CMC Cardiac Arrhythmia Management 2

Question 1

A patient with atrial fibrillation has a heart rate of 130 bpm and is hemodynamically stable. The onset is confirmed to be 36 hours ago. What is the preferred initial management?

Accepted Answer

Rate control and anticoagulation per CHA2DS2-VASc score before cardioversion

Answer

Immediate electrical cardioversion without anticoagulation

Answer

IV adenosine to restore sinus rhythm

Answer

IV digoxin for immediate rhythm conversion

Question 2

During post-cardiac surgery monitoring, a patient develops a wide-complex tachycardia at 200 bpm. Which ECG finding most strongly suggests ventricular tachycardia rather than SVT with aberrancy?

Accepted Answer

AV dissociation visible on the tracing

Answer

QRS duration less than 120 ms

Answer

Regular RR intervals

Answer

Concordant positive precordial R waves

Question 3

A patient with an implanted ICD receives multiple appropriate shocks for sustained VT. After stabilization, which long-term management strategy is most indicated to reduce recurrent ICD therapies?

Accepted Answer

Catheter ablation of the VT focus

Answer

Increasing the ICD detection rate threshold only

Answer

Discontinuing all antiarrhythmic medications

Answer

Replacing the ICD with a pacemaker

Question 4

Which AV block pattern is characterized by a progressively lengthening PR interval followed by a dropped QRS complex?

Accepted Answer

Mobitz type I (Wenckebach) second-degree AV block

Answer

First-degree AV block

Answer

Mobitz type II second-degree AV block

Answer

Third-degree (complete) AV block

Question 5

A 68-year-old patient with hypertension and prior stroke has new-onset atrial fibrillation. What CHA2DS2-VASc score should prompt initiation of anticoagulation?

Accepted Answer

Score of 2 or greater

Answer

Score of 0

Answer

Score of 1 in males

Answer

Score of 5 or greater

Question 6

Which antiarrhythmic drug classification includes agents that block sodium channels and slow phase 0 depolarization?

Accepted Answer

Class I (sodium channel blockers)

Answer

Class II (beta-blockers)

Answer

Class III (potassium channel blockers)

Answer

Class IV (calcium channel blockers)

Question 7

A patient on telemetry shows a rhythm with no P waves, an irregularly irregular ventricular response, and fine fibrillatory baseline between QRS complexes. The ventricular rate is 88 bpm. Which condition best describes this rhythm?

Accepted Answer

Atrial fibrillation with controlled ventricular rate

Answer

Multifocal atrial tachycardia

Answer

Atrial flutter with variable block

Answer

Junctional rhythm with PVCs