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Voltage is:
a.
b.
c.
d.
If the Pacemaker output voltage is 5v and the measured lead resistance is 330 ohms,
then the current that flows out of the pacemaker into the heart is:
a.
b.
c.
d.
If a unipolar lead wire has an insulation break one would expect the resistance to:
a.
b.
c.
d.
If the output voltage of the pacemaker is programmed from 5 volts to 2.5 volts, the
energy delivered to the heart is:
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____5.
Increases
Decreases
Increases then decreases
Has no change
.p
____4.
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er
____3.
1.65 mA
15.15 mA
66 mA
10 mA
ic
d.
____2.
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m
____1.
a.
b.
c.
d.
____6.
a.
b.
c.
d.
Doubled
Halved
Quartered
Quadrupled
____10.
a.
b.
c.
d.
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____11.
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er
a.
b.
c.
d.
.p
____9.
ic
d.
____8.
Patient #1 - AMP = 5v, L.R. = 90 BPM, Resistance - 500 , PW = .5ms, 100% pacing
Patient #2 - AMP = 5v, L.R. = 60 BPM, Resistance - 500 , PS = .5ms, 100% pacing
Patient #3 - AMP = 2.5v, L.R. = 60 BPM, Resistance - 330 , PW = .5ms, 100%
pacing
Patient #4 - AMP = 2.5v, L.R. = 60 BPM, Resistance - 500 , PW = .5ms, 50% pacing
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____7.
a.
b.
c.
d.
____12.
a.
b.
c.
d.
Page 2
____15.
a.
b.
c.
d.
____16.
a.
b.
c.
d.
____17.
Typical acceptable P-wave amplitude values for an acute atrial lead is:
Greater than 2mV
Less than 1.5mV
Greater than 7mV
4mV to 10mV
The slew rate is:
Not important to measure because they are dependent on the patients heart
Change in voltage divided by time or the slope of the EGM
Acceptable in the ventricle for <.75v/sec
Acceptable in the atrium for <.5v/sec
Typical lead resistance range measured in ohms is:
300 2000
Less than 300
Greater than 3000
Is not important
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a.
b.
c.
d.
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a.
b.
c.
d.
Typical acceptable R-wave amplitude values for an acute ventricular lead is:
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d.
____14.
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a.
b.
c.
d.
.p
____13.
____18.
a.
b.
c.
d.
Page 3
____21.
a.
b.
c.
d.
____22.
a.
b.
c.
d.
Hysteresis is:
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____23.
co
m
a.
b.
c.
d.
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d.
____20.
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a.
b.
c.
d.
.p
____19.
a.
b.
c.
d.
____24.
a.
b.
c.
d.
Page 4
____27.
a.
b.
c.
d.
____28.
Voltage
Current
Energy
All of the above
A pacemaker that paces and senses only in the ventricle and is inhibited by
spontaneous ventricular activity is designated:
VAT
VVT
VVI
VDD
w
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a.
b.
c.
d.
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m
a.
b.
c.
d.
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d.
____26.
Output voltage
Lead resistance
Pulse duration
Blanking
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a.
b.
c.
d.
Which of the following is/are NOT factor(s) which influence pacemaker longevity?
.p
____25.
____29.
a.
b.
c.
d.
____30.
a.
b.
c.
d.
Page 5
____33.
a.
b.
c.
d.
____34.
a.
b.
c.
d.
1.50V
2.50V
2.78V
5.0V
For a voltage of 5V, resistance of 500 ohms and pulse width of .5ms, calculate the
energy delivered:
25 joules
.25 joules
25 microjoules
None of the above
Which of the following factors does not contribute to development of the pacemaker
syndrome with ventricular pacing?
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____35.
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m
a.
b.
c.
d.
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d.
____32.
AV interval duration
Sensitivity
Refractory
Output
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a.
b.
c.
d.
All of the following functions are programmable in both VVI and DDD pacemakers,
except:
.p
____31.
a.
b.
c.
d.
Loss of AV synchrony
Hysteresis
Constant VA conduction
Inappropriate circulatory reflexes
Page 6
____38.
a.
b.
c.
d.
____39.
They provide the capability of a heart rate increase despite sinus node dysfunction
They are potentially useful in patients with atrial arrhythmias
Retrograde conduction is a potential problem with this pacing mode
They maintain constant AV synchrony
Characteristic findings in patients with the pacemaker syndrome include any of the
following except:
Pacing-induced hypotension
Symptoms of congestive heart failure
Febrile signs of pacemaker infection
Neurological symptoms
For a patient with evidence of sinus node dysfunction and intermittent heart block,
which of the following pacemakers would be inappropriate?
DDDR
AAI
VVI
VVIR
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a.
b.
c.
d.
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a.
b.
c.
d.
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d.
____37.
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a.
b.
c.
d.
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____36.
____40.
a.
b.
c.
d.
Which parameter provides the greatest safety when operating on the rheobase of the
strength duration curve?
PW
Sensitivity
Refractory
Voltage
Page 7
a.
b.
c.
d.
____43.
Setting a low pacing rate on a demand ventricular pacemaker may have all of the
following benefits except:
Allowing a patient with sinus rhythm to maintain AV synchrony for a significant
amount of time
Prolonging the life of the pulse generator
Preventing angina in patients with coronary artery disease
Allowing a lower output setting
In a bipolar pacing ventricular pacemaker:
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a.
b.
c.
d.
co
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____42.
Threshold
Intrinsic deflection
Pulse width
Slew rate
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d.
a.
b.
c.
d.
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____41.
Page 8
2.
co
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a.
b.
c.
d.
Extending the post-ventricular atrial refractory period results in which of the following?
a.
b.
c.
d.
ic
d.
1.
Some DDD pulse generators treat the first and last halves of the AV delay period
differently. (Ventricular Safety Pacing VSP, Ventricular Safety Standby, Nonphysiologic AV delay) With respect to this feature, mark the following true or false.
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3.
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The ventricular channel of a DDD pacemaker has two refractory periods. Which of the
following are characteristic of the first ventricular refractory period or the blanking
period?
4.
5.
a.
b.
c.
d.
e.
a.
b.
c.
d.
a.
b.
c.
d.
e.
8.
ic
d.
What is the optimal mode of pacing for sinus node dysfunction with paroxysmal atrial
arrhythmias, compromised AV conduction and when the patient is on medication to
control the tachyarrhythmias?
AAIR
VVIR
DDDR with Mode Switching
DDIR
VDD
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er
7.
Pulse width
Electrode surface area
Electrode lead impedance
Voltage
Cardiac enlargement
co
m
a.
b.
c.
d.
e.
What is the optimal mode of pacing for sinus node dysfunction with paroxysmal atrial
arrhythmias, intact AV conduction and anticipate starting on antiarrhythmic drugs?
AAIR
VVIR
DDDR with Mode Switching
DDIR
VDD
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w
a.
b.
c.
d.
e.
.p
6.
9.
What is the best mode of pacing for a 9 year old with congenital complete heart block,
sinus rate 92 bpm?
a.
b.
c.
d.
e.
AAIR
VVIR
DDD with Mode Switching
DDIR
VDD
d.
e.
d.
12.
The rate of the pacemaker-mediated tachycardia is more likely to be equal to the upper
tracking rate if:
a.
b.
c.
d.
13.
ic
d.
a.
b.
c.
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er
11.
Prevent the ventricular sensing amplifier from sensing the far-field P wave
Limit the maximal atrial rate which the pacemaker can track 1:1
Prevent the ventricular sensing amplifier from sensing the far-field atrial pacing
stimulus
Prevent sensing of the T wave
Prevent the inappropriate inhibition of ventricular pacing by environmental
electrical noise (EMI)
co
m
a.
b.
c.
Which of the following have been proposed as a sensor for rate adaptive pacing?
Minute Ventilation
QT interval
Body activity
Central O2 saturation
All of the above
w
w
a.
b.
c.
d.
e.
.p
10.
14.
a.
b.
c.
d.
The NBG code includes an indicator for the power source of the pacemaker.
a.
b.
The third position of the NBG code indicates the presence of hysteresis in the pacemaker
rate.
17.
Pacemaker mediated tachycardia often require therapeutic intervention with drugs and
other modalities.
a.
b.
18.
True
False
.p
a.
b.
All patients who require pacing except those with chronic atrial fibrillation, should have a
dual chamber system.
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w
20.
True
False
Most reported dual chamber malfunctions are not due to mechanical or electronic
pacemaker problems, but rather to errors of interpretations on the part of the observer.
a.
b.
19.
True
False
co
m
a.
b.
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d.
16.
True
False
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15.
a.
b.
21.
True
False
a.
b.
c.
d.
What is the first step to take in a patient with a DDD pacemaker experiencing a
pacemaker mediated tachycardia at the upper tracking limit?
24.
Wenckebach
Fallback
Conditional ventricular tracking limit (CVTL)
Rate smoothing
2:1 block
ic
d.
23.
Apply a magnet
Turn on the PMT intervention feature
Increase the PVARP
Shorten the AV delay
Turn on the PVC response feature
co
m
a.
b.
c.
d.
e.
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a.
b.
c.
d.
e.
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22.
3.
All of the following terms are associated with DDD upper rate behavior except
a.
b.
c.
d.
4.
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d.
a.
b.
c.
d.
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2.
co
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a.
b.
c.
d.
AV block
safety pacing
rate smoothing
pseudo-Wenckebach response
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a.
b.
c.
d.
.p
1.
5.
a.
b.
c.
d.
8.
9.
ic
d.
a.
b.
c.
d.
e.
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7.
increases crosstalk
is less susceptible to EMI
is more likely to cause pectoralis muscle stimulation
makes pacing artifacts easier to see on the ECG tracing
leads are smaller in diameter, and thus, easier to implant with a dual chamber
system
co
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a.
b.
c.
d.
e.
w
w
a.
b.
c.
d.
.p
6.
10.
a.
b.
c.
d.
13.
14.
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w
15.
ic
d.
a.
b.
c.
d.
e.
co
m
Normal function of a DDD pacemaker can include all of the following except:
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12.
.p
11.
16.
17.
co
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a. it results in VVIR pacing throughout the time the device has changed ( modes
in all generators which have mode switch as an option)
b. there is always some delay from the onset of the SVT until the actual mode
switch occurs
c. different manufacturers use different algorithms to achieve mode switching
d. it is programmable on or off for DDD, DDDR, and VDD modes (if it is a
parameter available in the generator)
All of the following are expected outcomes of mode switch except:
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ic
d.
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.p
A.
B.
C.
D.
E.
F.
18.
Temperature
19.
Activity
20.
O2 Sat.
21.
Impedance
22.
DP/DT
ic
d.
1.
2.
3.
4.
co
m
1.
2.
3.
4.
ac
er
1.
2.
3.
4.
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.p
co
m
a.
b.
c.
d.
e.
f.
In a dual chamber pacemaker, the period of time between an atrial event (sensed
or paced) and a paced ventricular event.
27.
In atrial tracking dual chamber pacemakers, the programmed rate at which the
pacemaker will pace the heart in the absence of cardiac activity.
28.
The propagation of depolarization from the ventricles to the atria, i.e., V-A
Conduction.
29.
Inhibition of a pacemaker by events other than those, which the pacemaker was
designed to sense, i.e., myopotentials, EMI, crosstalk, etc.
30.
Artificial pacing, which maintains the hearts normal contraction sequence with
resulting hemodynamic benefits.
31.
Stimulation of the heart at a fixed, preset rate, independent of any electrical and/or
mechanical activity of the heart.
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ic
d.
26.
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33.
In DDD pacing, the second position of the NBG code represents the
chamber (s) being sensed.
34.
35.
36.
37.
The Lower Rate, AV Interval, and the Upper Tracking Rate are all
parameters to be selected for the DDI mode.
38.
DDDR with mode switch is the therapy of choice for patients with SSS,
unreliable AV conduction or AV block, and intermittent SVTs.
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.p
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d.
co
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32.
co
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DDDR
VVIR
DDIR
AAIR
.p
A.
B.
C.
D.
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ic
d.
2. Before implant a patient presents with the following rhythm. Which pacing mode
would you recommend?
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3. Before implant a patient presents with the following rhythm. Which pacing mode
would you recommend?
A.
B.
C.
D.
DDDR
VVIR
DDIR
AAIR
ic
d.
co
m
After performing a final interrogation to retrieve a final printout at implant, you see the
following. Identify the problem. (The EGM source shown is from the atrium.)
A.
B.
C.
D.
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w
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A.
B.
C.
D.
.p
You are presented with the following tracing from a patient in a pacemaker clinic for a
routine visit. The patient is not pacemaker dependent and is asymptomatic. The
information you are given is as follows:
co
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Mode: VVI
Lower Rate: 70 PPM
A.
B.
C.
D.
ic
d.
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You are presented with the following tracing from a patient in the pacemaker clinic for a
routine visit. The patient is rather stoic and initially denies any problems. With further
questioning she admits that she occasionally has a very light and very transient sensation
of light-headedness but had discounted the symptoms. The information you are given is
as follows:
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w
.p
Mode: DDDR
Lower Rate: 50 ppm
Upper Rate: 110 ppm
PVARP: 160ms
8. Identify the problem in the ECG above and choose the best answer:
A.
B.
C.
D.
You are presented with the following tracing from a patient in the pacemaker clinic for a
routine visit. The patient is asymptomatic. The information you are given is as follows:
co
m
Mode: DDD
Lower Rate: 50ppm
Upper Rate: 110ppm
PVARP: 250ms
A.
B.
C.
D.
ic
d.
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.p
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10. The ECG presents with the following. Choose the best description of the problem:
A.
B.
C.
D.
CASE STUDIES
You will be presented with a case history with ECGs and/or programmer printouts
followed by a series of multiple choice questions regarding each case. Choose the BEST
answer.
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d.
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CASE #1
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d.
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Brady Pacing Test - #4
CASE #1
11. The narrow complex Tachycardia observed in ECG Strip #2 may have been initiated
from the atrial lead positioning.
a. true
b. false
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d.
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.p
15. The PSA threshold results on these two implanted tined steroid eluting pacemaker
leads would be best described by the following:
a. average
b. unacceptable, need for repositioning of leads
c. average with exceptional P-waves
d. exceptional
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ic
d.
co
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CASE #2
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d.
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Brady Pacing Test - #4
CASE STUDY 2
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16. Based on the findings from the initial ECG Strip #1 and EGM Strip #1, what is the
cause of this patients accelerated rate?
a. sensor driven pacing
b. PMT
c. balanced endless-loop Tachycardia
d. tracking atrial tachyarrhythmia
17. What is the most valuable tool for assessing this patients problem?
a. atrial EGM
b. ventricular EGM
c. surface ECG
d. chest X-ray
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ic
d.
19. Which diagnostic functions could be utilized to evaluate frequency of these episodes?
a. rate response optimization episodes and high atrial rate histogram
b. high atrial rate histogram and mode switch episode
c. rate vs. time trend and percent total event summary
d. mode switch episode and AV conduction histogram
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.p
20. If the patient develops this arrhythmia frequently, what mode could best be utilized?
a. VVIR
b. AAIR
c. DVIR
d. DDIR
10
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.p
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ic
d.
co
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Case #3
11
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d.
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Brady Pacing Test - #4
12
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d.
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Brady Pacing Test - #4
13
Case #3
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21. What timing period is not present in ECG Strip #1 that is present in ECG Strip #2?
a. PVARP (320ms)
b. ventricular blanking (24ms)
c. ventricular blanking (after V. pace 126ms)
d. atrial blanking (225ms)
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ic
d.
23. What is the recorded basis for atrial pacing above the programmed lower rate in ECG
strip #2?
a. atrial tracking
b. sensor drive
c. rate smoothing
d. all of the above
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.p
24. The purpose of the shortest blanking period observed in ECG Strip #2 is to prevent:
a. PMT
b. AVDA
c. crosstalk
d. atrial oversensing
14
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.p
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d.
co
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CASE #4
15
CASE #4
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25. The chest x-rays of this case study represent which of the following views?
a. AP and lateral
b. Left anterior oblique (LAO)
c. Right anterior oblique (RAO)
d. 2 lateral views
ic
d.
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27. An atrial lead position with the electrode facing posterior as opposed to anterior
would make the patient more susceptible to?
a. pericarditis
b. exit block
c. diaphragmatic stimulation
d. over-sensing
.p
28. The standard view for assessing ventricular lead redundancy (slack) would be?
a. AP or PA
b. Lateral
c. RAO
d. LAO
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16
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d.
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CASE #5
17
CASE #5
30. Which of the following do we know from ECG Strip #1?
a. atrial capture and ventricular sensing
b. atrial and ventricular sensing
c. ventricular sensing
d. none of the above
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ic
d.
32. Which of the following would be programmed in ECG Strip #1 to confirm atrial
sensing?
a. decrease low rate
b. increase low rate
c. increase AV interval
d. decrease AV interval
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18
E=(V2/R)*t
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39. b
40. d
41. b
42. d
43. c
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I=V/R=5v/.33 Kohm
20. c
21. b
22. a
23. d
24. b
25. d
26. d
27. a
28. c
29. b
30. a
31. a
32. c
33. b
34. c
35. b
36. d
37. d
38. c
ic
d.
1. a
2. b
3. c
4. a
5. c
6. d
7. d
8. a
9. b
10. a
11. a
12. c
13. c
14. d
15. a
16. b
17. a
18. b
19. b
.p
w
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E
C
B
A
E
D
B - False
B - False
B - False
A - True
B - False
B - True
C
A
C
D
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9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
ac
er
2.
3a.
3b.
3c.
3d.
3e.
4a.
4b.
4c.
4d.
4e.
4f.
5.
6.
7.
8.
C
D
False
False
True
True
False
False
False
True
False
True
True
C
E
C
D
ic
d.
1.
25.
.p
w
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D
F
All True
# 1-3 False,
# 4 True
# 1&3 True,
# 2&4 False
C
F
E
B
D
A
False
True
True
False
False
False
True
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21.
22.
23.
24.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
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er
2
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
D
D
B
B
C
B
E
D
A
D
B
E
D
D
C
A
C
A
C, E
B
ic
d.
1.
w
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d.
C
B
D
B
E
B
C
D
B
C
A
D
C
D
D
C
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18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
.p
2. B
3. A
4. C
5. B
6. D
7. C
8. A
9. B
10. D
11. A
12. C
13. C
14. D
15. C
16. D
17. A
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CRT Quiz
co
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ic
d.
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3. What 2 classes of drugs should be used with all heart failure patients?
a. ACE and BETA
b. BETA and Statins
c. BETA and Antiarrhythmic
d. BETA and Digoxin
.p
4. Epidemiological databases indicate that the mortality for patients who present
with heart failure is what at 2-3 years after diagnosis?
a. 15%
b. 35%
c. 50%
d. 70%
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5. What drug should be administered to all patients with symptomatic heart failure
when they become stable as well as patients with LV dysfunction after MI? Antihypertensive
a. Beta-Blocker
b. Anti-thrombolytic
c. Anti-arrhythmic
6. Match the following drugs to their appropriate classification:
Furosemide
Captopril
Carvedilol
Eplerenone
A. Beta-blocker
B. ACE-inhibitor
C. Aldosterone-antagonist
D. Diuretic
7. Do patients whose condition appear stable remain at risk for disease progression?
a. Yes
b. No
8. In clinical practice, what should be done first for heart failure treatment
a. ACE inhibitor
b. Beta-Blocker
c. Diuretics to rid excess volume
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ic
d.
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11. What causes the abnormal motion of the ventricular septum in a patient with a
LBBB?
a. The early activation of the LV
b. The Interventricular dyssynchrony and abnormal pressure gradient
between the ventricles
c. Early opening of the Aortic valve leading to decreased ventricular filling
.p
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13. Where is the place on the LV that shows the greatest improvement in dp/dt and
pulse pressure according to Path-CHF I?
a. Lateral
b. Posterior
c. Mid-Lateral
d. Apical
14. Is there evidence to support that a patient with a normal QRS and clinical heart
failure can have Interventricular dyssynchrony and can benefit from CRT?
a. Yes
b. No
15. What is a secondary effect of the decrease in MR and LV dimension from CRT?
a. Less VT
b. Less PVCs
c. Decrease in LA dimension
16. Identify the optimized AV delay for this patient. Explain your rationale.
AV 240
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AV 280
AV 180
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AV 200
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17. Please identify what device operation is occurring within this strip from a patient
with an InSync III 8042?
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18. What are the indications for CRT-ICD? (Mark all that apply)
a. NYHA class 2, 3
b. EF 35%
c. QRS 150 ms
d. Stable medical therapy
e. ICD indication
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19. This is a ventricular threshold test in the InSync 8040 device. What do you think
is going on and how do you fix it?
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21. A positive R-wave in Lead I would suggest a signal coming from where?
a. Left ventricle to right
b. Right ventricle to left
C
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27. Identify the veins in this venogram. What is the target lead placement site for the
LV lead in this venogram?
Balloon
D
Balloon
Catheter
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Ostium
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d.
Guide
Catheter
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28. In the normal state, sinus impulses from the junction of the RA reach the LA
primarily through the
a. Atrial septum
b. SA node
c. Roof of the atrium (Bachmanns Bundle)
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35. Septal to lateral wall delay by M-mode echo of more than what may be a good
predictor of CRT response?
a. 100ms
b. 130ms
c. 150ms
d. 180ms
36. ICD therapy for those at risk for having arrhythmias is
a. Primary prevention
b. Secondary prevention
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e. MUSTIC
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41. The following study demonstrated the benefit of CRT in improving patient risk
for heart failure hospitalization and mortality:
a. MADIT
b. CONSENSUS
c. COMPANION
d. COPERNICUS
e. AVID
CRT Quiz
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3. What 2 classes of drugs should be used with all heart failure patients?
a. ACE and BETA
b. BETA and Statins
c. BETA and Antiarrhythmic
d. BETA and Digoxin
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4. Epidemiological databases indicate that the mortality for patients who present
with heart failure is what at 2-3 years after diagnosis?
a. 15%
b. 35%
c. 50%
d. 70%
5. What drug should be administered to all patients with symptomatic heart failure
when they become stable as well as patients with LV dysfunction after MI?
a. Anti-hypertensive
b. Beta-Blocker
c. Anti-thrombolytic
d. Anti-arrhythmic
6. Match the following drugs to their appropriate classification:
Furosemide
Captopril
Carvedilol
Eplerenone
D
B
A
C
A. Beta-blocker
B. ACE-inhibitor
C. Aldosterone-antagonist
D. Diuretic
7.Do patients whose condition appear stable remain at risk for disease progression?
a. Yes
b. No
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8.In clinical practice, what should be done first for heart failure treatment
c. ACE inhibitor
d. Beta-Blocker
e. Diuretics to rid excess volume
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11. What causes the abnormal motion of the ventricular septum in a patient with a
LBBB?
a. The early activation of the LV
b. The Interventricular dyssynchrony and abnormal pressure gradient
between the ventricles
c. Early opening of the Aortic valve leading to decreased ventricular filling
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13. Where is the place on the LV that shows the greatest improvement in dp/dt and
pulse pressure according to Path-CHF I?
a. Lateral
b. Posterior
c. Mid-Lateral
d. Apical
14. Is there evidence to support that a patient with a normal QRS and clinical heart
failure can have Interventricular dyssynchrony and can benefit from CRT?
a. Yes
b. No
15. What is a secondary effect of the decrease in MR and LV dimension from CRT?
a. Less VT
b. Less PVCs
c. Decrease in LA dimension
16. Identify the optimized AV delay for this patient. Explain your rationale.
AV 240
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AV 180
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AV 200
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AV 280
Full E & A wave without A wave truncation. Therefore we will pace the ventricles at
the end of active filling and not interfere with the atrial contribution.
17. Please identify what device operation is occurring within this strip from a patient
with an InSync III 8042?
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VSR
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18. What are the indications for CRT-ICD? (Mark all that apply)
a. NYHA class 2, 3
b. EF 35%
c. QRS 150 ms
d. Stable medical therapy
e. ICD indication
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19. This is a ventricular threshold test in the InSync 8040 device. What do you think
is going on and how do you fix it?
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This is a LV lead dislodgement. The V EGM shows a large deflection after the A
sense. The LV lead is sensing atrial activity demonstrated by the initial VS that
is associated with the P wave and not the QRS complex on the surface ECG.
Also note only 1 sense with the QRS. The RV is still sensing ventricular activity
but the LV lead has dislodged and is probably in the main CS, therefore sensing
Atrial activity.
Suggest a chest X-ray and will probably need a lead revision to regain LV
capture.
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21. A positive R-wave in Lead I would suggest a signal coming from where?
a. Left ventricle to right
b. Right ventricle to left
22. What are the inferior leads?
a. II, III, aVF
b. I, aVL, V4
c. V4-V6
d. V1, aVR, III
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27. Identify the veins in this venogram. What is the target lead placement site for the
LV lead in this venogram?
Balloon
Catheter
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Ostium
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Guide
Catheter
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Balloon
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C. Main CS D. AIV
B is target
28. In the normal state, sinus impulses from the junction of the RA reach the LA
primarily through the
a. Atrial septum
b. SA node
c. Roof of the atrium (Bachmanns Bundle)
29. Programming a short AV delay causes
a. Late closure of the Mitral valve
b. Early closure of the Mitral valve
30. Short AV delays cause
a. Long diastolic filling time
b. Short diastolic filling time
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35. Septal to lateral wall delay by M-mode echo of more than what may be a good
predictor of CRT response?
a. 100ms
b. 130ms
c. 150ms
d. 180ms
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40. The following studies demonstrate the benefit of CRT on heart failure patient
functional status (ie, Quality of Life, NYHA Class, etc) Circle ALL that apply:
a. HOPE
b. MIRACLE
c. Contak CD
d. SOLVD
e. MUSTIC
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41. The following study demonstrated the benefit of CRT in improving patient risk
for heart failure hospitalization and mortality:
a. MADIT
b. CONSENSUS
c. COMPANION
d. COPERNICUS
e. AVID
Defib Questions.
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5. If external defibrillation is necessary, the preferred position for external Defib pad
placement in a patient with an implanted ICD is:
a. anterior-posterior
b. anterior-anterior with pads placed right pectoral and left lateral
c. apex-posterior
d. none of the above.
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5. If external defibrillation is necessary, the preferred position for external Defib pad
placement in a patient with an implanted ICD is:
a. anterior-posterior
b. anterior-anterior with pads placed right pectoral and left lateral
c. apex-posterior
d. none of the above.
Quiz
ICD Indications
Which of the following is not a class I indication for ICD implantation?
a. Cardiac arrest due to ventricular fibrillation (VF) or ventricular
tachycardia (VT) not due to a transient or reversible cause.
b. Syncope of undetermined origin with clinically relevant,
hemodynamically significant sustained VT or VF induced at EP study
when drug therapy is ineffective, not tolerated, or not preferred.
c. Patients with LV ejection fraction of less than or equal to 30%, at least one
month post myocardial infarction and three months post coronary artery
revascularization surgery.
d. Nonsustained VT with coronary disease, previous myocardial infarction,
left ventricular dysfunction, and inducible VF or sustained VT at EP tudy
that is not suppressible by a class I antiarrhythmic drug.
2.
3.
This study showed a 34% reduction in mortality for patients with nonischemic
cardiomyopathy, NSVT and low EF who received ICD therapy vs. optimal
medical therapy.
a. MADIT II
b. SCD-HeFT
c. DEFINITE
d. CABG-PATCH
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1.
5.
The only clinical trial which led to a class I indication for ICD implantation
for primary prevention of SCD was:
a. MADIT
b. MADIT II
c. SCD-HeFT
d. DEFINITE
Quiz
ICD Indications
Which of the following is not a class I indication for ICD implantation?
a. Cardiac arrest due to ventricular fibrillation (VF) or ventricular
tachycardia (VT) not due to a transient or reversible cause.
b. Syncope of undetermined origin with clinically relevant,
hemodynamically significant sustained VT or VF induced at EP study
when drug therapy is ineffective, not tolerated, or not preferred.
c. Patients with LV ejection fraction of less than or equal to 30%, at least
one month post myocardial infarction and three months post coronary
artery revascularization surgery.
d. Nonsustained VT with coronary disease, previous myocardial infarction,
left ventricular dysfunction, and inducible VF or sustained VT at EP tudy
that is not suppressible by a class I antiarrhythmic drug.
2.
3.
This study showed a 34% reduction in mortality for patients with nonischemic
cardiomyopathy, NSVT and low EF who received ICD therapy vs. optimal
medical therapy.
a. MADIT II
b. SCD-HeFT
c. DEFINITE
d. CABG-PATCH
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1.
5.
The only clinical trial which led to a class I indication for ICD implantation
for primary prevention of SCD was:
a. MADIT
b. MADIT II
c. SCD-HeFT
d. DEFINITE
Quiz
ICD Programming
This feature is designed to avoid delayed detection when an arrhythmia
straddles the VT and VF zones of an ICD:
a. FVT via VF
b. Auto-adjusting sensitivity
c. Combined count detection
d. Express TherapyTM
2.
3.
4.
The Guidant Atrial View detection enhancements add which of the following
features to stability and onset (choose all that apply):
a. A Rate > V Rate
b. AV Dissociation
c. Lookback
d. A Fib Rate Threshold
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1.
6.
7.
Quiz
ICD Programming
This feature is designed to avoid delayed detection when an arrhythmia
straddles the VT and VF zones of an ICD:
a. FVT via VF
b. Auto-adjusting sensitivity
c. Combined count detection
d. Express TherapyTM
2.
3.
4.
The Guidant Atrial View detection enhancements add which of the following
features to stability and onset (choose all that apply):
a. A Rate > V Rate
b. AV Dissociation
c. Lookback
d. A Fib Rate Threshold
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1.
6.
7.
Quiz
ICD Troubleshooting
What are the benefits of storing a far-field electrogram for ICD episode
analysis?
2.
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a.
b.
c.
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1.
3.
How can you tell whether the ventricular EGM is near-field or far-field?
4.
5.
Are multiple therapies (more than two) in a single episode always indicative
that the therapies are inappropriate? What about shocks? Why or why not?
Quiz
ICD Troubleshooting
1.
What are the benefits of storing a far-field electrogram for ICD episode
analysis?
How can you tell whether the ventricular EGM is near-field or far-field?
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a.
b.
c.
d.
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2.
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Look at all of the noise on the EGM, then notice that the marker channel is
showing normal ventricular sensing. If the tip or ring conductors were
involved over sensing on the V channel would have been noted
4.
5.
Are multiple therapies (more than two) in a single episode always indicative
that the therapies are inappropriate? What about shocks? Why or why not?
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NASPE PRE-TEST
History: A VVIR pacemaker was implanted three months earlier. The ECG
demonstrated loss of capture and intermittant loss of sensing.
1) Regarding the X-ray on the previous page. The ECG problems described
were most likely the result of:
A. inappropriate programming
B. twiddlers syndrome
C. lead fracture
D. right ventricular perforation
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2) Regarding the X-ray on the previous page. Based on the X-ray image, the
most probable indication for pacing in this patient was:
A. sarcoidosis induced AV block
B. hypertensive cardiomyopathy
C. congential AV block
D. sick sinus syndrome
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6) Which of the following assessments could one make from the tracing
above?
A. appropriate atrial and ventricular capture
B. appropriate atrial and ventricular sensing
C. appropriate rate response function
D. appropriate SVT discrimination
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7) The most likely pacing indication for this patient would be?
A. intermittent CHB
B. tachy-brady syndrome
C. hypertrophic obstructive cardiomyopathy
D. vasovagal syncope
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8) In the printout above, which of the following measured values would not
be considered normal?
A. cell impedance and battery current
B. battery voltage and cell impedance
C. atrial and ventricular lead impedance
D. atrial amplitude and ventricular lead impedance
E. both A and C
9) Based on the printout above, which of the following would be the most
likely ECG manifestation(s) of the abnormal telemetry readings?
A. change in magnet rate
B. intermittent failure to output on the atrial and ventricular channels
C. loss of atrial capture and ventricular oversensing
D. no ECG manifestations
E. premature battery depletion
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10) Dislodgement of the atrial lead is best assessed from which fluoroscopic
view?
A. anteroposterior
B. left anterior oblique
C. right anterior oblique
D. lateral
11) Of the ECG's above (A-D), which would be the most likely ECG follow up
presentation if the patient's indication for pacing was hypertrophic obstructive
cardiomyopathy?
A. A
B. B
C. C
D. D
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15) What is the most likely explanation for a new pacing system that fails to
pace in the bipolar configuration, but paces normally in the unipolar
configuration?
A. loose anodal setscrew
B. loose cathodal setscrew
C. unipolar lead
D. outer coil fracture
16) Which of the following detection enhancements improves specificity in
a patient with Ashman's phenomena?
A. onset
B. QRS morphology
C. stability
D. AV dissociation
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History: This 63 year old male with no known structural heart disease was
implanted with a defibrillator. The patient is also on antiarrhythmic drug
therapy for his tachyarrhythmias.
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History: The following strip was saved during a mode switch episode. The
device is programmed to DDDR LR60, UTR140, USR140.
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18) The pacing rate increases following the mode switch due to:
A. device switched to a tracking mode
B. rate responsive pacing at time of mode switch
C. smoothing algorhythm associated with mode switch
D. atrial oversensing
E. noise reversion pacing
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19) The DDD pacemaker implanted in a 75 year old male with an old
anterior myocardial infarction is set to a lower rate of 60 ppm, a MTR of 100
ppm, an AVI of 200 ms, an ARP of 350 ms and a VRP of 300 ms. The
Wenckebach interval is:
A. 0 ms
B. 50 ms
C. 75 ms
D. 100 ms
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21) Given the above ECG, which of the following best describes the
pacemaker function: (Mode: DDD, LR 60 ppm, AVI 200ms, UTR 100 ppm)
A. atrial oversensing
B. atrial undersensing
C. pacemaker wenckebach
D. pacemaker mediated tachycardia
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22) Given the above ECG, which of the following best describes the
pacemaker function. (Mode: DVI, LR 70 ppm, AVI 200 ms)
A. normal DVI pacemaker function
B. atrial undersensing or atrial oversensing
C. ventricular undersensing or ventricular oversensing
D. atrial or ventricular loss of capture
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24) Given the above ECG/Marker Channel, which of the following is most
clearly demonstrated? (Mode DDD, LR 60ppm, AVI 200ms, UTR 125,
PVARP 225ms)
A. atrial sensing
B. atrial capture
C. ventricular sensing
D. ventricular capture
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26) Which formula demonstrates that a pulse duration longer than the
chronaxie has relatively little effect on threshold voltage and stimulation
energy?
A. V = IR
B. E = V (squared) / R x T
C. E = I x V x T
D. CO = SV x HR
E. None of the above
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History: A 72 year old male was implanted with his third pulse generator
for sinus node disease. In addition, the patient has had two leads implanted
coinciding with the initial implant and the first generator change. The
current generator is attached to the original lead. The ventricular threshold
measures 3.0 V and .60 ms PW with R-waves measuring 7.0 mV.
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27) Regarding the X-ray image and history above. Considering the lead
system and current stimulation threshold, which of the following problems
did this patient most likely experience?
A. diaphragmatic stimulation
B. crosstalk
C. undersensing
D. oversensing
28) Regarding the X-ray image above. Event counters indicated 23%
ventricular pacing at a rate of 60 bpm in the VVI mode. The patient
complains of some palpitations and fatigue at rest. This patient would
probably best be served by programming his device to which of the
following settings?
A. VVI at 50 bpm
B. VVI at 70 bpm
C. VVIR at 50 bpm
D. VVIR at 70 bpm
E. DDD at 60 bpm
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29) What is the appropriate clinical response to a patient whose ICD reaches
the ERI after five years without a single shock?
A. conduct EP studies to determine if an ICD is needed
B. replace the ICD
C. reduce follow-up visits
D. explant the ICD and use drug therapy
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30) Which of the following settings are desirable when biventricular pacing
for heart failure in a 62 year old patient with no history of significant
arrhythmias?
A. mode switch on, UTR 120 ppm, ventricular sensitivity 1.4mV
B. mode switch off, UTR 120 ppm, ventricular sensitivity 2.8mV
C. mode switch on, UTR 150 ppm, ventricular sensitivity 1.4mV
D. mode switch off, UTR 150 ppm, ventricular sensitivity 2.8mV
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33) Which of the following V-V intervals is considered optimal when the
LV lead is placed in a lateral or anterior-lateral cardiac vein?
A. LV + 0 ms
B. LV - 5 ms to - 30 ms
C. LV + 5 ms to + 30 ms
D. LV - 40 ms to - 80 ms
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History: This 64 year old female was implanted with a DDD pacemaker
following an open heart procedure. The nursing staff questioned the
pacemaker functioning and called in the pacemaker representative to
evaluate the system. Below is seen an ECG tracing with a mean arterial and
pulmonary artery pressure tracing of 76 mm Hg and 53/22 mm Hg,
respectively.
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41) What would be the most likely reason for the frequent rapid ventricular
pacing in this patient?
A. pacemaker mediated tachycardia
B. intermittent tracking of atrial fibrillation
C. inappropriate rate modulation
D. tracking of atrial flutter
42) Which of the following drugs is not known for increasing the likelihood
of Torsade de Pointes?
A. lidocaine
B. quinidine
C. procainamide
D. sotalol
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History: A 78 year old male was implanted 14 months earlier with a DDDR
pacemaker for high grade AV block. The patient has a history of COPD,
CHF, and myoplasty. At the time the ECG below was recorded the patient
was in respiratory arrest. The pacemaker is programmed to DDDR with a
lower rate of 70 ppm and max tracking rate of 120 ppm.
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43) Which of the following modes does the pacemaker in the ECG above
appear to be functioning?
A. DDD
B. VDI
C. DVI
D. VDD
44) Which of the following scenarios would be the MOST likely explanation
for this patient's intermittent loss of capture?
A. intrinsic refractoriness of hypoxic tissue
B. unstable lead position
C. intermittent conductor fracture
D. inappropriate programming of output
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History: A 58 year old male was implanted 3 months earlier with an ICD
following an EP study performed for unexplained syncope. He has been
admitted to the hospital for reevaluation of his arrhythmias and medical
therapy due to his frequent shocks. (17 in first 3 months)
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45) Based on the above ECG, which of the following would best describe
this patient's arrhythmia?
A. atrial fibrillation with aberrancy
B. monomorphic ventricular tachycardia
C. polymorphic ventricular tachycardia
D. ventricular fibrillation
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46) In light of the frequent shocks and the EGM featured above, which of
the following therapies would be most appropriate to consider?
A. shock only
B. antitachy pacing then shock
C. antitachy pacing, cardioversion, then shock
D. cardioversion of the atrial fibrillation
47) When should Mitral valve closure occur?
A. after the E wave
B. during the A wave
C. at the very end of the A wave
D. delayed a set time after the A wave
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History: This 91 year old female was implanted 3.5 years ago with a
Telectronics Model 1250 pulse generator with Medtronic 4058M and 4004M
leads in the atrium and ventricle respectively. The initial indication for
DDDR pacing was tachy-brady syndrome but the patient had since
developed chronic atrial fibrillation and was programmed to VVIR mode.
The following telemetries and ECGs were obtained during routine
asymptomatic follow-up. Telemetry strip #1 corresponds with ECG strip #1
and telemetry strip #2 corresponds with ECG strip #2.
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48) With regards to the case presented on the previous page and the ECG
above: Having only reviewed the ECGs and knowing the history of the
implanted hardware, one would be suspicious of the:
A. pacemaker
B. atrial lead
C. ventricular lead
D. both A and C
E. both B and C
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49) In light of the telemetry readings, the most likely explanation for the
ECG strips is:
A. a short circuit in the soft header connector block
B. an atrial lead fracture
C. a ventricular lead fracture
D. normal inhibition of the pulse generator
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54) Doubling the distance from the radiation source reduces the level of
radiation exposure by:
A. 1/2
B. 1/3
C. 1/4
D. 1/8
E. It depends on whether the radiation is ionizing
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History: A 79 year old male had a CPI Model 926 DDDC pacemaker
implanted for second degree Mobitz type II heart block. The patient's
chronic follow-up visits consistently demonstrated a reliable escape rhythm.
Thirty months following the implant, the patient called the clinic stating that
he did not feel well and thought his pacemaker should be checked. The
patient was instructed to come to the pacemaker clinic and the following
telemetry and ECG strips were obtained.
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57) The fact that the pacemaker was firing intermittently in the ventricle at
360 beats per minute represents a failure of the pacemaker's:
A. reed switch
B. runaway protection circuit
C. Zener diode
D. noise reversion response
E. rate response sensor
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58) If the programming change that was done resulting in the second ECG
on the previous page had not been successful, an appropriate step for the
physician would be to:
A. defibrillate the patient
B. underdrive pace
C. place a temporary lead if the patient is unstable
D. cut the lead wires
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59) Eligibility criteria for the MADIT and MUSTT studies of ICD therapy
included all of the following except:
A. dilated left ventricle
B. coronary artery disease
C. reduced ejection fraction
D. nonsustained ventricular tachycardia
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63) This patient's one year risk of experiencing sudden cardiac death is
about:
A. 5%
B. 10%
C. 30%
D. it depends on his/her age
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This ECG was taken from a patient implanted with a DDD pacemaker for sinus
node disease.
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64) The patient's underlying atrial rate on ECG on the previous page is
approximately:
A. 47 bpm
B. 57 bpm
C. 67 bpm
D. too variable to assign one rate
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66) Regarding the ECG on the previous page: Intrinsic R-waves measured
14 mV and Intrinsic P-waves measured 1.8 mV in this patient. Repeated
isometric testing with appropriate programming of sensitivities in this
patient would most likely yield the following results:
A. atrial undersensing
B. ventricular oversensing
C. atrial oversensing
D. both A and B
E. both B and C
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History: A 66-year old male was implanted with a dual chamber ICD due to
a monomorphic VT at a rate of 150 bpm. This patient also suffers from a
dilated cardiomyopathy with an EF of 23%. His bradycardia requires dual
chamber pacing approximately 75% of the time. On this occasion the
patient was seen in the clinic for routine evaluation.
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69) In the case above and on the preceding page, what detection
enhancements are programmed on for this patient?
A. V rate > A rate
B. Stability
C. Onset
D. None
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70) In the case on the two preceding pages, what kind of rhythm does the
atrial intracardiac electrogram show?
A. sinus tach
B. atrial flutter
C. atrial fib
D. ventricular fib
ic
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71) In the case on the two preceding pages, what therapy is delivered during
this episode?
A. Ramp ATP
B. Burst ATP
C. Ramp/Scan ATP
D. Shock
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73) A patient's DDDR pacemaker is set to a lower rate limit of 60 ppm and
an upper tracking rate of 130 ppm. After a few minutes of converstion at
follow-up, the pacemaker is pacing at 110 ppm. Which of the following
programmed parameters should be adjusted?
A. sensitivity setting
B. sensor threshold
C. rate response slope
D. activities of daily living rate
E. upper sensor rate
74) The most common indication for permanent pacing is:
A. sick sinus syndrome
B. acquired AV block
C. chronic bifascicular block
D. carotid sinus syndrome
28
75) A pacemaker patient with lung cancer is scheduled for radiation therapy.
What precautions must be taken?
A. none, radiation does not affect the IPG
B. turn therapies off during treatment
C. avoid directing the radiation beam on the IPG
D. shield the IPG and limit the field of radiation
ic
d.
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76) Which of the following outputs are safest and most efficient for a
threshold measured at 2.0 V and .5 ms?
A. 4.0 V and .5 ms PW
B. 2.0 V and 1.5 ms PW
C. 4.0 V and 1.0 ms PW
D. 2.5 V and .6 ms PW
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77) What is the characteristic range of lead impedance for a high voltage
lead?
A. 800 to 1,000 ohms
B. 100 to 300 ohms
C. 20 to 70 ohms
D. 100 to 250 ohms
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78) The optimal tilt per phase for single capacitor biphasic waveforms is in
the range of:
A. 35% to 55%
B. 40% to 65%
C. 50% to 80%
D. 60% to 75%
79) Pulling back on a dedicated bipolar transvenous ICD lead can affect the
DFT by:
A. moving the distal coil closer to the ventricular apex
B. moving the distal coil closer to the proximal electrode
C. moving the distal coil away from the proximal electrode
D. moving the distal coil away from the ventricular apex
29
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History: The printout below was taken from a moderately active 78 year
old male implanted with a DDDR pacemaker.
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80) The event summary would seem to indicate that this patient is:
A. chronotopically competant
B. chronotopically incompetant
C. in need of mode switch turned on
D. in danger of sudden cardiac death
E. none of the above
81) The programmed rate adaptive settings in the above patient would most
likely correspond with which of the following:
A. initiate rate response with heavy activity and increase rate slowly
B. increase rate slowly and initiate rate response with light activity
C. initiate rate response with light activity and increase rate rapidly
D. increase rate rapidly with medium to heavy activity
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84) Loss or intermittent loss of atrial sensing may result in which of the
following:
A. falsely high PVC count
B. inappropriate rate drop response therapy
C. frequent safety pacing
D. Both A and B
E. All of the above
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89) Which of the following studies compared the benefits of controlling rate
vs. maintaining the sinus rhythm in patients at high risk for atrial
fibrillation?
A. AFFIRM
B. MIRACLE
C. COMPANION
D. MUSTIC
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33
Pacer Questions: 46
1, 2, 3, 6, 7, 8, 9, 11, 12, 15, 18, 19, 20, 21
22, 24, 25, 27, 28, 31, 32, 37, 41, 43, 44, 48
49, 56, 57, 58, 61, 64, 65, 66, 73, 74, 75, 76
80, 81, 82, 83, 84, 85, 88, 89
CRT Questions: 7
30, 33, 39, 47, 50, 51, 68
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X-ray Questions: 8
1, 2, 10, 27, 28, 50, 51 75
ic
d.
ICD Questions: 28
4, 5, 13, 14, 16, 17, 29, 34, 37, 38, 45, 46, 52
53, 55, 59, 60, 62, 69, 70, 71, 72, 77, 78, 79
86, 87, 90
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Drug Questions: 3
4, 42, 53
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Indications Questions: 7
2, 7, 11, 12, 60, 62, 74
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Topics
X-Ray, Twiddler Syndrome
X-Ray, Pediatric Indications
Ohms law, longevity calculation
AntiArrythmic Medications
Tachy Concepts
Sensing/Capture, Rate Drop Response
Indications, Rate Drop Response
Lead Failure, lead impedance
Lead Failure, lead impedance
Fluro / X-ray views, lead dislodgement
Pacing in HOCM
Indications, HOCM
ICD implant protocol, VF testing
DFT's, Coil placement
Implant troubleshooting
ICD Detection Enhancements
Episode recognition / diagnostics
Mode Switching
Upper rate behavior
Lead maturation
Upper rate behavior
Ventricular Safety Pacing, DVI mode
Physiology of Depolarization
ECG troubleshooting
Energy, threshold concepts
Energy, threshold concepts
X-Ray, LV pacing issues, Complications
Pacemaker Syndrome
Indications, ERI
CRT Programming
Defibrialltion of Pacer Patients
Evaluation of retrograde conduction
CRT V-V timing
Tachy Diagostics, atrial cardioversion
Complications, Infection
Complications, Infection
Tachy theory, Re-entry pathology
Atrial Cardioversion for AF
AF leads to CHF
Pulmonary arterial pressure
ECG troubleshooting
Drugs, Torsade de Pointes
Mode Recognition
Cardiac Physiology
Rhythm Recognition, VT
Treatment of polymorphic VT
CRT - Echo AV optimization
Recall knowledge
Recall knowledge
X-ray / fluoro, Cardiac Anatomy
X-ray / fluoro, CRT follow up issues
Epicardial patch, complications
ic
d.
Twiddler Syndrome
Congential AV Block
Increase longevity
Sotalol
None of the above
Appropriate A & V sensing
vasovagal syncope
A & V lead impedance
loss of A capture, V oversensing
Lateral
C - As Vp with short AV
Class Iib
Least sensitive setting
Cardiac Vein
loose anodal setscrew
Stability
sinus-VT-sinus
smoothing algorhythm
50 ms
Fibrous Layer
Pacemaker Wenckebach
Normal DVI (with VSP)
minus 60 mv to minus 70 mv
Ventricular Sensing
Chronaxie
E = V(squared) / R x T
Diaphragmatic Stimuation
VVI at 50 ppm
replace the ICD
Msoff,UTR150,vsense2.8
AP position
retrograde conduction
LV-5msto30ms
AF with cardioversion
50-65%
Staph Epi
area of ischemic tissue
lower than Vent. Thresholds
All of the above
High
intermittent tracking of AF
lidocaine
VDI
refractory hypoxic tissue
polymorphic VT
shock only
at the very end of the A wave
both A and C
short circuit in pacer
Coronary Sinus
2 V thresholds, stability LV lead
All of the above
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B
C
B
A
D
B
D
C
C
D
C
C
A
D
A
C
B
C
B
B
C
A
C
C
A
B
A
A
B
D
A
C
C
B
D
D
D
A
D
C
B
A
B
A
C
A
C
D
A
A
D
E
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Answer Answer
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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
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
.p
Question
90
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m
drug effects
Radiation Effects
ICD Detection Enhancements
Rate hysteresis
runaway pacemaker
runaway pacemaker
ICD Clinical Studies
ICD Indications
EMI, oversensing
ICD indications, CRT indications
Epidemiology / Heart Disease Stats
calipers / rate assessment
Troubleshooting, Noise
Troubleshooting, Noise, Sensing
ECG leads, basic ECG
Echo, CRT
ICD Detection Enhancements
Rhythm Recognition, Afib
ATP therapy, Rhythm Recognition
ICD Detection Enhancements
Rate Response
Epidemiology / Heart Disease Stats
Radiation Effects
Threshold Safety Margins
Tachy function / electrical impedance
Tachy function / tilt
Tachy function, lead placement
Rate Response
Rate Response
ECG troubleshooting
Rate Drop Response
Atrial Undersensing
Implant troubleshooting
ICD Detection Enhancements
ICD Troubleshooting, lead failure
Troubleshooting, electrolytes
Clincal Studies
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B
C
A
B
B
D
A
B
A
D
B
A
E
C
A
C
D
C
A
A
B
A
D
A
C
B
D
B
C
A
D
E
D
B
D
B
A
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53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
Tachy Concepts