[MCQ] The Tachyarrhythmias- Part 1

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The Tachyarrhythmias- Part 1

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Question 1

Tachyarrhythmias typically refer to ?

A	Isolated premature complexes (depolarizations)
B	Nonsustained forms of tachycardia originating from myocardial foci or reentrant circuits
C	Sustained forms of tachycardia originating from myocardial foci or reentrant circuits
D	All of the above

Question 2

In tachycardia, the ventricular rate should be ?

A	> 90 beats/minute
B	> 100 beats/minute
C	> 110 beats/minute
D	> 120 beats/minute

Question 2 Explanation:

Definition of tachycardia is rhythm that produces a ventricular rate >100 beats/minute

Question 3

Which of the following statements is false ?

A	Pacing does not provoke automatic rhythms
B	Pacing provoke tachycardias due to triggered activity
C	Abnormal automaticity is responsible for APCs & VPCs
D	None of the above

Question 4

Abnormal impulse formation due to triggered activity is related to ?

A	Reentry
B	Extra pathways
C	Myocardial ion channel abnormalities
D	Myocardial ion channel abnormalities

Question 4 Explanation:

Abnormal impulse formation is due to the development of triggered activity. Triggered activity is related to cellular afterdepolarizations that occur at the end of the action potential, during phase 3 (early afterdepolarizations), or after the action potential, during phase 4 (late afterdepolarizations

Question 5

Afterdepolarizations are due to an increase in ?

A	Intracellular calcium accumulation
B	Altered sodium transport
C	Altered potassium transport
D	Intracellular potassium deficiency

Question 5 Explanation:

Afterdepolarizations are attributable to an increase in intracellular calcium accumulation

Question 6

Early afterdepolarizations is responsible for ?

A	Catecholamine-sensitive VT
B	Atrial tachyarrhythmias caused by digoxin toxicity
C	Torsades des pointes
D	All of the above

Question 6 Explanation:

Early afterdepolarizations may be responsible for VPCs that trigger torsades des pointes (TDP). Late afterdepolarizations are responsible for atrial, junctional & fascicular tachyarrhythmias caused by digoxin toxicity and for catecholamine-sensitive VT originating in the outflow tract

Question 7

Late afterdepolarizations in digoxin toxicity may lead to ?

A	Atrial tachyarrhythmias
B	Junctional tachyarrhythmias
C	Fascicular tachyarrhythmias
D	All of the above

Question 7 Explanation:

Late afterdepolarizations caused by digoxin toxicity may lead to atrial, junctional, and fascicular tachyarrhythmias

Question 8

Inhomogeneities in myocardial conduction and/or recovery leading to reentry is exaggerated by ?

A	Presence of extra pathways
B	Myocardial ion channel abnormalities
C	Myocardial fibrosis
D	All of the above

Question 8 Explanation:

Reentry is due to inhomogeneities in myocardial conduction and/or recovery properties. Inhomogeneities can be exaggerated by the presence of extra pathways (WPW syndrome), generalized genetically determined myocardial ion channel abnormalities (long QT syndrome) or by the interruption of normal myocardial patterns of activation due to the development of fibrosis.

Question 9

Crista terminalis is located in ?

A	Right atrium
B	Left atrium
C	Right ventricle
D	Left ventricle

Question 9 Explanation:

Crista terminalis is a natural anatomic barrier of conduction. It is the vertical crest on interior wall of right atrium that separates nontrabeculated posterior right atrium from rest of the trabeculated right atrium.

Question 10

Which of the following is a genetically determined ion channel abnormality ?

A	Brugada syndrome
B	LQTS
C	Catecholaminergic polymorphic VT
D	All of the above

Question 11

Which of the following statements about mechanism of sustained paroxysmal tachyarrhythmia is false ?

A	Electrophysiologic inhomogeneity
B	Unidirectional block in one pathway
C	Fast conduction over an alternative pathway
D	Reexcitation of the initially blocked pathway

Question 12

Which of the following statements about mechanism of tachyarrhythmia is false ?

A	Reentrant arrhythmias can be reproducibly initiated and terminated by premature complexes and rapid stimulation
B	Myocardial cells do not possess pacemaker activity
C	Tachycardia caused by automaticity cannot be started or stopped by pacing
D	Triggered activity is caused by early afterdepolarizations only

Question 13

Which of the following statements about atrial premature complexes (APCs) is false ?

A	Can be found in over 90 % of normal adults
B	May originate from any location in either atrium
C	P wave of APC differs from sinus P wave morphology
D	Conduct to ventricles when they occur late in cardiac cycle

Question 14

Which of the following statements about atrial premature complexes (APCs) is false ?

A	Sum of pre-and postextrasystolic PP intervals is less than the sum of two sinus PP intervals
B	QRS complex following most APCs is normal
C	Alcohol, tobacco or adrenergic stimulants precipitate APCs
D	None of the above

Question 15

Which of the following about APCs is false ?

A	Most common arrhythmia
B	Frequently increases with age & structural heart disease
C	Asymptomatic
D	None of the above

Question 16

APCs from which of the following may mimic the sinus P wave morphology ?

A	Right atrial appendage
B	Superior vena cava (SVC)
C	Superior aspect of crista terminalis
D	All of the above

Question 16 Explanation:

P wave contour differs from that seen during sinus rhythm. APCs from right atrial appendage, superior vena cava (SVC) and superior aspect of the crista terminalis in the region of sinus node may mimic sinus P wave morphology

Question 17

Which of the following about APCs is false ?

A	APCs characteristically reset the sinus node
B	Sum of pre- & post-APC RR is < 2 sinus PP intervals
C	Class IC antiarrhythmic agents may eliminate APCs
D	None of the above

Question 17 Explanation:

APCs characteristically reset the sinus node. The resulting sum of the pre- and post-APC RR interval is less than two sinus PP intervals. Class IC antiarrhythmic agents may eliminate the APCs but should be avoided if structural heart disease is present

Question 18

Which of the following about junctional premature complexes is false ?

A	Extremely uncommon
B	Originate from AV node & His bundle region
C	Produce retrograde atrial activation
D	None of the above

Question 18 Explanation:

JPCs are extremely uncommon. Complexes originate from AV node & His bundle region & may produce retrograde atrial activation with P wave distorting the initial or terminal portions of QRS complex producing pseudo Q or S waves in leads II, III, and aVF.

Question 19

Which of the following is not true for physiologic sinus tachycardia ?

A	Present when heart rate exceeds 100 beats/min
B	Heart rate rarely exceeds 200 beats/min
C	Has a gradual onset and offset
D	Carotid sinus pressure produces slowing with sudden return to previous rate upon cessation

Question 19 Explanation:

Sinus tachycardia, carotid sinus pressure produces modest & transient slowing but no abrupt termination.

Question 20

Which of the following about inappropriate sinus tachycardia is false ?

A	Heart rate increases spontaneously
B	Heart rate increases out of proportion to stress/exercise
C	Part of postviral dysautonomia
D	Anxiolytics are the treatment of choice

Question 20 Explanation:

In inappropriate sinus tachycardia, heart rate increases either spontaneously or out of proportion to the degree of physiologic stress/exercise. It may occur after a viral illness and resolve spontaneously over 3 - 12 months (postviral dysautonomia). Maintaining hydration, salt loading, and beta blockers minimizes symptoms

Question 21

Which of the following is the most common sustained arrhythmia ?

A	Atrial flutter
B	Atrial fibrillation
C	AV nodal reentrant tachycardia (AVNRT)
D	None of the above

Question 21 Explanation:

AF is the most common sustained arrhythmia.

Question 22

Paroxysmal AF is triggered by automatic foci located in ?

A	Left atrium
B	Right atrium
C	Pulmonary veins
D	All of the above

Question 23

In atrial fibrillation, the ventricular rate is usually ?

A	120 and 160 bpm
B	150 and 180 bpm
C	200 and 260 bpm
D	250 and 280 bpm

Question 23 Explanation:

AF produces disorganized, rapid & irregular atrial activation with irregular ventricular response. Depending on conduction properties of AV junction, rate varies between 120 & 160 beats/minute.

Question 24

Which of the following relates best to AF initiation & maintenance ?

A	Atrial scarring
B	Atrialized musculature that enters pulmonary veins
C	Accessory atrio-ventricular tracts
D	All of the above

Question 24 Explanation:

Drivers responsible for initiation and maintenance of AF originate from atrialized musculature that enters the pulmonary veins.

Question 25

Lone AF’ often represents the tachycardia phase of ?

A	Thyrotoxicosis
B	Tachycardia - bradycardia syndrome
C	Acute alcoholic intoxication
D	All of the above

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See all quizzes of the The Tachyarrhythmias at here:

1. Tachyarrhythmias typically refer to ?
A. Isolated premature complexes (depolarizations)
B. Nonsustained forms of tachycardia originating from myocardial foci or reentrant circuits
C. Sustained forms of tachycardia originating from myocardial foci or reentrant circuits
D. All of the above

2. In tachycardia, the ventricular rate should be ?
A. > 90 beats/minute
B. > 100 beats/minute
C. > 110 beats/minute
D. > 120 beats/minute

3. Which of the following statements is false ?
A. Pacing does not provoke automatic rhythms
B. Pacing provoke tachycardias due to triggered activity
C. Abnormal automaticity is responsible for APCs & VPCs
D. None of the above

4. Abnormal impulse formation due to triggered activity is related to ?
A. Reentry
B. Extra pathways
C. Myocardial ion channel abnormalities
D. Cellular afterdepolarizations

5. Afterdepolarizations are due to an increase in ?
A. Intracellular calcium accumulation
B. Altered sodium transport
C. Altered potassium transport
D. Intracellular potassium deficiency

6. Early afterdepolarizations is responsible for ?

A. Catecholamine-sensitive VT
B. Atrial tachyarrhythmias caused by digoxin toxicity
C. Torsades des pointes
D. All of the above

7. Late afterdepolarizations in digoxin toxicity may lead to ?
A. Atrial tachyarrhythmias
B. Junctional tachyarrhythmias
C. Fascicular tachyarrhythmias
D. All of the above

8. Inhomogeneities in myocardial conduction and/or recovery leading to reentry is exaggerated by ?
A. Presence of extra pathways
B. Myocardial ion channel abnormalities
C. Myocardial fibrosis
D. All of the above

9. Crista terminalis is located in ?
A. Right atrium
B. Left atrium
C. Right ventricle
D. Left ventricle

10. Which of the following is a genetically determined ion channel abnormality ?
A. Brugada syndrome
B. LQTS
C. Catecholaminergic polymorphic VT
D. All of the above

11. Which of the following statements about mechanism of sustained paroxysmal tachyarrhythmia is false ?
A. Electrophysiologic inhomogeneity
B. Unidirectional block in one pathway
C. Fast conduction over an alternative pathway
D. Reexcitation of the initially blocked pathway

12. Which of the following statements about mechanism of tachyarrhythmia is false ?
A. Reentrant arrhythmias can be reproducibly initiated and
terminated by premature complexes and rapid stimulation
B. Myocardial cells do not possess pacemaker activity
C. Tachycardia caused by automaticity cannot be started or stopped by pacing
D. Triggered activity is caused by early afterdepolarizations only

13. Which of the following statements about atrial premature complexes (APCs) is false ?
A. Can be found in over 90 % of normal adults
B. May originate from any location in either atrium
C. P wave of APC differs from sinus P wave morphology
D. Conduct to ventricles when they occur late in cardiac cycle

14. Which of the following statements about atrial premature complexes (APCs) is false ?
A. Sum of pre-and postextrasystolic PP intervals is less than the sum of two sinus PP intervals
B. QRS complex following most APCs is normal
C. Alcohol, tobacco or adrenergic stimulants precipitate APCs
D. None of the above

15. Which of the following about APCs is false ?
A. Most common arrhythmia
B. Frequently increases with age & structural heart disease
C. Asymptomatic
D. None of the above

16. APCs from which of the following may mimic the sinus P wave morphology ?
A. Right atrial appendage

B. Superior vena cava (SVC)
C. Superior aspect of crista terminalis
D. All of the above

17. Which of the following about APCs is false ?
A. APCs characteristically reset the sinus node
B. Sum of pre- & post-APC RR is < 2 sinus PP intervals
C. Class IC antiarrhythmic agents may eliminate APCs
D. None of the above

18. Which of the following about junctional premature complexes is false ?
A. Extremely uncommon
B. Originate from AV node & His bundle region
C. Produce retrograde atrial activation
D. None of the above

19. Which of the following is not true for physiologic sinus tachycardia ?
A. Present when heart rate exceeds 100 beats/min
B. Heart rate rarely exceeds 200 beats/min
C. Has a gradual onset and offset
D. Carotid sinus pressure produces slowing with sudden return to previous rate upon cessation

20. Which of the following about inappropriate sinus tachycardia is false ?
A. Heart rate increases spontaneously
B. Heart rate increases out of proportion to stress/exercise
C. Part of postviral dysautonomia
D. Anxiolytics are the treatment of choice

21. Which of the following is the most common sustained arrhythmia ?
A. Atrial flutter
B. Atrial fibrillation
C. AV nodal reentrant tachycardia (AVNRT)
D. None of the above

22. Paroxysmal AF is triggered by automatic foci located in ?
A. Left atrium
B. Right atrium
C. Pulmonary veins
D. All of the above

23. In atrial fibrillation, the ventricular rate is usually ?
A. 120 and 160 bpm
B. 150 and 180 bpm
C. 200 and 260 bpm
D. 250 and 280 bpm

24. Which of the following relates best to AF initiation & maintenance ?
A. Atrial scarring
B. Atrialized musculature that enters pulmonary veins
C. Accessory atrio-ventricular tracts
D. All of the above
Drivers responsible for initiation and maintenance of AF originate from atrialized musculature
that enters the pulmonary veins.

25. ‘Lone AF’ often represents the tachycardia phase of ?
A. Thyrotoxicosis
B. Tachycardia – bradycardia syndrome
C. Acute alcoholic intoxication
D. All of the above

The Tachyarrhythmias

[MCQ] The Tachyarrhythmias- Part 1

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The Tachyarrhythmias- Part 1

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