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 consistent pattern. Rate:
110-130 bpm. P waves: Present with at least three distinct morphologies in same lead.
PR interval: Variable, 0.12-0.20s. QRS: Narrow (0.08s). ST/T: Normal baseline.
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: Irregularly irregular - characteristic of multiple ectopic atrial foci.
2. Rate: 110-130 bpm (exceeds 100 bpm threshold for tachycardia vs WAP).
3. P waves: ≥3 distinct morphologies - hallmark of multifocal atrial activity.
4. PR interval: Variable due to different conduction pathways from ectopic sites.
5. QRS: Narrow, indicating supraventricular origin with normal conduction.
6. Interpretation: Multifocal Atrial Tachycardia - all criteria met: irregular, rate >100,
multiple P wave morphologies.
Clinical Significance: Associated with severe COPD exacerbation, hypoxia. Treat
underlying disease; avoid calcium channel blockers in severe lung disease.
, 7. Differentiation from WAP: Wandering Atrial Pacemaker has identical features but
rate <100 bpm.
Q2: EKG Description: Rhythm: Regular. Rate: 52 bpm. P waves: Absent. PR interval:
Not measurable. QRS: Narrow (0.06s). ST/T: Normal. No preceding atrial activity 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: Regular - consistent R-R intervals.
2. Rate: 52 bpm (within 40-60 bpm junctional escape rate range).
3. P waves: Absent - no visible P waves before QRS complexes.
4. PR interval: Not measurable due to absence of P waves.
5. QRS: Narrow (0.06s) - critical differentiator from ventricular rhythm.
6. Interpretation: Junctional rhythm - secondary pacemaker at AV node/His bundle.
Clinical Action: Assess perfusion, monitor for symptoms. If symptomatic: atropine 0.5mg
IV, consider pacing.
7. Differentiation: Idioventricular rhythm would have wide QRS >0.12s.
Q3: EKG Description: Rhythm: Irregular. Rate: 85 bpm. P waves: Present with three
distinct morphologies shifting across strip. PR interval: Variable 0.14-0.22s. QRS:
Narrow (0.07s). ST/T: Normal.
A. Multifocal atrial tachycardia
B. Wandering atrial pacemaker (WAP)
C. Atrial flutter with variable block
,D. Sinus rhythm with multifocal PACs
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular due to shifting pacemaker sites.
2. Rate: 85 bpm (<100 bpm - key differentiator from MAT).
3. P waves: ≥3 distinct morphologies - indicates shifting atrial pacemaker.
4. PR interval: Variable, reflecting different conduction times.
5. QRS: Narrow, confirming supraventricular origin.
6. Interpretation: Wandering Atrial Pacemaker - normal variant, no treatment
needed.
Clinical Significance: Benign finding in athletes, can occur with vagal tone.
7. Differentiation from MAT: MAT requires rate >100 bpm.
Q4: EKG Description: Rhythm: Regular. Rate: 160 bpm. P waves: Difficult to discern,
retrograde P waves visible after QRS. PR interval: Not applicable. QRS: Narrow (0.08s).
ST/T: Normal. Sudden onset/offset pattern reported.
A. Sinus tachycardia
B. Atrial flutter with 2:1 conduction
C. AV nodal reentrant tachycardia (AVNRT)
D. Atrial fibrillation
Correct Answer: C
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular - consistent R-R intervals.
2. Rate: 160 bpm (typical for AVNRT: 150-250 bpm).
3. P waves: Retrograde P waves after QRS ("pseudo R' in V1" or "pseudo S in II,
III, aVF").
, 4. PR interval: Short RP interval if P visible, often buried in QRS.
5. QRS: Narrow - supraventricular origin with normal conduction.
6. Interpretation: AVNRT - reentry circuit within AV node, classic narrow complex
SVT.
Clinical Action: Vagal maneuvers, adenosine 6mg rapid IV push if unstable.
7. Differentiation from AVRT: AVRT has longer RP interval, may show pre-excitation
in sinus rhythm.
Q5: EKG Description: Rhythm: Regular. Rate: 130 bpm. P waves: Different morphology
from sinus P, upright in II but different shape. PR interval: Constant 0.16s. QRS: Wide
(0.14s) with right bundle branch block pattern. ST/T: Discordant changes.
A. SVT with aberrancy
B. Atrial tachycardia with RBBB aberrancy
C. Ventricular tachycardia
D. Pre-excited tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular - consistent R-R intervals.
2. Rate: 130 bpm (supraventricular tachycardia range).
3. P waves: Abnormal P morphology - indicates ectopic atrial focus, not sinus.
4. PR interval: Constant 0.16s - fixed relationship between P and QRS.
5. QRS: Wide (0.14s) with RBBB pattern - delay in right ventricular conduction.
6. Interpretation: Atrial tachycardia with rate-dependent RBBB aberrancy.
Clinical Action: Treat underlying atrial tachycardia (beta-blockers, calcium channel
blockers), aberrancy will resolve with rate control.
7. Differentiation from VT: VT would show AV dissociation and no fixed P:QRS
relationship.
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 consistent pattern. Rate:
110-130 bpm. P waves: Present with at least three distinct morphologies in same lead.
PR interval: Variable, 0.12-0.20s. QRS: Narrow (0.08s). ST/T: Normal baseline.
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: Irregularly irregular - characteristic of multiple ectopic atrial foci.
2. Rate: 110-130 bpm (exceeds 100 bpm threshold for tachycardia vs WAP).
3. P waves: ≥3 distinct morphologies - hallmark of multifocal atrial activity.
4. PR interval: Variable due to different conduction pathways from ectopic sites.
5. QRS: Narrow, indicating supraventricular origin with normal conduction.
6. Interpretation: Multifocal Atrial Tachycardia - all criteria met: irregular, rate >100,
multiple P wave morphologies.
Clinical Significance: Associated with severe COPD exacerbation, hypoxia. Treat
underlying disease; avoid calcium channel blockers in severe lung disease.
, 7. Differentiation from WAP: Wandering Atrial Pacemaker has identical features but
rate <100 bpm.
Q2: EKG Description: Rhythm: Regular. Rate: 52 bpm. P waves: Absent. PR interval:
Not measurable. QRS: Narrow (0.06s). ST/T: Normal. No preceding atrial activity 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: Regular - consistent R-R intervals.
2. Rate: 52 bpm (within 40-60 bpm junctional escape rate range).
3. P waves: Absent - no visible P waves before QRS complexes.
4. PR interval: Not measurable due to absence of P waves.
5. QRS: Narrow (0.06s) - critical differentiator from ventricular rhythm.
6. Interpretation: Junctional rhythm - secondary pacemaker at AV node/His bundle.
Clinical Action: Assess perfusion, monitor for symptoms. If symptomatic: atropine 0.5mg
IV, consider pacing.
7. Differentiation: Idioventricular rhythm would have wide QRS >0.12s.
Q3: EKG Description: Rhythm: Irregular. Rate: 85 bpm. P waves: Present with three
distinct morphologies shifting across strip. PR interval: Variable 0.14-0.22s. QRS:
Narrow (0.07s). ST/T: Normal.
A. Multifocal atrial tachycardia
B. Wandering atrial pacemaker (WAP)
C. Atrial flutter with variable block
,D. Sinus rhythm with multifocal PACs
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Irregular due to shifting pacemaker sites.
2. Rate: 85 bpm (<100 bpm - key differentiator from MAT).
3. P waves: ≥3 distinct morphologies - indicates shifting atrial pacemaker.
4. PR interval: Variable, reflecting different conduction times.
5. QRS: Narrow, confirming supraventricular origin.
6. Interpretation: Wandering Atrial Pacemaker - normal variant, no treatment
needed.
Clinical Significance: Benign finding in athletes, can occur with vagal tone.
7. Differentiation from MAT: MAT requires rate >100 bpm.
Q4: EKG Description: Rhythm: Regular. Rate: 160 bpm. P waves: Difficult to discern,
retrograde P waves visible after QRS. PR interval: Not applicable. QRS: Narrow (0.08s).
ST/T: Normal. Sudden onset/offset pattern reported.
A. Sinus tachycardia
B. Atrial flutter with 2:1 conduction
C. AV nodal reentrant tachycardia (AVNRT)
D. Atrial fibrillation
Correct Answer: C
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular - consistent R-R intervals.
2. Rate: 160 bpm (typical for AVNRT: 150-250 bpm).
3. P waves: Retrograde P waves after QRS ("pseudo R' in V1" or "pseudo S in II,
III, aVF").
, 4. PR interval: Short RP interval if P visible, often buried in QRS.
5. QRS: Narrow - supraventricular origin with normal conduction.
6. Interpretation: AVNRT - reentry circuit within AV node, classic narrow complex
SVT.
Clinical Action: Vagal maneuvers, adenosine 6mg rapid IV push if unstable.
7. Differentiation from AVRT: AVRT has longer RP interval, may show pre-excitation
in sinus rhythm.
Q5: EKG Description: Rhythm: Regular. Rate: 130 bpm. P waves: Different morphology
from sinus P, upright in II but different shape. PR interval: Constant 0.16s. QRS: Wide
(0.14s) with right bundle branch block pattern. ST/T: Discordant changes.
A. SVT with aberrancy
B. Atrial tachycardia with RBBB aberrancy
C. Ventricular tachycardia
D. Pre-excited tachycardia
Correct Answer: B
Rationale: Step-by-Step Analysis:
1. Rhythm: Regular - consistent R-R intervals.
2. Rate: 130 bpm (supraventricular tachycardia range).
3. P waves: Abnormal P morphology - indicates ectopic atrial focus, not sinus.
4. PR interval: Constant 0.16s - fixed relationship between P and QRS.
5. QRS: Wide (0.14s) with RBBB pattern - delay in right ventricular conduction.
6. Interpretation: Atrial tachycardia with rate-dependent RBBB aberrancy.
Clinical Action: Treat underlying atrial tachycardia (beta-blockers, calcium channel
blockers), aberrancy will resolve with rate control.
7. Differentiation from VT: VT would show AV dissociation and no fixed P:QRS
relationship.
