Antiarrhythmics: pre-excited atrial fibrillation: practice question

A Pharmacology 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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Pharmacology · Antiarrhythmics: pre-excited atrial fibrillation

Sample item

A patient with Wolff-Parkinson-White syndrome develops irregular broad-complex tachycardia from atrial fibrillation. Which drug should be avoided?

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

The answer and the reasoning

B. Verapamil

AV nodal blockers such as verapamil can force more impulses down the accessory pathway, dangerously accelerating ventricular rate. Procainamide or cardioversion is preferred depending on stability.

Option by option

  • A. Ibutilide

    Ibutilide may be used in selected stable cases under monitoring.

  • B. Verapamil (correct)

    Correct. AV nodal blockade can worsen pre-excited atrial fibrillation.

  • C. Electrical cardioversion if unstable

    Synchronized cardioversion is appropriate for instability.

  • D. Procainamide

    Procainamide slows conduction in the accessory pathway and can be used when stable.

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.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Verapamil. AV nodal blockers such as verapamil can force more impulses down the accessory pathway, dangerously accelerating ventricular rate.

Why is "Ibutilide" not the answer?

Ibutilide may be used in selected stable cases under monitoring.

Why is "Electrical cardioversion if unstable" not the answer?

Synchronized cardioversion is appropriate for instability.

Why is "Procainamide" not the answer?

Procainamide slows conduction in the accessory pathway and can be used when stable.

What concept does this question test?

It tests Antiarrhythmics: pre-excited atrial fibrillation in Pharmacology. Procainamide or cardioversion is preferred depending on stability.

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 Antiarrhythmics: pre-excited atrial fibrillation?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.