Cardiology: tachycardia-bradycardia syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: tachycardia-bradycardia syndrome

Sample item

A 76-year-old woman has episodes of fast palpitations alternating with dizziness, and one syncopal attack. Holter monitoring shows paroxysms of atrial fibrillation that end with pauses of 4.5 seconds. What is the best step before using rate-controlling drugs?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Permanent pacemaker implantation

Alternating fast and slow rhythms with post-conversion pauses define the tachycardia-bradycardia form of sick sinus syndrome. Drugs that control the fast phase would worsen the pauses, so a permanent pacemaker is placed first to allow safe rate control.

Option by option

  • A. Permanent pacemaker implantation (correct)

    Correct. Pacing protects against the pauses and permits rate-controlling drugs afterwards.

  • B. Amiodarone loading dose

    Amiodarone also slows sinus and AV nodal function and can worsen pauses.

  • C. Beta-blocker up-titration

    A beta-blocker would deepen the sinus pauses and may cause syncope.

  • D. Verapamil infusion

    Verapamil slows nodal function and would aggravate bradycardia and pauses.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Permanent pacemaker implantation. Alternating fast and slow rhythms with post-conversion pauses define the tachycardia-bradycardia form of sick sinus syndrome.

Why is "Amiodarone loading dose" not the answer?

Amiodarone also slows sinus and AV nodal function and can worsen pauses.

Why is "Beta-blocker up-titration" not the answer?

A beta-blocker would deepen the sinus pauses and may cause syncope.

Why is "Verapamil infusion" not the answer?

Verapamil slows nodal function and would aggravate bradycardia and pauses.

What concept does this question test?

It tests Cardiology: tachycardia-bradycardia syndrome in General Medicine. Drugs that control the fast phase would worsen the pauses, so a permanent pacemaker is placed first to allow safe rate control.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: tachycardia-bradycardia syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.