Paramedics Exam Cardiology & Resuscitation 4 — Questions and Answers
Question 1: A patient presents with palpitations. The 12-lead ECG shows a narrow-complex tachycardia at 280 bpm with a delta wave visible during brief slowing. This is most consistent with:
- Atrial fibrillation with aberrant conduction
- Wolff-Parkinson-White (WPW) syndrome (Correct answer)
- AV nodal reentrant tachycardia
- Atrial flutter with 1:1 conduction
Correct answer: Wolff-Parkinson-White (WPW) syndrome
A delta wave and tachycardia exceeding 250 bpm strongly suggest WPW syndrome with an accessory pathway.
Question 2: Which medication is CONTRAINDICATED in a patient with WPW syndrome and atrial fibrillation?
- Amiodarone
- Adenosine (Correct answer)
- Procainamide
- Electrical cardioversion
Correct answer: Adenosine
Adenosine and other AV nodal blockers are contraindicated in WPW with AF as they can accelerate conduction through the accessory pathway causing VF.
Question 3: During resuscitation of a hypothermic cardiac arrest patient, the core temperature is estimated at 28°C. What is the appropriate CPR modification?
- Deliver shocks at double the standard energy
- Continue standard CPR; limit defibrillation attempts until temperature >30°C (Correct answer)
- Withhold CPR to conserve energy
- Give epinephrine every 2 minutes as usual
Correct answer: Continue standard CPR; limit defibrillation attempts until temperature >30°C
In severe hypothermia (<30°C), the heart is often unresponsive to defibrillation; standard CPR continues while rewarming to >30°C.
Question 4: What does the 'T' wave on the ECG represent?
- Atrial depolarization
- Ventricular repolarization (Correct answer)
- Ventricular depolarization
- Atrial repolarization
Correct answer: Ventricular repolarization
The T wave represents ventricular repolarization, the electrical recovery phase of the ventricles.
Question 5: A patient receives lidocaine for a ventricular rhythm but the infusion runs too fast. Which toxicity sign should the paramedic monitor for first?
- Hypertensive crisis
- CNS symptoms such as confusion, seizures, or altered mental status (Correct answer)
- Severe bradycardia
- Anaphylaxis
Correct answer: CNS symptoms such as confusion, seizures, or altered mental status
Lidocaine toxicity first manifests as CNS symptoms including perioral numbness, dizziness, confusion, and seizures.
Question 6: Which of the following correctly describes pulseless electrical activity (PEA)?
- Disorganized chaotic electrical activity with no pulse
- Organized electrical activity on ECG but no detectable pulse (Correct answer)
- No electrical activity and no pulse
- Rapid narrow-complex tachycardia without a palpable pulse
Correct answer: Organized electrical activity on ECG but no detectable pulse
PEA is defined as organized electrical activity visible on ECG without a corresponding palpable pulse or blood pressure.
Question 7: During a 12-lead ECG acquisition in a patient with chest pain, you note new ST elevation in V1–V4. This pattern is most consistent with an occlusion of which vessel?
- Right coronary artery
- Left anterior descending artery (Correct answer)
- Left circumflex artery
- Posterior descending artery
Correct answer: Left anterior descending artery
Anterior STEMI (ST elevation in V1–V4) indicates occlusion of the left anterior descending (LAD) artery.
Paramedics Exam Cardiology & Resuscitation 4
A patient presents with palpitations.
The 12-lead ECG shows a narrow-complex tachycardia at 280 bpm with a delta wave visible during brief slowing.
This is most consistent with: