Master Arrhythmias: Comprehensive Learning Quizzes for Medical Students

Question 1

Which arrhythmia is most common in the general population?

Accepted Answer

Atrial fibrillation

Answer

Ventricular tachycardia

Answer

Supraventricular tachycardia

Answer

Torsades de pointes

Question 2

Which of the following is NOT a type of supraventricular tachycardia (SVT)?

Accepted Answer

Sinus tachycardia

Answer

Atrioventricular nodal reentrant tachycardia (AVNRT)

Answer

Atrioventricular reciprocating tachycardia (AVRT)

Answer

Junctional ectopic tachycardia (JET)

Question 3

Which type of arrhythmia is characterized by irregular and inconsistent R-R intervals?

Accepted Answer

Atrial fibrillation

Answer

Ventricular tachycardia

Answer

Supraventricular tachycardia

Answer

Bradycardia

Question 4

What is the distinctive ECG feature of atrial fibrillation?

Accepted Answer

Absence of P waves and irregularly irregular R-R intervals

Answer

Narrow QRS complex tachycardia with regular R-R intervals

Answer

Prolonged PR interval and widened QRS complex

Answer

Short PR interval and narrow QRS complex

Question 5

When managing a patient with symptomatic supraventricular tachycardia, which intervention is typically attempted first?

Accepted Answer

Vagal maneuvers

Answer

Intravenous adenosine

Answer

Amiodarone administration

Answer

Electrical cardioversion

Question 6

In atrial fibrillation, why is digoxin use contraindicated in the presence of Wolff-Parkinson-White syndrome?

Accepted Answer

Increased risk of ventricular arrhythmias

Answer

Potential for supraventricular tachycardia

Answer

Reduced efficacy due to rapid ventricular rate

Answer

Drug interactions with antiarrhythmic medications

Question 7

In young athletes, which condition is the leading cause of sudden cardiac death?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Commotio cordis

Answer

Aortic dissection

Answer

Myocarditis

Question 8

Which electrocardiographic (ECG) feature is characteristic of atrial fibrillation?

Accepted Answer

Absent P waves with irregular QRS complexes

Answer

Regular P waves

Answer

Irregular P waves

Answer

Wide QRS complexes with a slow rate

Question 9

Identify the most severe potential complication associated with ventricular tachycardia:

Accepted Answer

Sudden cardiac death

Answer

Heart failure

Answer

Pulmonary edema

Answer

Cardiogenic shock

Question 10

What is the primary objective in managing arrhythmias?

Accepted Answer

Preventing sudden cardiac death

Answer

Relieving symptoms

Answer

Improving left ventricular function

Answer

Reducing the risk of stroke

Question 11

Which medical device is used to treat bradyarrhythmias?

Accepted Answer

Pacemaker

Answer

Implantable cardioverter-defibrillator (ICD)

Answer

Left ventricular assist device (LVAD)

Answer

Extracorporeal membrane oxygenation (ECMO)

Question 12

In patients with arrhythmias, what is the most common cause of syncope?

Accepted Answer

Sick sinus syndrome

Answer

Asystole

Answer

Ventricular tachycardia

Answer

Atrial fibrillation

Question 13

Identify a contraindication to catheter ablation for atrial fibrillation:

Accepted Answer

Left ventricular thrombus

Answer

Severe valvular heart disease

Answer

Advanced age

Answer

Previous stroke

Question 14

What is the prognosis for patients with untreated ventricular tachycardia?

Accepted Answer

Poor

Answer

Excellent

Answer

Good

Answer

Fair

Question 15

Outline the appropriate sequential steps in the management of symptomatic sinus bradycardia, including non-pharmacological and pharmacological interventions.

Accepted Answer

Vagal maneuvers, atropine, pacemaker insertion

Answer

Pacemaker insertion, atropine, vagal maneuvers

Answer

Atropine, vagal maneuvers, pacemaker insertion

Answer

Isoproterenol, vagal maneuvers, pacemaker insertion

Question 16

The characteristic electrocardiographic finding of atrial fibrillation is:

Accepted Answer

P waves absent, irregular R-R intervals, rapid ventricular rate

Answer

P waves present, regular R-R intervals, slow ventricular rate

Answer

P waves present, irregular R-R intervals, rapid ventricular rate

Answer

P waves absent, regular R-R intervals, slow ventricular rate

Question 17

Which of the following drugs is commonly used to terminate paroxysmal supraventricular tachycardia (PSVT)?

Accepted Answer

Verapamil

Answer

Amiodarone

Answer

Digoxin

Answer

Warfarin

Question 18

The implantable cardioverter-defibrillator (ICD) is primarily indicated for:

Accepted Answer

Prevention of sudden cardiac death in patients with ventricular arrhythmias

Answer

Treatment of atrial fibrillation

Answer

Control of heart rate in bradycardia

Answer

Diagnosis of arrhythmias

Question 19

Which of the following risk factors is most strongly associated with the development of atrial fibrillation?

Accepted Answer

Hypertension

Answer

Diabetes mellitus

Answer

Obesity

Answer

Smoking

Question 20

The Valsalva maneuver is commonly used to:

Accepted Answer

Terminate supraventricular tachycardia

Answer

Induce bradycardia

Answer

Induce tachycardia

Answer

Diagnose ventricular tachycardia

Question 21

The electrocardiographic finding of a widened QRS complex (≥120 ms) is characteristic of which type of arrhythmia?

Accepted Answer

Ventricular tachycardia

Answer

Supraventricular tachycardia

Answer

Atrial fibrillation

Answer

Bradycardia

Question 22

Which of the following is a non-modifiable risk factor for arrhythmias?

Accepted Answer

Age

Answer

Smoking

Answer

Obesity

Answer

Hypertension

Question 23

An ECG reveals absent P waves, a widened QRS complex, and an atrial rate slower than the ventricular rate. Which of the following best describes the underlying arrhythmia mechanism?

Accepted Answer

Atrioventricular block

Answer

Sinus tachycardia

Answer

Atrial fibrillation

Answer

Premature ventricular contraction

Question 24

Which arrhythmia carries the greatest risk of causing sudden cardiac death?

Accepted Answer

Ventricular tachycardia

Answer

Sick sinus syndrome

Answer

Atrial fibrillation

Answer

Supraventricular tachycardia

Question 25

Which of the following is NOT a characteristic of supraventricular tachycardia (SVT)?

Accepted Answer

Wide QRS complex

Answer

Regular heart rate

Answer

Abrupt onset and offset

Answer

Narrow QRS complex indicative of atrial origin

Question 26

What is the most common type of atrial fibrillation (AF)?

Accepted Answer

Paroxysmal AF

Answer

Persistent AF: Continuous atrial fibrillation, lasting >7 days, but can be terminated

Answer

Permanent AF: Continuous, unremitting atrial fibrillation

Question 27

Which of the following medications is contraindicated in patients with a prolonged QT interval?

Accepted Answer

Dofetilide

Answer

Amiodarone: Can prolong the QT interval but may be used cautiously in some cases

Answer

Digoxin: Can also prolong the QT interval but may be used in specific situations

Answer

Metoprolol: A beta-blocker that does not typically affect the QT interval

Question 28

What is the primary goal of treating ventricular tachycardia (VT)?

Accepted Answer

Preventing sudden cardiac death

Answer

Improving cardiac function: VT can impair cardiac function, but the primary goal is preventing sudden death

Answer

Preventing stroke: VT does not typically cause stroke

Answer

Relieving symptoms: While symptom management is important, it is secondary to preventing life-threatening complications

Question 29

What is the most common cause of bradycardia?

Accepted Answer

Sinus node dysfunction: Dysfunction of the heart's natural pacemaker

Answer

Atrial fibrillation: Typically causes tachycardia, not bradycardia

Answer

Ventricular tachycardia: Causes tachycardia, not bradycardia

Answer

Heart block: Can also cause bradycardia but is less common

Question 30

Which of the following is a symptom of atrial flutter?

Accepted Answer

Palpitations: Fast, fluttering heartbeats

Answer

Chest pain: Not typically a symptom of atrial flutter

Answer

Shortness of breath: Can occur but is more common in other arrhythmias

Answer

Syncope: Rare in atrial flutter, more common in severe bradycardia or ventricular arrhythmias

Question 31

What is the gold standard for diagnosing arrhythmias?

Accepted Answer

Electrocardiogram (ECG): Records electrical activity of the heart

Answer

Electrophysiological study: Invasive procedure used to diagnose complex arrhythmias, but not routinely used as the first-line test

Answer

Echocardiogram: Images the heart's structure and function, but not as useful for diagnosing arrhythmias

Answer

Holter monitor: Records heart rhythm over an extended period, but not as detailed as an ECG

Question 32

Which of the following is the most common type of supraventricular tachycardia (SVT), accounting for approximately 60% of cases?

Accepted Answer

Atrioventricular nodal reentrant tachycardia (AVNRT)

Answer

Atrial fibrillation

Answer

Atrial flutter

Question 33

What is the primary hemodynamic consequence of sustained ventricular tachycardia (VT) and how does it manifest clinically?

Accepted Answer

Reduced cardiac output, which can lead to hypotension, decreased tissue perfusion, and ultimately organ dysfunction

Answer

Increased stroke volume, which can lead to hypertension

Answer

Increased afterload, which can lead to dyspnea

Answer

Increased preload, which can lead to pulmonary edema

Question 34

Which of the following is a major risk factor for sudden cardiac death (SCD) in patients with ventricular fibrillation (VF), contributing significantly to its high mortality rate?

Accepted Answer

Reduced left ventricular ejection fraction (< 35%)

Answer

Diabetes mellitus

Answer

Hypertension

Answer

Age > 65 years

Question 35

What is the first-line treatment for acute paroxysmal supraventricular tachycardia (PSVT) that is hemodynamically stable, aiming to restore normal sinus rhythm?

Accepted Answer

Vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage

Answer

Immediate pacemaker insertion

Answer

Electrical cardioversion

Answer

Administration of antiarrhythmic drugs

Question 36

Which of the following is a contraindication to adenosine administration in the emergency treatment of supraventricular tachycardia (SVT), as it can worsen the arrhythmia?

Accepted Answer

Second- or third-degree atrioventricular block

Answer

Hypertension

Answer

Asthma

Question 37

What is the most common underlying cause of sustained monomorphic ventricular tachycardia (VT), accounting for approximately 80% of cases?

Accepted Answer

Coronary artery disease with myocardial ischemia or infarction

Answer

Valvular heart disease

Answer

Hypertrophic cardiomyopathy

Answer

Dilated cardiomyopathy

Question 38

Which of the following is a characteristic ECG finding of atrial fibrillation (AF), reflecting the disorganized electrical activity in the atria?

Accepted Answer

Irregularly irregular ventricular response, often described as absence of distinct P waves and variable R-R intervals

Answer

Narrow QRS complex, suggesting supraventricular origin

Answer

Ventricular capture beats, causing regular QRS complexes

Answer

Regularly irregular ventricular response, such as in atrial flutter

Question 39

What is the primary goal of rate control in managing atrial fibrillation (AF), aiming to improve symptoms and prevent complications?

Accepted Answer

To maintain ventricular rate below 110 beats per minute, reducing symptoms such as palpitations, shortness of breath, and fatigue

Answer

To eliminate the arrhythmia and restore normal sinus rhythm

Answer

To prevent thromboembolic events, such as stroke

Answer

To improve left ventricular function and cardiac output

Question 40

Which of the following is a potential complication associated with catheter ablation therapy for atrial fibrillation (AF), which aims to isolate the pulmonary veins?

Accepted Answer

Pulmonary vein stenosis, which can occur after radiofrequency ablation due to inflammation and scarring

Answer

Stroke, a risk associated with AF itself rather than ablation

Answer

Myocardial infarction, a rare but serious complication of ablation

Answer

Hypertension, not typically associated with ablation therapy

Question 41

What is the preferred oral anticoagulant for patients with non-valvular atrial fibrillation (AF) who have a high risk of stroke, according to current guidelines?

Accepted Answer

Apixaban, a direct oral anticoagulant (DOAC) shown to be effective and well-tolerated in this population

Answer

Rivaroxaban, a DOAC primarily approved for deep vein thrombosis

Answer

Warfarin, a traditional anticoagulant that requires regular monitoring

Answer

Dabigatran, another DOAC with similar efficacy to apixaban

Question 42

Which of the following conditions is considered a contraindication to electrical cardioversion?

Accepted Answer

Recent myocardial infarction (within 48 hours)

Answer

Pregnancy (with appropriate precautions)

Answer

Digitalis toxicity (may require close monitoring)

Answer

Uncontrolled hypertension (requiring immediate management)

Question 43

A 28-year-old female presents with palpitations, shortness of breath, and dizziness. Her ECG reveals a narrow QRS complex tachycardia with a regular rhythm and a rate of 180 bpm. What is the most likely diagnosis?

Accepted Answer

Supraventricular tachycardia (SVT)

Answer

Ventricular tachycardia (VT)

Answer

Atrial fibrillation (AF) with rapid ventricular response

Answer

Atrial flutter with variable conduction

Question 44

In a hemodynamically stable patient with acute symptomatic atrial fibrillation and rapid ventricular response, which of the following medications is typically the first-line treatment?

Accepted Answer

Diltiazem (calcium channel blocker)

Answer

Lidocaine (primarily for ventricular arrhythmias)

Answer

Amiodarone (for more complex or refractory arrhythmias)

Answer

Adenosine (for paroxysmal SVT, not typically first-line for AF)

Question 45

A patient presents with syncope. Their ECG shows a short PR interval, a slurred upstroke of the QRS complex (delta wave), and a widened QRS complex. Which arrhythmia is most likely present?

Accepted Answer

Wolff-Parkinson-White syndrome

Answer

Long QT syndrome (prolonged QT interval, risk of torsades de pointes)

Answer

Sick sinus syndrome (irregular heart rate with bradycardia and pauses)

Answer

Brugada syndrome (characterized by ST segment elevation in specific leads)

Question 46

A patient with a history of myocardial infarction presents with recurrent episodes of ventricular tachycardia. Which intervention is most likely to improve long-term survival?

Accepted Answer

Implantable cardioverter-defibrillator (ICD)

Answer

Cardiac resynchronization therapy (CRT) (primarily for heart failure with conduction abnormalities)

Answer

Catheter ablation (may be effective but not always curative for VT)

Answer

Antiarrhythmic medications alone (may not be sufficient for life-threatening VT)

Question 47

Which of the following electrolyte abnormalities is a common trigger for Torsades de Pointes?

Accepted Answer

Hypomagnesemia

Answer

Hyperkalemia (can cause bradycardia and other arrhythmias)

Answer

Hyponatremia (can lead to other arrhythmias)

Answer

Hypocalcemia (can lead to prolonged QT but not specifically Torsades)

Question 48

A patient with a history of hypertension and diabetes presents with new-onset atrial fibrillation. Which investigation is most important to order first?

Accepted Answer

Transthoracic echocardiography

Answer

Cardiac MRI (more detailed imaging, not typically the first step)

Answer

Electrophysiology study (invasive procedure, not necessary initially)

Answer

Holter monitor (for long-term rhythm monitoring, not initial assessment)

Question 49

Which of the following is a potential complication of atrial fibrillation that warrants anticoagulation therapy?

Accepted Answer

Stroke (due to thrombus formation in the atria)

Answer

Pulmonary embolism (can occur in AF but is not the primary concern)

Answer

Myocardial infarction (not directly caused by AF)

Question 50

A young athlete experiences sudden cardiac death during a basketball game. His family has a history of sudden cardiac death at a young age. Which of the following inherited cardiac conditions is most likely responsible?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Dilated cardiomyopathy (can cause heart failure, but less likely for sudden death in young athletes)

Answer

Arrhythmogenic right ventricular dysplasia (ARVD) (can also cause sudden death)

Answer

Restrictive cardiomyopathy (rare cause of sudden death)

Question 51

A patient presents with symptomatic bradycardia with a heart rate of 40 bpm. His ECG shows a regular rhythm with a complete dissociation between the P waves and QRS complexes. What is the most likely diagnosis?

Accepted Answer

Third-degree atrioventricular (AV) block

Answer

Second-degree AV block Mobitz Type II (dropped QRS complexes)

Answer

First-degree AV block (prolonged PR interval)

Answer

Second-degree AV block Mobitz Type I (progressive lengthening of PR interval)

Question 52

Which of the following is a non-pharmacological treatment option for atrial fibrillation?

Accepted Answer

Catheter ablation

Answer

Beta-blockers

Answer

Amiodarone

Answer

Digoxin