Relias Advanced Dysrhythmia Exam B Complete 52 Questions Answered step-by-step Relias
Advanced Dysrhythmia Clinical Assessment
,1) A fast, repeatable step-by-step approach for any
dysrhythmia question
When you see an ECG or clinical vignette, always work in
this order:
1. Clinical context first — symptoms, blood pressure,
consciousness, chest pain, meds, electrolytes,
pacemaker. (This drives treatment.)
2. Rate — count beats (300 / # large boxes between R–R)
or count over 6 sec ×10. Decide if brady (<60), normal
(60–100), tachy (>100).
3. Rhythm regularity — are R-R intervals regular,
regularly irregular, or irregularly irregular?
4. P waves — present? identical? before each QRS?
morphology (sinus vs ectopic atrial vs absent).
5. PR interval — constant or variable; prolonged (>0.20 s)
suggests AV block.
6. QRS width — narrow (<0.12 s) → supraventricular
origin; wide (≥0.12 s) → ventricular origin or
aberrancy/BBB.
7. Atrial rate vs ventricular rate — helps identify AV block,
A-flutter, A-fib.
8. Look for classic patterns (sawtooth flutter waves,
chaotic baseline in A-fib, wide monomorphic VT,
polymorphic VT/Torsades).
9. Assess hemodynamic stability — hypotension, shock,
ischemia, altered mental status, heart failure →
immediate synchronized cardioversion if unstable for
many tachyarrhythmias.
, 10. Choose treatment algorithm (ACLS): vagal
maneuvers/adenosine for narrow regular SVT; beta-
blocker/CCB for stable A-fib with RVR; amiodarone for
VT (stable) or notorious situations; synchronized
cardioversion for unstable tachyarrhythmias;
immediate defib for pulseless VT/VF.
Memorize these three quick differentiators:
• Regular + narrow + rate >150 → SVT (AVNRT/AVRT)
likely; try vagal/adenosine.
• Irregularly irregular + absent P waves → A-fib; rate
control or anticoagulation decisions depend on context.
• Wide complex tachycardia (≥0.12 s) with regular
rhythm → treat as VT until proven otherwise.
2) Quick ACLS/clinical decision snippets (useful for exam
answers)
• Pulseless VT / VF → immediate CPR + defibrillation +
epinephrine every 3–5 min; amiodarone after second
shock.
• Unstable tachycardia with pulse (hypotension,
ischemia, AMS, shock) → synchronized cardioversion.
• Stable narrow-complex SVT → vagal maneuvers →
adenosine (6 mg rapid IV push; if no effect 12 mg).
• Atrial fibrillation, stable with RVR → rate control (IV
beta-blocker or non-DHP CCB); if WPW present → avoid
CCBs/digoxin; use procainamide.
, • Torsades de pointes (polymorphic VT with prolonged
QT) → IV magnesium 2 g; if unstable, defibrillate.
Correct K+/Mg2+.
• Bradycardia with symptoms → atropine 0.5 mg IV
(repeat q3–5 min to max 3 mg). If refractory →
transcutaneous pacing or dopamine/epinephrine
infusion.
3) Practice questions (20). Read each, choose the best
answer, then read step-by-step explanation.
Questions and answers
Q1
A patient is symptomatic (dizzy, hypotensive). ECG: regular
rhythm, rate 180 bpm, narrow QRS complexes, P waves not
visible; R-R regular. Most likely diagnosis?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Supraventricular tachycardia (AVNRT/AVRT)
D. Atrial flutter with 2:1 conduction
Answer: C — SVT (AVNRT/AVRT).
Why: Narrow QRS + very regular rate ~180 + P waves
absent/hidden suggests SVT (AVNRT/AVRT). A-fib is
irregularly irregular. A-flutter often has atrial rate ~300
Advanced Dysrhythmia Clinical Assessment
,1) A fast, repeatable step-by-step approach for any
dysrhythmia question
When you see an ECG or clinical vignette, always work in
this order:
1. Clinical context first — symptoms, blood pressure,
consciousness, chest pain, meds, electrolytes,
pacemaker. (This drives treatment.)
2. Rate — count beats (300 / # large boxes between R–R)
or count over 6 sec ×10. Decide if brady (<60), normal
(60–100), tachy (>100).
3. Rhythm regularity — are R-R intervals regular,
regularly irregular, or irregularly irregular?
4. P waves — present? identical? before each QRS?
morphology (sinus vs ectopic atrial vs absent).
5. PR interval — constant or variable; prolonged (>0.20 s)
suggests AV block.
6. QRS width — narrow (<0.12 s) → supraventricular
origin; wide (≥0.12 s) → ventricular origin or
aberrancy/BBB.
7. Atrial rate vs ventricular rate — helps identify AV block,
A-flutter, A-fib.
8. Look for classic patterns (sawtooth flutter waves,
chaotic baseline in A-fib, wide monomorphic VT,
polymorphic VT/Torsades).
9. Assess hemodynamic stability — hypotension, shock,
ischemia, altered mental status, heart failure →
immediate synchronized cardioversion if unstable for
many tachyarrhythmias.
, 10. Choose treatment algorithm (ACLS): vagal
maneuvers/adenosine for narrow regular SVT; beta-
blocker/CCB for stable A-fib with RVR; amiodarone for
VT (stable) or notorious situations; synchronized
cardioversion for unstable tachyarrhythmias;
immediate defib for pulseless VT/VF.
Memorize these three quick differentiators:
• Regular + narrow + rate >150 → SVT (AVNRT/AVRT)
likely; try vagal/adenosine.
• Irregularly irregular + absent P waves → A-fib; rate
control or anticoagulation decisions depend on context.
• Wide complex tachycardia (≥0.12 s) with regular
rhythm → treat as VT until proven otherwise.
2) Quick ACLS/clinical decision snippets (useful for exam
answers)
• Pulseless VT / VF → immediate CPR + defibrillation +
epinephrine every 3–5 min; amiodarone after second
shock.
• Unstable tachycardia with pulse (hypotension,
ischemia, AMS, shock) → synchronized cardioversion.
• Stable narrow-complex SVT → vagal maneuvers →
adenosine (6 mg rapid IV push; if no effect 12 mg).
• Atrial fibrillation, stable with RVR → rate control (IV
beta-blocker or non-DHP CCB); if WPW present → avoid
CCBs/digoxin; use procainamide.
, • Torsades de pointes (polymorphic VT with prolonged
QT) → IV magnesium 2 g; if unstable, defibrillate.
Correct K+/Mg2+.
• Bradycardia with symptoms → atropine 0.5 mg IV
(repeat q3–5 min to max 3 mg). If refractory →
transcutaneous pacing or dopamine/epinephrine
infusion.
3) Practice questions (20). Read each, choose the best
answer, then read step-by-step explanation.
Questions and answers
Q1
A patient is symptomatic (dizzy, hypotensive). ECG: regular
rhythm, rate 180 bpm, narrow QRS complexes, P waves not
visible; R-R regular. Most likely diagnosis?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Supraventricular tachycardia (AVNRT/AVRT)
D. Atrial flutter with 2:1 conduction
Answer: C — SVT (AVNRT/AVRT).
Why: Narrow QRS + very regular rate ~180 + P waves
absent/hidden suggests SVT (AVNRT/AVRT). A-fib is
irregularly irregular. A-flutter often has atrial rate ~300
