ADVANCED DYSRHYTHMIA FINAL
EXAM 2026/2027 QUESTIONS AND
ANSWERS
1. Which of the following describes the Ashman phenomenon?
A. A paradoxical increase in heart rate during a vagal maneuver
B. A delta wave seen in the presence of an accessory pathway
C. A progressive prolongation of the PR interval until a QRS is dropped
D. A wide QRS complex following a short R-R interval preceded by a long R-R interval
Answer: D
Conceptual Explanation: The Ashman phenomenon occurs when a long R-R cycle is
followed by a short R-R cycle, causing the second beat to be conducted with aberrancy
(usually RBBB) because the bundle branch is still refractory.
2. In Wolff-Parkinson-White (WPW) syndrome, the bypass tract is known as:
A. Bundle of Kent
B. James Fibers
C. Mahaim Fibers
,D. Bachmann’s Bundle
Answer: A
Conceptual Explanation: The Bundle of Kent is the classic accessory pathway in WPW
that allows electrical impulses to bypass the AV node, leading to pre-excitation and a delta
wave.
3. Which electrolyte abnormality is most commonly associated with Torsades de Pointes?
A. Hypomagnesemia
B. Hypercalcemia
C. Hyperkalemia
D. Hyponatremia
Answer: A
Conceptual Explanation: Low magnesium levels are a primary trigger for Torsades de
Pointes; IV Magnesium Sulfate is the first-line treatment for this arrhythmia.
4. Which EKG finding is pathognomonic for Brugada Syndrome Type 1?
A. Short PR interval with a Delta wave
B. Coved ST-segment elevation >2mm in V1-V3 followed by a negative T-wave
C. Saddle-back ST-segment elevation in V1-V2
D. Deeply inverted T-waves in leads II, III, and aVF
, Answer: B
Conceptual Explanation: Brugada Type 1 is identified by a coved-type ST elevation in the
right precordial leads (V1-V3), which carries a high risk of sudden cardiac death.
5. A 3rd-degree AV block is characterized by:
A. Complete dissociation between P waves and QRS complexes
B. A progressive lengthening of the PR interval
C. A constant PR interval with intermittently dropped QRS complexes
D. A PR interval greater than 0.20 seconds with 1:1 conduction
Answer: A
Conceptual Explanation: In 3rd-degree (complete) heart block, the atria and ventricles
beat independently because no impulses from the atria reach the ventricles.
6. What is the primary difference between Multifocal Atrial Tachycardia (MAT) and
Wandering Atrial Pacemaker (WAP)?
A. WAP has a regular rhythm, while MAT is irregular
B. MAT has a heart rate >100 bpm, while WAP is <100 bpm
C. MAT has consistent P waves, while WAP has varied P waves
D. WAP is only seen in pediatric patients
Answer: B
EXAM 2026/2027 QUESTIONS AND
ANSWERS
1. Which of the following describes the Ashman phenomenon?
A. A paradoxical increase in heart rate during a vagal maneuver
B. A delta wave seen in the presence of an accessory pathway
C. A progressive prolongation of the PR interval until a QRS is dropped
D. A wide QRS complex following a short R-R interval preceded by a long R-R interval
Answer: D
Conceptual Explanation: The Ashman phenomenon occurs when a long R-R cycle is
followed by a short R-R cycle, causing the second beat to be conducted with aberrancy
(usually RBBB) because the bundle branch is still refractory.
2. In Wolff-Parkinson-White (WPW) syndrome, the bypass tract is known as:
A. Bundle of Kent
B. James Fibers
C. Mahaim Fibers
,D. Bachmann’s Bundle
Answer: A
Conceptual Explanation: The Bundle of Kent is the classic accessory pathway in WPW
that allows electrical impulses to bypass the AV node, leading to pre-excitation and a delta
wave.
3. Which electrolyte abnormality is most commonly associated with Torsades de Pointes?
A. Hypomagnesemia
B. Hypercalcemia
C. Hyperkalemia
D. Hyponatremia
Answer: A
Conceptual Explanation: Low magnesium levels are a primary trigger for Torsades de
Pointes; IV Magnesium Sulfate is the first-line treatment for this arrhythmia.
4. Which EKG finding is pathognomonic for Brugada Syndrome Type 1?
A. Short PR interval with a Delta wave
B. Coved ST-segment elevation >2mm in V1-V3 followed by a negative T-wave
C. Saddle-back ST-segment elevation in V1-V2
D. Deeply inverted T-waves in leads II, III, and aVF
, Answer: B
Conceptual Explanation: Brugada Type 1 is identified by a coved-type ST elevation in the
right precordial leads (V1-V3), which carries a high risk of sudden cardiac death.
5. A 3rd-degree AV block is characterized by:
A. Complete dissociation between P waves and QRS complexes
B. A progressive lengthening of the PR interval
C. A constant PR interval with intermittently dropped QRS complexes
D. A PR interval greater than 0.20 seconds with 1:1 conduction
Answer: A
Conceptual Explanation: In 3rd-degree (complete) heart block, the atria and ventricles
beat independently because no impulses from the atria reach the ventricles.
6. What is the primary difference between Multifocal Atrial Tachycardia (MAT) and
Wandering Atrial Pacemaker (WAP)?
A. WAP has a regular rhythm, while MAT is irregular
B. MAT has a heart rate >100 bpm, while WAP is <100 bpm
C. MAT has consistent P waves, while WAP has varied P waves
D. WAP is only seen in pediatric patients
Answer: B
