Relias Advanced Dysrhythmia Exam B Actual Exam
2026/2027 | Questions with Verified Answers |
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SECTION 1: Complex Sinus & Atrial Dysrhythmias (10 Questions)
Q1: EKG Description: Rhythm: Irregular with grouped beating. Rate: 75 bpm. P waves: At
least 3 different morphologies visible. PR interval: Varies between 0.12-0.20s. QRS:
Narrow (0.08s). No ST/T abnormalities.
A. Sinus arrhythmia
B. Multifocal atrial tachycardia
C. Atrial flutter with variable block
D. Wandering atrial pacemaker
Correct Answer: D
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular with changing patterns
2. Rate: 75 bpm (<100 bpm - key distinction from MAT)
3. P waves: ≥3 different morphologies - pathognomonic for WAP/MAT
4. PR interval: Varies with different pacemaker sites
5. QRS: Normal width indicating supraventricular origin
6. Interpretation: Wandering atrial pacemaker (rate <100 defines WAP vs MAT)
Clinical Significance: Often benign, seen in COPD, usually requires no treatment
7. Distinguishing from MAT: Identical features except MAT has rate >100 bpm
Q2: EKG Description: Rhythm: Regular. Rate: 150 bpm. P waves: Hidden in preceding T
waves. PR interval: Not measurable. QRS: Narrow (0.08s). ST depression in inferior
leads.
A. Sinus tachycardia
,B. Paroxysmal supraventricular tachycardia
C. Atrial flutter 2:1
D. Ventricular tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular
2. Rate: 150 bpm (typical for PSVT)
3. P waves: Hidden in T waves - common in PSVT
4. PR interval: Not measurable due to hidden P waves
5. QRS: Narrow indicating supraventricular origin
6. Interpretation: Paroxysmal supraventricular tachycardia
Clinical Significance: Sudden onset/offset, may respond to vagal maneuvers
7. Why not others: Sinus tachycardia would have visible P waves, flutter would have
sawtooth pattern, VT would be wide QRS
Q3: EKG Description: Rhythm: Regular sawtooth pattern. Rate: Atrial 300 bpm,
ventricular 150 bpm. P waves: Classic sawtooth flutter waves. PR interval: Not
applicable. QRS: Narrow (0.08s). No ST/T abnormalities.
A. Atrial fibrillation
B. Atrial flutter 2:1 conduction
C. Sinus tachycardia
D. PSVT
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular sawtooth pattern
2. Rate: Atrial 300 bpm, ventricular 150 bpm (2:1 ratio)
3. P waves: Classic sawtooth flutter waves
4. PR interval: Not measurable - continuous flutter waves
5. QRS: Normal width
6. Interpretation: Atrial flutter with 2:1 conduction
, Clinical Significance: Often 2:1, 3:1, or 4:1 conduction ratios; may require rate/rhythm
control
7. Key feature: Atrial rate of 300 bpm with sawtooth pattern is pathognomonic
Q4: EKG Description: Rhythm: Irregularly irregular. Rate: 350-400 atrial, 120-160
ventricular. P waves: Chaotic fibrillatory waves. PR interval: Not measurable. QRS:
Narrow (0.08s). Irregular R-R intervals.
A. Atrial flutter
B. Atrial fibrillation
C. Multifocal atrial tachycardia
D. Sinus arrhythmia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregularly irregular
2. Rate: Atrial 350-400 bpm, ventricular 120-160 bpm
3. P waves: Chaotic fibrillatory waves - no organized atrial activity
4. PR interval: Not measurable
5. QRS: Normal width
6. Interpretation: Atrial fibrillation with rapid ventricular response
Clinical Significance: Requires rate control and anticoagulation; risk of stroke
7. Distinguishing features: Chaotic baseline, irregularly irregular rhythm, no discrete
P waves
Q5: EKG Description: Rhythm: Regular. Rate: 180 bpm. P waves: 1:1 ratio with QRS,
upright in II. PR interval: Normal (0.16s). QRS: Narrow (0.08s). Gradual onset/offset.
A. PSVT
B. Sinus tachycardia
C. Atrial flutter
D. Ventricular tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
2026/2027 | Questions with Verified Answers |
100% Correct | Pass Guaranteed
SECTION 1: Complex Sinus & Atrial Dysrhythmias (10 Questions)
Q1: EKG Description: Rhythm: Irregular with grouped beating. Rate: 75 bpm. P waves: At
least 3 different morphologies visible. PR interval: Varies between 0.12-0.20s. QRS:
Narrow (0.08s). No ST/T abnormalities.
A. Sinus arrhythmia
B. Multifocal atrial tachycardia
C. Atrial flutter with variable block
D. Wandering atrial pacemaker
Correct Answer: D
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular with changing patterns
2. Rate: 75 bpm (<100 bpm - key distinction from MAT)
3. P waves: ≥3 different morphologies - pathognomonic for WAP/MAT
4. PR interval: Varies with different pacemaker sites
5. QRS: Normal width indicating supraventricular origin
6. Interpretation: Wandering atrial pacemaker (rate <100 defines WAP vs MAT)
Clinical Significance: Often benign, seen in COPD, usually requires no treatment
7. Distinguishing from MAT: Identical features except MAT has rate >100 bpm
Q2: EKG Description: Rhythm: Regular. Rate: 150 bpm. P waves: Hidden in preceding T
waves. PR interval: Not measurable. QRS: Narrow (0.08s). ST depression in inferior
leads.
A. Sinus tachycardia
,B. Paroxysmal supraventricular tachycardia
C. Atrial flutter 2:1
D. Ventricular tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular
2. Rate: 150 bpm (typical for PSVT)
3. P waves: Hidden in T waves - common in PSVT
4. PR interval: Not measurable due to hidden P waves
5. QRS: Narrow indicating supraventricular origin
6. Interpretation: Paroxysmal supraventricular tachycardia
Clinical Significance: Sudden onset/offset, may respond to vagal maneuvers
7. Why not others: Sinus tachycardia would have visible P waves, flutter would have
sawtooth pattern, VT would be wide QRS
Q3: EKG Description: Rhythm: Regular sawtooth pattern. Rate: Atrial 300 bpm,
ventricular 150 bpm. P waves: Classic sawtooth flutter waves. PR interval: Not
applicable. QRS: Narrow (0.08s). No ST/T abnormalities.
A. Atrial fibrillation
B. Atrial flutter 2:1 conduction
C. Sinus tachycardia
D. PSVT
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular sawtooth pattern
2. Rate: Atrial 300 bpm, ventricular 150 bpm (2:1 ratio)
3. P waves: Classic sawtooth flutter waves
4. PR interval: Not measurable - continuous flutter waves
5. QRS: Normal width
6. Interpretation: Atrial flutter with 2:1 conduction
, Clinical Significance: Often 2:1, 3:1, or 4:1 conduction ratios; may require rate/rhythm
control
7. Key feature: Atrial rate of 300 bpm with sawtooth pattern is pathognomonic
Q4: EKG Description: Rhythm: Irregularly irregular. Rate: 350-400 atrial, 120-160
ventricular. P waves: Chaotic fibrillatory waves. PR interval: Not measurable. QRS:
Narrow (0.08s). Irregular R-R intervals.
A. Atrial flutter
B. Atrial fibrillation
C. Multifocal atrial tachycardia
D. Sinus arrhythmia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregularly irregular
2. Rate: Atrial 350-400 bpm, ventricular 120-160 bpm
3. P waves: Chaotic fibrillatory waves - no organized atrial activity
4. PR interval: Not measurable
5. QRS: Normal width
6. Interpretation: Atrial fibrillation with rapid ventricular response
Clinical Significance: Requires rate control and anticoagulation; risk of stroke
7. Distinguishing features: Chaotic baseline, irregularly irregular rhythm, no discrete
P waves
Q5: EKG Description: Rhythm: Regular. Rate: 180 bpm. P waves: 1:1 ratio with QRS,
upright in II. PR interval: Normal (0.16s). QRS: Narrow (0.08s). Gradual onset/offset.
A. PSVT
B. Sinus tachycardia
C. Atrial flutter
D. Ventricular tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
