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IBHRE CEPS TEST FINAL EXAM 2024-2025 ACTUAL EXAM AND PRACTICE EXAM QUESTIONS COMPLETE, Exams of Health sciences

IBHRE CEPS TEST FINAL EXAM 2024-2025 ACTUAL EXAM AND PRACTICE EXAM QUESTIONS COMPLETE ACCURATE EXAM QUESTIONS WITH DETAILED VERIFIED ANSWERS (100% CORRECT ANSWERS). GRADED A

Typology: Exams

2024/2025

Available from 12/19/2024

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Download IBHRE CEPS TEST FINAL EXAM 2024-2025 ACTUAL EXAM AND PRACTICE EXAM QUESTIONS COMPLETE and more Exams Health sciences in PDF only on Docsity!

IBHRE CEPS TEST FINAL EXAM 2024-2025 ACTUAL

EXAM AND PRACTICE EXAM QUESTIONS

COMPLETE ACCURATE EXAM QUESTIONS WITH

DETAILED VERIFIED ANSWERS (100% CORRECT

ANSWERS). GRADED A

% of filling volume from different methods - ANSrapid diastolic filling (suction cup) = 60% Diastasis (passive filling) = 25% Atrial kick (active filling) = 15-20% % of pathways that are bidirectional - ANS60% 1 cm =? mV - ANS1 cm = 1 mV 1 small box on EKG is how many ms/ seconds - ANS40 ms / .04 s 2 most common complications during PVI procedures - ANS1. PV stenosis

  1. Cardiac tamponade 2 things to monitor to prevent phrenic nerve damage - ANS1. pacing phrenic
  2. observe inhalation on fluoro (if one side stops moving=bad) 3 things that change automaticity of automatic cells - ANS1. slope of phase 4
  1. Change of threshold potential
  2. Change of resting membrane potential 6 P's of acute arterial occlusion - ANS1. Pain
  3. Pulseless
  4. Paralysis
  5. Paraesthesia (numbness)
  6. Polar (coldness)
  7. Pallor a systole is represented by what portion of the ECG - ANSQT interval ACLS definition - ANSadvanced cardiac life support ACT for using array - ANSACT 250- ACT when pulling - ANSshould be less than 160 Adherence to tissue with cryocath is indicated by - ANSdistal electrode electrical noise advantage of bipolar leads - ANSless prone to EMI noise Afterload - ANSThe force or resistance against which the heart pumps (force opposing ejection of blood). Increased afterload will decrease CO

arterial pulse pressure - ANSthe difference between systolic and diastolic blood pressure asymptomatic phrenic nerve damage can be seen with - ANShemidiaphragm on x- ray (half of diaphragm is elevated) At rest, what is intracellular/extracellular environment - ANSinside negative, outside positive athletes lower heart rate due to - ANSintrinsic decreased SAN rate Baylis NRG RF Transseptal needle has - ANSSide holes for pressure and contrast Bazett's formula - ANScorrected QT = QT/Square root of RR interval // it is used to correct for patients heart rate because QT becomes shorter at faster rates Beck's Triad - ANSAcute signs of tamponade (hypotension, distended neck veins, distant heart sounds) Best leads to look at for LV acute MI (septal, anterior, lateral, posterior, inferior) - ANSSeptal: V1, V Anterior: V3, V Lateral: 1, aVL Posterior: V1-V4 (reciprocal changes) Inferior: II, III, aVF

Best needle to use for pericardial space via subxyphoid approach - ANSTuohy needle Best numbers for ventricular lead - ANSThreshold <1 V / Sensing >4 mV bipolar cardiac electrodes record local _________ that occur during phase _______ - ANSdepolarizations / phase 0 Blood pressure ranges - ANSSystolic- less than 120 Diastolic- less than 80 BP equation - ANSBP = CO x SVR C to F - ANSF=9/5C+ Cardiac muscle cell depol occurs via what channel - ANSNa+ fast channel Carotid sinus massage - ANS-chronotropic effect CO equation - ANSCO = HR x SV Coagulum - ANS-Denatured protein from boiled blood -when blood at surface of tissue/electrode interface begins to boil at 100 C, this causes coagulum formation

-rapid rise in impedance Common complication with high femoral artery punctures - ANSRetroperitoneal hemorrhage or bleeding into the belly Cryomapping performed at what specs? - ANS-30 C for <60s Diaphragmatic surface of LV is - ANSinferior wall dicrotic notch - ANSmarks beginning of LV diastole doppler transducer uses what - ANSsingle piezoelectric crystal that sends and receives During which phases is cell refractory - ANS1,2, each small box on EKG is how big - ANS1 mm each small box on y axis of EKG is how many mV - ANS1 box = 0.1 mV Earliest phase of infarction - ANSSeen by tall upright T waves ("hyperacute T waves") EF equation - ANSEF = SV/EDV

EKG changes with myocardial ischemia - ANSInverted T / ST depression EKG characteristic most associated with transmural MI - ANSpathalogic Q waves EKG monitored patient should be __________, monitor chassis should be ___________ (nonconductive). Why - ANSungrounded, grounded. Grounded patient would be able to conduct leakage currents. we dont want this Electrical cardioversion is contraindicated in what patients - ANS-hypokalemia (makes them arrhythmia prone) -Digitalis toxicity -presence of atrial thrombus F to C - ANSC=5/9(F-32) fastest blood flow - ANSaorta Fentanyl antagonist - ANSNaloxone Fentanyl use during procedure - ANSpain relief first heart sound - ANSclosing of AV valves first medication given to all ACLS patients - ANSOxygen

First sign of acute injury to myocardium - ANSST elevation Fourth heart sound (S4) - ANSvery soft, low-pitched ventricular filling sound that occurs in late diastole Fr to mm - ANS1 Fr = .33 mm holding pressure: venous vs arterial sheath removal - ANSVenous: on the site / Arterial: just above How do ultrasound transducers work - ANSTransducers convert one form of energy into another. Ultrasound transducers convert electric signals into ultrasonic energy. The ultrasonic energy is transmitted into tissues, bounces back and then is converted back to electric energy How each is measured: Diagnostic catheter OD , Inflated balloon cath OD, Needle OD, Guide wire - ANSDiag: Fr / Balloon: mm / Needle: gauge / GW: inch (thousandth of inches) how many electrodes for 12 lead EKG - ANS10: RA, LA, RL, LL, V1-V ICE advantage over TEE - ANSGeneral anesthesia not needed for ICE In cardiovascular doppler, what is target off of which ultrasound waves are reflected back - ANSRBC's

Infundibulum - ANSAKA Conus arteriosus / outflow track of RV (RVOT) inferior to the pulmonary valve Inner/outer diameter of FlexCath - ANS12 Fr/15 Fr Inotropism - ANSintrinsic ability of heart to contract with particular intensity inspiration results in - ANSincreased heart rate and RV stroke volume, increased venous return, decreased intracardiac pressure Instructions to patient after femoral artery puncture - ANS1. Keep head down

  1. hold puncture site when coughing
  2. keep leg straight
  3. stay in bed
  4. drink fluids
  5. call nurse if symptoms isovolumetric relaxation - ANS-Ventricles relax (no change in volume) -Ventricular pressure becomes < aortic pressure = semilunar valves shut -2nd heart sound occurs in this phase (closing of semilunar valves) -dicrotic notch occurs -beginning of V Diastole -all valves closed -once V pressure is less than atrial, AV valves open and passive filling occurs (end of isovolumetric relaxation)

largest mean blood pressure drop occurs where - ANSarterioles lb to kg - ANS2.2 lb = 1 kg leads I and III during appropriate Bi-V pacing and why - ANSbecause Bi-V pacing simultaneously conducts straight upward, I will be small/isoelectric and III will be negative. Left coronary blood flow occurs during what and why - ANSdiastole because diastole releases compressed endocardial capillaries Loculated definition - ANSMeans effusion is in small compartments (localized to certain area in the heart) Long QT / AV block - ANS-long QT = increased refractory period of ventricular tissue -this can cause functional block between his bundle and ventricular tissue due to increased refractoriness -can lead to 2:1 block and severe bradycardia Long vs short QT with calcium - ANSLong QT = hypocalcemia short QT = hypercalcemia lowest blood pressure - ANSSVC / IVC

LV pacing only I and III - ANSI is negative and III is positive (LV pacing looks like an LV PVC with a RBBB pattern) LV PVC's - ANS-more likely to precipitate VF -more often associated with heart disease main cause of BB reentry VT - ANSdilated cardiomyopathy (SHD) Main EKG difference: AVNRT vs ORT - ANS-ORT usually always has distinct P waves after the QRS due to sequential ventricular-atrial activation -AVNRT usually does not have distinct P waves due to simultaneous A/V contraction main thing to watch for when using irrigated catheter with CHF patients/dialysis patients - ANShypervolemia Morady maneuver is used to differentiate - ANSdifferentiate AT from AVNRT/AVRT Most common arrhythmia - ANSAF Most common chamber of perforation in right/left heart cath - ANSRV most common complication of uncontrolled hypertension - ANScerebral hemorrhage

Most common form of idiopathic VT in patients with no structural heart disease is

  • ANSRVOT VT Most common SVT - ANSAVNRT Most important measure of LV function - ANSEF Most of the lesion is due to what and why is this important - ANS-conductive heating 2-5 mm below surface -important because it means we have to ablate for at least 30-60 seconds to allow for conductive heating to form a full lesion neurotransmitter at parasympathetic nerve junctions - ANSacetylcholine Never do what with cryoballoon - ANSnever pull balloon sheath of catheter, only pull it back onto shaft / dont pull back while frozen Nodal depolarization occurs via what channel - ANSCa2+ slow channel non compensatory pause vs compensatory - ANSnon: PAC's due to resetting of SAN / comp: PVC's causing refractory AVN with following P wave not conducting Normal EGM filter settings - ANS30 - 300 Hz Normal QTc value - ANS<450 ms

notch filter - ANSused to filter AC (60 Hz) interference / on EKG without notch, it can look like vibrating baseline occlusion of dominant coronary arteries most likely leads to - ANSAV Block Ohm's law equation - ANSV=IR Order of pulling sheaths - ANSshould pull arterial, hold pressure, then pull venous (Kern) OT VT mechanism - ANScAMP mediated DAD's (triggered activity) P value - ANSProbability of certainty / smaller p value means the more likely the result could not occur by chance Patient position for pericardiocentesis - ANSPropped to 45 degrees to allow for effusion to pool in more anterior/inferior portion of heart PEA - ANS-pulseless electrical activity -organized cardiac electrical depolarizations with no mechanical contraction -EKG usually looks like bradycardia but no pulse is detected -most commonly caused by hypovolemia -can be corrected by fluid administration Peak exercise, why BP doesnt significantly elevate even though CO may increase 7 fold? - ANSdecreased systemic VR

Pericardium - ANS-visceral pericardium is layer closest to heart -pericardial fluid is in between the visceral and parietal pericardium. -the fibrous pericardium is the most outer layer on top of the parietal pericardium -serous pericardium: visceral and parietal Preload - ANSend diastolic filling or stretching of ventricles. Increased preload means increase SV Preload occurs during - ANSV diastole programmed stimulation - ANSConsists of incremental pacing and extrastimuli Propofol - ANSanesthetic, sedative PVC common characteristics - ANSWide (>120 ms) with bizarre shaped, opposite direction T waves RVOT VT EKG - ANS-LBBB appearance -monomorphic -usually non-sustained -inferior axis -precordial transition occurs AFTER lead V3 (usually in V4) second heart sound - ANSclosure of semilunar valves

Sharp, curved GW used to go transseptal - ANSSafeSept Guidewire significant Q waves - ANSRepresent a TRANSMURAL infarction (>1/3 height of QRS and >.04 sec wide (1 small box)) Slanted AP's - ANS-when pacing from different sites, the orientation of the fibers of the AP can lead to different VA or AV times at certain points ST elevation - ANSinjury Standard deviation - ANSsquare root of variance Standard sizes of micropuncture introducer sets and their purpose - ANS21 gauge needle / .018 inch wire. Purpose of micropuncture introducer set is for placement of .035-.038 inch GW Stereotaxis catheters - ANSHave magnets in tip for maneuverability in response to changes in magnetic field Steroid tip leads reduce acute: - ANSinflammation and stimulation threshold surface EKG leads usually filtered at what - ANS.1 - 100 Hz survival curve showing % of patients surviving treatment over time - ANSKaplan - Meier curves

SV equations - ANSSV = CO/HR SV= EDV - ESV SVC obstruction treatment - ANSstents SVC obstruction usually caused by - ANSindwelling pacer leads (can sometimes see obstruction when shooting contrast) T wave depression - ANSischemia T wave elevation/broadening - ANShyperacute ischemia TDP caused by what mechanism usually - ANSEAD's (triggered activity) TDP rates - ANS200-250 bpm The main factor opposing RF heating is what - ANS-convective cooling (heat loss) to surrounding blood The worm like muscle strands within the RV chamber are termed? - ANSTrabeculae carnea Thermal latency - ANSdeep tissue temps continue to rise for several seconds after RF energy has stopped (conductive heating still occurring even though resistive heating has stopped)

third heart sound - ANSsoft, low-pitched ventricular filling sound that occurs in early diastole and may be an early sign of heart failure Tip inner diameter standard diagnostic cardiac catheters and why - ANS.038 inch / because it is supposed to be used with .035-.038 inch guide wires To rule out pneumothorax, it is most important to order a ____ - ANSPA and lateral chest x-ray typical lesion size of 7 Fr 4 mm dry tip - ANS5-6 mm wide / 2-3 mm deep Typical settings for ablating AP with a 4 mm dry tip - ANS30 W / 60 degrees C -usually creates a lesion 4-5 mm deep -prevents excessive heating and usually uses a temperature controlled setting Ultrasound transducers are composed of - ANSPiezoelectric crystals Unipolar filter setting - ANS.05 - 300 Hz Unipolar leads more prone to - ANS1. EMI / muscle artifact oversensing

  1. pectoralis muscle stimulation (pocket stim) Variance - ANSTake each number in sample, subtract each number from mean, square each difference, add all, divide sum by number in sample -

vascular resistance occurs at - ANSarterioles Verapamil drug class - ANSClass IV Verapamil sensitive fascicular VT - ANS-Verapamil used to treat it -Most common Idiopathic LV VT -Reentry -RBBB -Left axis deviation -usually posterior fascicle Versed use anesthesia - ANSrelieve anxiety, drowsiness vessels with greatest cross-sectional area - ANScapillaries VF provides no - ANSno pulse or cardiac output, patient is clinically dead VOM location - ANSBranch of CS anterior to LPV's Wandering baseline on EKG - ANSusually due to muscle tremor (patient movement) and not due to other issues like electrical what best diagnoses a posterior acute MI and why - ANSV1-V4 ST segment depression (utilizing reciprocal changes) due to the fact that there are no EKG leads on the back to show ST elevation

What happens to pump when coming on ablation - ANSincreases flow (8- ml/min) What increases cardiac filling pressure (CVP) - ANS1. calf muscle contraction

  1. sympathetic vasomotor activity
  2. exercise ANYTHING that increase venous return and thus increases preload What is 2 rules for CMC's like spiral or lasso - ANS1. Only approved for use in LA due to chordae tendinea
  3. Only rotate shaft clockwise What is main ion transfer during systole - ANSK+ seeps out, Ca2+ enters What is reciprocal ekg changes in STEMI? - ANSleads that face the wall opposite to the MI will start have ST depression while the ones on the wall of MI will usually have ST elevation What is used to visualize shunts or distinguish right from left chamber - ANSAgitated saline What landmark is used to find 2nd intercostal space - ANSangle of Louis (junction of manubrium and sternum - bump)

what phase is the beginning of Ventricular diastole - ANSisovolumetric relaxation What phase of AP is resting membrane potential - ANSphase 4 What system remotely steers guided catheters - ANSHansen robotic system What to administer during cardiac arrest and why - ANS-Should administer epinephrine every 3-5 minutes -increases BP (is a strong vasoconstrictor) and CO -enhances defib -increases myocardial and cerebral blood flow What to do if T waves interfere with A/V and why - ANSIncrease the high pass filter because T waves are lower frequency as well as far field What to do when using irrigated ablation catheter at more than 30 W and why - ANSincrease flow rate to 15-30 ml/min to avoid char formation What type of single use devices can be resterilized and why? - ANSDiagnostic EP electrodes because lumen and technically not a catheter because no lumen What will be seen when pericardiocentesis needle touches epicardium - ANSST elevation When do pathalogic Q waves appear on MI patient - ANSin the first day of MI

When does pericardial effusion become tamponade? - ANSWhen cardiac compression begins. The pericardial pressure equals RA and RV diastolic filling pressure. RV preload fails due to inability to fill which causes LV preload and SV to drop. When is BP considered hypertension - ANSSystolic: > Diastolic: > When is BP considered hypotension - ANSSystolic: < Diastolic: < When is ST depression significant? - ANS>1 mm from baseline in V5, V6 / >1.5 mm in aVF or III when measuring EGM's, earliest atrial activation usually from _____ and earliest ventricular usually from ______ - ANSP wave / QRS Where are baroreceptors located? - ANScarotid sinus and aortic arch Where does conductive heating occur - ANS2-5 mm beneath electrode Where does delay occur in AVN - ANSupper region (AN-N) where is blood flow slowest - ANScapillaries

which type of guide wire is 260-300 cm long? - ANSexchange guide wires (much longer than diagnostic catheter) which vessels have most smooth muscle - ANSlarge arteries Which vessels store largest volume of blood - ANSsystemic veins