ADVANCED DYSRHYTHMIA PRACTICE EXAM
RELIAS ADVANCED DYSRHYTHMIA EXAM A
2025/2026 COMPLETE 200 QUESTIONS WITH
STEP-BY-STEP VERIFIED ANSWERS AND
CLINICAL ASSESSMENT EXPLANATIONS
Exam Type: Advanced Cardiac Rhythm Interpretation
Content Covered (Most Tested Areas):
• Advanced ECG interpretation
• Atrial, junctional, and ventricular dysrhythmias
• AV blocks (all degrees)
• Bundle branch blocks
• Pacemaker rhythms and malfunction
• Acute coronary syndromes on ECG
• Electrolyte-related ECG changes
• ACLS-based rhythm management
• Hemodynamic correlation
1. A rhythm strip shows a regular rhythm at 150 bpm, narrow QRS
complexes, and no visible P waves. What is the rhythm?
Answer: Supraventricular tachycardia (SVT)
explanation:
Rate is fast (150 bpm). Rhythm is regular. QRS is narrow, indicating
,supraventricular origin. Absence of visible P waves suggests AV nodal
reentry tachycardia. Therefore, SVT.
2. An ECG shows sawtooth flutter waves with a ventricular rate of 75
bpm and an atrial rate of 300 bpm. Diagnosis?
Answer: Atrial flutter with 4:1 conduction
explanation:
Atrial rate ~300 bpm with flutter waves. Ventricular rate 75 bpm. 300
÷ 4 = 75. This confirms 4:1 AV conduction.
3. A rhythm strip shows irregularly irregular rhythm, no distinct P
waves, narrow QRS. Diagnosis?
Answer: Atrial fibrillation
Explanation:
Irregularly irregular rhythm + absence of P waves = atrial fibrillation.
4. PR interval progressively lengthens until a QRS drops. Diagnosis?
Answer: Second-degree AV block Type I (Mobitz I, Wenckebach)
Explanation:
Gradual PR prolongation followed by dropped beat is hallmark of
Mobitz I.
, 5. PR interval constant but intermittent dropped QRS complexes.
Diagnosis?
Answer: Second-degree AV block Type II (Mobitz II)
Explanation:
Fixed PR interval with sudden dropped QRS indicates Mobitz II, often
requiring pacing.
6. No relationship between P waves and QRS complexes. Diagnosis?
Answer: Third-degree AV block (Complete heart block)
Explanation:
AV dissociation present. Atria and ventricles beat independently.
7. Wide QRS >0.12 sec, regular rhythm at 180 bpm, no P waves
visible. Diagnosis?
Answer: Monomorphic ventricular tachycardia
Explanation:
Wide complex tachycardia with regular rhythm suggests VT.
8. Chaotic irregular waveform, no identifiable QRS complexes.
Diagnosis?
Answer: Ventricular fibrillation
Explanation:
No organized electrical activity. Immediate defibrillation required.
, 9. Flat line with occasional P waves but no QRS complexes.
Diagnosis?
Answer: Ventricular standstill
Explanation:
Atrial activity without ventricular response.
10. Progressive widening of QRS with sine-wave appearance in
hyperkalemic patient. Cause?
Answer: Severe hyperkalemia
Explanation:
Hyperkalemia causes peaked T waves → widened QRS → sine wave
pattern.
11. ST elevation in leads II, III, aVF. Location of infarct?
Answer: Inferior wall myocardial infarction
Explanation:
Leads II, III, aVF represent inferior wall supplied by RCA.
12. ST elevation in V1–V4. Diagnosis?
Answer: Anterior wall myocardial infarction
Explanation:
Precordial leads V1–V4 represent anterior wall (LAD artery).
RELIAS ADVANCED DYSRHYTHMIA EXAM A
2025/2026 COMPLETE 200 QUESTIONS WITH
STEP-BY-STEP VERIFIED ANSWERS AND
CLINICAL ASSESSMENT EXPLANATIONS
Exam Type: Advanced Cardiac Rhythm Interpretation
Content Covered (Most Tested Areas):
• Advanced ECG interpretation
• Atrial, junctional, and ventricular dysrhythmias
• AV blocks (all degrees)
• Bundle branch blocks
• Pacemaker rhythms and malfunction
• Acute coronary syndromes on ECG
• Electrolyte-related ECG changes
• ACLS-based rhythm management
• Hemodynamic correlation
1. A rhythm strip shows a regular rhythm at 150 bpm, narrow QRS
complexes, and no visible P waves. What is the rhythm?
Answer: Supraventricular tachycardia (SVT)
explanation:
Rate is fast (150 bpm). Rhythm is regular. QRS is narrow, indicating
,supraventricular origin. Absence of visible P waves suggests AV nodal
reentry tachycardia. Therefore, SVT.
2. An ECG shows sawtooth flutter waves with a ventricular rate of 75
bpm and an atrial rate of 300 bpm. Diagnosis?
Answer: Atrial flutter with 4:1 conduction
explanation:
Atrial rate ~300 bpm with flutter waves. Ventricular rate 75 bpm. 300
÷ 4 = 75. This confirms 4:1 AV conduction.
3. A rhythm strip shows irregularly irregular rhythm, no distinct P
waves, narrow QRS. Diagnosis?
Answer: Atrial fibrillation
Explanation:
Irregularly irregular rhythm + absence of P waves = atrial fibrillation.
4. PR interval progressively lengthens until a QRS drops. Diagnosis?
Answer: Second-degree AV block Type I (Mobitz I, Wenckebach)
Explanation:
Gradual PR prolongation followed by dropped beat is hallmark of
Mobitz I.
, 5. PR interval constant but intermittent dropped QRS complexes.
Diagnosis?
Answer: Second-degree AV block Type II (Mobitz II)
Explanation:
Fixed PR interval with sudden dropped QRS indicates Mobitz II, often
requiring pacing.
6. No relationship between P waves and QRS complexes. Diagnosis?
Answer: Third-degree AV block (Complete heart block)
Explanation:
AV dissociation present. Atria and ventricles beat independently.
7. Wide QRS >0.12 sec, regular rhythm at 180 bpm, no P waves
visible. Diagnosis?
Answer: Monomorphic ventricular tachycardia
Explanation:
Wide complex tachycardia with regular rhythm suggests VT.
8. Chaotic irregular waveform, no identifiable QRS complexes.
Diagnosis?
Answer: Ventricular fibrillation
Explanation:
No organized electrical activity. Immediate defibrillation required.
, 9. Flat line with occasional P waves but no QRS complexes.
Diagnosis?
Answer: Ventricular standstill
Explanation:
Atrial activity without ventricular response.
10. Progressive widening of QRS with sine-wave appearance in
hyperkalemic patient. Cause?
Answer: Severe hyperkalemia
Explanation:
Hyperkalemia causes peaked T waves → widened QRS → sine wave
pattern.
11. ST elevation in leads II, III, aVF. Location of infarct?
Answer: Inferior wall myocardial infarction
Explanation:
Leads II, III, aVF represent inferior wall supplied by RCA.
12. ST elevation in V1–V4. Diagnosis?
Answer: Anterior wall myocardial infarction
Explanation:
Precordial leads V1–V4 represent anterior wall (LAD artery).
