemakers.
D) demand pacemakers.
E) dual-chambered pacemakers.

91) Scenario: You are called to an office building where a 52-year-old male feels as if his pacemaker 91) ______
is not functioning properly. You place him on your monitor and see mostly artifact. All of the
following might cause the artifact EXCEPT:
A) patient movement.
B) hypoglycemia.
C) muscle tremors.
 D) 60 hertz interference.
E) loose monitor electrodes.

92) All of the following are common causes of pacemaker failure EXCEPT: 92) ______
A) failure to recognize adequate intrinsic heart rate.
B) battery failure.
C) body rejection.
D) low battery energy.
E) lead displacement.

93) Which of the following items can interfere with pacemaker operation? 93) ______
A) vacuum cleaner
B) hair dryer
C) cellular telephone
D) television remote control
E) magnet

94) Which of the following indicates possible pacemaker failure? 94) ______
A) pacemaker spike preceding each QRS complex
B) occasional QRS complexes without pacer spikes
C) a pacemaker spike preceding the P wave
D) a QRS complex duration of 0.20 seconds
E) pacemaker spikes without QRS complex following

95) Scenario: Your patient has had steadily worsening chest pain for four hours. He has not had 95) ______
relief with Nitrostat. The BEST description for this chest pain is:
A) vasospastic angina.
B) stable angina.
C) unstable angina.
D) Prinzmetal's angina.
E) atypical angina.

96) Scenario: While you are evaluating a patient with complaints of chest pain, he tells you that the 96) ______
pain began 2 hours ago after eating lunch. He says he has never experienced any chest pain like
this. He rates the pain as a 10 and states that it is radiating into his jaw. He has taken antacids to
alleviate the pain without success. Which statement BEST indicates palliation with regards to the
OPQRST assessment?
A) Pain is a 10.
B) Pain began 2 hours ago.
C) Pain radiates into his jaw.
D) Pain is unlike any he has ever experienced.
E) Pain is unrelieved by antacids.

97) Which of the following complications is a cardiovascular problem that can result in chest pain? 97) ______
A) croup
B) cholecystitis
 C) pneumonia
D) costochondritis
E) cardiac ischemia

98) Which of the following ECG findings can occur with unstable angina? 98) ______
A) elevated T wave
B) S-T segment depression
C) delta wave
D) Osborn wave
E) U wave

99) Scenario: A 67-year-old male patient is experiencing chest pain, shortness of breath, and nausea. 99) ______
Management for this patient should consist of:
A) oxygen, ECG monitoring, and transport.
B) oxygen, IV, Nitrostat, and ECG monitoring, and transport.
C) oxygen and transport.
D) oxygen, IV, Nitropruside drip, and transport emergency traffic.
E) oxygen, ET, Nitrostat, and transport.

100) Which of the following dysrhythmias may occur within 1 hour of a myocardial infarction and 100) _____
result in death?
A) atrial fibrillation
B) premature atrial contractions
C) ventricular tachycardia
D) atrial flutter
E) 2nd-degree type II AV block

101) Which of the following is a traumatic insult that could result in a myocardial infarction? 101) _____
A) traumatic asphyxia
B) atherosclerotic heart disease
C) microemboli
D) pulmonary edema
E) acute volume overload

102) Which of the following is NOT an assessment priority when evaluating a patient suspected of 102) _____
suffering an AMI?
A) breath sounds
B) pulse
C) pupilary response
D) blood pressure
E) ECG

103) Scenario: Your patient is experiencing substernal chest pain radiating into his jaw and right 103) _____
shoulder. He states that the pain has been a dull sensation over the past week but has steadily
increased in intensity, and he now rates it as an 8. You might expect to see all of the following
signs EXCEPT:
 A) pallor.
B) anxiety.
C) diaphoresis.
D) diarrhea.
E) dyspnea.

104) Your patient has had steadily worsening chest pain for 4 hours. He has not had relief with 104) _____
Nitrostat. This patient is MOST likely experiencing:
A) stable angina.
B) Prinzmetal's angina.
C) myocardial infarction.
D) syncopal episode.
E) vasospastic angina.

105) Which of the following ECG characteristics is NOT anticipated in a patient experiencing an acute 105) _____
myocardial infarction?
A) T-wave inversion
B) Osborn wave
C) S-T elevation
D) S-T depression
E) Q wave wider than 0.04 seconds

106) A ________ infarction involves the entire thickness of the myocardium. 106) _____
A) transmural
B) subendocardial
C) internodal
D) complete
E) thrombotic

107) Which of these patients is a candidate for thrombolytic therapy? 107) _____
A) a 63-year-old male with diffuse, radiating chest pain x 2 days and a history of lower GI
bleeds
B) a 74-year-old male complaining of chest pain beginning 1 hour ago and a 2-week history of
coronary artery bypass
C) a 17-year-old female complaining of chest, abdominal, and epigastric pain after being
involved in a motor vehicle collision
D) a 54-year-old female with substernal chest pain beginning 4 hours ago
E) a 15-year-old male complaining of chest pain who was struck in the chest by another
football player

108) Reperfusion of ischemic cardiac tissue is MOST successful when it begins within: 108) _____
A) 6 hours of the infarct.
B) 10 hours of the infarct.
C) 12 hours of the infarct.
D) 24 hours of the infarct.
E) 18 hours of the infarct.
109) Which of the following presents the MOST lethal problem for a patient suffering from an AMI? 109) _____
A) AV dissociation
B) supraventricular tachycardia
C) accelerated junctional escape rhythm
D) ventricular fibrillation
E) atrial flutter with rapid ventricular response

110) Which of the following laboratory assays is NOT a valid test for determining the presence of 110) _____
myocardial infarction?
A) KCl
B) Troponin-I
C) CK
D) CK-MB
E) LDH

111) Scenario: A 48-year-old male fell from a ladder. Prior to falling he experienced a sensation of 111) _____
vertigo and nausea. A family member stated that the patient was caught as he stumbled off the
ladder and no trauma occurred. Also the patient has been experiencing heartburn for 4 days
without relief. Vitals are blood pressure of 132/92, pulse of 64, and respirations of 32. He ate two
hours ago and denies any respiratory or cardiac history. He refuses transport but allows the
paramedics to perform an ECG. The ECG shows a sinus rhythm with S-T segment depression in
leads II and III. Based upon the information, the paramedics should:
A) tell the patient that he will probably be ok if he is not treated immediately.
B) encourage the patient to go to the hospital by private vehicle.
C) explain that your assessment and the patient's history are very concerning and strongly
recommend EMS transport.
D) let the patient refuse transport since there is no cardiac history.
E) tell the patient's family that he will die within 12 hours if not immediately transported to
hospital

112) You are managing a patient in cardiac arrest with persistent ventricular fibrillation refractory to 112) _____
Amiodarone. Which of the following is the next appropriate medication and dose?
A) lidocaine 0.5 to 0.75 mg/kg
B) lidocaine 1.5 mg/kg
C) atropine 1 mg
D) magnesium 2 mg
E) procainamide 50 mg/kg

113) All of the following medications are considered vasopressors EXCEPT: 113) _____
A) Levophed.
B) dobutamine.
C) norepinephrine.
D) adenosine.
E) dopamine.

114) The MOST common reason for hospitalization in patients over 65 years old is: 114) _____
 A) COPD.
B) congestive heart failure.
C) cancer.
D) chronic hypertension.
E) falls.

115) All of the following factors have been shown to contribute to heart failure EXCEPT: 115) _____
A) sepsis.
B) diabetes.
C) pulmonary embolism.
D) hypertension.
E) excess salt intake.

116) Scenario: Your patient is experiencing left-sided heart failure. Which of the following would you 116) _____
NOT expect to find?
A) hypoxia
B) JVD
C) tachycardia
D) rales
E) pulmonary edema

117) The compensatory mechanism of the heart when a patient is in heart failure is BEST described 117) _____
by:
A) Poiseuille's law.
B) Herring-Breuer reflex.
C) Beck's triad.
D) Starling's law.
E) Dalton's law.

118) In the patient suffering from suspected right ventricular failure, as preload rises, increased 118) _____
pressure is placed on the right atria. This results in:
A) emphysema.
B) abdominal ascites.
C) pulmonary edema.
D) decreased oxygen capacity in the lungs.
E) jugular vein distention.

119) The underlying problem in a patient with left heart failure is: 119) _____
A) decreased afterload.
B) increased afterload.
C) increased preload.
D) cor pulmonale.
E) pulmonary hypertension.

120) Scenario: A 74-year-old female patient is experiencing dyspnea, pulmonary edema, pedal 120) _____
edema, and jugular vein distention. The patient is MOST likely suffering from:
 A) pulmonary embolism.
B) congestive heart failure.
C) right ventricular failure.
D) left ventricular failure.
E) pulmonary edema.

121) Scenario: A 68-year-old male patient calls you to his home at 3:00 A.M. He is complaining of 121) _____
shortness of breath, which woke him up. He states that he has experienced this for about three
weeks, but not as severely. This condition is known as:
A) paroxysmal nocturnal dyspnea.
B) sleep apnea.
C) pulsus paradoxus.
D) pulmonary embolism.
E) exacerbation of COPD.

122) Which of the following regimens is NOT recommended for the CHF patient? 122) _____
A) IV of NS wide open
B) high-flow oxygen
C) ECG evaluation
D) morphine sulfate
E) PEEP

123) The condition in which excess fluid accumulates between the visceral and parietal pericardium 123) _____
is known as:
A) cor pulmonale.
B) 3rd-space edema.
C) cardiac tamponade.
D) hemothorax.
E) hemomediastinum.

124) Scenario: Your patient has been in a car accident and is experiencing bulging neck veins, 124) _____
difficulty breathing, and a narrowing pulse pressure. The patient is MOST likely suffering from:
A) cardiac tamponade.
B) hemothorax.
C) traumatic asphyxia.
D) cardiac neoplasm.
E) pulsus paradoxus.

125) Scenario: You are managing a patient who has been in a motor vehicle collision. He presents 125) _____
with dyspnea, rapid and weak pulses, jugular vein distention, and a midline trachea. You would
also expect:
A) pedal edema.
B) decreased diastolic pressure.
C) diminished breath sounds.
D) pulsus paradoxus.
E) increased systolic pressure.
126) The condition that occurs when systolic blood pressure drops more than 10 mmHg with 126) _____
inspiration is:
A) pulsus paradoxus.
B) cor pulmonale.
C) pulsus alternans.
D) electrical alternans.
E) electrical paradoxus.

127) Pulsus alternans occurs when a pulse alternates between: 127) _____
A) regular and irregular.
B) weak and strong.
C) slow and fast.
D) absent and irregular.
E) normal and inverted.

128) Which of the following would be most appropriate for a paramedic to perform when 128) _____
encountering a patient who has muffled heart tones, narrowing pulse pressure, and labored
breathing?
A) amniocentesis
B) delayed transport
C) administration of 80 mg of furosemide
D) chest decompressions
E) two large-bore IVs with rapid infusion

129) Which of the following conditions' prevalence increases with age, has a higher incidence among 129) _____
blacks, and frequently results in ischemic or hemorrhagic stroke?
A) hypertension
B) emphysema
C) congestive heart failure
D) cor pulmonale
E) pulmonary embolism

130) A hypertensive emergency is characterized by restlessness, confusion, nausea, vomiting, and 130) _____
diastolic blood pressure greater than:
A) 110 mmHg.
B) 90 mmHg.
C) 120 mmHg.
D) 130 mmHg.
E) 100 mmHg.

131) A cerebral disorder due to hypertension and characterized by severe headache, nausea, 131) _____
vomiting, blindness, aphasia, and muscle weakness is known as:
A) hypertensive shock.
B) neurologic hypertension.
C) neurologic encephalopathy.
D) hypertensive encephalopathy.
 E) eclampsia

132) Scenario: A 38-year-old female suddenly experiences epistaxis, tinnitus, vertigo, and diploplia. 132) _____
The BEST treatment for this patient should consist of:
A) administering nifedipine.
B) administering levophed.
C) establishing an IV and providing oxygen.
D) inserting an NG tube and withholding oxygen.
E) administering verapamil.

133) Which of the following pharmacological interventions is the BEST for a patient experiencing a 133) _____
hypertensive crisis?
A) Procardia
B) dopamine
C) oxygen
D) adenosine
E) verapamil

134) The inability of the heart to meet the metabolic needs of the body is termed: 134) _____
A) septic shock.
B) anaphylactic shock.
C) neurogenic shock.
D) hypovolemic shock.
E) cardiogenic shock.

135) In the patient with cardiogenic shock, the patient's mental status diminishes and peripheral 135) _____
pulses become unpalpable due to:
A) decreased automaticity.
B) decreased contractility.
C) decreased conductivity.
D) increased afterload.
E) increased preload.

136) The body attempts to compensate for cardiogenic shock by: 136) _____
A) increasing peripheral vascular resistance.
B) increasing afterload.
C) decreasing inotropic effects.
D) decreasing chronotropic effects.
E) improving preload.

137) An early sign of cardiogenic shock may present as: 137) _____
A) altered mental status.
B) absent distal pulses.
C) systolic less than 80 mmHg.
D) coma.
E) cool extremities, weak pulses.
138) Scenario: A patient presents with a history of myocardial infarction, paroxysmal nocturnal 138) _____
dyspnea, and pedal edema. It would be safe to conclude that this patient is experiencing:
A) psychogenic shock.
B) hypovolemic shock.
C) septic shock.
D) cardiogenic shock.
E) neurogenic shock.

139) Which of the following patients has the HIGHEST risk for developing cardiogenic shock? 139) _____
A) 58-year-old patient with a UTI that has just started antibiotics
B) 78-year-old with a history of MI and triple coronary artery bypass surgery
C) 28-year-old patient with profuse bleeding involved in a motor vehicle accident
D) 2-year-old patient with a history of surgical repair of a septal wall defect
E) 48-year-old male that became septic after knee surgery

140) Scenario: A 58-year-old patient is experiencing chest pain and shortness of breath. ECG shows a 140) _____
sinus tachycardia at 126; pulse is weak, and blood pressure is 92/52. Which pharmaceutical agent
and dose would be MOST appropriate for this patient?
A) dopamine 5-15 mcg/kg/min
B) nitroprusside 0.1-5 mcg/kg/min
C) Nitrostat 0.4 mg SL
D) Lasix 40 mg
E) morphine sulfate 5 mg

141) The absence of ventricular contraction is known as: 141) _____

A) pulseless ventricular activity.
B) cardiac arrest.
C) AV dissociation.
D) sinus arrest.
E) sudden death.

142) The common precipitating event in a case of myocardial infarction is: 142) _____
A) peripheral arterial atherosclerotic disease.
B) abdominal aortic aneurysm.
C) dysrhythmia.
D) thrombus.
E) acute pulmonary embolus.

143) All of the following dysrhythmias are typically seen in cardiac arrest EXCEPT: 143) _____
A) atrial fibrillation.
B) ventricular fibrillation.
C) asystole.
D) pulseless ventricular tachycardia.
E) pulseless electrical activity.
144) The most critical treatment that a paramedic can perform for a patient in ventricular fibrillation 144) _____
cardiac arrest is:
A) intubation.
B) pulse oximetry.
C) IV therapy.
D) defibrillation.
E) thrombolytic administration.

145) When presented with asystole, the paramedic should perform all of the following EXCEPT: 145) _____
A) check for lead placement.
B) start CPR.
C) take a 12-lead ECG.
D) check for a pulse.
E) confirm rhythm in more than one lead.

146) All of the following factors might influence chest wall resistance during defibrillation EXCEPT: 146) _____
A) timing to defibrillation.
B) pad pressure.
C) pad surface area.
D) pad-skin surface area.
E) previous countershocks.

147) Proper pad placement for defibrillation is: 147) _____

A) left of the lower sternum and directly over the sternum.
B) right over the sternum and left inferior to the left breast.
C) left of the upper sternum and right and inferior to the right breast.
D) right of the upper sternum and directly over the sternum.
E) right of the upper sternum and left in an anterior axillary line over the apex of the heart.

148) The process of passing an electrical current through the heart during the R wave of the cardiac 148) _____
cycle to terminate tachydysrhythmias is known as:
A) synchronized cardioversion.
B) transvenous pacing.
C) defibrillation.
D) transcutaneous pacing.
E) rapid synchronized pacing.

149) Which of the following is NOT a medication commonly used during cardiac arrest resuscitation? 149) _____
A) lidocaine
B) adenosine
C) epinephrine
D) atropine
E) amiodarone

150) Efforts to encourage the return of spontaneous pulse and breathing are known as: 150) _____
 A) down time intervention.
B) defibrillation.
C) survival.
D) resuscitation.
E) cardioversion.

151) For which of the following patients would resuscitation efforts be initiated? 151) _____
A) a patient who drowned 20 minutes ago in cold water
B) a patient with rigor mortis and dependent lividity
C) a patient with terminal cancer who has an advanced directive
D) a patient who has been involved in a motor vehicle collision and has obvious brain matter
visible
E) a patient with 3rd- and 4th-degree burns over 100 percent of his body

152) All of the following are valid criteria for termination of resuscitation efforts EXCEPT: 152) _____
A) successful intubation was performed and maintained throughout the resuscitation.
B) arrest is cardiac related and not due to hypothermia, overdose, or hypovolemia.
C) a patient has been burned beyond recognition.
D) presentation of a valid advance directive after initiation of resuscitation efforts.
E) ACLS standards have been followed.

153) For which of the following patients would resuscitation efforts properly be discontinued? 153) _____
A) 89-year-old male with a history of Alzheimer's and an advanced directive
B) 24-year-old female in cardiac arrest who suffered severe bleeding during childbirth
C) 58-year-old male with persistent ventricular tachycardia
D) pediatric patient in arrest due to a drug overdose
E) 17-year-old male in arrest following ejection from a boat and witnessed drowning

154) Which of the following statements regarding termination of resuscitation efforts in the field is 154) _____
NOT true?
A) The EMS personnel should provide grief support to the family at the scene.
B) The paramedic should discard the ECG tracings, since the patient was not resuscitated.
C) The paramedic should document all therapy performed.
D) EMS should notify law enforcement.
E) EMS personnel should consult with medical direction regarding termination efforts.

155) All of the following are predisposing factors for a dissecting aortic aneurysm EXCEPT: 155) _____
A) men over age 50.
B) pregnant women.
C) hypertension.
D) family history.
E) children under age 13.

156) All of the following factors would predispose a patient to acute pulmonary embolism EXCEPT: 156) _____
A) thrombophlebitis.
B) recent hip surgery.
 C) atrial fibrillation.
D) PVCs.
E) recent childbirth.

157) Which of the following is NOT typically a cause of acute arterial occlusion? 157) _____
A) mural emboli
B) tumour
C) vascular hypertrophy
D) atrial fibrillation
E) abdominal aortic atherosclerosis

158) ________ is a progressive, degenerative disease of the medium-sized and large arteries. 158) _____
A) Acute abdominal aneurysm
B) Vascular arterioscleritis
C) Deep vein thrombosis
D) Claudication
E) Aatherosclerosis

159) Severe pain in the calf muscle that is due to inadequate blood supply and typically occurs with 159) _____
exertion and subsides with rest is known as:
A) varicose veins.
B) thromboembolosis.
C) phlebitis.
D) atherosclerosis.
E) claudication.

160) Which of the following vascular structures has the GREATEST chance of acute arterial 160) _____
occlusion?
A) ascending aorta
B) subclavian artery
C) external carotid artery
D) popliteal artery
E) descending aorta

161) Dilated superficial veins in the lower extremities are known as: 161) _____
A) peripheral arterial atherosclerosis.
B) deep venous thrombosis.
C) thrombovascular aneurysm.
D) varicose veins.
E) vasculitis.

162) An aneurysm occurs when blood passes through the vascular layer called the ________. 162) _____
A) tunica media
B) tunica adventitia
C) lumen
D) venous sinus
 E) tunica intima

163) Which of the following is one of the "Five Ps" used to evaluate acute arterial occlusion? 163) _____
A) Point tenderness
B) Proprioception
C) Perfusion
D) Paresthesia
E) Passivity

164) Auscultation of carotid bruits indicates the possibility of: 164) _____
A) atherosclerosis.
B) varicose veins.
C) vasculitis.
D) an aneurysm.
E) a pulmonary embolism.

165) Unequal bilateral blood pressures in the arms may indicate: 165) _____
A) an abdominal aortic aneurysm.
B) a carotid aneurysm.
C) a high thoracic aneurysm.
D) a subclavian aneurysm.
E) a cerebral aneurysm.

166) Scenario: A 20-year-old male athlete suddenly experiences a tearing sensation in his lower back 166) _____
while stretching before practice. He presents cool and clammy, with pain in his back and flank,
and states that he has been recently diagnosed with Marfan's syndrome during an arthroscopy
of his left knee. Your patient MOST likely has:
A) inguinal hernia.
B) mesenteric tear.
C) kidney infection.
D) abdominal aortic aneurysm.
E) lumbar strain.

167) All of the following statements regarding vascular occlusion disorder are true EXCEPT: 167) _____
A) shock may occur.
B) there is no need to transport if pain medications provide relief.
C) the possible embolus could travel to the brain, resulting in a cerebral vascular event.
D) patients with a prior vascular emergency are prone to recurrences.
E) loss of a limb could occur.

168) Management of a patient with a vascular emergency should consist of: 168) _____
A) encouraged activity and follow-up with a family physician.
B) pain relief measures and no transport.
C) IV at KVO, oxygen, and lasix administration.
D) aggressive IV therapy and administration of a beta agonist.
E) general supportive therapy as indicated by signs and symptoms.
169) Which of the following is a precordial lead? 169) _____
A) MCL1 B) Lead I C) rVR D) V1 E) aVR

170) Which lead is determined by placing the positive electrode to the left of the sternum at the fourth 170) _____
intercostal space?
A) V2 B) V3 C) V1 D) V4 E) V5
 1) A

2) A

3) B

4) E

5) D

6) E

7) C

8) D

9) D

10) C

11) A

12) B

13) C

14) D

15) E

16) B

17) B

18) B

19) A

20) D

21) B

22) B

23) C

24) A

25) B

26) B
27) D

28) D

29) C

30) D

31) D

32) B

33) B

34) C

35) D

36) B

37) A

38) C

39) C

40) B

41) A

42) C

43) A

44) E

45) E

46) D

47) A

48) B

49) C

50) C

51) B

52) D
53) E

54) E

55) D

56) C

57) E

58) E

59) B

60) B

61) B

62) B

63) B

64) B

65) D

66) B

67) D

68) A

69) A

70) D

71) E

72) A

73) B

74) A

75) A

76) E

77) B

78) A
 79) D

80) E

81) C

82) E

83) E

84) E

85) D

86) A

87) B

88) A

89) E

90) D

91) B

92) C

93) E

94) E

95) C

96) E

97) E

98) B

99) B

100) C

101) A

102) C

103) D

104) C
105) B

106) A

107) D

108) A

109) D

110) A

111) C

112) B

113) D

114) B

115) B

116) B

117) D

118) E

119) C

120) B

121) A

122) A

123) C

124) A

125) D

126) A

127) B

128) C

129) A

130) D
131) D

132) C

133) C

134) E

135) B

136) E

137) E

138) D

139) B

140) A

141) B

142) D

143) A

144) D

145) C

146) A

147) E

148) A

149) B

150) D

151) A

152) B

153) A

154) B

155) E

156) D
157) C

158) E

159) E

160) D

161) D

162) E

163) D

164) A

165) C

166) D

167) B

168) E

169) D

170) A