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Chapter 17 Test — Hypertrophy Patterns: LVH, RVH and Atrial Enlargement
25 questions · 25 min · +4 / -1
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Question 1
Question 1
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In the ECG diagnosis of left ventricular hypertrophy (LVH), the Sokolow-Lyon voltage criterion is the sum of the S wave in lead V1 and the tallest R wave in lead V5 or V6. This criterion is considered positive at which threshold (in mm)?
A.
25
B.
30
C.
35
D.
45
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Question 2
Question 2
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A 52-year-old man with long-standing poorly controlled hypertension attends for routine review. His resting 12-lead ECG is shown, with strikingly tall QRS complexes in the precordial leads, particularly V4 and V5. Which ECG criterion most reliably confirms left ventricular hypertrophy in this patient?
A.
Prolonged QRS duration of more than 120 ms in leads V5 and V6
B.
Sokolow-Lyon voltage criterion (S in V1 + R in V5/V6 ≥ 35 mm)
C.
Pathological Q waves in leads V4, V5 and V6
D.
PR interval greater than 200 ms in lead II
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Question 3
Question 3
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The ECG of a 40-year-old man was recorded using the standard bipolar limb leads. The sum of the QRS voltages of the three standard leads was 5 millivolts. This indicates:
A.
A completely normal heart with normal muscle mass
B.
Right ventricular hypertrophy specifically, rather than left
C.
Left ventricular hypertrophy specifically, rather than right
D.
Increased cardiac muscle mass, without indicating which chamber
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Question 4
Question 4
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Which of the following statements about left ventricular hypertrophy (LVH) is FALSE?
A.
Left atrial abnormality increases the likelihood of underlying LVH
B.
LVH often progresses to incomplete or complete left bundle branch block
C.
The sensitivity of conventional voltage criteria for LVH is decreased in thin persons
D.
ECG evidence of LVH is a marker of increased risk of sudden cardiac death
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Question 5
Question 5
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Left ventricular hypertrophy is caused by all of the following EXCEPT:
A.
Aortic stenosis
B.
Chronic cor pulmonale
C.
Chronic kidney disease
D.
Essential hypertension
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Question 6
Question 6
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Low QRS voltage on the ECG in a patient whose echocardiogram shows marked left ventricular hypertrophy suggests:
A.
Pericardial effusion
B.
Cardiac amyloidosis
C.
Cor pulmonale
D.
Infective endocarditis
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Question 7
Question 7
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A QRS axis of −30° to −60° (left axis deviation) is characteristically seen with:
A.
Left ventricular hypertrophy
B.
Right ventricular hypertrophy
C.
Aortic stenosis
D.
Left atrial enlargement
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Question 8
Question 8
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An ECG showing right ventricular enlargement in a 2-year-old child is most consistent with which of the following?
A.
Atrial septal defect
B.
Patent ductus arteriosus
C.
Ventricular septal defect
D.
Coarctation of the aorta
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Question 9
Question 9
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A 65-year-old Japanese woman presents with worsening angina and palpitations. Physical examination is normal. The ECG shows giant T wave inversions in the precordial leads, coronary angiography is normal, and left ventriculography shows a spade-like deformity of the left ventricle. The most probable diagnosis is:
A.
Dilated cardiomyopathy
B.
Restrictive cardiomyopathy
C.
Hypertensive left ventricular hypertrophy
D.
Apical hypertrophic cardiomyopathy
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Question 10
Question 10
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This ECG was recorded from a 30-year-old man with exertional light-headedness and palpitations. Note the very tall precordial QRS complexes and the deep, narrow Q waves arrowed in the lateral and inferior leads. The most probable diagnosis is:
A.
Hypertrophic cardiomyopathy
B.
Dilated cardiomyopathy
C.
Restrictive cardiomyopathy
D.
Chronic obstructive pulmonary disease
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Question 11
Question 11
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A 58-year-old man with hypertension has an ECG showing an R wave of 22 mm in lead aVF and ST depression with T wave inversion in I, aVL, V5 and V6. He is not on digoxin. Using the Romhilt-Estes point score, what is his total and what does it mean?
A.
3 points — no evidence of LVH
B.
4 points — probable LVH
C.
6 points — probable LVH only
D.
6 points — definite LVH
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Question 12
Question 12
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Which single-lead voltage measurement, taken in isolation, satisfies a criterion for left ventricular hypertrophy?
A.
S wave in V1 greater than 7 mm
B.
P wave amplitude in lead II greater than 2.5 mm
C.
R wave in V1 greater than 7 mm
D.
R wave in aVL greater than 11 mm
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Question 13
Question 13
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A 60-year-old obese woman with resistant hypertension has borderline Sokolow-Lyon voltage on her ECG. Which voltage criterion is most appropriate to apply next, and what is her threshold?
A.
Cornell criterion — S in V3 + R in aVL ≥ 20 mm
B.
Sokolow-Lyon repeated — R in V5 alone > 26 mm
C.
Cornell criterion — S in V3 + R in aVL ≥ 28 mm
D.
Romhilt-Estes voltage item alone — any limb lead R ≥ 20 mm
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Question 14
Question 14
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A 64-year-old hypertensive man with no chest pain has an ECG showing tall R waves in V5-V6 with down-sloping ST depression and asymmetric T wave inversion in I, aVL, V5 and V6. Troponin is normal. The most appropriate interpretation is:
A.
Acute non-ST-elevation myocardial infarction
B.
Acute pericarditis
C.
Left bundle branch block
D.
Left ventricular hypertrophy with strain
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Question 15
Question 15
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A 62-year-old hypertensive woman has an ECG meeting voltage criteria for LVH together with a broad, bifid P wave of 130 ms in lead II. Which complication is she at particularly high risk of?
A.
Complete heart block
B.
Atrial fibrillation
C.
Wolff-Parkinson-White syndrome
D.
Pulmonary embolism
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Question 16
Question 16
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A 55-year-old man with a 15-year history of hypertension has a loud fourth heart sound and a displaced apex beat. His ECG voltages are entirely normal. What is the most appropriate conclusion?
A.
Repeat ECG at double standardisation will confirm or exclude LVH
B.
LVH is excluded; no further cardiac imaging is needed
C.
ECG sensitivity for LVH is only ~50%, so arrange echocardiography
D.
LVH is present only if a strain pattern later develops
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Question 17
Question 17
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A 46-year-old woman with long-standing pulmonary hypertension has the 12-lead ECG shown, with a dominant R wave in V1, right axis deviation, persistent deep S waves in V5-V6 and ST depression with T inversion in V1-V3. The diagnosis is:
A.
Right ventricular hypertrophy with strain
B.
Posterior wall myocardial infarction
C.
Wolff-Parkinson-White syndrome, type A
D.
Left ventricular hypertrophy with strain
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Question 18
Question 18
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The precordial patterns of ventricular hypertrophy are compared in the figure. Which finding in panel B is the
most specific
ECG criterion for right ventricular hypertrophy?
A.
A deep S wave in lead V6
B.
A tall R wave in V1 with R/S ratio > 1
C.
Poor R wave progression across leads V1 to V4
D.
T wave inversion in leads V1 and V2
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Question 19
Question 19
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An ECG shows a tall positive complex in V1. Which feature most reliably indicates right bundle branch block rather than right ventricular hypertrophy?
A.
T wave inversion in leads V1 to V3
B.
Right axis deviation beyond +110°
C.
An RSR' complex in V1 with QRS duration ≥ 120 ms
D.
A deep S wave in lead V6 with a tall R wave in V1
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Question 20
Question 20
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Which is the most common cause of right ventricular hypertrophy in adults?
A.
Chronic obstructive pulmonary disease
B.
Severe aortic valve stenosis
C.
Chronic mitral regurgitation
D.
Poorly controlled systemic hypertension
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Question 21
Question 21
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In right ventricular hypertrophy, the strain pattern (ST depression with T wave inversion) is expected in which leads?
A.
aVR and V1 only
B.
V1–V3, and often II, III and aVF
C.
V4–V6 only, with reciprocal changes in aVR
D.
I, aVL, V5 and V6
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Question 22
Question 22
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A 50-year-old man with both severe aortic stenosis and pulmonary hypertension has an ECG that meets Sokolow-Lyon voltage criteria for LVH but also shows right axis deviation and a tall R wave in V1. The best interpretation is:
A.
Isolated left ventricular hypertrophy with lead misplacement
B.
Left posterior fascicular block
C.
Biventricular hypertrophy
D.
Isolated right ventricular hypertrophy
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Question 23
Question 23
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The figure compares P wave patterns in leads II and V1. The pattern in the bottom row (a broad P in lead II with both a tall initial and a deep terminal component in V1) is most characteristic of which clinical situation?
A.
Acute pulmonary embolism with right heart strain
B.
Isolated systemic hypertension without valve disease
C.
Severe mitral stenosis with pulmonary hypertension
D.
First-degree atrioventricular block
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Question 24
Question 24
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A 22-year-old footballer with exertional chest tightness has the ECG shown, with markedly increased QRS voltage in the mid-precordial leads and deep narrow Q waves in the inferior and lateral leads. He has never had chest pain at rest. Which feature best distinguishes hypertrophic cardiomyopathy from an old myocardial infarction on this ECG?
A.
A QRS duration greater than 120 ms
B.
T wave inversion in the precordial leads
C.
The presence of deep Q waves in more than one territory
D.
Preserved or increased R wave progression across the chest leads
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Question 25
Question 25
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A 21-year-old asymptomatic endurance athlete has an ECG with an S in V1 plus R in V5 of 40 mm, sinus bradycardia at 48/min and early repolarisation. ST segments and T waves are otherwise normal. What is the correct interpretation?
A.
Right ventricular hypertrophy from training
B.
Definite pathological LVH — start antihypertensive therapy
C.
Hypertrophic cardiomyopathy — immediate sports restriction
D.
Athlete's heart — physiological findings; no pathological LVH
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