ECG Question - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-19-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default ECG Question

A 66 year old man comes for a routine check up ,he feels well apart from occasional cough which he tells, he is use to from a long time . He drinks alcohol 2 beers in weekends and he smokes a pack of cigarette since 30 years.He was recently vaccinated for influenza and pneumococcus.He admits of feeling fatigue at times ,but blames it to his age.He gives a history of an angina attack 1 year back ,but was relieved when doctor gave him 'a pill to suck on'.Since then he is been taking only asprin and he said he refused the doctor to take any other drug.He admits to trying smoking cessation ,but he just couldn't do it .His Blood pressure is 130/85,pulse is 80/min and respiratory rate is 18/min.His physical examination is done ,heart sounds were normal.Chest auscultation revealed wheezes and crackled.Spirometry was done and found lower FEV1 to FVC ratio.His chest Xray shows enlarged anterio-posterior diameter.His ECG was done and as was as follows.ECG is showing which of the following conditions

1.Atrial Fibrialltion
2.Multifocal atrial tachycardia
3.Sick Sinus syndrome
4.Wandering pacemaker
5.AV Nodal Re-entrant Tachycardia (AVNRT)
6.Wolf Parkinson White Syndorme



I have made this Question myself,so apologies if its badly worded or has grammatical mistakes ,I just hope a good discussion of the topic ,so that we all can learn together
__________________
"Don't Forget they need us too"

Last edited by step_enhancer; 09-19-2012 at 11:32 AM.
Reply With Quote Quick reply to this message



  #2  
Old 09-19-2012
koolkiller88's Avatar
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 864
Threads: 62
Thanked 374 Times in 225 Posts
Reputation: 384
Default

Wolf Parkinson's white syndrome


Sent from my iPad using Tapatalk HD
__________________
One day i will infect these microbes and they will search for "Anti-MEbiotic"....
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (09-20-2012)
  #3  
Old 09-19-2012
Anders's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 289
Threads: 7
Thanked 129 Times in 102 Posts
Reputation: 139
Default 6

Quote:
Originally Posted by step_enhancer View Post
A 66 year old man comes for a routine check up ,he feels well apart from occasional cough which he tells, he is use to from a long time . He drinks alcohol 2 beers in weekends and he smokes a pack of cigarette since 30 years.He was recently vaccinated for influenza and pneumococcus.He admits of feeling fatigue at times ,but blames it to his age.He gives a history of an angina attack 1 year back ,but was relieved when doctor gave him 'a pill to suck on'.Since then he is been taking only asprin and he said he refused the doctor to take any other drug.He admits to trying smoking cessation ,but he just couldn't do it .His Blood pressure is 130/85,pulse is 80/min and respiratory rate is 18/min.His physical examination is done ,heart sounds were normal.Chest auscultation revealed wheezes and crackled.Spirometry was done and found lower FEV1 to FVC ratio.His chest Xray shows enlarged anterio-posterior diameter.His ECG was done and as was as follows.ECG is showing which of the following conditions

1.Atrial Fibrialltion
2.Multifocal atrial tachycardia
3.Sick Sinus syndrome
4.Wandering pacemaker
5.AV Nodal Re-entrant Tachycardia (AVNRT)
6.Wolf Parkinson White Syndorme



I have made this Question myself,so apologies if its badly worded or has grammatical mistakes ,I just hope a good discussion of the topic ,so that we all can learn together
6- WPW syndrom
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (09-20-2012)
 
  #4  
Old 09-19-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Default

Quote:
Originally Posted by step_enhancer View Post
A 66 year old man comes for a routine check up ,he feels well apart from occasional cough which he tells, he is use to from a long time . He drinks alcohol 2 beers in weekends and he smokes a pack of cigarette since 30 years.He was recently vaccinated for influenza and pneumococcus.He admits of feeling fatigue at times ,but blames it to his age.He gives a history of an angina attack 1 year back ,but was relieved when doctor gave him 'a pill to suck on'.Since then he is been taking only asprin and he said he refused the doctor to take any other drug.He admits to trying smoking cessation ,but he just couldn't do it .His Blood pressure is 130/85,pulse is 80/min and respiratory rate is 18/min.His physical examination is done ,heart sounds were normal.Chest auscultation revealed wheezes and crackled.Spirometry was done and found lower FEV1 to FVC ratio.His chest Xray shows enlarged anterio-posterior diameter.His ECG was done and as was as follows.ECG is showing which of the following conditions

1.Atrial Fibrialltion
2.Multifocal atrial tachycardia
3.Sick Sinus syndrome
4.Wandering pacemaker
5.AV Nodal Re-entrant Tachycardia (AVNRT)
6.Wolf Parkinson White Syndorme



I have made this Question myself,so apologies if its badly worded or has grammatical mistakes ,I just hope a good discussion of the topic ,so that we all can learn together

He has Multifocal atrial tachycardia, which is the most common arrhythmia in patients with emphysema/COPD.

If you look carefully at the P waves in the V6 long strip, or even at the others youll see 3 clearly different P wave morphologies.
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (09-20-2012)
  #5  
Old 09-19-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

Everyone try try try !
__________________
"Don't Forget they need us too"
Reply With Quote Quick reply to this message
  #6  
Old 09-19-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 791
Threads: 76
Thanked 673 Times in 317 Posts
Reputation: 691
Default

multifocal atrial tachycardia....three different P wave morphologies and associated lung disease
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (09-20-2012)
  #7  
Old 09-19-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

Quote:
Originally Posted by XpaezX View Post
He has Multifocal atrial tachycardia, which is the most common arrhythmia in patients with emphysema/COPD.

If you look carefully at the P waves in the V6 long strip, or even at the others youll see 3 clearly different P wave morphologies.
Multifocal atrial tachycardia but this patient does not have tachycardia ,his pulse is 75-80 /min
__________________
"Don't Forget they need us too"
Reply With Quote Quick reply to this message
  #8  
Old 09-19-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 460
Threads: 278
Thanked 166 Times in 81 Posts
Reputation: 176
Default

WPW syndrome

there is delta wave
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (09-20-2012)
  #9  
Old 09-19-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 618 Times in 234 Posts
Reputation: 628
Default

No abnormal rhythm or tachycardia so exclude 1, 2, 3, and 5 and no delta wave so exclude 6
May be correct answer is Wandering pacemaker =just coz know nothing about it

Last edited by heartbeat; 09-19-2012 at 11:58 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (09-20-2012)
  #10  
Old 09-20-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

Answer. Wandering paecemaker

Quote:
In cardiology, a wandering pacemaker is an atrial arrhythmia that occurs when the natural cardiac pacemaker site shifts between the sinoatrial node (SA node), the atria, and/or the atrioventricular node (AV node). This shifting of the pacemaker from the SA node to adjacent tissues is identifiable on ECG Lead II by morphological changes in the P-wave; sinus beats have smooth upright P waves, while atrial beats have flattened, notched, or diphasic P-waves.

Ventricular conduction is normal with wandering pacemaker, and thus the QRS complex is normal.

Wandering pacemaker is usually caused by varying vagal tone. With increased vagal tone the SA Node slows, allowing a pacemaker in the atria or AV Nodal area, which may briefly become slightly faster. After vagal tone decreases, the SA Node assumes its natural pace.

It is often seen in the very young, very old, in athletes and rarely causes symptoms or requires treatment
Quote:
Multifocal atrial tachycardia is characterized by an electrocardiogram (ECG) strip with 3 or more P-waves of variable morphology and varying PR intervals, plus tachycardia, which is a heart rate exceeding 100 beats per minute. Narrow QRS complexes are visible as well.

The P-waves and PR intervals are variable due to a phenomenon called wandering atrial pacemaker (WAP). The electrical impulse is generated at a different focus within the atria of the heart each time. WAP is positive once the heart generates at least three different P-wave formations from the same ECG lead. Then, if the heart rate exceeds 100 beats per minute, the phenomenon is called multifocal atrial tachycardia.
So similarities between WAP and MAT are three different morphologies of P wave and varying PR interval
Difference is the heart rate ,if HR >100 its multifocal atrial tachycardia and if HR <100 its wandering pacemaker
__________________
"Don't Forget they need us too"
Reply With Quote Quick reply to this message
The above post was thanked by:
anomali (09-20-2012), XpaezX (09-20-2012)
  #11  
Old 09-20-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Default

WOW never heard of this disease but thanks for the question! now I learnt something good! thanks step_enhancer.. I wont forget from now on
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (09-20-2012)



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
question help: diabetic foot related question dezirablize USMLE Step 2 CK Forum 5 01-15-2015 02:42 PM
a question concerning step1 question length sfsheran USMLE Step 1 Forum 2 01-30-2012 08:29 PM
Set Question list/Different Question for each CC tbk568 USMLE Step 2 CS Forum 0 12-13-2011 01:47 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)