menu_book
Dynoble Books
Login
Chapter 23 Test — ECG in ICU, Shock and Cardiac Arrest
27 questions · 27 min · +4 / -1
--:--
Question
1
of 27
0
/27 answered
Question 1
Question 1
Mark for review
A 55-year-old man is brought unconscious to the emergency department, found pulseless and apneic. The cardiac monitor displays the rhythm strip shown. What is the most appropriate immediate management?
A.
Synchronized DC cardioversion at 200 J biphasic
B.
IV amiodarone 300 mg bolus
C.
Unsynchronized defibrillation at 200 J biphasic
D.
IV atropine 1 mg stat
Clear my answer
Question 2
Question 2
Mark for review
A patient collapses in the ICU. There is no palpable carotid pulse. The monitor strip shown was recorded at the moment of collapse (upper strips) with the rhythm that followed after intervention (lower strips). What is the next best step in management?
A.
Defibrillate and immediately continue chest compressions
B.
Defibrillate and then check the pulse
C.
Check the pulse and give synchronized DC shock
D.
Give synchronized DC shock and continue chest compressions
Clear my answer
Question 3
Question 3
Mark for review
A young man collapses at a railway station and is brought to the emergency department, where he is pulseless with ventricular fibrillation on the monitor. Immediate defibrillation is performed. According to the ACLS algorithm, what is the next step?
A.
Check for a pulse
B.
Resume chest compressions
C.
Epinephrine 1 mg IV
D.
Amiodarone 300 mg IV bolus
Clear my answer
Question 4
Question 4
Mark for review
A young patient sustains cardiac arrest in the medical ward. Immediate defibrillation is advised when the ECG shows:
A.
Ventricular tachycardia
B.
Asystole
C.
Electromechanical dissociation
D.
Persistent bradyarrhythmia
Clear my answer
Question 5
Question 5
Mark for review
Which one of the following is a NON-shockable rhythm with respect to an Automated External Defibrillator (AED)?
A.
Monomorphic ventricular tachycardia
B.
Polymorphic ventricular tachycardia
C.
Ventricular fibrillation
D.
Pulseless electrical activity
Clear my answer
Question 6
Question 6
Mark for review
In ACLS, which drug — other than epinephrine — can be given for ventricular fibrillation during cardiac arrest?
A.
Amiodarone
B.
Dopamine
C.
Adenosine
D.
Atropine
Clear my answer
Question 7
Question 7
Mark for review
A patient develops ventricular fibrillation immediately after an intravenous injection of potassium chloride. What is the first line of treatment?
A.
Cardiac massage
B.
IV adrenaline
C.
Defibrillation
D.
Intermittent positive pressure ventilation
Clear my answer
Question 8
Question 8
Mark for review
The best chance of recovery after successful cardiopulmonary resuscitation is seen when the presenting arrest rhythm is:
A.
Ventricular tachycardia
B.
Ventricular fibrillation
C.
Asystole
D.
Electromechanical dissociation
Clear my answer
Question 9
Question 9
Mark for review
Which of the following statements about pulseless electrical activity (PEA) is INCORRECT?
A.
It is pulselessness in the presence of organized electrical activity
B.
Cardiac tamponade can lead to PEA
C.
Immediate defibrillation is required
D.
Epinephrine 1 mg IV is given
Clear my answer
Question 10
Question 10
Mark for review
Which among the following is the most common cause of pulseless electrical activity?
A.
Cardiac tamponade
B.
Pulmonary embolism
C.
Tension pneumothorax
D.
Hypovolemia
Clear my answer
Question 11
Question 11
Mark for review
Which of the following are reversible causes of electromechanical dissociation seen in pulseless electrical activity?
1. Pericardial tamponade
2. Pulmonary thromboembolism
3. Hyperthermia
4. Hypokalemia
A.
1, 2 and 3
B.
1, 2 and 4
C.
1, 3 and 4
D.
2, 3 and 4
Clear my answer
Question 12
Question 12
Mark for review
An elderly woman presents 5 days after a large transmural myocardial infarction with sudden haemodynamic collapse, hypotension, a raised JVP and pulseless electrical activity on the monitor. Emergency bedside echocardiography is most likely to reveal:
A.
Pericardial friction rub
B.
Mobitz type II block
C.
A significant pericardial effusion
D.
Lower limb deep vein thrombosis
Clear my answer
Question 13
Question 13
Mark for review
A 30-year-old man is brought to the ER unconscious after collapsing at a railway station. There is no pulse, CPR is started, and the monitor shows asystole (confirmed in two leads at increased gain). What is the next step in management?
A.
Defibrillation
B.
Synchronized cardioversion
C.
Atropine 0.5 mg IV
D.
Epinephrine 1 mg IV
Clear my answer
Question 14
Question 14
Mark for review
A 62-year-old ventilated ICU patient suddenly loses his carotid and femoral pulses. CPR is begun. The monitor shows the rhythm below, essentially unchanged from before the collapse. What is the most appropriate immediate management?
A.
Synchronized cardioversion at 100 J
B.
High-quality CPR with epinephrine 1 mg IV/IO
C.
Immediate unsynchronized defibrillation at 200 J biphasic
D.
IV amiodarone 300 mg by bolus injection
Clear my answer
Question 15
Question 15
Mark for review
A patient has been in cardiac arrest for 12 minutes. At the 2-minute rhythm check the monitor shows the trace below. The gain is increased and the finding is confirmed in a second lead; the electrodes are correctly attached. What is the correct interpretation and action?
A.
Fine ventricular fibrillation — defibrillate and resume compressions
B.
Asystole — continue CPR and epinephrine; do not shock
C.
Pulseless electrical activity — give epinephrine and look for reversible causes
D.
Lead-disconnection artefact — reattach the electrodes and reassess
Clear my answer
Question 16
Question 16
Mark for review
A patient in the ICU is found unresponsive and pulseless. The monitor shows a flat line in the lead being displayed. Before declaring asystole, what is the single most important immediate step?
A.
Stop resuscitation if the flat line persists for 5 minutes
B.
Check the electrodes, increase the gain and confirm in a second lead
C.
Give atropine 1 mg IV and reassess after 2 minutes
D.
Deliver one unsynchronized shock in case the rhythm is fine VF
Clear my answer
Question 17
Question 17
Mark for review
A ventilated ICU patient with end-stage renal disease misses dialysis. The monitor shows tall peaked T waves, then progressive PR prolongation and QRS widening, and he arrests with an organized wide-complex rhythm and no pulse. Alongside CPR and epinephrine, what is the most appropriate immediate treatment of the underlying cause?
A.
Immediate systemic thrombolysis
B.
Needle decompression in the 2nd intercostal space
C.
A rapid IV fluid bolus with blood transfusion
D.
Calcium chloride IV, then insulin with glucose
Clear my answer
Question 18
Question 18
Mark for review
A ventilated ICU patient suddenly deteriorates. The monitor shows an abrupt fall in QRS voltage with a shift in axis, followed within a minute by an organized rhythm with no pulse. Breath sounds are absent on the right with a hyper-resonant hemithorax and a deviated trachea. Which reversible cause is responsible, and what is the immediate treatment?
A.
Massive coronary thrombosis — emergency PCI
B.
Tension pneumothorax — needle decompression
C.
Hyperkalaemia — IV calcium chloride
D.
Cardiac tamponade — emergency pericardiocentesis
Clear my answer
Question 19
Question 19
Mark for review
A 58-year-old man in the ICU with severe pneumonia and septic shock has an ECG showing sinus tachycardia and ST-T changes spread diffusely across several coronary territories. The changes do not progress on serial tracings and resolve as his haemodynamics improve; troponin is only minimally raised. What is the most appropriate interpretation?
A.
Acute anterior STEMI — activate the cath lab immediately
B.
Hyperkalaemia — give calcium chloride
C.
Sepsis-induced non-specific (pseudo-ischaemic) ST-T changes
D.
Acute pericarditis requiring anti-inflammatory therapy
Clear my answer
Question 20
Question 20
Mark for review
A 58-year-old man presents with 2 hours of crushing chest pain. He is cold and clammy with BP 78/50 mmHg and bibasal crackles. His 12-lead ECG is shown. What is the most appropriate immediate management?
A.
IV amiodarone 150 mg over 10 minutes
B.
Emergency coronary angiography with a view to primary PCI
C.
Immediate pericardiocentesis
D.
A 2-litre crystalloid fluid bolus and reassessment
Clear my answer
Question 21
Question 21
Mark for review
A 66-year-old man arrives with ongoing chest pain, BP 84/56 mmHg and cool peripheries. His ECG shows a left bundle branch block that was not present on a tracing taken 6 months ago. Troponin has been sent but is not yet available. What is the correct management?
A.
Treat as a STEMI equivalent and activate the cath lab immediately
B.
Wait for the troponin result before deciding on reperfusion
C.
Start a beta-blocker and admit for serial ECGs
D.
Give IV furosemide and repeat the ECG in 6 hours
Clear my answer
Question 22
Question 22
Mark for review
A 60-year-old man collapses with sudden breathlessness. He is hypotensive and hypoxic. His ECG is shown, demonstrating sinus tachycardia, an S wave in lead I with a Q wave and T inversion in lead III, and T-wave inversions in V1–V4. What is the most likely cause of his shock?
A.
Acute anterior STEMI
B.
Septic shock
C.
Cardiac tamponade
D.
Massive pulmonary embolism
Clear my answer
Question 23
Question 23
Mark for review
A 42-year-old woman presents with a week of worsening breathlessness and chest discomfort. Examination shows distant heart sounds and an elevated JVP, with BP 80/60 mmHg. Her ECG shows low-voltage QRS complexes. What is the most likely diagnosis?
A.
Acute myocardial infarction
B.
Acute pericarditis
C.
Cardiac tamponade
D.
Pericardial effusion without tamponade
Clear my answer
Question 24
Question 24
Mark for review
A 30-year-old trauma victim has ongoing intra-abdominal haemorrhage. If the bleeding is not controlled, which sequence of ECG changes is expected?
A.
Peaked T waves → widened QRS → sine wave → ventricular fibrillation
B.
Osborn J waves → sinus bradycardia → ventricular fibrillation
C.
Low voltage with electrical alternans → asystole
D.
Sinus tachycardia → falling QRS voltage → pulseless electrical activity
Clear my answer
Question 25
Question 25
Mark for review
The deflection marked in the tracing shown — a positive hump at the junction of the QRS complex and the ST segment — is characteristic of:
A.
Hypothyroidism
B.
Hypovolemia
C.
Hypothermia
D.
Hypocalcemia
Clear my answer
Question 26
Question 26
Mark for review
A 64-year-old man is resuscitated from an out-of-hospital cardiac arrest and achieves ROSC. He remains comatose and is intubated. A 12-lead ECG with right-sided precordial leads is recorded immediately and is shown. What is the most appropriate next step?
A.
Repeat the ECG in 6 hours and treat conservatively
B.
Immediate coronary angiography with a view to PCI
C.
Withhold coronary intervention until the patient regains consciousness
D.
Systemic thrombolysis for presumed pulmonary embolism
Clear my answer
Question 27
Question 27
Mark for review
Which of the following is NOT correct about the management of a patient after return of spontaneous circulation (ROSC) following CPR?
A.
Targeted temperature management at 32–36°C if the patient is awake
B.
Maintain a mean arterial pressure above 65 mmHg
C.
Target an oxygen saturation of 92–98%
D.
Emergency cardiac intervention if ST elevation is present on the post-ROSC ECG
Clear my answer
Next
Finish & see my score
All questions
Close
answered
marked for review
not answered
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Finish & see my score