EKG Rhythm Strip Quiz (Smarty PANCE) with Verified Answers
Rated A
Atrial Flutter Treat underlying causes (e.g., digoxin toxicity,
Rate: Atrial 250–350 bpm, ventricular varies ischemia, electrolyte imbalance)
Rhythm: Regular or variable (depends on -
conduction)
Resemblance: “Sawtooth” flutter waves
Intervention: Rate control (diltiazem, beta- Normal Sinus Rhythm
blockers), anticoagulation, cardioversion if Rate: 60–100 bpm
unstable Rhythm: Regular
- Resemblance: Normal P before every QRS,
upright, consistent
Intervention: Continue monitoring, no treatment
Bundle Branch Block needed
Rate: Depends on underlying rhythm -
Rhythm: Regular
Resemblance: Wide QRS (>0.12 sec), “bunny
ears” in V leads Second Degree AV Block, Type 2
Intervention: Usually no acute intervention, Second-Degree AV Block (Mobitz II)
monitor for progression Rate: Atrial normal, ventricular slow
- Rhythm: Irregular
Resemblance: P waves with some dropped QRS
(fixed PR intervals)
First Degree AV Block Intervention: Atropine (sometimes ineffective),
Rate: Usually 60–100 bpm pacing, dopamine/epi drip if unstable
Rhythm: Regular -
Resemblance: PR interval prolonged >0.20 sec,
otherwise normal
Intervention: Usually benign, monitor
- Sinus Arrhythmia
Rate: 60–100 bpm (can vary slightly with
breathing)
Rhythm: Irregular – varies with respiration (faster
Junctional Rhythm on inspiration, slower on expiration)
Rate: 40–60 bpm (accelerated junctional: 60– Resemblance:
100; junctional tachycardia: >100) Normal P-QRS-T sequence
Rhythm: Regular Cyclic irregularity in rhythm (not random like A-
Resemblance: Fib)
P wave inverted, absent, or after the QRS Notable Interventions:
Narrow QRS complexes Usually benign, no intervention needed
Notable Interventions: Common in children, young adults, and during
If asymptomatic → usually monitor only sleep
If symptomatic (low cardiac output, dizziness, Monitor; treat only if associated with symptoms or
hypotension): another underlying condition
Atropine (for bradycardia) -
Transcutaneous pacing
Dopamine or epinephrine infusion if unstable
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, EKG Rhythm Strip Quiz (Smarty PANCE) with Verified Answers
Rated A
pulseless, correct electrolytes
Sinus Tach -
Rate: 100–150 bpm
Rhythm: Regular
Resemblance: NSR but faster Third Degree Heart Block (Complete Heart Block)
Intervention: Treat underlying cause (pain, fever, Rate: Atrial normal, ventricular 20–40 bpm
hypovolemia, anxiety, hypoxia Rhythm: Regular but atrial and ventricular
- independent
Resemblance: P waves and QRS “marching
through,” no relationship
Sinus Brady Intervention: Transcutaneous pacing,
Rate: <60 bpm dopamine/epi infusion, permanent pacemaker
Rhythm: Regular -
Resemblance: Looks like NSR but slower
Intervention: If symptomatic → Atropine, pacing,
O₂, IV access V-Fib
- Rate: None
Rhythm: Chaotic, no pattern
Resemblance: Wavy, disorganized baseline, no
SVTRate: 150–250 bpm QRS
Rhythm: Regular Intervention: Immediate CPR, defibrillation,
Resemblance: Narrow QRS, often hidden P epinephrine, amiodarone
waves -
Intervention: Vagal maneuvers, adenosine,
synchronized cardioversion if unstable
- V-Fib
Rate: None
Rhythm: Chaotic, no pattern
SVT Resemblance: Wavy, disorganized baseline, no
Rate: 150–250 bpm QRS
Rhythm: Regular Intervention: Immediate CPR, defibrillation,
Resemblance: Narrow QRS, often hidden P epinephrine, amiodarone
waves -
Intervention: Vagal maneuvers, adenosine,
synchronized cardioversion if unstable
- V-Fib
Rate: None
Rhythm: Chaotic, no pattern
Torsades de pointes Resemblance: Wavy, disorganized baseline, no
Rate: 150–250 bpm QRS
Rhythm: Irregular, polymorphic Intervention: Immediate CPR, defibrillation,
Resemblance: “Twisting of the points” around epinephrine, amiodarone
baseline -
Intervention: Magnesium sulfate, defibrillation if
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Rated A
Atrial Flutter Treat underlying causes (e.g., digoxin toxicity,
Rate: Atrial 250–350 bpm, ventricular varies ischemia, electrolyte imbalance)
Rhythm: Regular or variable (depends on -
conduction)
Resemblance: “Sawtooth” flutter waves
Intervention: Rate control (diltiazem, beta- Normal Sinus Rhythm
blockers), anticoagulation, cardioversion if Rate: 60–100 bpm
unstable Rhythm: Regular
- Resemblance: Normal P before every QRS,
upright, consistent
Intervention: Continue monitoring, no treatment
Bundle Branch Block needed
Rate: Depends on underlying rhythm -
Rhythm: Regular
Resemblance: Wide QRS (>0.12 sec), “bunny
ears” in V leads Second Degree AV Block, Type 2
Intervention: Usually no acute intervention, Second-Degree AV Block (Mobitz II)
monitor for progression Rate: Atrial normal, ventricular slow
- Rhythm: Irregular
Resemblance: P waves with some dropped QRS
(fixed PR intervals)
First Degree AV Block Intervention: Atropine (sometimes ineffective),
Rate: Usually 60–100 bpm pacing, dopamine/epi drip if unstable
Rhythm: Regular -
Resemblance: PR interval prolonged >0.20 sec,
otherwise normal
Intervention: Usually benign, monitor
- Sinus Arrhythmia
Rate: 60–100 bpm (can vary slightly with
breathing)
Rhythm: Irregular – varies with respiration (faster
Junctional Rhythm on inspiration, slower on expiration)
Rate: 40–60 bpm (accelerated junctional: 60– Resemblance:
100; junctional tachycardia: >100) Normal P-QRS-T sequence
Rhythm: Regular Cyclic irregularity in rhythm (not random like A-
Resemblance: Fib)
P wave inverted, absent, or after the QRS Notable Interventions:
Narrow QRS complexes Usually benign, no intervention needed
Notable Interventions: Common in children, young adults, and during
If asymptomatic → usually monitor only sleep
If symptomatic (low cardiac output, dizziness, Monitor; treat only if associated with symptoms or
hypotension): another underlying condition
Atropine (for bradycardia) -
Transcutaneous pacing
Dopamine or epinephrine infusion if unstable
1/6
, EKG Rhythm Strip Quiz (Smarty PANCE) with Verified Answers
Rated A
pulseless, correct electrolytes
Sinus Tach -
Rate: 100–150 bpm
Rhythm: Regular
Resemblance: NSR but faster Third Degree Heart Block (Complete Heart Block)
Intervention: Treat underlying cause (pain, fever, Rate: Atrial normal, ventricular 20–40 bpm
hypovolemia, anxiety, hypoxia Rhythm: Regular but atrial and ventricular
- independent
Resemblance: P waves and QRS “marching
through,” no relationship
Sinus Brady Intervention: Transcutaneous pacing,
Rate: <60 bpm dopamine/epi infusion, permanent pacemaker
Rhythm: Regular -
Resemblance: Looks like NSR but slower
Intervention: If symptomatic → Atropine, pacing,
O₂, IV access V-Fib
- Rate: None
Rhythm: Chaotic, no pattern
Resemblance: Wavy, disorganized baseline, no
SVTRate: 150–250 bpm QRS
Rhythm: Regular Intervention: Immediate CPR, defibrillation,
Resemblance: Narrow QRS, often hidden P epinephrine, amiodarone
waves -
Intervention: Vagal maneuvers, adenosine,
synchronized cardioversion if unstable
- V-Fib
Rate: None
Rhythm: Chaotic, no pattern
SVT Resemblance: Wavy, disorganized baseline, no
Rate: 150–250 bpm QRS
Rhythm: Regular Intervention: Immediate CPR, defibrillation,
Resemblance: Narrow QRS, often hidden P epinephrine, amiodarone
waves -
Intervention: Vagal maneuvers, adenosine,
synchronized cardioversion if unstable
- V-Fib
Rate: None
Rhythm: Chaotic, no pattern
Torsades de pointes Resemblance: Wavy, disorganized baseline, no
Rate: 150–250 bpm QRS
Rhythm: Irregular, polymorphic Intervention: Immediate CPR, defibrillation,
Resemblance: “Twisting of the points” around epinephrine, amiodarone
baseline -
Intervention: Magnesium sulfate, defibrillation if
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