EKG Rhythm Strip Quiz Study Guide (Smarty PANCE Style) Based on 2026/2027 Syllabus

EKG Rhythm Strip Quiz Study Guide (Smarty PANCE Style)
Based on 2026/2027 Syllabus

Instructions: For each strip, identify the rhythm. Choose the single best answer.




Question 1:
![Strip Description: Regular rhythm, rate ~75 bpm, normal PR interval, normal QRS, one
P wave before each QRS. No extra beats.]

 A. Sinus bradycardia
 B. Sinus tachycardia
 C. Normal sinus rhythm ✓
 D. Sinus arrhythmia

ANSWER ✓ Normal sinus rhythm is characterized by a regular rhythm, rate 60-100 bpm,
a constant and normal PR interval, and a P wave before every QRS complex.




Question 2:
![Strip Description: Regular rhythm, rate ~40 bpm, normal P waves, PR, and QRS.]

 A. Junctional rhythm
 B. Sinus bradycardia ✓
 C. Complete heart block
 D. Sinus arrest

ANSWER ✓ Sinus bradycardia meets all criteria for normal sinus rhythm except the rate
is less than 60 bpm.

, Question 3:
![Strip Description: Regular rhythm, rate ~130 bpm, normal P waves, PR, and QRS.]

 A. Atrial flutter
 B. Sinus tachycardia ✓
 C. Supraventricular tachycardia (SVT)
 D. Ventricular tachycardia

ANSWER ✓ Sinus tachycardia meets all criteria for normal sinus rhythm except the rate
is greater than 100 bpm. P waves are typically upright and normal.




Question 4:
![Strip Description: Rhythm is irregularly irregular. No discernible P waves. Rate ~110
bpm.]

 A. Atrial flutter with variable block
 B. Sinus arrhythmia
 C. Atrial fibrillation ✓
 D. Multifocal atrial tachycardia

ANSWER ✓ Atrial fibrillation is classically "irregularly irregular" with no organized P
waves, only fibrillatory waves.




Question 5:
![Strip Description: Sawtooth pattern of atrial flutter waves at ~300/min, ventricular rate
~75 bpm with variable conduction (2:1, 3:1, etc.).]

 A. Atrial fibrillation
 B. Atrial tachycardia
 C. Atrial flutter with variable AV block ✓
 D. Sinus rhythm with PACs

ANSWER ✓ Atrial flutter shows characteristic "sawtooth" flutter waves. An irregular
ventricular response indicates variable AV conduction (e.g., 2:1, 3:1, 4:1 block).

, Question 6:
![Strip Description: Regular rhythm, rate ~150 bpm. No visible P waves. QRS is narrow
(<0.12 sec).]

 A. Sinus tachycardia
 B. Atrial flutter (2:1 block)
 C. Supraventricular tachycardia (SVT) ✓
 D. Ventricular tachycardia

ANSWER ✓ Supraventricular tachycardia is a regular, rapid rhythm (>150 bpm) with a
narrow QRS complex. P waves are often buried and not visible.




Question 7:
![Strip Description: Regular rhythm, rate ~180 bpm. Wide, bizarre QRS complexes (>0.12
sec). No P waves visible.]

 A. SVT with aberrancy
 B. Ventricular tachycardia ✓
 C. Accelerated idioventricular rhythm
 D. Torsades de pointes

ANSWER ✓ Ventricular tachycardia is a regular, rapid rhythm (usually >120 bpm)
originating in the ventricles, characterized by wide, abnormal QRS complexes and often
no associated P waves.




Question 8:
![Strip Description: Irregular rhythm with pauses. A normal sinus beat is followed by an
early, abnormal P wave and a normal QRS. The pause after it is non-compensatory.]

 A. Premature ventricular complex (PVC)
 B. Premature atrial complex (PAC) ✓
 C. Sinus pause
 D. Ventricular escape beat

, ANSWER ✓ A PAC is an early beat initiated by an ectopic atrial focus. The P wave looks
different from the sinus P wave, and the following QRS is typically narrow. The
subsequent pause is usually incomplete (non-compensatory).




Question 9:
![Strip Description: An early, wide, and bizarre QRS complex without a preceding P wave.
The T wave is in the opposite direction of the QRS. Followed by a full compensatory
pause.]

 A. Premature atrial complex (PAC)
 B. Premature junctional complex (PJC)
 C. Premature ventricular complex (PVC) ✓
 D. Ventricular paced beat

ANSWER ✓ A PVC is characterized by a premature, wide QRS complex (>0.12 sec) that
is bizarre in shape, often with a T wave opposite the QRS vector. The pause following it
is typically a full compensatory pause.




Question 10:
![Strip Description: Regular rhythm, rate ~50 bpm. No P waves before QRS. QRS is
narrow.]

 A. Sinus bradycardia
 B. Idioventricular rhythm
 C. Junctional rhythm ✓
 D. Complete heart block

ANSWER ✓ A junctional rhythm (often 40-60 bpm) originates at the AV node. There are
no preceding P waves, or P waves may be inverted and occur after the QRS. The QRS is
typically narrow.