CET Stress Testing Procedures 3 — Questions and Answers
Question 1: When applying electrodes for a stress ECG, which skin preparation step is most important for reducing artifact?
- Applying conductive gel before the electrode
- Lightly abrading the skin with fine sandpaper or prep pad (Correct answer)
- Warming the electrode in warm water
- Shaving the electrode site only
Correct answer: Lightly abrading the skin with fine sandpaper or prep pad
Light abrasion of the skin removes the outer dead cell layer, significantly lowering skin impedance and reducing motion artifact.
Question 2: What does a horizontal or downsloping ST depression of ≥1mm at 80ms after the J-point during stress testing indicate?
- Normal exercise response
- Myocardial ischemia (Correct answer)
- Left ventricular hypertrophy
- Bundle branch block development
Correct answer: Myocardial ischemia
Horizontal or downsloping ST depression ≥1mm measured 80ms after the J-point is the classic ECG sign of exercise-induced myocardial ischemia.
Question 3: Which of the following is a contraindication to performing an exercise stress test?
- Controlled hypertension with BP 145/90
- Recent acute MI within the past 2 days (Correct answer)
- Stable angina pectoris
- LBBB on resting ECG
Correct answer: Recent acute MI within the past 2 days
Acute MI within the past 2 days is an absolute contraindication because exercise can extend the infarct and precipitate fatal arrhythmias.
Question 4: During a stress test, a patient develops symptomatic second-degree Mobitz II AV block. The correct action is:
- Continue testing and observe for progression
- Reduce the workload to the previous stage
- Immediately terminate the test (Correct answer)
- Administer atropine and continue
Correct answer: Immediately terminate the test
New second-degree Mobitz II or third-degree AV block during exercise is an absolute indication for immediate test termination.
Question 5: The maximum predicted heart rate (MPHR) for stress testing is calculated as:
- 200 minus age
- 220 minus age (Correct answer)
- 180 minus age
- 210 minus half the age
Correct answer: 220 minus age
The standard formula for MPHR is 220 minus the patient's age in years, and 85% of this value defines an adequate submaximal effort.
Question 6: Which lead combination provides the highest sensitivity for detecting ischemia during exercise stress testing?
- Lead I and aVL
- Leads II, III, and aVF
- Lead V5 alone
- V4, V5, and V6 combined with II (Correct answer)
Correct answer: V4, V5, and V6 combined with II
Using leads V4, V5, V6, and II together provides the highest sensitivity for detecting lateral and inferior wall ischemia during stress testing.
Question 7: What is the primary purpose of performing a cool-down walk rather than an abrupt stop at the end of treadmill exercise?
- To allow more time for ECG recording
- To prevent venous pooling and hypotension (Correct answer)
- To reduce muscle fatigue
- To allow the blood pressure cuff to deflate safely
Correct answer: To prevent venous pooling and hypotension
A cool-down walk prevents sudden venous pooling in the legs that can cause post-exercise hypotension and syncope.
CET Stress Testing Procedures 3
When applying electrodes for a stress ECG, which skin preparation step is most important for reducing artifact?