Relias Advanced Dysrhythmia Exam B Actual Exam
2026/2027 | 52 Questions with Verified Answers |
100% Correct | Pass Guaranteed
SECTION 1: Complex Atrial & Junctional Dysrhythmias (12 Questions)
Q1: EKG Description: Rhythm: Irregularly irregular with no pattern. Rate: 110-130 bpm. P
waves: Present but at least 3 different morphologies. PR interval: Varies. QRS: Narrow
(0.08s). ST/T: Normal. Additional features: Isoelectric baseline between P waves.
A. Atrial fibrillation
B. Multifocal atrial tachycardia (MAT)
C. Sinus arrhythmia
D. Atrial flutter with variable conduction
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Irregularly irregular rhythm with chaotic P wave
appearance
2. Rate calculation: 110-130 bpm (atrial and ventricular rates are identical)
3. P wave analysis: Present with ≥3 distinct morphologies - hallmark of wandering
atrial pacemaker sites
4. PR interval measurement: Variable due to different atrial foci (0.12-0.20s range)
5. QRS analysis: Narrow at 0.08s, confirming supraventricular origin
6. Interpretation and diagnosis: Multifocal atrial tachycardia - meets all criteria:
irregular, rate >100, multiple P wave morphologies
7. Clinical significance and intervention: Associated with COPD exacerbations; treat
underlying disease, not rate control. Magnesium may help.Differentiation from
WAP: Wandering atrial pacemaker has identical P wave criteria but rate <100
bpm.
,Q2: EKG Description: Rhythm: Regular. Rate: 52 bpm. P waves: Absent. PR interval: Not
measurable. QRS: Narrow (0.08s). ST/T: Normal. Additional features: No ectopic beats
noted.
A. Sinus bradycardia
B. Junctional rhythm
C. 2:1 AV block
D. Idioventricular rhythm
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Completely regular R-R intervals
2. Rate calculation: 52 bpm (40-60 is junctional escape rate)
3. P wave analysis: Absent - key finding; may be retrograde within QRS
4. PR interval measurement: Not measurable due to absent P waves
5. QRS analysis: Narrow 0.08s indicates AV junctional origin (His bundle)
6. Interpretation and diagnosis: Junctional rhythm - regular narrow QRS at 40-60
bpm without P waves
7. Clinical significance and intervention: Assess for hypotension, dizziness.
Atropine 0.5mg IV if symptomatic.Differentiation: Idioventricular rhythm would
have wide QRS >0.12s.
Q3: EKG Description: Rhythm: Irregularly irregular. Rate: 86 bpm. P waves: Present with
3 different shapes. PR interval: Variable from 0.14-0.18s. QRS: Narrow (0.09s). ST/T:
Normal. Additional features: P-P interval varies by >0.16s.
A. Atrial ectopic tachycardia
B. Sinus rhythm with PACs
C. Wandering atrial pacemaker (WAP)
D. Atrial tachycardia with block
Correct Answer: C
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Irregularly irregular due to competing atrial foci
2. Rate calculation: 86 bpm (ventricular rate <100)
3. P wave analysis: 3 distinct morphologies indicating multiple atrial pacemaker
sites
4. PR interval measurement: Variable between 0.14-0.18s as foci change
, 5. QRS analysis: Narrow at 0.09s, confirming supraventricular conduction
6. Interpretation and diagnosis: Wandering atrial pacemaker - identical to MAT but
rate <100
7. Clinical significance and intervention: Usually benign, observe. May indicate
underlying cardiac or pulmonary disease.Differentiation from MAT: Rate <100
bpm is defining feature.
Q4: EKG Description: Rhythm: Regular atrial activity at 210 bpm, irregular ventricular
response at 70 bpm. P waves: Sawtooth flutter waves. PR interval: Variable and
unrelated. QRS: Narrow (0.08s). ST/T: Normal. Additional features: Flutter waves visible
in leads II, III, aVF.
A. Atrial flutter with 3:1 conduction
B. Atrial fibrillation with RVR
C. SVT with block
D. Multifocal atrial tachycardia
Correct Answer: A
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Regular atrial activity, irregular ventricular response
2. Rate calculation: Atrial 210 bpm, ventricular 70 bpm (3:1 ratio)
3. P wave analysis: Sawtooth flutter waves at 210 bpm - pathognomonic for atrial
flutter
4. PR interval measurement: Variable due to AV node conduction ratio
5. QRS analysis: Narrow at 0.08s, normal conduction
6. Interpretation and diagnosis: Atrial flutter with 3:1 conduction - regular sawtooth
waves with organized ventricular response
7. Clinical significance and intervention: Rate control with beta-blocker or CCB.
Consider anticoagulation.Differentiation from AFib: AFib has no organized atrial
activity; flutter has sawtooth pattern.
Q5: EKG Description: Rhythm: Regular. Rate: 140 bpm. P waves: Present but inverted in
II, III, aVF. PR interval: Short at 0.10s. QRS: Narrow (0.08s). ST/T: Normal. Additional
features: Retrograde P waves follow QRS.
A. Sinus tachycardia
B. Ectopic atrial tachycardia
C. Junctional tachycardia
, D. AVRT
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Regular R-R intervals throughout strip
2. Rate calculation: 140 bpm (>100 = tachycardia)
3. P wave analysis: Inverted in inferior leads indicating non-sinus origin, ectopic
atrial focus
4. PR interval measurement: Short at 0.10s due to ectopic focus near AV node
5. QRS analysis: Narrow at 0.08s, supraventricular conduction intact
6. Interpretation and diagnosis: Ectopic atrial tachycardia - abnormal P wave
morphology with narrow QRS
7. Clinical significance and intervention: Consider underlying cause (digoxin toxicity,
structural heart disease). Vagal maneuvers won't terminate.Differentiation:
Junctional tachycardia would have absent/invisible P waves.
Q6: EKG Description: Rhythm: Regular. Rate: 110 bpm. P waves: Not visible. PR interval:
Not measurable. QRS: Narrow (0.09s). ST/T: Normal. Additional features: No P waves
seen in any lead.
A. Sinus tachycardia
B. Junctional tachycardia
C. Atrial tachycardia
D. AVNRT
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Regular narrow-complex tachycardia
2. Rate calculation: 110 bpm (>100)
3. P wave analysis: Absent/invisible - key diagnostic feature
4. PR interval measurement: Not measurable
5. QRS analysis: Narrow at 0.09s, confirming junctional origin
6. Interpretation and diagnosis: Junctional tachycardia - rate 100-150, absent P
waves, narrow QRS
7. Clinical significance and intervention: May indicate digoxin toxicity or myocardial
ischemia. Treat underlying cause.Differentiation from AVNRT: AVNRT would have
P waves buried in QRS (pseudo-R' in V1).
2026/2027 | 52 Questions with Verified Answers |
100% Correct | Pass Guaranteed
SECTION 1: Complex Atrial & Junctional Dysrhythmias (12 Questions)
Q1: EKG Description: Rhythm: Irregularly irregular with no pattern. Rate: 110-130 bpm. P
waves: Present but at least 3 different morphologies. PR interval: Varies. QRS: Narrow
(0.08s). ST/T: Normal. Additional features: Isoelectric baseline between P waves.
A. Atrial fibrillation
B. Multifocal atrial tachycardia (MAT)
C. Sinus arrhythmia
D. Atrial flutter with variable conduction
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Irregularly irregular rhythm with chaotic P wave
appearance
2. Rate calculation: 110-130 bpm (atrial and ventricular rates are identical)
3. P wave analysis: Present with ≥3 distinct morphologies - hallmark of wandering
atrial pacemaker sites
4. PR interval measurement: Variable due to different atrial foci (0.12-0.20s range)
5. QRS analysis: Narrow at 0.08s, confirming supraventricular origin
6. Interpretation and diagnosis: Multifocal atrial tachycardia - meets all criteria:
irregular, rate >100, multiple P wave morphologies
7. Clinical significance and intervention: Associated with COPD exacerbations; treat
underlying disease, not rate control. Magnesium may help.Differentiation from
WAP: Wandering atrial pacemaker has identical P wave criteria but rate <100
bpm.
,Q2: EKG Description: Rhythm: Regular. Rate: 52 bpm. P waves: Absent. PR interval: Not
measurable. QRS: Narrow (0.08s). ST/T: Normal. Additional features: No ectopic beats
noted.
A. Sinus bradycardia
B. Junctional rhythm
C. 2:1 AV block
D. Idioventricular rhythm
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Completely regular R-R intervals
2. Rate calculation: 52 bpm (40-60 is junctional escape rate)
3. P wave analysis: Absent - key finding; may be retrograde within QRS
4. PR interval measurement: Not measurable due to absent P waves
5. QRS analysis: Narrow 0.08s indicates AV junctional origin (His bundle)
6. Interpretation and diagnosis: Junctional rhythm - regular narrow QRS at 40-60
bpm without P waves
7. Clinical significance and intervention: Assess for hypotension, dizziness.
Atropine 0.5mg IV if symptomatic.Differentiation: Idioventricular rhythm would
have wide QRS >0.12s.
Q3: EKG Description: Rhythm: Irregularly irregular. Rate: 86 bpm. P waves: Present with
3 different shapes. PR interval: Variable from 0.14-0.18s. QRS: Narrow (0.09s). ST/T:
Normal. Additional features: P-P interval varies by >0.16s.
A. Atrial ectopic tachycardia
B. Sinus rhythm with PACs
C. Wandering atrial pacemaker (WAP)
D. Atrial tachycardia with block
Correct Answer: C
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Irregularly irregular due to competing atrial foci
2. Rate calculation: 86 bpm (ventricular rate <100)
3. P wave analysis: 3 distinct morphologies indicating multiple atrial pacemaker
sites
4. PR interval measurement: Variable between 0.14-0.18s as foci change
, 5. QRS analysis: Narrow at 0.09s, confirming supraventricular conduction
6. Interpretation and diagnosis: Wandering atrial pacemaker - identical to MAT but
rate <100
7. Clinical significance and intervention: Usually benign, observe. May indicate
underlying cardiac or pulmonary disease.Differentiation from MAT: Rate <100
bpm is defining feature.
Q4: EKG Description: Rhythm: Regular atrial activity at 210 bpm, irregular ventricular
response at 70 bpm. P waves: Sawtooth flutter waves. PR interval: Variable and
unrelated. QRS: Narrow (0.08s). ST/T: Normal. Additional features: Flutter waves visible
in leads II, III, aVF.
A. Atrial flutter with 3:1 conduction
B. Atrial fibrillation with RVR
C. SVT with block
D. Multifocal atrial tachycardia
Correct Answer: A
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Regular atrial activity, irregular ventricular response
2. Rate calculation: Atrial 210 bpm, ventricular 70 bpm (3:1 ratio)
3. P wave analysis: Sawtooth flutter waves at 210 bpm - pathognomonic for atrial
flutter
4. PR interval measurement: Variable due to AV node conduction ratio
5. QRS analysis: Narrow at 0.08s, normal conduction
6. Interpretation and diagnosis: Atrial flutter with 3:1 conduction - regular sawtooth
waves with organized ventricular response
7. Clinical significance and intervention: Rate control with beta-blocker or CCB.
Consider anticoagulation.Differentiation from AFib: AFib has no organized atrial
activity; flutter has sawtooth pattern.
Q5: EKG Description: Rhythm: Regular. Rate: 140 bpm. P waves: Present but inverted in
II, III, aVF. PR interval: Short at 0.10s. QRS: Narrow (0.08s). ST/T: Normal. Additional
features: Retrograde P waves follow QRS.
A. Sinus tachycardia
B. Ectopic atrial tachycardia
C. Junctional tachycardia
, D. AVRT
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Regular R-R intervals throughout strip
2. Rate calculation: 140 bpm (>100 = tachycardia)
3. P wave analysis: Inverted in inferior leads indicating non-sinus origin, ectopic
atrial focus
4. PR interval measurement: Short at 0.10s due to ectopic focus near AV node
5. QRS analysis: Narrow at 0.08s, supraventricular conduction intact
6. Interpretation and diagnosis: Ectopic atrial tachycardia - abnormal P wave
morphology with narrow QRS
7. Clinical significance and intervention: Consider underlying cause (digoxin toxicity,
structural heart disease). Vagal maneuvers won't terminate.Differentiation:
Junctional tachycardia would have absent/invisible P waves.
Q6: EKG Description: Rhythm: Regular. Rate: 110 bpm. P waves: Not visible. PR interval:
Not measurable. QRS: Narrow (0.09s). ST/T: Normal. Additional features: No P waves
seen in any lead.
A. Sinus tachycardia
B. Junctional tachycardia
C. Atrial tachycardia
D. AVNRT
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm regularity analysis: Regular narrow-complex tachycardia
2. Rate calculation: 110 bpm (>100)
3. P wave analysis: Absent/invisible - key diagnostic feature
4. PR interval measurement: Not measurable
5. QRS analysis: Narrow at 0.09s, confirming junctional origin
6. Interpretation and diagnosis: Junctional tachycardia - rate 100-150, absent P
waves, narrow QRS
7. Clinical significance and intervention: May indicate digoxin toxicity or myocardial
ischemia. Treat underlying cause.Differentiation from AVNRT: AVNRT would have
P waves buried in QRS (pseudo-R' in V1).
