Match List I with List II:List I (ECG Leads): (A) V2, (B) V4, (C) V5, (D) V6List II (Placement Position): (I) 5th Intercostal space, mid axillary line, (II) 5th Intercostal space, anterior axillary line, (III) 5th Intercostal space, mid clavicular line, (IV) 4th Intercostal space, Left margin of sternumChoose the correct answer:

1. A

   (A)-(IV), (B)-(III), (C)-(I), (D)-(II)

2. B

   (A)-(I), (B)-(II), (C)-(IV), (D)-(III)

3. C

   (A)-(III), (B)-(IV), (C)-(II), (D)-(I)

4. D

   (A)-(IV), (B)-(III), (C)-(II), (D)-(I)

Appeared in: BHU NO - 12 April 2024

Explanation

• The question requires matching standard precordial ECG leads to their correct anatomical placement sites.
• Lead V2 is correctly placed at the 4th intercostal space (ICS) on the left sternal border.
• Lead V4 is placed at the 5th ICS in the mid-clavicular line. Note that V3 is placed midway between V2 and V4.
• Lead V5 is placed on the same horizontal level as V4, but at the anterior axillary line.
• Lead V6 is placed on the same horizontal level as V4 and V5, but at the mid-axillary line.
• The correct sequence of matches is therefore (A)-(IV), (B)-(III), (C)-(II), and (D)-(I).

Why Other Options Were Wrong

• Option A: This option incorrectly matches V5 with the mid-axillary line (I) and V6 with the anterior axillary line (II). The positions are swapped.
• Option B: This option incorrectly matches every single lead. For example, it pairs V2 (A) with the 5th ICS, mid-axillary line (I), which is the position for V6.
• Option C: This option incorrectly matches V2 (A) with the 5th ICS, mid-clavicular line (III), which is the position for V4. It also incorrectly pairs V4 (B) with the 4th ICS (IV), the position for V2.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Placement of precordial (chest) ECG leads as background academic context rather than a clinical decision trigger.
• Accurate ECG lead placement is fundamental for obtaining a reliable trace. Misplacing leads can significantly alter the ECG morphology, potentially leading to misdiagnosis of serious conditions like myocardial infarction, bundle branch blocks, or ventricular hypertrophy.
• A common error is placing the V1 and V2 leads too high (in the 2nd or 3rd ICS instead of the 4th). This can create a pattern that mimics an anterior myocardial infarction (pseudo-infarct pattern), causing unnecessary alarm and potentially leading to inappropriate invasive procedures.
• What if? If a patient has dextrocardia (heart on the right side), the precordial leads must be placed in a mirror-image position on the right side of the chest to get an accurate reading. This is denoted as V1R, V2R, etc.

How to Approach the Question

• First, identify the two lists that need to be matched: List I (ECG Leads) and List II (Placement Positions).
• Systematically recall or look up the correct anatomical position for each lead in List I.
• Match V2: 4th ICS, left sternal margin. This corresponds to (IV).
• Match V4: 5th ICS, mid-clavicular line. This corresponds to (III).
• Match V5: 5th ICS, anterior axillary line. This corresponds to (II).
• Match V6: 5th ICS, mid-axillary line. This corresponds to (I).

Concept Tested & Keywords

• Concept Tested: Placement of precordial (chest) ECG leads
• Stem keywords: ECG Leads, V2, V4, V5, V6, Placement Position, Intercostal space, mid axillary line
• Lead-in keywords: Match List I with List II, Choose the correct answer
• Negative lead-in flag: false

Question ID

QDUsCiJzi969waM4mu_Rhf

Copy ID

Reference Book

E6 Physiology Ganong 27e Vol 2 Part 1 p. 73-75

E6 Medicine Davidson Principles Practice 24e p. 468-470