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Chapter 12 Test — Irregular Rhythms
25 questions · 25 min · +4 / -1
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Question 1
Question 1
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A 23-year-old woman has had fever for one week. The monitor rhythm strip shown was recorded. The rhythm is most consistent with:
A.
Atrial fibrillation
B.
Atrial flutter
C.
Supraventricular tachycardia
D.
Ventricular tachycardia
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Question 2
Question 2
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A 62-year-old hypertensive man presents with sudden-onset palpitations. His ECG shows an irregularly irregular rhythm with no discernible P waves and a ventricular rate of 132/min. What is the most likely diagnosis?
A.
Atrial fibrillation
B.
Atrial flutter with variable AV block
C.
Multifocal atrial tachycardia
D.
AV nodal re-entrant tachycardia
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Question 3
Question 3
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A 60-year-old man presents with palpitations and shortness of breath. His ECG shows an irregularly irregular rhythm. Which ECG wave is absent in this patient?
A.
P wave
B.
T wave
C.
Q wave
D.
U wave
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Question 4
Question 4
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ECG changes in atrial fibrillation do NOT include:
A.
Absence of P waves
B.
Irregularity of the R-R interval
C.
Tall P waves
D.
Fibrillatory baseline
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Question 5
Question 5
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The rhythm strip shown demonstrates the classic features of atrial fibrillation. The absence of discrete P waves in this rhythm is best explained by:
A.
Failure of the sinoatrial node to depolarise
B.
Complete block of every atrial impulse at the AV node
C.
Retrograde atrial activation hiding each P wave inside the QRS complex
D.
Simultaneous firing of 350–600 disorganised atrial wavelets
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Question 6
Question 6
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A 22-year-old man is brought to casualty with palpitations and near-syncope. His ECG shows a very rapid (>250/min), grossly irregular tachycardia with wide QRS complexes that vary in width and morphology from beat to beat. Which diagnosis must be assumed until proven otherwise?
A.
Multifocal atrial tachycardia with aberrancy
B.
Atrial flutter with 1:1 AV nodal conduction
C.
Atrial fibrillation conducting down an accessory pathway (AF with WPW)
D.
Atrial fibrillation with a pre-existing bundle branch block
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Question 7
Question 7
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The rhythm strip shown is most indicative of:
A.
Sinus tachycardia
B.
Ventricular fibrillation
C.
Atrial flutter
D.
Sinus bradycardia
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Question 8
Question 8
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The tracing shown was recorded from a 68-year-old man whose pulse felt completely irregular at the bedside, prompting a diagnosis of atrial fibrillation. Which feature on this ECG proves the diagnosis is NOT atrial fibrillation?
A.
The R-R intervals vary irregularly from one beat to the next
B.
The QRS complexes are narrow and uniform
C.
The atrial activity is perfectly regular at about 300/min
D.
The ventricular rate is below 100 beats per minute
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Question 9
Question 9
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In typical atrial flutter with an atrial rate of 300/min, a 4:1 AV conduction ratio will produce a ventricular rate of approximately:
A.
75/min
B.
100/min
C.
150/min
D.
50/min
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Question 10
Question 10
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A patient has a regular narrow-complex tachycardia at 150/min. IV adenosine is given: the ventricular rate slows abruptly for a few seconds, revealing continuous sawtooth waves in the inferior leads, and then the rhythm returns to 150/min. What does this tell you?
A.
The rhythm is sinus tachycardia with buried P waves
B.
The rhythm is AVNRT, since adenosine produced a transient response
C.
Adenosine has terminated the arrhythmia; no further treatment is needed
D.
Adenosine has increased AV block and unmasked atrial flutter
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Question 11
Question 11
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A 60-year-old man admitted with an exacerbation of COPD develops palpitations. His rhythm strip is shown (arrows mark the atrial deflections). The most probable diagnosis is:
A.
Atrial fibrillation
B.
Atrial flutter
C.
Multifocal atrial tachycardia
D.
Ventricular fibrillation
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Question 12
Question 12
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A 68-year-old man with COPD presents with palpitations, dizziness and breathlessness. His heart rate is 110/min and the rhythm is irregular. The ECG shows irregular R-R intervals with discrete P waves of at least three different morphologies and varying PR intervals. The most likely diagnosis is:
A.
Ventricular tachycardia
B.
Multifocal atrial tachycardia
C.
Atrial fibrillation
D.
Sinus tachycardia
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Question 13
Question 13
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A breathless elderly smoker has an irregularly irregular pulse at 115/min. Which single ECG observation most reliably separates multifocal atrial tachycardia from atrial fibrillation?
A.
The degree of beat-to-beat variability in the R-R intervals
B.
The presence of discrete P waves on a clean baseline
C.
The absolute ventricular rate
D.
The width of the QRS complex in lead V1
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Question 14
Question 14
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The rhythm shown was recorded in a 65-year-old man admitted with an exacerbation of COPD; his oxygen saturation is 86% on room air and the ventricular rate is 118/min. Which management step is INAPPROPRIATE for this rhythm?
A.
Treating the COPD exacerbation and checking potassium and magnesium
B.
Starting long-term oral anticoagulation for stroke prevention
C.
Correcting hypoxia with controlled oxygen therapy
D.
Using verapamil or diltiazem for ventricular rate control
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Question 15
Question 15
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A 26-year-old asymptomatic athlete has an irregular pulse at a routine check-up. His heart rate is 78/min and the rhythm strip shown demonstrates at least three different P-wave morphologies with varying PR intervals and a clean isoelectric baseline. The most likely diagnosis is:
A.
Atrial flutter with variable block
B.
Atrial fibrillation
C.
Multifocal atrial tachycardia
D.
Wandering atrial pacemaker
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Question 16
Question 16
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The two rhythm strips shown demonstrate ventricular bigeminy and ventricular trigeminy. Using the chapter's classification, this type of rhythm disturbance is best described as:
A.
Pseudo-irregularity due to artifact
B.
A pause-type irregularity
C.
Irregularly irregular
D.
Regularly irregular
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Question 17
Question 17
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A 19-year-old healthy woman is found to have an irregular pulse. Her ECG shows a normal P wave before every QRS, a constant normal PR interval, and R-R intervals that shorten during inspiration and lengthen during expiration. The most appropriate action is:
A.
Arrange 24-hour Holter monitoring and an electrophysiology referral
B.
Reassurance — this is a normal physiological finding
C.
Start a beta-blocker to stabilise the rhythm
D.
Begin anticoagulation because of the irregular rhythm
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Question 18
Question 18
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An ECG shows sinus rhythm interrupted by a sudden pause in which a P-QRS-T complex is completely missing. The duration of the pause measures exactly twice the underlying P-P interval. This is most consistent with:
A.
Mobitz type II AV block
B.
Sinus pause (sinus arrest)
C.
A non-conducted premature atrial complex
D.
Sinoatrial (SA) exit block
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Question 19
Question 19
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An adult with palpitations has an irregularly irregular pulse. The heart rate is 120/min, the radial pulse is 100/min (pulse deficit 20) and the BP is 110/70 mmHg. Which finding is expected on examination of the jugular venous pulse?
A.
Absent 'a' wave
B.
Cannon 'a' wave
C.
Absent 'y' descent
D.
Prominent 'v' wave
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Question 20
Question 20
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An ECG obtained from a 57-year-old man during a routine examination reveals atrial fibrillation. Which of the following is most likely to accompany this condition?
A.
An increased venous 'a' wave
B.
An increased left atrial pressure
C.
A decreased heart rate
D.
An increased stroke volume
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Question 21
Question 21
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Which of the following is NOT a common cause of atrial fibrillation?
A.
Mitral regurgitation
B.
Hypothyroidism
C.
Hypertension
D.
Acute myocardial infarction
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Question 22
Question 22
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A young man has recent-onset palpitations and dizziness. His ECG shows absent P waves with irregular R-R intervals, and his BP is 80/60 mmHg. What is the next step in management?
A.
IV verapamil
B.
IV amiodarone
C.
Synchronised DC cardioversion
D.
IV adenosine
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Question 23
Question 23
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A 72-year-old woman has new-onset atrial flutter with a ventricular rate of 150/min. She is haemodynamically stable (BP 155/90 mmHg) but has palpitations. Which is the best intravenous drug for controlling her heart rate?
A.
Diltiazem
B.
Lidocaine
C.
Aminophylline
D.
Magnesium
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Question 24
Question 24
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A 66-year-old man with palpitations is found to be in atrial fibrillation. He is haemodynamically stable and cannot say when the palpitations began. Elective cardioversion is planned. Which is the correct approach?
A.
Anticoagulate for 3 weeks, or exclude thrombus on TOE, before cardioverting
B.
Give a single dose of aspirin and cardiovert the same day
C.
Cardiovert today and start anticoagulation only if he develops symptoms afterwards
D.
Cardiovert immediately, since he is haemodynamically stable
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Question 25
Question 25
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A 65-year-old woman is being discharged after an admission for a new ischaemic stroke. She has hypertension, diabetes, COPD and non-valvular atrial fibrillation. What is her CHA
2
DS
2
-VASc score?
A.
2
B.
3
C.
4
D.
6
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