NASPExAM Review

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IBHRE Review Exam Content Areas w
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1) Fundamentals of Electrophysiology and Electronics 2) Applied Science and Technology 3) Pharmacology 4) Electrocardiography 5) Clinical Assessment 6) Pre and Perioperative Practice 7) Safety 8) Device/Patient Follow‐up 9) Clinical Trials 10) Radiology 11) Cardiac Life Support 1 Review Exam
Basic and Applied Science and Technology
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Select the single best answer for the following questions.
1. A function of pacemaker circuitry that allows the pacemaker output pulse to
be dissipated quickly maximizing both the output and sensing capabilities.
a) circuit resistors
b) charge dump
c) pulse neutralizer
d) current consumption
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2. AV sequentially paced patients with frequent ventricular ectopy should have
the following pacemaker parameters programmed to decrease the chance of
competition:
a) short blanking period
b) slower base rate
c) increased ventricular refractory period
d) none of the above
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3. Low threshold electrode materials include each of the following EXCEPT:
a) iridium oxide
b) elgiloy
c) platinized platinum
d) titanium nitride
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4. The strength duration curve resulting in a parabolic shape is described by
which of the following formulas?
a) I x t
b) I x V x t
c) I x R
d) all of the above
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5. The ventriculoatrial conduction time of a pacemaker patient with a typical
endless-loop-tachycardia may be calculated by which equation?
a) (upper rate limit interval) - ( AV delay + PVARP)
b) (upper rate limit interval) - ( AV delay + PVARP + Wenckebach interval
c) (lower rate limit interval) - ( upper rate limit interval)
d) none of the above
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Medical Applications and Indications
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77. What is the national incidence of pacemaker pocket infection?
a) <2%
b) 2-4%
c) 5-10%
d) 10-15%
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78. Acutely, the most frequently identified microorganisms from pacemaker
pocket infections are:
a) Staphylococcus epidermidis
b) Staphylococcus aureus
c) Staphylococcus albus
d) Escherichia coli
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79. An early discrete hematoma at the pacemaker site which does not
compromise the skin integrity of the suture line should be treated by:
a) aspiration
b) heparinization
c) observation
d) debridement
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80. The cardioinhibitory response to carotid sinus massage may be manifested
by:
a) advanced AV block
b) sinus bradycardia
c) PR prolongation
d) all of the above
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81. A potential complication of single lead VDD pacing is:
a) pacemaker syndrome
b) atrial lead dislodgment
c) crosstalk
d) atrial exit block
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Clinical Pacing
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A 72 year old female with complete heart block was implanted with a VVIC
pacemaker. The pacemaker reached its normal ERI demonstrated by a 100 ms
increase in the magnet interval. The following continuous ECG was obtained
during the changeout surgery as the patient was upgraded to a VVIR pacemaker.
A pacing systems analyzer was used to temporarily pace at a rate of 70 ppm
during the changeout procedure.
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Figure: 142
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142. How would one classify this patient’s level of pacemaker dependency?
a) Class I
b) Class II
c) Class III
d) Class IV
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143. Although the chronic lead was connected to the new pacemaker, only
intermittent pacing took place until the pacemaker was securely in the pocket.
This is most likely explained by which of the following?
a) unipolar pacemaker
b) loose set screw
c) mismatch of the Medtronic 3.2 mm lead with the pacemaker connector
d) fractured lead coil
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Clinical ICDs
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259. Autodecremental pacing within a burst is known as:
a) burst pacing
b) scanning
c) marginal underdrive
d) ramp pacing
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260. Which of the following potential pacemaker/defibrillator interactions can
result in defibrillator inhibition in a patient implanted with both devices?
a) double or triple counting of pacing stimuli
b) electromagnetic interference during pacer programming
c) pacemaker in back-up mode
d) pacemaker failure to sense ventricular fibrillation
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261. When defibrillating a pacemaker patient, the defibrillator paddles should be
positioned:
a) anterior/posterior
b) parallel to the pacing system
c) adjacent to the pacing system
d) pacemaker patients should not be defibrillated
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262. Which of the following situations could result in an implanted defibrillator
over-counting?
a) T-wave oversensing
b) unipolar dual chamber pacing
c) electromagnetic interference
d) all the above
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263. Which of the following describes a defibrillator algorithm that discriminates
between atrial fibrillation and ventricular tachycardia on the basis of cycle
length variability?
a) probability density function (PDF)
b) onset
c) stability
d) sustained high rate
264. Types of pacemaker-ICD interaction(s) previously reported include:
a) reprogramming of the pacemaker by ICD discharge
b) double or triple sensing of pacing artifacts and ventricular
depolarizations by the ICD
c) failure of the pacemaker to sense and pace appropriately after ICD
discharge
d) all of the above
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Radiology
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Figure: 330
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330. The above x-ray demonstrates:
A. classic RV apical lead positioning
B. an active ventricular lead
C. a bipolar ventricular lead
D. ventricular lead dislodgment
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331. The above x-ray also demonstrates:
A. RV perforation
B. a prosthetic tricuspid valve
C. a ventricular septal defect
D. a lead insulation break
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Ventricular Resynchronization
Select the single best answer for the following questions.
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356. What would one determine to be the biventricular and right ventricular
threshold, respectively, from the ECG’s below?
a) .3 ms & .2 ms
b) .3 ms & .06 ms
c) .2 ms & .1 ms
d) .2 ms & .03 ms
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