Diagnose the underlying medical disorder by ECG change in photograph:

Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Medical Surgical Nursing

Easy

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

The ECG in the image shows tall, peaked, and narrow-based T-waves, which are the earliest and most common sign of hyperkalemia.
This specific T-wave morphology, often described as 'tented', is due to altered ventricular repolarization caused by elevated extracellular potassium levels.
Other subtle changes like a slightly widened QRS complex may also be present, indicating progression of the condition.
These findings collectively point to a diagnosis of hyperkalemia.

Option A: Hypokalemia presents with ECG changes that are opposite to what is shown. It causes ST depression, T-wave flattening or inversion, and the appearance of a prominent U wave.
Option B: Hypercalcemia is characterized by a shortened QT interval. The ECG in the image does not show a shortened QT interval; its most prominent feature is the abnormal T-wave morphology.
Option C: Hypocalcemia leads to a prolonged QT interval due to a lengthened ST segment. The ECG shown does not demonstrate QT prolongation as the primary feature.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain ECG Interpretation in Electrolyte Imbalances as background academic context rather than a clinical decision trigger.
Recognizing hyperkalemia on an ECG is a critical nursing skill because it is a medical emergency that can lead to life-threatening cardiac arrhythmias and cardiac arrest.
A nurse observing these ECG changes must immediately notify the physician, anticipate orders for a stat serum potassium level, and prepare for emergency interventions.
Emergency management includes stabilizing the cardiac membrane with intravenous calcium gluconate, shifting potassium into cells with insulin and dextrose, and removing potassium from the body using diuretics or potassium-binding resins (e.g., Kayexalate).

How to Approach the Question

This is an image-based question that requires you to identify a classic ECG pattern.
First, systematically analyze the ECG strip. Look at the P wave, PR interval, QRS complex, ST segment, and T wave in multiple leads.
Identify the most prominent abnormality. In this ECG, the T-waves are strikingly tall and peaked ('tented'), especially in the precordial leads.
Recall the characteristic ECG findings for the electrolyte imbalances listed in the options.
Match the observed pattern (tall, peaked T-waves) with the correct diagnosis. This pattern is the hallmark of hyperkalemia.
Rule out the other options by confirming their ECG patterns (e.g., hypokalemia causes flat T-waves and U-waves) do not match the image.

Concept Tested & Keywords

Concept Tested: ECG Interpretation in Electrolyte Imbalances
Stem keywords: ECG change, diagnose, medical disorder, photograph
Lead-in keywords: Diagnose
Clinical cues: The visual cue is the tall, peaked T-wave, which is a hallmark sign of hyperkalemia.

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