ECG: MCQ. 1- In the fundamental rules of the ECG all the following are right EXCEP: a- It is a biphasic record of myocardial action
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1 ECG: MCQ 1- In the fundamental rules of the ECG all the following are right EXCEP: a- It is a biphasic record of myocardial action potential fluctuations. b- Deflection record occurs only during complete depolarization or repolarization. c- +ve wave occurs when depolarizing current approaches the +ve terminal electrode of the meter. d- -ve wave happens when repolarizing current approaches the +ve terminal electrode. 1
2 2- Regarding the causes of the ECG waves all the following are correct EXCEPT: a- P wave by atrial depolarization. ation b- QRS complex by ventricular depolarization. c- T wave by ventricular repolarization. d- U wave by papillary muscle depolarization. 3- The causes of the ECG intervals : a- PR by AV nodal conduction. b- ST by atrial repolarization. c- QT by ventricular depolarization and ventricular repolarization. d- All of the above. 2
3 4- In the ECG: a- ST segment is part of depolarization & coincides with plateau. b- T wave has the same voltage of QRS. c- QRS & T wave are in the same direction. d- QRS & T wave are in opposite directions. 5- The voltage of the ECG: a- Is normal summation of QRS complexes in standard limb leads. b- Is normally >1.5 mv. c- Is low in individual having body mass index (BMI) 35. d- All of the above. 3
4 5- Regarding the flow of electrical currents around the heart all the followings are correct EXCEPT: a- From left to right in the mid portion of the ventricular septum. b- From the base to the apex during almost depolarization. c- From the epicardium to the subendocardium di during repolarization. d- From the epicardium to the subendocardium during depolarization. 6- Axis of the heart is: a- Mean instantaneous vector of QRS complexes in vertical plane. b- Normally from-30 to +60. c- Deviated to left side in full term pregnant woman. d- Deviated to right side in long slender person (e.g., +80). 4
5 7- The P-wave of normal ECG: a- Has voltage and duration nearly equal 2.5X 2.5 mm. b- Is upright in avr. c- Represents right atrial depolarization in its second half. d- Coincides with atrial systole. 8- The configuration of QRS complex in normal ECG: a- Depends only on the direction of depolarizing current. b- Is mainly positive in right ventricular surface pattern. c- Exhibits growing R in chest leads. d- Is positive in avr. 5
6 9- As regards Q wave all the followings are correct EXCEPT: a- Represents septal depolarization from left to right in V 5. b- Its depth is not more than 1/4 its corresponding R. c- Its duration is not more than 0.04 sec. d- Deep and wide Q is seen in recent myocardial infarction. 10- In normal ECG: a- The average duration of QT interval is 0.50 sec. b- The ST segment is an isoelectric line. c- The T wave is rounded and symmetrical. d- The height of the T wave is > 10 mm in chest leads. 6
7 11- Regarding the Voltage of ECG: a- Algebraic summations of QRS complexes in LI, II, & III b- Normally from 1.5 mv to 3.5 mv c- Low in obesity, hypothyroidism, and hypernatremia d- High in ventricular hypertrophy and short stunted adult individuals 12- Regarding the PR interval of the ECG all the followings are correct EXCEPT: a- Represents atrial depolarization and conduction through AV node. b- Normal duration from 0.16 to 0.20 second c- Prolonged in right bundle branch block d- Prolonged in 1 st degree heart block. 7
8 13- Regarding the ECG findings in atrial (A) arrhythmias all the followings are correct EXCEPT: a- (A) fibrillation: caused by multiple atrial ectopic foci that discharged very rapidly and irregularly. b- (A) tachycardia: paroxymal rapid and irregular rate ( b/min). c- (A) flutter: saw tooth waves associated with partial AV block. d- (A) fibrillation: absence of P waves, very irregular rate and normal QRS. 14- Ventricular premature beat VPB is: a- Caused by an ectopic ventricular focus that discharges regularly. b- Preceded by P wave and has bizarre prolonged QRS. c- Followed by a compensatory pause. d- Occurs in series without normal beats in between.. 8
9 15- All the followings cause low voltage ECG EXCEPT: a- Hyponatremia. b- Body mass index (BMI) > 35. c- Hypothyroidim. d- Hypokalemia. 16- Left axis deviation of the ECG is described when: a- The axis of the heart is from -30 to +90. b- The QRS complex is prominent positive in lead avf. c- The QRS is prominent positive in lead I and prominent negative in lead III. d- Right ventricle is enlarged. 9
10 17- Regarding the ECG findings in heart block (HB) all the followings are correct EXCEPT: a- Complete (HB): complete dissociation between P waves and QRS complexes. b- 1 st degree(hb): PR interval is abnormally long. c- 2 nd degree (HB): a ventricular beat may follow every 2 nd or 3 rd atrial beat. d- 1 st degree(hb): PR interval lengthens progressively until a ventricular beat is dropped. 18- The ECG findings of bundle branch block (BBB): a- Associated with absence of P waves. b- HR rate is slowed <60 b/min. c- Double hump QRS complex occurs in V5 & V6 in right BBB. d- QRS complexes are prolonged & deformed. 10
11 19- Regarding the ECG of ventricular hypertrophy (VH): a- Axis of the heart is from - 30 to +90 in right VH. b- S wave in V 1 or V 2 plus R wave in V 5 or V 6 account > 35 mm in left VH in adults. c- S wave is deep in V 1 and V 2 and R wave is tall in V 5 and V 6 in right VH. d- Right VH may occur in systemic hypertension. 20- Regarding the ECG findings of myocardial infarction (MI) all the following are correct EXCEPT: a- Elevation of the ST segment in recent (acute) MI. b- Deep and wide Q in old MI. c- Low voltage in massive MI. d- Prominent U wave. 11
12 21- The ECG findings in electrolyte imbalance: a- Tall and peaked T wave in hypokalemia. b- T wave inversion & prominent U wave in hyperkalemia. c- Prolonged QT interval in hypocalcemia. d- High voltage in hyponatremia. V6(+ve) V1(+ve) 12
13 U wave: inconstant finding due to slow repolarization of the papillary muscles. + Terminal Electrode LI Last Depolarization ve to +ve current 1st 13
14 + Terminal Electrode LI 1st Repolarization +ve to ve current Last 14
15 V3(+ve) V4(+ve) 15
16 Atrial flutter with 2:1 and 4:1 heart block Atrial fibrillation Ventricular extrasystole (PVBs) 16
17 Ventricular fibrillation An electrode over a window in the left ventricle (necrotic area) records a Q wave 17
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