[MCQ] The Tachyarrhythmias- Part 5

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The Tachyarrhythmias- Part 5

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Question 1

The WPW ECG may mimic the following ?

A	Left ventricular hypertrophy
B	Right ventricular hypertrophy
C	Bundle branch block
D	All of the above

Question 2

AV bypass tract in ventricular preexcitation are composed of ?

A	Atrial-like muscle
B	Ventricular-like muscle
C	Specialized conduction tissue
D	All of the above

Question 3

AV bypass tracts are associated with which of the following congenital abnormalities ?

A	ASD
B	VSD
C	TOF
D	Ebstein’s anomaly

Question 4

Which of the following is not a feature of Wolff-Parkinson-White (WPW) syndrome ?

A	Short PR interval (< 0.12 sec.)
B	Slurred upstroke of QRS complex (delta wave)
C	Wide QRS complex
D	Prolonged QT interval

Question 5

Which of the following is not true regarding Wolff-Parkinson White syndrome ?

A	During PSVT in WPW, impulse is conducted antegradely over normal AV system and retrogradely through bypass tract
B	Atrial flutter and AF are common
C	Ventricular responses during atrial flutter or fibrillation is unusually rapid and may cause VF
D	Quinidine or flecainide slow conduction and increase refractoriness primarily of the AV node

Question 6

Which of the following statements about VPCs is false ?

A	May occur in up to 80 % of patients with previous MI
B	On ECG show wide (usually > 0.12 s), bizarre QRS complexes not preceded by P waves
C	When they arise in specialized conduction system (fascicles), they may be < 0.12 s in duration
D	They result in a fully compensatory pause

Question 6 Explanation:

VPCs are associated with a “fully compensatory pause” i.e. duration between last QRS before PVC and next QRS complex is equal to twice the sinus rate. VPC produces slow ventricular activation and a wide QRS complex that is typically >140 ms in duration.

Question 7

Which of the following statements about VPCs is false ?

A	When fixed coupling is not present and interval between VPCs has a common denominator, ventricular parasystoleis said to be present
B	Trigeminy means two sinus beats followed by a VPC
C	Two successive VPCs are termed pairs or couplets
D	>= 3 consecutive VPCs are termed ventricular tachycardia when the rate exceeds 160 beats/min

Question 7 Explanation:

VPCs may occur in patterns of bigeminy, in which every sinus beat is followed by a VPC, or trigeminy, in which two sinus beats are followed by a VPC. VPCs may have different morphologies

Question 8

Which of the following statements about VPCs is false ?

A	Ventricular impulses are never conducted retrogradely to atrium
B	VPC that does not produce retrograde concealed conduction and fails to influence oncoming sinus impulse is termed interpolated VPC
C	Antiarrhythmic agents can produce lethal arrhythmias
D	Prophylactic antiarrhythmic therapy is recommended only for young patients with complicated MI

Question 8 Explanation:

VPC typically does not conduct to the atrium. Occasionally VPC can occur early enough & conduct retrograde to atrium to reset the sinus node. Pause that results will be less than compensatory. VPCs that fail to influence the oncoming sinus impulse are termed interpolated VPCs.

Question 9

QRS duration of a ventricular premature complex (VPC) is ?

A	> 110 ms
B	> 120 ms
C	> 130 ms
D	> 140 ms

Question 9 Explanation:

A VPC has a wide QRS complex that is typically >140 ms in duration.

Question 10

Accelerated idioventricular rhythm (AIVR) has overlap features with ?

A	Monomorphic VT
B	Polymorphic VT
C	Slow VT
D	None of the above

Question 10 Explanation:

By definition there is an overlap between AIVR and “slow” VT

Question 11

Which of the following about AIVR is false ?

A	Heart rate ranges from 60 to 120 beats/min
B	Occurs in acute MI
C	Usually transient
D	Treatment consists of  blockers

Question 11 Explanation:

AIVR refers to a ventricular rhythm that is characterized by three or more complexes at a rate >40 and <120 beats/minute due to abnormal automaticity. Transient AIVR is frequently seen in acute myocardial infarction, cocaine intoxication, acute myocarditis, digoxin intoxication & postoperative cardiac surgery. Sustained AIVR is seen in acute MI & postoperatively. Treatment consists of atropine and atrial pacing

Question 12

Sustained ventricular tachycardia is defined as VT that persists for ?

A	> 10 seconds
B	> 15 seconds
C	> 20 seconds
D	> 30 seconds

Question 13

Which of the following is not true for sustained VT ?

A	Almost always symptomatic
B	Mostly associated with marked hemodynamic compromise
C	Almost always leads to development of myocardial ischemia
D	Acute ischemia is responsible for most recurrent episodes of sustained uniform VT

Question 14

The heart rate in ventricular flutter usually is ?

A	100 to 150 beats/minute
B	150 to 300 beats/minute
C	300 to 450 beats/minute
D	450 to 600 beats/minute

Question 14 Explanation:

Ventricular flutter appears as a sine wave on the ECG and has a rate of >250 beats/minute.

Question 15

It is not possible to assign a specific morphology to which of the following arrhythmia ?

A	Atrial flutter
B	Ventricular flutter
C	Torsades de pointes
D	WPW syndrome with AF

Question 15 Explanation:

A rapid rate with sine wave oscillations of ventricular flutter make it impossible to assign it a specific morphology and in some cases to distinguish it from rapid VT

Question 16

VT that shows an alternation in QRS axis is called ?

A	Monomorphic VT
B	Polymorphic VT
C	Bidirectional tachycardia
D	Torsades de pointes

Question 17

Characteristics ECG findings that suggest VT are all except ?

A	QRS complex > 0.20 seconds
B	AV dissociation
C	Inferior QRS frontal plane axis
D	Concordance of QRS pattern in all precordial leads

Question 17 Explanation:

Ventricular tachycardia on ECG shows AV dissociation, wide QRS >200 ms, superior frontal plane axis, slurring of initial portion of QRS, and large S wave in V6.

Question 18

Which of the following always produce hemodynamic collapse if allowed to continue ?

A	Which of the following always produce hemodynamic collapse if allowed to continue ?
B	Ventricular flutter
C	Ventricular fibrillation
D	All of the above

Question 18 Explanation:

Polymorphic ventricular arrhythmias, ventricular flutter, and VF always produce hemodynamic collapse if allowed to continue

Question 19

Characteristics ECG findings that suggest VT are all except ?

A	Superior and rightward QRS frontal plane axis
B	Bizarre QRS complex mimiking LBBB or RBBB QRS
C	Slurring of the initial portion of QRS
D	AV dissociation

Question 19 Explanation:

VT on ECG is suggested by presence of QRS duration >140 ms in the absence of drug therapy, superior & rightward QRS frontal plane axis, bizarre QRS complex that does not mimic the characteristic QRS pattern associated with LBBB or RBBB, and slurring of initial portion of QRS

Question 20

Repeated VT episodes requiring defibrillation is called ?

A	VT storm
B	VT paroxysm
C	VT battle
D	VT flow

Question 20 Explanation:

Repeated VT episodes requiring external cardioversion/defibrillation or repeated appropriate ICD shock therapy are referred to as VT storm.

Question 21

Which of the following should be considered for polymorphic VT storm ?

A	Intravenous beta blocker
B	Intravenous calcium channel blocker
C	Intravenous nitroglycerine
D	Intravenous digoxin

Question 22

Which of the following can prevent recurrences in patients with recurrent monomorphic VT ?

A	IV lidocaine
B	IV procainamide
C	IV amiodarone
D	Any of the above

Question 22 Explanation:

In patients with recurrent monomorphic VT, acute IV administration of lidocaine, procainamide, or amiodarone can prevent recurrences.

Question 23

VT in the absence of structural heart disease is called ? Harrison’s 18th Ed. 1894

A	Functional VT
B	Idiopathic VT
C	Casual VT
D	Benign VT

Question 23 Explanation:

VT in the absence of structural heart disease is called idiopathic VT.

Question 24

Which of the following about idiopathic outflow tract VT is false ?

A	~80% of outflow tract VTs originate in LV
B	Not associated with SCD
C	Vagal maneuvers terminate them
D	Adenosine & beta blockers terminate them

Question 24 Explanation:

~80% of outflow tract VTs originate in RV & ~20% in LV outflow tract regions

Question 25

Which of the following about idiopathic outflow tract VT is false ?

A	Produces monophasic R waves in leads II, III & aVF
B	Typically occur as nonsustained bursts of VT
C	Cycle length oscillations are common
D	More commonly in men

Question 25 Explanation:

Acute medical therapy for idiopathic outflow tract VT is rarely required because the VT is hemodynamically tolerated and is typically nonsustained. Intravenous beta blockers frequently terminate the tachycardia. They are more common in women.

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See all quizzes of the The Tachyarrhythmias at here:

1.The WPW ECG may mimic the following ?
A. Left ventricular hypertrophy
B. Right ventricular hypertrophy
C. Bundle branch block
D. All of the above

2. AV bypass tract in ventricular preexcitation are composed of ?
A. Atrial-like muscle
B. Ventricular-like muscle
C. Specialized conduction tissue
D. All of the above

3. AV bypass tracts are associated with which of the following congenital abnormalities ?
A. ASD
B. VSD
C. TOF
D. Ebstein’s anomaly

4. Which of the following is not a feature of Wolff-Parkinson-White (WPW) syndrome ?
A. Short PR interval (< 0.12 sec.)
B. Slurred upstroke of QRS complex (delta wave)
C. Wide QRS complex
D. Prolonged QT interval

5. Which of the following is not true regarding Wolff-Parkinson White syndrome ?
A. During PSVT in WPW, impulse is conducted antegradely over normal AV system and retrogradely through bypass tract
B. Atrial flutter and AF are common
C. Ventricular responses during atrial flutter or fibrillation is unusually rapid and may cause VF
D. Quinidine or flecainide slow conduction and increase refractoriness primarily of the AV node

6. Which of the following statements about VPCs is false ?
A. May occur in up to 80 % of patients with previous MI
B. On ECG show wide (usually > 0.12 s), bizarre QRScomplexes not preceded by P waves
C. When they arise in specialized conduction system (fascicles),they may be < 0.12 s in duration
D. They result in a fully compensatory pause

7. Which of the following statements about VPCs is false ?
A. When fixed coupling is not present and interval between VPCs has a common denominator, ventricular parasystole is said to be present
B. Trigeminy means two sinus beats followed by a VPC
C. Two successive VPCs are termed pairs or couplets
D. >= 3 consecutive VPCs are termed ventricular tachycardia when the rate exceeds 160 beats/min

8. Which of the following statements about VPCs is false ?
A. Ventricular impulses are never conducted retrogradely to atrium
B. VPC that does not produce retrograde concealed conduction and fails to influence oncoming sinus impulse is termed interpolated VPC
C. Antiarrhythmic agents can produce lethal arrhythmias
D. Prophylactic antiarrhythmic therapy is recommended only for young patients with complicated MI

9. QRS duration of a ventricular premature complex (VPC) is ?
A. > 110 ms
B. > 120 ms
C. > 130 ms
D. > 140 ms

10. Accelerated idioventricular rhythm (AIVR) has overlap features with ?
A. Monomorphic VT
B. Polymorphic VT
C. Slow VT
D. None of the above

11. Which of the following about AIVR is false ?
A. Heart rate ranges from 60 to 120 beats/min
B. Occurs in acute MI
C. Usually transient
D. Treatment consists of  blockers

12. Sustained ventricular tachycardia is defined as VT that persists for ?
A. > 10 seconds
B. > 15 seconds
C. > 20 seconds
D. > 30 seconds

13. Which of the following is not true for sustained VT ?

A. Almost always symptomatic
B. Mostly associated with marked hemodynamic compromise
C. Almost always leads to development of myocardial ischemia
D. Acute ischemia is responsible for most recurrent episodes of sustained uniform VT

14. The heart rate in ventricular flutter usually is ?
A. 100 to 150 beats/minute
B. 150 to 300 beats/minute
C. 300 to 450 beats/minute
D. 450 to 600 beats/minute

15. It is not possible to assign a specific morphology to which of the following arrhythmia ?
A. Atrial flutter
B. Ventricular flutter
C. Torsades de pointes
D. WPW syndrome with AF

16. VT that shows an alternation in QRS axis is called ?
A. Monomorphic VT
B. Polymorphic VT
C. Bidirectional tachycardia
D. Torsades de pointes

17. Characteristics ECG findings that suggest VT are all except ?
A. QRS complex > 0.20 seconds
B. AV dissociation
C. Inferior QRS frontal plane axis
D. Concordance of QRS pattern in all precordial leads

18. Which of the following always produce hemodynamic collapse if allowed to continue ?
A. Polymorphic ventricular arrhythmias
B. Ventricular flutter
C. Ventricular fibrillation
D. All of the above

19. Characteristics ECG findings that suggest VT are all except ?
A. Superior and rightward QRS frontal plane axis
B. Bizarre QRS complex mimiking LBBB or RBBB QRS
C. Slurring of the initial portion of QRS

D. AV dissociation

20. Repeated VT episodes requiring defibrillation is called ?
A. VT storm
B. VT paroxysm
C. VT battle
D. VT flow

21. Which of the following should be considered for polymorphic VT storm ?
A. Intravenous beta blocker
B. Intravenous calcium channel blocker
C. Intravenous nitroglycerine
D. Intravenous digoxin

22. Which of the following can prevent recurrences in patients with recurrent monomorphic VT ?
A. IV lidocaine
B. IV procainamide
C. IV amiodarone
D. Any of the above

23. VT in the absence of structural heart disease is called ?
A. Functional VT
B. Idiopathic VT
C. Casual VT
D. Benign VT

24. Which of the following about idiopathic outflow tract VT is false ?
A. ~80% of outflow tract VTs originate in LV
B. Not associated with SCD
C. Vagal maneuvers terminate them
D. Adenosine & beta blockers terminate them ~80% of outflow tract VTs originate in RV & ~20% in LV outflow tract regions.

25. Which of the following about idiopathic outflow tract VT is false ?
A. Produces monophasic R waves in leads II, III & aVF
B. Typically occur as nonsustained bursts of VT
C. Cycle length oscillations are common
D. More commonly in men

The Tachyarrhythmias

[MCQ] The Tachyarrhythmias- Part 5

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The Tachyarrhythmias- Part 5

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