CCDS IBHRE UPDATED 2026 EXAM SCRIPT QUESTIONS
AND SOLUTIONS RATED A+
✔✔Voltage of PPM battery? - ✔✔2.8V
✔✔Voltage of ICD battery? - ✔✔3.2V
✔✔Types of Sensors: Open Loop - ✔✔Only takes in positive feedback; ex: piezoelectric
sensor senses movement -> increased rate until no more sensed movement
✔✔Types of sensor: closed loop - ✔✔More physiologic than open loop; rate changes in
response to physiologic change -> rate stays until physiologic state indicates it needs to
slow (ex: 02 sats)
✔✔Types of Sensors: Primary - ✔✔Detects changes that normal effect the sinus node
(02 sats, myocardial contractilty)
✔✔Types of sensors: Secondary - ✔✔Detects internal changes that result from exercise
✔✔Types of sensors: Tertiary - ✔✔Detects external changes as a result of exercise
(piezoelectric, accelerometer)
✔✔Describe acute threshold graph of steroid eluting lead VS polished platinum post
implat - ✔✔Steroid: low threshold and not much change
polished platinum: bad. High threshold, acute rise, then chronic high threshold
✔✔What creates a higher current density? - ✔✔Smaller pacing cathode
✔✔Anode must be atleast _____ times _______ than cathode - ✔✔3x Larger
✔✔ohms law - ✔✔V=IR
✔✔Most common electrolyte abnormality to cause LOC? - ✔✔Hyperkalemia
✔✔Effects of Hyperkalemia - ✔✔Increase in threshold, wide paced complex, latency,
peaked T wave
✔✔Effects of Hypokalemia - ✔✔Irratble foci, R on T, Torsades
✔✔Equation for current drain - ✔✔Time = Battery capacity / current drain
Time = AmpHour/amperes = Hours
✔✔Micro units - ✔✔10^-6
,✔✔BOL
ERI
EOS - ✔✔Beginning of Life
Elective Replacement Indicator
End of Service
✔✔Cardiac cell charge and electrolyte membrane potential at rest - ✔✔Charge: ~(-
90mV) inside of cell
Membrane: Na+ outside;
✔✔Cardiac action potentials - ✔✔0 - depolarization; Rapid Na+ influx
1 - early rapid depolarization; Na+ influx STOPS,
2 - Plateau phase; Ca+ enters
3 - Rapid depolarization; K+ outflux and Ca+ channels close
4 - alert
✔✔Preferred Peak to Peak for P and R waves - ✔✔P waves: >2mV
R waves: >5mV
✔✔Preferred slew rate for P and R waves - ✔✔P waves: > .5 V/s
R waves: > .75V/s
✔✔Co- Axial VS Co-radial conductor types - ✔✔Co - Axial: One conductor coil inside
the other
Co - radial: Two coils overlayed around the radius of lead
✔✔S1
S2 - ✔✔S1: Drive train
S2: First premature impulse
✔✔What is Wedensky Effect? When is its effect the greatest? - ✔✔Threshold going
from capture to LOC is lower than going in the opposite direction; more prevalent at
SHORT pulse widths
✔✔What is Heart Rate Turbulence? What can presence/absence predict? - ✔✔Short
term fluctuation in sinus cycle length over ~15 beats following PVC (healthy heart
increases rate)
Absence of this can predict mortality
✔✔Study that found pts with <30% EF with abnormal Turbulence Slope and Turbulence
Onset had 40% 2yr mortality - ✔✔EMIAT
, ✔✔When does threshold begin to rise in tined leads? - ✔✔2-3 days
✔✔Flouroquinolones is known for what cardiac effect? - ✔✔Prolonging QT
✔✔What protects ppm circuity from external shock? - ✔✔Zener Diode
✔✔Strength Duration Curve definitions:
Rheobase - ✔✔Lowest stimulus voltage that will stimulate myocardium at any pulse
duration; once we get below rheobase V, the myocardium wont react
✔✔Strength Duration Curve definitions:
Chronaxie - ✔✔Pulse duration that is on the strength duration curve at 2x the rheobase
amplitude
*approximates the min threshold E*
✔✔Normal EF - ✔✔50-65%
✔✔Heart Rate Variability - ✔✔Changes in Heart Rate throughout a patients day/life.
Healthy heart has a greater degree of variability.
✔✔HRV vs HRT - ✔✔Heart Rate Variability: Range of Heart Rates all the time
Heart Rate Turbulence: Hearts compensatory effect to speed up rate after PVC for
15ish beats
✔✔What component of ppm is most susceptible to effects of radiation? - ✔✔CMOS
(brains of ppm)
✔✔Statistics Terms:
P Value - ✔✔The probability that an outcome occured by chance
✔✔Stats Terms:
Confidence Interval - ✔✔A measure of precision of results
✔✔Voltage at EOL for PPM - ✔✔2.01V
✔✔EOL Cell Impedance in PPM - ✔✔5000-10000 ohms
✔✔Determining Imp in parallel system - ✔✔R=(R1xR2)/(R1+R2)
Ex Resistance 1 500 ohms; R2 600
R=(500x600)/(500=600)=
AND SOLUTIONS RATED A+
✔✔Voltage of PPM battery? - ✔✔2.8V
✔✔Voltage of ICD battery? - ✔✔3.2V
✔✔Types of Sensors: Open Loop - ✔✔Only takes in positive feedback; ex: piezoelectric
sensor senses movement -> increased rate until no more sensed movement
✔✔Types of sensor: closed loop - ✔✔More physiologic than open loop; rate changes in
response to physiologic change -> rate stays until physiologic state indicates it needs to
slow (ex: 02 sats)
✔✔Types of Sensors: Primary - ✔✔Detects changes that normal effect the sinus node
(02 sats, myocardial contractilty)
✔✔Types of sensors: Secondary - ✔✔Detects internal changes that result from exercise
✔✔Types of sensors: Tertiary - ✔✔Detects external changes as a result of exercise
(piezoelectric, accelerometer)
✔✔Describe acute threshold graph of steroid eluting lead VS polished platinum post
implat - ✔✔Steroid: low threshold and not much change
polished platinum: bad. High threshold, acute rise, then chronic high threshold
✔✔What creates a higher current density? - ✔✔Smaller pacing cathode
✔✔Anode must be atleast _____ times _______ than cathode - ✔✔3x Larger
✔✔ohms law - ✔✔V=IR
✔✔Most common electrolyte abnormality to cause LOC? - ✔✔Hyperkalemia
✔✔Effects of Hyperkalemia - ✔✔Increase in threshold, wide paced complex, latency,
peaked T wave
✔✔Effects of Hypokalemia - ✔✔Irratble foci, R on T, Torsades
✔✔Equation for current drain - ✔✔Time = Battery capacity / current drain
Time = AmpHour/amperes = Hours
✔✔Micro units - ✔✔10^-6
,✔✔BOL
ERI
EOS - ✔✔Beginning of Life
Elective Replacement Indicator
End of Service
✔✔Cardiac cell charge and electrolyte membrane potential at rest - ✔✔Charge: ~(-
90mV) inside of cell
Membrane: Na+ outside;
✔✔Cardiac action potentials - ✔✔0 - depolarization; Rapid Na+ influx
1 - early rapid depolarization; Na+ influx STOPS,
2 - Plateau phase; Ca+ enters
3 - Rapid depolarization; K+ outflux and Ca+ channels close
4 - alert
✔✔Preferred Peak to Peak for P and R waves - ✔✔P waves: >2mV
R waves: >5mV
✔✔Preferred slew rate for P and R waves - ✔✔P waves: > .5 V/s
R waves: > .75V/s
✔✔Co- Axial VS Co-radial conductor types - ✔✔Co - Axial: One conductor coil inside
the other
Co - radial: Two coils overlayed around the radius of lead
✔✔S1
S2 - ✔✔S1: Drive train
S2: First premature impulse
✔✔What is Wedensky Effect? When is its effect the greatest? - ✔✔Threshold going
from capture to LOC is lower than going in the opposite direction; more prevalent at
SHORT pulse widths
✔✔What is Heart Rate Turbulence? What can presence/absence predict? - ✔✔Short
term fluctuation in sinus cycle length over ~15 beats following PVC (healthy heart
increases rate)
Absence of this can predict mortality
✔✔Study that found pts with <30% EF with abnormal Turbulence Slope and Turbulence
Onset had 40% 2yr mortality - ✔✔EMIAT
, ✔✔When does threshold begin to rise in tined leads? - ✔✔2-3 days
✔✔Flouroquinolones is known for what cardiac effect? - ✔✔Prolonging QT
✔✔What protects ppm circuity from external shock? - ✔✔Zener Diode
✔✔Strength Duration Curve definitions:
Rheobase - ✔✔Lowest stimulus voltage that will stimulate myocardium at any pulse
duration; once we get below rheobase V, the myocardium wont react
✔✔Strength Duration Curve definitions:
Chronaxie - ✔✔Pulse duration that is on the strength duration curve at 2x the rheobase
amplitude
*approximates the min threshold E*
✔✔Normal EF - ✔✔50-65%
✔✔Heart Rate Variability - ✔✔Changes in Heart Rate throughout a patients day/life.
Healthy heart has a greater degree of variability.
✔✔HRV vs HRT - ✔✔Heart Rate Variability: Range of Heart Rates all the time
Heart Rate Turbulence: Hearts compensatory effect to speed up rate after PVC for
15ish beats
✔✔What component of ppm is most susceptible to effects of radiation? - ✔✔CMOS
(brains of ppm)
✔✔Statistics Terms:
P Value - ✔✔The probability that an outcome occured by chance
✔✔Stats Terms:
Confidence Interval - ✔✔A measure of precision of results
✔✔Voltage at EOL for PPM - ✔✔2.01V
✔✔EOL Cell Impedance in PPM - ✔✔5000-10000 ohms
✔✔Determining Imp in parallel system - ✔✔R=(R1xR2)/(R1+R2)
Ex Resistance 1 500 ohms; R2 600
R=(500x600)/(500=600)=
