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Section 1 – Rhythm Identification & Analysis (Questions 1–25)
1. The rhythm strip shows a regular rhythm at a rate of 58 bpm. Each QRS complex
(0.08 s) is preceded by a normal, upright P wave with a consistent PR interval of
0.16 s. No ectopic beats are seen.
What is the correct rhythm interpretation?
A. Sinus tachycardia
B. Sinus bradycardia
C. First-degree AV block
D. Normal sinus rhythm
Correct Answer: B
Rationale: Rate < 60 bpm with otherwise normal sinus morphology defines sinus
bradycardia.
2. The strip displays an irregularly irregular rhythm at 100–120 bpm. P waves are
absent; baseline shows fine fibrillatory waves. QRS complexes are narrow (0.08
s).
Which finding is most consistent with this dysrhythmia?
A. Sinus arrhythmia
B. Atrial fibrillation
C. Atrial flutter
D. Ventricular tachycardia
Correct Answer: B
Rationale: Absent P waves with irregularly irregular RR intervals are hallmark of
atrial fibrillation.
3. Regular rhythm at 150 bpm; “saw-tooth” flutter waves best seen in lead II; QRS
0.08 s; 2:1 AV conduction.
Correct interpretation:
A. Atrial flutter
B. Sinus tachycardia
, C. Supraventricular tachycardia
D. Ventricular tachycardia
Correct Answer: A
Rationale: Saw-tooth baseline with fixed 2:1 conduction is classic atrial flutter.
4. Regular narrow-complex tachycardia at 180 bpm; P waves hidden within T waves;
QRS 0.06 s; rhythm starts and stops abruptly.
Most likely rhythm:
A. Paroxysmal supraventricular tachycardia (PSVT)
B. Ventricular tachycardia
C. Atrial fibrillation
D. Sinus tachycardia
Correct Answer: A
Rationale: Sudden-onset, regular, narrow-complex tachycardia > 150 bpm with
hidden or retrograde P waves is PSVT.
5. Rhythm strip shows regular atrial activity at 300 bpm with variable AV block
(3:1–5:1); QRS narrow.
Interpretation:
A. Atrial fibrillation
B. Atrial flutter
C. Ventricular flutter
D. Third-degree AV block
Correct Answer: B
Rationale: Atrial rate 250–350 bpm with variable block defines atrial flutter.
6. Irregular rhythm averaging 90 bpm; P waves uniform; PR constant; occasional
early P-QRS complexes followed by a pause.
Correct rhythm:
A. Sinus arrhythmia
B. Premature atrial contractions (PACs)
C. Wandering pacemaker
D. Atrial fibrillation
Correct Answer: B
Rationale: Premature upright P waves with morphology similar but slightly
different from sinus beats indicate PACs.
7. Strip shows regular rhythm at 110 bpm; each P wave followed by QRS; PR 0.20 s;
QRS 0.08 s.
Interpretation:
A. Sinus tachycardia
B. Atrial tachycardia
C. Junctional rhythm