FLORENCE BLACKMAN I HUMAN CASE
STUDY 66 YEARS OLD PATIENT STUDY
GUIDE 2026 COMPREHENSIVE QUESTIONS
WITH EXPERT ANSWERS GRADED A+
⩥ ECG Rate Rhythm and Axis
-what is normal rate?
-how do you determine if rhythm is normal?
-how do you determine axis? Answer: Rate
-normal is between 60-100
Sinus rhythm: normal rhythm that originates form the sinus node has a p
before every QRS and a QRS after every p
Axis: can be determined by examining the QRS in leads 1 and AVF
-normal: up in lead 1 and up in AVF (-30 to 90)
-left axis deviation lead 1 up and AVF down (<-30)
-right axis deviation lead 1 down and AVF up (> 90)
⩥ ECG intervals
-PR interval
-QRS interval: what can a Wide QRS be indicative of?
,-Normal QTc. Answer: PR interval: normally between 120-200
milliseconds
QRS inteval: normall < 120 msec
Wide QRS interval can be indicative of bundle branch block
QT interval: normal QTc (the QT interval corrected for extremes in heart
rate) is < 440 msec. In long QT syndrome, QTc > 440 msec. Long QT
syndorme is an underdiagnosed congenital disorder that is one cause of
long QT and predisposes to ventricular tachyarrhythmias
⩥ right and left bundle branch block. Answer: RBBB: QRS >120, RSR'
complex (rabbit ears), qR or R morphology with a wide R wave in V1;
QRS pattern wiht a wide S wave in 1, V5, and V6
LBBB: QRS duration > 120 msec; deep S wave and no R wave in V1;
wide, tall R waves in 1, V5, and V6
⩥ Acute ischemia on ECG
-what is the progression of ischemic changes on ECG?
-Q wave criteria?
-What about R waves as a determination of ischemia?. Answer: Natural
progression starts withT wave inversion, progresses to ST segment
,changes (either depression or elevation), and finally results in Q waves
(> 40 msec or more than one-third of the QRS amplitude) on the ECG.
Because of this, Q waves signify either acute or prior ischemic events
and do not provide information on when an event took place.
Poor R wave progression in precordial waves can also be a sign of
ischemia, although it is not specific. In a normal ECG, R waves increase
in size compared to the S wave between leads V1 and V5. Poor R wave
progression refers to diminished R waves in these precordial leads
⩥ Right atrial abnormality
Left atrial abnormality. Answer: Right atrial abnormality: The p wave
amplitude in lead 2 is > 2.5mm
Left atrial abnormality: The P Wave width in lead 2 is > 120 msec, or
terminal - defleciton in V1 is > 1mm in amplitude and > 40 msec in
duration. Notched P waves can frequentl y be seen in lead 2
⩥ Left and right ventricular hypertrophy. Answer: LVH: the amplitude
of S in V1 + R in V5 or V6 > 35mm
-alternative criteria= The amplitude of R in avl + S in V3 is > 28 mm in
men or > 20 in women
, RVH: right axid deviation and an R wave in V1 > 7
⩥ Juglar venous distension
Hepato jugular reflux
Kussmal sign. Answer: Juglar venous distension:
-> 7 cm above the sternal angle: most typically from volume overload,
stemming form conditions such as right heart failure or pulmonary
hypertension
Hepato jugular reflux
-distension of neck veins upon applying pressure to the liver: seen in
same conditions as JVD
Kussmal sign
-increase in jugular venous pressure with inspiration: often seen in
cardiac tamponade and constrictie pericarditis.
⩥ Systolic murmurs. Answer: Aortic stenosis: A harsh systolic ejeciton
murmur that radiates to the carotids
Mitral regurgitation: a holosystolic murmur that radiates to the axxila
STUDY 66 YEARS OLD PATIENT STUDY
GUIDE 2026 COMPREHENSIVE QUESTIONS
WITH EXPERT ANSWERS GRADED A+
⩥ ECG Rate Rhythm and Axis
-what is normal rate?
-how do you determine if rhythm is normal?
-how do you determine axis? Answer: Rate
-normal is between 60-100
Sinus rhythm: normal rhythm that originates form the sinus node has a p
before every QRS and a QRS after every p
Axis: can be determined by examining the QRS in leads 1 and AVF
-normal: up in lead 1 and up in AVF (-30 to 90)
-left axis deviation lead 1 up and AVF down (<-30)
-right axis deviation lead 1 down and AVF up (> 90)
⩥ ECG intervals
-PR interval
-QRS interval: what can a Wide QRS be indicative of?
,-Normal QTc. Answer: PR interval: normally between 120-200
milliseconds
QRS inteval: normall < 120 msec
Wide QRS interval can be indicative of bundle branch block
QT interval: normal QTc (the QT interval corrected for extremes in heart
rate) is < 440 msec. In long QT syndrome, QTc > 440 msec. Long QT
syndorme is an underdiagnosed congenital disorder that is one cause of
long QT and predisposes to ventricular tachyarrhythmias
⩥ right and left bundle branch block. Answer: RBBB: QRS >120, RSR'
complex (rabbit ears), qR or R morphology with a wide R wave in V1;
QRS pattern wiht a wide S wave in 1, V5, and V6
LBBB: QRS duration > 120 msec; deep S wave and no R wave in V1;
wide, tall R waves in 1, V5, and V6
⩥ Acute ischemia on ECG
-what is the progression of ischemic changes on ECG?
-Q wave criteria?
-What about R waves as a determination of ischemia?. Answer: Natural
progression starts withT wave inversion, progresses to ST segment
,changes (either depression or elevation), and finally results in Q waves
(> 40 msec or more than one-third of the QRS amplitude) on the ECG.
Because of this, Q waves signify either acute or prior ischemic events
and do not provide information on when an event took place.
Poor R wave progression in precordial waves can also be a sign of
ischemia, although it is not specific. In a normal ECG, R waves increase
in size compared to the S wave between leads V1 and V5. Poor R wave
progression refers to diminished R waves in these precordial leads
⩥ Right atrial abnormality
Left atrial abnormality. Answer: Right atrial abnormality: The p wave
amplitude in lead 2 is > 2.5mm
Left atrial abnormality: The P Wave width in lead 2 is > 120 msec, or
terminal - defleciton in V1 is > 1mm in amplitude and > 40 msec in
duration. Notched P waves can frequentl y be seen in lead 2
⩥ Left and right ventricular hypertrophy. Answer: LVH: the amplitude
of S in V1 + R in V5 or V6 > 35mm
-alternative criteria= The amplitude of R in avl + S in V3 is > 28 mm in
men or > 20 in women
, RVH: right axid deviation and an R wave in V1 > 7
⩥ Juglar venous distension
Hepato jugular reflux
Kussmal sign. Answer: Juglar venous distension:
-> 7 cm above the sternal angle: most typically from volume overload,
stemming form conditions such as right heart failure or pulmonary
hypertension
Hepato jugular reflux
-distension of neck veins upon applying pressure to the liver: seen in
same conditions as JVD
Kussmal sign
-increase in jugular venous pressure with inspiration: often seen in
cardiac tamponade and constrictie pericarditis.
⩥ Systolic murmurs. Answer: Aortic stenosis: A harsh systolic ejeciton
murmur that radiates to the carotids
Mitral regurgitation: a holosystolic murmur that radiates to the axxila
