Q.1 Which of the following is the first-line treatment for ventricular fibrillation?
Amiodarone
Defibrillation
Atropine
Adenosine
Explanation - Ventricular fibrillation is a life-threatening arrhythmia. Immediate defibrillation is the treatment of choice to restore normal cardiac rhythm.
Correct answer is: Defibrillation
Q.2 Which ECG finding is characteristic of ventricular tachycardia?
Narrow QRS complexes with regular rhythm
Wide QRS complexes with regular rhythm
ST elevation in leads II, III, aVF
T wave inversion in precordial leads
Explanation - Ventricular tachycardia is identified by a rapid heart rate with wide QRS complexes, typically >120 ms, often regular in rhythm.
Correct answer is: Wide QRS complexes with regular rhythm
Q.3 A patient with a history of myocardial infarction develops sudden chest pain and hypotension. Which arrhythmia is most immediately life-threatening?
Atrial fibrillation
Ventricular fibrillation
Sinus bradycardia
First-degree AV block
Explanation - Ventricular fibrillation is a sudden, uncoordinated contraction of the ventricles, leading to cardiac arrest if not treated immediately.
Correct answer is: Ventricular fibrillation
Q.4 Which electrolyte imbalance is most likely to precipitate ventricular arrhythmias?
Hypercalcemia
Hypokalemia
Hypernatremia
Hypomagnesemia
Explanation - Low potassium levels can alter cardiac conduction, increasing the risk of ventricular arrhythmias including ventricular tachycardia and fibrillation.
Correct answer is: Hypokalemia
Q.5 During ventricular tachycardia with a pulse, which is the preferred initial management?
Immediate defibrillation
Synchronized cardioversion
IV atropine
Observation only
Explanation - For hemodynamically stable VT with a pulse, synchronized cardioversion is preferred. Unstable VT requires immediate defibrillation.
Correct answer is: Synchronized cardioversion
Q.6 Which medication is commonly used to prevent recurrent ventricular arrhythmias after cardiac arrest?
Adenosine
Amiodarone
Digoxin
Metoprolol
Explanation - Amiodarone is an antiarrhythmic agent used in both the acute and post-resuscitation phases to prevent recurrent ventricular arrhythmias.
Correct answer is: Amiodarone
Q.7 Which of the following is a contraindication to defibrillation?
Ventricular fibrillation
Pulseless ventricular tachycardia
Asystole
Torsades de pointes
Explanation - Defibrillation is ineffective in asystole; CPR and pharmacologic therapy with epinephrine are indicated instead.
Correct answer is: Asystole
Q.8 Which rhythm is characterized by a twisting of QRS complexes around the isoelectric line?
Ventricular fibrillation
Torsades de pointes
Atrial flutter
Second-degree AV block
Explanation - Torsades de pointes is a polymorphic ventricular tachycardia with QRS complexes that appear to twist around the baseline, often associated with prolonged QT interval.
Correct answer is: Torsades de pointes
Q.9 A patient on digoxin presents with nausea, vomiting, and ventricular arrhythmias. What is the likely cause?
Hyperkalemia
Digoxin toxicity
Hypocalcemia
Beta-blocker overdose
Explanation - Digoxin toxicity can present with gastrointestinal symptoms and life-threatening ventricular arrhythmias.
Correct answer is: Digoxin toxicity
Q.10 Which of the following is an early sign of acute myocardial infarction leading to ventricular arrhythmias?
ST depression in V1-V3
Peaked T waves
Prolonged PR interval
QT shortening
Explanation - Peaked T waves are often one of the earliest ECG changes in acute MI and may precede ventricular arrhythmias.
Correct answer is: Peaked T waves
Q.11 Which intervention is critical immediately after defibrillation in a cardiac arrest patient?
Administer IV atropine
Continue high-quality CPR
Start antiarrhythmic infusion
Monitor for ST-segment changes only
Explanation - Post-defibrillation CPR is essential to maintain perfusion and increase chances of ROSC (Return of Spontaneous Circulation).
Correct answer is: Continue high-quality CPR
Q.12 Which type of shock is most commonly associated with ventricular arrhythmias?
Hypovolemic shock
Cardiogenic shock
Septic shock
Neurogenic shock
Explanation - Cardiogenic shock due to acute MI or heart failure increases the risk of ventricular arrhythmias.
Correct answer is: Cardiogenic shock
Q.13 Magnesium sulfate is the treatment of choice for which ventricular arrhythmia?
Ventricular fibrillation
Torsades de pointes
Monomorphic VT
Atrial fibrillation
Explanation - Magnesium stabilizes cardiac myocytes and is the drug of choice for torsades de pointes, especially with prolonged QT.
Correct answer is: Torsades de pointes
Q.14 Which sign indicates a patient may be hemodynamically unstable during VT?
BP 90/60 mmHg with altered consciousness
Pulse 80 bpm, asymptomatic
Mild palpitations without hypotension
BP 130/80 mmHg, alert
Explanation - Hypotension with altered mental status during VT suggests instability and requires urgent intervention.
Correct answer is: BP 90/60 mmHg with altered consciousness
Q.15 Which monitoring device is most important in the management of ventricular arrhythmias in ICU?
Pulse oximeter
ECG monitor
Non-invasive BP cuff
Capnography
Explanation - Continuous ECG monitoring is essential for early detection and management of ventricular arrhythmias in critically ill patients.
Correct answer is: ECG monitor
Q.16 Which antiarrhythmic drug is preferred for recurrent VT in a post-MI patient?
Lidocaine
Amiodarone
Verapamil
Digoxin
Explanation - Amiodarone is preferred for recurrent ventricular tachycardia in post-MI patients due to its efficacy and safety profile.
Correct answer is: Amiodarone
Q.17 During CPR for pulseless VT, which medication is administered after the second defibrillation attempt?
Epinephrine
Amiodarone
Atropine
Adenosine
Explanation - Amiodarone is given after the second defibrillation attempt to improve chances of ROSC in refractory VT or VF.
Correct answer is: Amiodarone
Q.18 Which clinical feature differentiates VT from supraventricular tachycardia with aberrancy?
Narrow QRS complex
Presence of AV dissociation
Regular pulse
Palpitations only
Explanation - AV dissociation on ECG is a hallmark feature of ventricular tachycardia, helping differentiate it from SVT with wide QRS.
Correct answer is: Presence of AV dissociation
Q.19 Which structural heart condition increases risk for sudden ventricular arrhythmias?
Mitral valve prolapse
Hypertrophic cardiomyopathy
Aortic stenosis mild
Mild tricuspid regurgitation
Explanation - Patients with hypertrophic cardiomyopathy are at risk for sudden cardiac death due to ventricular arrhythmias.
Correct answer is: Hypertrophic cardiomyopathy
Q.20 Which is the preferred vascular access for rapid drug administration during cardiac arrest?
Peripheral IV
Central venous line
Intraosseous
Subcutaneous
Explanation - Intraosseous access is used for rapid administration of drugs if IV access is difficult during cardiac arrest.
Correct answer is: Intraosseous
Q.21 What is the target rate of chest compressions per minute during CPR in adults with ventricular fibrillation?
60-80 compressions/min
80-100 compressions/min
100-120 compressions/min
120-140 compressions/min
Explanation - Current guidelines recommend 100-120 compressions per minute during CPR to optimize perfusion during cardiac arrest.
Correct answer is: 100-120 compressions/min
Q.22 Which of the following is a reversible cause of ventricular fibrillation?
Hyperthyroidism
Hypovolemia
Pulmonary embolism
Both B and C
Explanation - Ventricular fibrillation can result from reversible causes like hypovolemia and pulmonary embolism, which should be addressed during resuscitation.
Correct answer is: Both B and C
Q.23 Which biomarker is commonly elevated after ventricular arrhythmias due to myocardial injury?
Troponin
BNP
CRP
ALT
Explanation - Troponin rises in myocardial injury, which can occur after sustained ventricular arrhythmias or cardiac arrest.
Correct answer is: Troponin
Q.24 Which lifestyle modification reduces the risk of recurrent ventricular arrhythmias?
Low sodium diet
Avoiding strenuous activity in high-risk patients
Regular alcohol consumption
High caffeine intake
Explanation - Avoiding strenuous activity in patients at risk for sudden cardiac death can prevent trigger-induced ventricular arrhythmias.
Correct answer is: Avoiding strenuous activity in high-risk patients