Download CCDS IBHRE Actual Exam Questions And Correct Answers Latest Version 2024-2025 A+ Graded and more Exams Nursing in PDF only on Docsity!
Answers Latest Version 2024-2025 A+ Graded
CCDS IBHRE Actual Exam Questions And Correct
Answers Latest Version 2024-2025 A+ Graded
Rheobase - Correct Answer-the lowest point on a strength duration curve at an infinitely long pulse duration Chronaxie time - Correct Answer-the pulse width at twice the rheobase value. It approximates the most efficient stimulation pulse duration Charge (formula) - Correct Answer-Charge= I(current) x T(time) Furman's formula - Correct Answer-Energy(microjoules)= I(current)xV(voltage)xT(pulse width) Ohms law formula - Correct Answer-Voltage(electromotive force)= I(current/flow of electrons) x R(resistance to current flow in ohms) Functional Refractory Period - Correct Answer-the coupling interval which first results in a measurable degree of delay in impulse conduction Effective Refractory Period - Correct Answer-the longest coupling interval to be associated with block Devices with NO interaction with pacers - Correct Answer-1. microwave oven, 2. CT scan/Ultrasound 3. X-rays (diagnostic) Devices that cause transient or 1 beat inhibition - Correct Answer-1. EAS 2. Cellphones
- Arc Welding 4. airport metal detector 5. TENS 6. Electric appliances such as electric blanket & power tools Devices that may damage the pacemaker - Correct Answer-1. MRI 2. Defibrillator 3. Cardioversion 4. Cautery/RF Ablation 5. Radiation Therapy Resistance in Series - Correct Answer-Series means the beginning of one resistance is connected to another Sum the resistances: R1+R2= total resistance. EX: A LEAD FRACTURE (fractures INCREASE impedance) Resistance in Parallel - Correct Answer-Parallel means all the resistances are connected to the same point. (R1xR2)/(R1+R2)= total resistance
Answers Latest Version 2024-2025 A+ Graded
EX: LEAD INSULATION DEFECTS (insulation defects DECREASE impedance) Permanent pacemakers are constant voltage or constant current? - Correct Answer-ALL permanent pacemakers are constant voltage devices. SOME temp pacemakers are constant voltage, most are constant current. LOAD - Correct Answer-Load refers to impedance (or resistance) applied to a circuit. A system with a SMALL load (low impedance) applied to the circuit is said to be a constant current device A system with LARGE load is said to be a constant voltage device Guidelines for Permanent Pacing - Correct Answer-1. Patient is symptomatic
- The heart rate is less than 40 bpm
- Asystole of greater than 3 seconds is documented NOTE: Pt may be asymptomatic with 2 or 3 Slew Rate - Correct Answer-Slew rate = peak slope of an electrogram slew rate= change in voltage/ change in time Normal slew rate in atrium - Correct Answer->.3 V/s Normal slew rate in ventricle - Correct Answer->.5V/s Steroid used in electrodes - Correct Answer-dexamethasone sodium phosphate in the silicone core(a corticosteriod) Steroid-Eluting Electrodes - Correct Answer-1. The acute threshold is relatively flat compared to non-steroid electrodes
- The initial capture threshold is similar to non-steroid leads Silicone Rubber lead insulation Pros - Correct Answer-1. Can easily be repaired
- Flexible
- Proven performance history
- Easy to make Silicone Rubber lead insulation cons - Correct Answer-1. high friction coefficient
- Absorbs lipids
- More thrombogenic and fibrotic
- Cuts easily
Answers Latest Version 2024-2025 A+ Graded
sensor upper rate behavior - Correct Answer-if the sinus rate is faster than the sensor indicated rate, P synchronous pacing occurs if the sensor indicated rate is faster, AV pacing at the sensor indicated rate occurs mixed scenario: when the device is sensor driven AV pacing for a few cycles and a sinus rate sudden emerges faster than the sensor indicated rate. The sensor driven atrial output will be inhibited, a PR interval started, and a ventricular output will occur at the end of the sensor AV interval. That is, the ventricular rate will be equal to the sensor indicated rate, but the PV interval may be longer than expected Medtronic Rate Drop Response - Correct Answer-1. Increase in HR (Pacer is programmed to a top rate)
- Rise in HR is immediately followed by a fall in HR. (pacer is programmed to a "bottom" rate 3.The HR drop must be identified, therefore a number of "Width" beats must be programmed the HR must fall to the bottom rate in fewer than the programmed "width" beats
- To confirm the rate drop, a small number of confirmation beats must be programmed. The HR must remain below the bottom rate for this number of confirmation beats in order for the algorithm to activate Tilt Testing Results for RDR - Correct Answer-1. An initial rise in the HR to a value at or above the "Top Rate" must occur
- A rapid fall in HR must then follow
- A fall in BP resulting in symptoms must occur next
- Syncope should not occur until the HR has dropped by 20-30 bpm X-ray Exposure (formula) - Correct Answer-Exposure= exposure rate x time Longevity calculation - Correct Answer-longevity is usable battery in Amp Hours Pacer current drain = in micro amps hours in one year = 8760 hours Usable battery capacity/pacer current drain = # of hours Battery longevity (in yrs)= 114x(Ahr battery capacity)/(current drain in uA)=c Bisping Coaxial Lead - Correct Answer-Bisping is an extendable/retractable helix type lead. MDT owns the patent Chagas disease - Correct Answer-Vector: kissing bug in central & south America Symptoms: acute heart infection & symptoms subside within 4 to 8 weeks
Answers Latest Version 2024-2025 A+ Graded
If goes unrecognized, the disease can surface 10-20 yrs later in the form of chronic heart disease. Infected heart muscle fibers are replaced by scar tissue, thinning the walls of the heart. The nervous system may also be affected Persistent SVC - Correct Answer-SVC connects to RA via CS (90%) Lyme's Disease - Correct Answer-Varying degrees of AV block Upper Limit of Vulnerability - Correct Answer-the weakest shock strength at or above which VF is not induced when the shock is delivered at any time during the vulnerable period. AVNRT - Correct Answer-- AV node can be thought of as divided into two conduction pathways
- premature impulse is blocked in the fast pathway
- impulse travels down the slow pathway
- impulse again reaches the fast pathway in retrograde fashion
- impulse then reenter the slow pathyway rule of thumb for AVNRT ablation, which pathway should you ablate? (slow vs fast) - Correct Answer-slow pathway because ablation of fast pathway will significantly increase the risk of complete heart block a successful ablation of slow pathway in AVNRT is indicated by: - Correct Answer-1. an accelerated junctional rhythm with 1:1 VA conduction during the burn
- an increase in refractoriness of the anterograde AV node
- elimination or alteration in dual AV nodal physiology Complication of fast pathway ablation in AVNRT - Correct Answer-1. high grade heart block
- marked first degree heart block
- pseudo-pacemaker syndrome caused by prolonged AV conduction times resulting in atrial contraction during AV valve closure
- persistence of atypical AV nodal reentry implying slow pathways as both the antegrade and retrograde limbs of the tachycardia p wave characteristics in AVNRT - Correct Answer-- negative in inferior leads
- positive in V Resting (transmembrane) potential - Correct Answer-the voltage difference between the inside and the outside of the cell fiber
Answers Latest Version 2024-2025 A+ Graded
- morphology of the QRS complex resembling J point elevation
- related to sudden death
- structurally normal heart
- based on phase 2 of the action potential retry due to Na channel involvement Brugada syndrome presentation - Correct Answer-1. syncope and sudden death caused by fast, POLYMORPHIC ventricular tachycardia or ventricular fibrillation
- no warning
- no prolongation of the QT interval during sinus rhythm
- only in very few cases there is alternation of long-short sequences before the polymorphic VT
- no preceding acceleration in the heart rate as the case of catecholamine-dependent polymorphic VT Brugada syndrome EP findings - Correct Answer-1. majority of the patients with normal sinus node
- 10% with afib
- inducibility of VF - easily induced by 1 or 2 ventricular pacing, or 3.
- sustained VF, cause hemodynamic collapse, and requires external DC
- HV interval is prolonged in about half of the patients, but rarely exceeding 70ms Drugs that are primarily eliminated by liver - Correct Answer-- quinidine
- mexiletine
- propafenone
- verapamil
- procainamide
- flecainide
- moricizine
- diltiazem
- lidocaine
- encainide
- amiodarone Drugs that are primarily eliminated by kidneys - Correct Answer-- disopyramide
- tocainide
- bretylium
- sotalol
- digoxin AAD eliminates through the vascular endothelium, erythrocytes - Correct Answer- adenosine drugs that increase the digoxin level - Correct Answer-- quinidine
- flecainide
- propafenone
Answers Latest Version 2024-2025 A+ Graded
- amiodarone
- verapamil lidocaine and beta blockers - Correct Answer-beta blocker increases lidocaine level medications use with beta blocker cause additive inotropic effects - Correct Answer-- disopyramide
- flecainide medications that use with beta blocker cause increase beta blocking effect - Correct Answer-- amiodarone
- propafenone medications that use with calcium channel blockers cause additive inotropic effect - Correct Answer-- flecainide
- propafenone
- disopyramide type IA antiarrhythmic drugs - Correct Answer-- quinidine
- procainamide
- disopyramide type IB antiarrhythmic drugs - Correct Answer-- lidocaine
- mexiletine type IC antiarrhythmic drugs - Correct Answer-- flecainide
- propafenone
- moricizine type II antiarrhythmic drugs - Correct Answer-beta blockers type III antiarrhythmic drugs - Correct Answer-- amiodarone
- bretylium
- dofetilide
- ibutilide
- sotalol type IV antiarrhythmic drugs - Correct Answer-- calcium channel blockers
- verapamil
- diltiazem drugs that increase DFT threshold - Correct Answer-- lidocaine
- diphenlhydantoin
- quinidine
- flecainide
Answers Latest Version 2024-2025 A+ Graded
AV delay interval - Correct Answer-the period of time between the atrial output pulse and the ventricular output pulse maybe fixed or variable atrial channel is refractory PV delay interval - Correct Answer-also known as p tracking interval may be a fixed or variable value What can start a PV interval - Correct Answer-sensed atrial events including
- far field R wave
- noise or extraneous noise events
- retrograde p wave progressive lengthening of PV interval during increase rate - Correct Answer- pacemaker wenkebach sensed p rate is faster than the programmed maximum tracking rate or upper rate interval when should you see pacemaker pacing below base rate? - Correct Answer-VDD pacing when AV interval is started when the p wave is sensed and delays the ventricular output AR interval - Correct Answer-begins when the atrial escape interval (AEI) is allowed to "time out" completely. An atrial output occurs at the end of the AEI, the AV delay interval is started but is interrupted by a sensed ventricular channel event(usually an intrinsic R wave) Ventricular based timing pacemaker - Correct Answer-the sensed R wave causes the atrial escape interval timer to the next atrial output is based on when and where the R wave is sensed if the AV delay interval is programmed to 200ms and the sensed R wave occurs at 150ms, the next atrial output will occur 50ms earlier. Hence, the base rate will be faster What is the atrial output interval after a PVC if the pacemaker AV delay is set at 200ms and programmed to 60ppm - Correct Answer-60ppm = 1000ms 1000ms - 200ms AV delay 800ms 4 states of DDD pacing - Correct Answer-AV, PV, AR, PR when will the PR interval greater than the set AV delay? - Correct Answer-if the sinus rate is greater than the upper rate limit of the ventricular pacing
Answers Latest Version 2024-2025 A+ Graded
device longevity formula - Correct Answer-114 x (Ahr battery capacity)/(current drain in uA) = Longevity in years Ashman's disease - Correct Answer-occasional wide complex beats during atrial fibrillation with a right bundle branch morphology are due to aberrant conduction Bisping Coaxial lead - Correct Answer-Bisping - an extendable/retractable helix type lead. The helix or screw is active How can you determine Dextrocardia vs a flipped X ray - Correct Answer-1. look at the gastric bubble
- look at the "L" marker types of pacing leads: unipolar and bipolar - Correct Answer-1. unipolar - consisting of an outer insulator and a conductor (the cathode)
- bipolar - consisting of an outer insulator, an outer conductor (the anode), an inner insulator, and an inner conductor (the cathode) what are the clinical presentations when the outer insulator becomes compromised in a unipolar system - Correct Answer-- muscle stimulation
- myopotential inhibition
- myopotential tracking
- reduced lead impedance
- noisy electrogram
- possible attenuation (damping) of the pacemaker artifact
- capture threshold may appear to increase
- ventricular lead insulation defects above the tricuspid valve may result in p wave sensing if the outer insular becomes compromised in a bipolar system, the clinical presentation will be ... - Correct Answer-- muscle stimulation
- myopotential inhibition
- myopotential tracking
- reduced lead impedance
- noisy electrogram
- capture threshold may appear to increase
- ventricular lead insulation defects above the tricuspid valve may result in p wave sensing ****unipolarization of the output spike (larger than normal spike) ****programming the device to unipolar sensing/pacing should eliminate the effects if the inner insulator become defective... - Correct Answer-1. "Make/break" signals may be visible
- pauses due to detection of the make/break signals
Answers Latest Version 2024-2025 A+ Graded
how to calculate the rate smoothing atrial and ventricular window - Correct Answer-atrial window = (previous RR interval +/- rate smoothing value) - AV delay ventricular window = (previous RR interval +/- rate smoothing value) downside of rate smoothing function - Correct Answer-may lead to VA conduction and PMT because a PAC will lead to delay AV conduction Chagas disease - Correct Answer-the vector is in insect parasite Trypanosoma cruizi an acute infection of the heart is the main result, damaging the heart muscle heart muscle fibers are slowly replaced by scar tissue, thinning the walls of the heart, severely affecting heart function, and ultimately resulting in death serial connections - Correct Answer-uses a single impedance to determine the output current parallel connection - Correct Answer-occur when there are two independent impedance the sum of the output current is used to determine the final lead impedance crosstalk - Correct Answer-an inappropriate detection of a pacemaker-generated event in one channel by the sensing of the other channel that causes inhibition of the second channel's output When does crosstalk occur? - Correct Answer-1. when the atrial output is at a high value (>5V)
- the ventricular sensitivity is high (usually <1mV)
- when the insulation has been rubbed away from two leads in very closed proximity and the energy is transferred to the ventricular lead at the time of an atrial output how to prevent crosstalk - Correct Answer--a detection window immediately after the atrial output pulse
- device resets the AVD interval
- at the end of the shortened AVD a ventricular output is issued
- or increase the ventricular blanking period how to minimize pain for transcutaneous external pacing? - Correct Answer-- increase electrode surface area
- longer pulse duration
- placing electrode over area with least skeletal muscle persistent left SVC - Correct Answer-connecting to the right atrium via coronary sinus
- if it connects to the left atrium then it causes right to left shunt of a rather small magnitude
Answers Latest Version 2024-2025 A+ Graded
Lyme disease prevalence and presentation - Correct Answer-- most common tick-borne disease presentation:
- erythema migrans - an expanding red rash, usually round or oval in shape
- develops 7-14 days after tick detachment
- arthalgias, fatigue, headache, neck pain, +/- fever
- if not treated, 60% of patients will develop monoarticular or oligoarticular arthritis, typically involved the knee
- some 10% will develop neuro manifestation - facial nerve palsy
- 5% without cardiac complication - AV block treatment of lyme disease - Correct Answer-doxycycline 10-20 days ceftriaxone in patients with AV block or lyme carditis cardiac manifestation of Lyme disease - Correct Answer-- palpitation, lightheadedness, syncope in heart block
- chest pain and dyspnea in lyme pericarditis
- tamponade
- cannon A wave in the neck
- cardiac rub S3 or S4 with myocarditis
- CHF symptoms Antitachycardia pacing - Correct Answer-a sequence of pacing impulses faster than the tachycardia rate in an attempt to terminate an arrhythmia
- placing the pacing lead close to reentry site may increase ATP effectiveness Effects of ATP - Correct Answer-1. no effect
- accelerate the tachycardia(may lead to ventricular flutter or vfib)
- terminate the arrhythmia Advantages and disadvantages of ATP - Correct Answer-advantage:
- minimal symptoms, immediate delivery of therapy disadvantage:
- may need multiple burst, may accelerate the arrhythmia, prolonged high voltage therapy difference between RAMP and BURST - Correct Answer-burst pacing stimuli are delivered at a fixed cycle length ramp pacing successively decreases the intervals between pulses within a burst ramp step - Correct Answer-the amount by which each pacing interval within a burst is decremented during ramp pacing scan step - Correct Answer-the amount the cycle length changes from one burst to the next during scanning
Answers Latest Version 2024-2025 A+ Graded
On Shock Strength and time axes to determine shock pulse, which is on the t axis? - Correct Answer-Ordinate - shock strength lead tip materials - Correct Answer-- platinum/Iridium
- Elgiloy
- Silver/stainless steel combo
- Activated vitreous carbon
- Platinum with Titanium Nitride coating nearly all leads contain a steroid eluting capsule containing dexamethasone The sprayed or sputtered newer leads with fine coating of TiN, activated vitreous carbon, Elgiloy, silver or other substance provide... - Correct Answer-- lower polarization
- fibrous ingrowth
- a smaller fibrous capsule
- lower impedance which may improve sensing
- lower current and voltage to improve the stimulation threshold What are the types of lead insulation? - Correct Answer-silicone rubber and polyurethane polyurethane leads P80A and P55D - which one is no longer used - Correct Answer- P80A is no longer used because it tends to biodegrade, resulting in cracks and insulation failure pros of silicone rubber leads - Correct Answer-repairable, low process sensitivity, easy to fabricate, very flexible pros of polyurethane insulation - Correct Answer-high tear strength, resistant to cutting, low friction, thin, abrasion resistant, relatively nonthrombogentic/fibrotic cons of silicone rubber insulation - Correct Answer-tears/cuts easily low abrasion resistance high friction thicker more thrombogenic and fibrotic cold flow failure calcifies due to absorption of lipids cons of polyurethane insulation - Correct Answer-not repairable stuff difficult to build
Answers Latest Version 2024-2025 A+ Graded
four possible insulator/conductor configurations for pacing electrodes - Correct Answer-
- Coaxial configuration - with an inner coil being the cathode and the insulator wrapped with a conductor being the anode
- two insulated, unifilar conductors surrounded by lead body insulation
- bipolar lead with a quadrifilar inner coil insulated by a thin layer of silicone or polyurethane, then the quadrifilar anodal coil that is insulated with the outer coating of the lead
- Unipolar lead with quadrifilar coil is surrounded by insulator The connector - IS-1 and IS- 4 - Correct Answer-IS-1 connector body incorporates a maximum diameter of 3.23mm with cathodal pin diameter of 1.59mm, or .34mm larger than the connector pin for the DF-1 connector. This prevents the low voltage lead from being accidentally connected to a high voltage port in a defibrillator. differences and similarities of IS-1, VS-1A, and IS-1B or VS-1B - Correct Answer-they are all 3.2mm diameter VS-1A has longer receptacle for lead terminal while VS-1B has sealing rings in header AND longer receptacle for lead terminal. Tetralogy of Fallot - Correct Answer-- ventricular septal defect
- many levels of obstruction from the RV to the lungs(pulmonary stenosis)
- the aorta lies directly over the ventricular septal defect
- the RV develops thickened muscle temporary surgical intervention: shunt between the aorta and the pulmonary artery complete repair: close the ventricular septal repair, opens the RV outflow tract by removing some thickened muscle below the pulmonary valve, repairing or removing the pulmonary valve and enlarging the peripheral pulmonary arteries. Sometimes a tube is placed between the RV and the pulmonary artery(Rastelli repair). Transposition of the Great Arteries - Correct Answer-- the aorta and pulmonary artery are reversed
- the aorta receives the oxygen-poor blood from the RV, then carried back to the body without receiving more oxygen, the pulmonary artery receives the oxygen-rich blood from the LV but carries it back o the lungs surgical treatment: requires surgery early in life! Temp intervention: enlarge the PFO and lets the blood mix
- tunnel between the atria (atrial or venous switch= Mustard procedure=Senning procedure)2. arterial switch operation(switching the aorta and the pulmonary artery back). then reattach the coronary arteries also Truncus Arteriosus - Correct Answer-- a large ventricular septal defect which single great vessel carries blood both to the body and to the lungs
Answers Latest Version 2024-2025 A+ Graded
Possible outomes of programming in a "common ring" configuration in LV lead when the anodal electrode of the RV lead is used as anodal electrode of the coronary sinus lead - Correct Answer-- simultaneous biventricular activation
- but if the LV capture threshold is greater than the RV anodal capture threshold, then there may be RV anodal only capture observing biventricular pacing assoicated with LV versus RV capture - Correct Answer-- a change from BV to LV capture was best identified as increasing positivity of the QRS in lead III
- a change from BV to RV capture was best recognized as increasing positivity of the QRS in lead I different ways for atrial tachyarrhythmia to be detected - Correct Answer-1. "rate cutoff" criterion: the sensed atrial rate exceeds a programmable value
- "Running average rate" criterion: the atrial rate exceeds a mean atrial rate calculated by the pacemaker from the duration of the preceding atrial rate
- "sensor determined" physiological rate to distinguish sinus rhythm from atrial tachyarrhythmia
- Complex algorithms that combine one or more of the above criteria , with or without additional methods such as examining the AV relationship Capacitor - Correct Answer-a device that stores an electric charge on closely spaced conductors(plates) Capacitance - Correct Answer-a measure of the amount of electric charge stored for a given electric potential capacitance formula - Correct Answer-C=Q/V (capacitance = charge / voltage) Farad - Correct Answer-the capacitance of a dielectric for which a potential difference of one volt results in a static charge of one coulomb ICD capacitors are generally rated at between about 90 and 150 microfarads the smaller the capacitor - Correct Answer-the greater the amount of voltage required to deliver an equal charge to the tissue. The greater the voltage, the faster the charged is delivered advantages of lithium/iodine cells battery - Correct Answer-1. the self discharge rate is very low, which gives the pacemaker a long shelf life
- the voltage characteristics remain stable, allowing a clear delineation between working voltage, recommended replacement time, and end of service
Answers Latest Version 2024-2025 A+ Graded
battery capacity in Ah(Ampere Hours), total or usable capacity - Correct Answer-Total battery = capacity includes the unusable capacity and overestimates the usefulness of the cell by about 10 percent Usable capacity = takes into account the lithium cells are only usable for about 85 to 90% of their total capacity Companion trial - Correct Answer-36% reduction in mortality in the CHF-defibrillator group decrease in total mortality and total hospitalization in CRT/CRT-ICD group SCD-HeFT trial - Correct Answer-amiodarone has no effect on mortality but there is a 23% decrease risk of death for ICD therapy MADIT I trial - Correct Answer-comparing antiarrhyhmic drug vs ICD in mortality reduction relative reduction of 54% in the risk of death in ICD group than antiarrhythmic drug group mortality rate in antiarrhythmic drug group was higher than those in ICD group MADIT II trial - Correct Answer-prophylactic ICD in patients with prior MI and LVEF <30%, group of patients with ICD vs conventional medical therapy absolute mortality reduction in the ICD group and relative reduction of 31% in the risk of death in the ICD group the study was stopped early because of the benefit in survival for patients receiving the ICD AVID trial - Correct Answer-largest trial but shortest, using antiarhythmics vs ICD , most patients in AAD group receives amiodarone patients with LVEF =35% survival was comparable, but for those with LVEF <35% survival from all cause and arrhythmic death was superior in patients who received ICD therapy MUSTT trial - Correct Answer-randomized patients with inducible ventricular arrhythmia to no AAD or EP guided therapy ICDs reduced the risk of sudden death, but antiarrhythmic drug therapy was not effective CASH trial - Correct Answer-randomized patients to ICD, amiodarone, and metoprolol. Mortality in the metoprolol group was similar to amiodarone. The benefit of ICD therapy is more evident during the first five years after the index event
