ELIAS ADVANCED DYSRHYTHMIA
PRACTICE EXAM QUESTIONSA AND
ANSWERS
1. A patient exhibits a regular wide-complex tachycardia at a rate of 170 bpm. Fusion beats
and capture beats are noted on the rhythm strip. What is the most likely diagnosis?
A. Ventricular Tachycardia
B. SVT with Aberrancy
C. Atrial Flutter with 2:1 Conduction
D. Wolff-Parkinson-White Syndrome
Answer: A
Conceptual Explanation: The presence of fusion and capture beats is highly specific for
Ventricular Tachycardia (VT), as they indicate AV dissociation where an occasional sinus
impulse ‘captures’ the ventricles.
2. In a patient with a suspected Mobitz Type II Second-Degree AV Block, what is the most
critical clinical concern?
A. Development of Atrial Fibrillation
,B. Increasing PR interval length
C. Progression to Third-Degree Heart Block
D. Vagal induced bradycardia
Answer: C
Conceptual Explanation: Mobitz Type II is characterized by intermittent dropped QRS
complexes without PR lengthening and often progresses suddenly to complete (Third-
Degree) heart block.
3. Which EKG finding is most characteristic of Torsades de Pointes?
A. Polymorphic QRS complexes that twist around the isoelectric line
B. A ‘sawtooth’ baseline at a rate of 300 bpm
C. Fixed PR intervals with dropped beats
D. Biphasic P waves in Lead V1
Answer: A
Conceptual Explanation: Torsades de Pointes is a specific form of polymorphic VT
occurring in the context of QT prolongation, appearing as QRS complexes that rotate
around the baseline.
4. An elderly patient has a heart rate of 35 bpm, a regular rhythm, and no discernible
relationship between P waves and QRS complexes. What is the definitive treatment?
A. Atropine 0.5mg IV push
, B. Adenosine 6mg rapid IV bolus
C. Permanent Pacemaker insertion
D. Synchronized cardioversion
Answer: C
Conceptual Explanation: The description fits Third-Degree AV Block. While temporary
pacing or atropine may be used emergently, a permanent pacemaker is the definitive
treatment for chronic high-grade blocks.
5. Which of the following is a classic EKG sign of Hyperkalemia?
A. Shortened QT interval and Osborn waves
B. Prominent U waves and ST depression
C. Peaked T waves and widened QRS complexes
D. Delta waves and a short PR interval
Answer: C
Conceptual Explanation: Hyperkalemia causes peaked T waves initially, followed by P
wave flattening, PR prolongation, and eventually QRS widening leading to a sine-wave
pattern.
6. Failure to Sense in a permanent pacemaker is identified on an EKG by:
A. Pacemaker spikes occurring regardless of the patient’s intrinsic rhythm
B. Pacemaker spikes not followed by a QRS complex
PRACTICE EXAM QUESTIONSA AND
ANSWERS
1. A patient exhibits a regular wide-complex tachycardia at a rate of 170 bpm. Fusion beats
and capture beats are noted on the rhythm strip. What is the most likely diagnosis?
A. Ventricular Tachycardia
B. SVT with Aberrancy
C. Atrial Flutter with 2:1 Conduction
D. Wolff-Parkinson-White Syndrome
Answer: A
Conceptual Explanation: The presence of fusion and capture beats is highly specific for
Ventricular Tachycardia (VT), as they indicate AV dissociation where an occasional sinus
impulse ‘captures’ the ventricles.
2. In a patient with a suspected Mobitz Type II Second-Degree AV Block, what is the most
critical clinical concern?
A. Development of Atrial Fibrillation
,B. Increasing PR interval length
C. Progression to Third-Degree Heart Block
D. Vagal induced bradycardia
Answer: C
Conceptual Explanation: Mobitz Type II is characterized by intermittent dropped QRS
complexes without PR lengthening and often progresses suddenly to complete (Third-
Degree) heart block.
3. Which EKG finding is most characteristic of Torsades de Pointes?
A. Polymorphic QRS complexes that twist around the isoelectric line
B. A ‘sawtooth’ baseline at a rate of 300 bpm
C. Fixed PR intervals with dropped beats
D. Biphasic P waves in Lead V1
Answer: A
Conceptual Explanation: Torsades de Pointes is a specific form of polymorphic VT
occurring in the context of QT prolongation, appearing as QRS complexes that rotate
around the baseline.
4. An elderly patient has a heart rate of 35 bpm, a regular rhythm, and no discernible
relationship between P waves and QRS complexes. What is the definitive treatment?
A. Atropine 0.5mg IV push
, B. Adenosine 6mg rapid IV bolus
C. Permanent Pacemaker insertion
D. Synchronized cardioversion
Answer: C
Conceptual Explanation: The description fits Third-Degree AV Block. While temporary
pacing or atropine may be used emergently, a permanent pacemaker is the definitive
treatment for chronic high-grade blocks.
5. Which of the following is a classic EKG sign of Hyperkalemia?
A. Shortened QT interval and Osborn waves
B. Prominent U waves and ST depression
C. Peaked T waves and widened QRS complexes
D. Delta waves and a short PR interval
Answer: C
Conceptual Explanation: Hyperkalemia causes peaked T waves initially, followed by P
wave flattening, PR prolongation, and eventually QRS widening leading to a sine-wave
pattern.
6. Failure to Sense in a permanent pacemaker is identified on an EKG by:
A. Pacemaker spikes occurring regardless of the patient’s intrinsic rhythm
B. Pacemaker spikes not followed by a QRS complex
