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Quizzes > Health & Medicine > Human Anatomy & Medicine

Can You Ace This EKG Multiple Choice Quiz?

Dive into the ECG Quiz Multiple Choice Challenge - think you can ace it?

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration for EKG practice test quiz on a dark blue background

Think you're ready to conquer the ekg practice test multiple choice challenge? Designed for nursing students, paramedics, and anyone brushing up on heart rhythms, this quiz lets you test your ECG interpretation in real-world scenarios. You'll face ekg multiple choice questions on P waves, QRS complexes and arrhythmia recognition to boost your confidence. Check out our interactive practice ekg strips for a hands-on warm-up, then tackle the full-scale ecg quiz multiple choice to measure your progress. Jump in now, sharpen your skills with this engaging ekg quiz practice, and show yourself you've got what it takes!

What does the P wave on an ECG represent?
Ventricular repolarization
Atrial repolarization
Ventricular depolarization
Atrial depolarization
The P wave represents atrial depolarization, reflecting the electrical activation of both atria. Atrial repolarization occurs during the QRS complex and is typically obscured. Identifying the P wave is essential for assessing atrial rhythm and conduction. Understanding P wave morphology helps in diagnosing atrial arrhythmias. Wikipedia - P wave
Which part of the ECG corresponds to ventricular depolarization?
PR interval
ST segment
QT interval
QRS complex
The QRS complex corresponds to the rapid depolarization of the right and left ventricles. It is normally less than 120 ms in duration. The ST segment and T wave reflect ventricular repolarization, while the PR interval represents conduction through the AV node. Recognizing the QRS complex is vital for identifying conduction abnormalities. Wikipedia - QRS complex
What is the standard paper speed for ECG recordings?
25 mm/s
10 mm/s
50 mm/s
5 mm/s
The standard ECG paper speed is 25 millimeters per second, which allows consistent measurement of wave durations and intervals. At this speed, one small box equals 0.04 seconds and one large box equals 0.2 seconds. Faster or slower speeds are used for special assessments but are not routine. Accurate paper speed is crucial for proper interval calculation. Wikipedia - Electrocardiography
What is the normal duration of the PR interval?
240 - 300 ms (0.24 - 0.30 s)
120 - 200 ms (0.12 - 0.20 s)
200 - 240 ms (0.20 - 0.24 s)
80 - 120 ms (0.08 - 0.12 s)
The normal PR interval ranges from 120 to 200 milliseconds, representing conduction time from atrial depolarization to ventricular depolarization. A prolonged PR interval (>200 ms) suggests first-degree AV block. Shortened PR intervals may indicate pre-excitation pathways. Precise measurement of the PR interval assists in diagnosing conduction system diseases. Wikipedia - PR interval
What does the QRS duration represent?
Ventricular depolarization
Ventricular repolarization
AV nodal delay
Atrial depolarization
The QRS duration measures the time it takes for ventricular depolarization, typically less than 120 milliseconds. Widened QRS complexes suggest intraventricular conduction delays or bundle branch blocks. It does not reflect repolarization, which is seen in the ST segment and T wave. Accurate QRS measurement is key for identifying conduction abnormalities. Wikipedia - QRS complex
Which ECG pattern is characteristic of atrial fibrillation?
Irregular RR intervals and absent P waves
Prolonged PR intervals
Wide QRS complexes at a regular rhythm
Regular RR intervals with sawtooth P waves
Atrial fibrillation is characterized by an irregularly irregular ventricular rhythm with absent discrete P waves. Instead, chaotic atrial electrical activity produces fibrillatory waves. The QRS complexes are typically narrow and respond irregularly to the AV node. Recognizing this pattern is crucial for appropriate management. Wikipedia - Atrial fibrillation
Which lead in a standard 12-lead ECG is typically used as the rhythm strip?
V1
Lead II
Lead I
aVR
Lead II is most commonly used as the rhythm strip because it provides a clear view of atrial activity and P waves. Its axis aligns well with the overall direction of atrial depolarization. This makes it ideal for assessing heart rate, rhythm regularity, and P-wave morphology. Accurate rhythm interpretation often starts with a good Lead II tracing. Life in the Fastlane - Lead II
Which criterion defines a first-degree AV block on ECG?
RR interval <600 ms
QRS duration >120 ms
PR interval >200 ms
QT interval >440 ms
First-degree AV block is diagnosed when the PR interval exceeds 200 milliseconds. It indicates delayed conduction through the AV node but all atrial impulses reach the ventricles. This block is usually benign but warrants monitoring for progression. It is distinguished from higher-degree blocks by a consistent PR delay. Wikipedia - First-degree AV block
A positive QRS in lead I and negative QRS in lead aVF indicates which axis deviation?
Extreme axis deviation
Normal axis
Right axis deviation
Left axis deviation
A positive QRS in lead I and a negative QRS in aVF indicates that the mean QRS vector lies between -30° and -90°, consistent with left axis deviation. Right axis deviation is the opposite pattern. Normal axis is between -30° and +90° with both leads positive. Axis assessment helps identify chamber enlargement and conduction defects. Wikipedia - Cardiac axis
How is heart rate estimated using the '300 rule' on an ECG?
Multiply the number of large boxes by 300
Multiply the number of small boxes by 60
Divide 300 by the number of large boxes between R waves
Divide 1500 by the number of small boxes between R waves
The '300 rule' estimates heart rate by dividing 300 by the number of large 0.2-second boxes between consecutive R waves. It is a quick method for regular rhythms. For irregular rhythms, other methods like counting R waves over 6 seconds are recommended. Consistent measurement improves diagnostic accuracy. Wikipedia - Heart rate calculation
What is the hallmark ECG feature of a premature ventricular complex (PVC)?
Narrow QRS complex
Regular RR intervals
Wide QRS complex without a preceding P wave
P wave before every QRS
PVCs originate in the ventricles and are not preceded by atrial depolarization, so there is no P wave before the aberrant beat. The QRS is wide (?120 ms) and bizarre in morphology. A compensatory pause often follows a PVC. Recognizing PVCs is important for assessing arrhythmia burden. Wikipedia - PVC
Which rhythm is defined by three or more consecutive PVCs at a rate over 100 beats per minute?
Ventricular bigeminy
Torsades de pointes
Ventricular tachycardia
Ventricular fibrillation
Ventricular tachycardia is diagnosed when three or more PVCs occur sequentially at a rate exceeding 100 bpm. It is a potentially life-threatening arrhythmia requiring prompt evaluation. Torsades de pointes is a form of polymorphic VT associated with prolonged QT. Ventricular bigeminy is alternating PVCs and normal beats. Early recognition guides emergent therapy. Wikipedia - Ventricular tachycardia
ST-segment elevation in leads II, III, and aVF most strongly suggests infarction of which myocardial region?
Septal wall
Inferior wall
Anterior wall
Lateral wall
Leads II, III, and aVF view the inferior surface of the heart, served by the right coronary artery in most individuals. ST elevation in these leads indicates an acute inferior MI. Anterior infarctions show changes in V1 - V4, while lateral infarctions occur in I, aVL, V5, and V6. Precise localization informs reperfusion strategy. Wikipedia - Inferior myocardial infarction
Which ECG finding characterizes a Mobitz Type II second-degree AV block?
Progressive PR prolongation until a beat is dropped
Absence of P waves
Fixed PR interval with sudden dropped QRS complexes
Variable PR intervals with irregular QRS
Mobitz Type II block features consistent PR intervals on conducted beats with intermittent nonconducted P waves causing dropped QRS complexes. There is no gradual PR prolongation, distinguishing it from Mobitz I. It can progress unpredictably to complete heart block and often requires pacing. Early recognition is critical. Wikipedia - Second-degree AV block
What ECG finding is most consistent with atrial flutter?
Irregularly irregular rhythm with absent P waves
Presence of delta waves preceding QRS
Sawtooth atrial pattern at ~300 bpm with regular ventricular response
Prolonged PR interval >200 ms
Atrial flutter produces a sawtooth pattern of atrial activity typically around 250 - 350 bpm, most evident in the inferior leads. Ventricular conduction often shows a fixed ratio (e.g., 2:1). It differs from atrial fibrillation by its regular atrial activity. Accurate identification is essential for targeted therapy. Wikipedia - Atrial flutter
Torsades de pointes is best described on ECG as:
Polymorphic narrow complex tachycardia
Irregularly irregular wide complex tachycardia with twisting QRS amplitudes
Regular wide complex tachycardia
Monomorphic wide complex tachycardia
Torsades de pointes is a polymorphic ventricular tachycardia with QRS complexes that appear to twist around the baseline. It is often associated with a prolonged QT interval and can degenerate into ventricular fibrillation. Identification on ECG is crucial as treatment differs from monomorphic VT. Magnesium sulfate is first-line therapy. Wikipedia - Torsades de pointes
Which ECG pattern is characteristic of Brugada syndrome type I?
Coved ST-segment elevation ?2 mm in V1 - V3 with T-wave inversion
Saddleback ST depression in V5 - V6
Prolonged QT interval >500 ms
Delta wave before the QRS complex
Type I Brugada syndrome shows a coved ST elevation of ?2 mm in V1 - V3 followed by a negative T wave. This pattern is diagnostic and associated with risk of sudden cardiac death. The saddleback pattern is type II or III and less specific. Early recognition guides consideration for ICD placement. Wikipedia - Brugada syndrome
Which ECG change is most indicative of hyperkalemia?
U waves
Tented (peaked) T waves
ST-segment depression
P wave widening
Hyperkalemia often produces tall, peaked (tented) T waves as an early sign. As potassium rises further, P waves flatten and QRS widens. U waves are more characteristic of hypokalemia. Prompt recognition of peaked T waves can prevent life-threatening arrhythmias. LITFL - Hyperkalemia ECG
Which of the following defines left bundle branch block (LBBB) criteria on ECG?
RSR' pattern in V1
QRS ?120 ms with RS complex in V1
QRS <120 ms with a q wave in V6
QRS ?120 ms with broad R waves in leads I, V5, V6
LBBB is diagnosed by a QRS duration ?120 ms with broad, notched, or slurred R waves in leads I, V5, and V6 and absent Q waves in those leads. V1 shows a deep S wave. It indicates delayed activation of the left ventricle. Identification of LBBB is important in evaluating myocardial ischemia. Wikipedia - LBBB
Which ECG pattern describes right bundle branch block (RBBB)?
QRS <120 ms with monophasic R in V1
Delta wave in pre-excitation
Elevated ST in V1 only
QRS ?120 ms with rsR' in V1 and broad S in I, V6
RBBB is characterized by a QRS duration ?120 ms with an rsR' (rabbit ears) pattern in V1 and a wide, slurred S wave in leads I and V6. It indicates delayed right ventricular activation. Differentiation from other conduction delays is essential for accurate diagnosis. Wikipedia - RBBB
What does the U wave on an ECG most commonly represent?
Atrial repolarization
SA node depolarization
Ventricular depolarization
Repolarization of Purkinje fibers
The U wave is thought to represent repolarization of the Purkinje fibers or mid-myocardial cells. It is usually small and follows the T wave. Prominent U waves may be seen in hypokalemia and other conditions. Recognizing U waves assists in comprehensive ECG interpretation. Wikipedia - U wave
A delta wave on an ECG is most indicative of which condition?
Torsades de pointes
Pre-excitation syndrome (Wolff - Parkinson - White)
Ventricular tachycardia
Myocardial ischemia
A delta wave is a slurred upstroke of the QRS complex, indicating early ventricular activation via an accessory pathway. It is characteristic of Wolff - Parkinson - White syndrome. This pre-excitation shortens the PR interval and can predispose to tachyarrhythmias. Identification guides electrophysiological evaluation. Wikipedia - WPW syndrome
Which ECG leads are most useful for diagnosing a posterior myocardial infarction?
Leads I and aVL
V7 - V9
V1 - V3
V4R - V6R
Posterior MI is best detected using additional leads V7 - V9 placed on the back, as standard leads face away from the posterior wall. ST depression in V1 - V3 with reciprocal elevation in posterior leads confirms the diagnosis. Without these leads, posterior infarctions may be missed. Proper lead placement is critical for accurate localization. Wikipedia - Posterior MI
An epsilon wave on an ECG is a small positive deflection seen at the end of the QRS complex and is associated with which condition?
Hypertrophic cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
Brugada syndrome
Long QT syndrome
Epsilon waves are small post-QRS potentials seen best in the right precordial leads and are a hallmark of arrhythmogenic right ventricular cardiomyopathy (ARVC). They represent delayed right ventricular activation from fibrofatty replacement. Identification supports ARVC diagnosis and risk stratification. Advanced imaging and genetic testing often follow. Wikipedia - ARVC
How can multifocal atrial tachycardia (MAT) be differentiated from atrial fibrillation on ECG?
MAT shows at least three different P-wave morphologies with irregular rhythm
MAT demonstrates absent P waves throughout
MAT presents as regular narrow QRS tachycardia
MAT is characterized by delta waves before QRS complexes
MAT features an irregular rhythm with at least three distinct P-wave morphologies, indicating multiple atrial pacemaker foci. In contrast, atrial fibrillation shows no discrete P waves and a completely irregular rhythm. MAT often occurs in the setting of pulmonary disease. Distinguishing these arrhythmias guides appropriate management strategies. AHA Journals - MAT
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Study Outcomes

  1. Identify Key ECG Waveforms -

    Recognize and label P waves, QRS complexes, T waves, and intervals on multiple choice ECG quiz questions.

  2. Interpret Common Arrhythmias -

    Analyze ECG tracings to pinpoint atrial and ventricular rhythm disturbances with accuracy.

  3. Differentiate Normal from Abnormal Tracings -

    Distinguish between physiologic variants and pathological ECG findings in quiz format.

  4. Apply a Systematic Analysis Approach -

    Use step-by-step methods to solve ekg practice test multiple choice challenges efficiently.

  5. Analyze Rate and Rhythm Patterns -

    Calculate heart rate and categorize rhythm regularity to select correct answers.

  6. Evaluate Clinical Implications -

    Connect ECG interpretation results to potential patient scenarios and treatment considerations.

Cheat Sheet

  1. Electrical Axis Determination -

    Use the hexaxial reference system's quadrant method by evaluating the QRS complex in lead I and aVF to determine normal, left, or right axis deviation. A handy mnemonic is "All Physicians Take Money" (I, II, III, aVF) to remember lead sequence, and you'll encounter axis deviation scenarios frequently in ekg multiple choice questions. Review sample ECGs from the American Heart Association's guidelines to solidify your understanding for any ekg quiz practice session.

  2. Heart Rate Calculation Methods -

    Master the 300, 1500, and six-second strip techniques to quickly calculate heart rate in both regular and irregular rhythms on your ekg practice test multiple choice. For a regular rhythm, divide 300 by the number of large boxes between R waves; for irregular patterns, count QRS complexes in a six-second strip and multiply by 10. This formulaic approach appears often in ecg quiz multiple choice materials from sources like Medscape and UpToDate.

  3. PR Interval & AV Block Recognition -

    Understand that a normal PR interval ranges from 120 - 200 ms, and differences in prolongation identify first-degree, Mobitz I (Wenckebach), and Mobitz II AV blocks. Use the "longer, longer, drop" mnemonic to spot Mobitz I, and watch for sudden dropped QRS complexes without PR prolongation in Mobitz II. Such distinctions are core concepts tested in ekg quiz practice and ekg multiple choice questions for clinical exams (ESC guidelines).

  4. QRS Complex & Bundle Branch Blocks -

    Recognize right bundle branch block by "rabbit ears" in V1 and wide S waves in V6, and left bundle branch block by broad, slurred R waves in V6. Remember that a QRS duration ≥120 ms indicates intraventricular conduction delay, which is a key point in many ecg practice test scenarios. Consult cardiology texts like Kumar's EKG Interpretation for detailed waveform examples you might encounter in an ekg practice test multiple choice quiz.

  5. ST Segment & T Wave Abnormalities -

    Identify ST elevation in contiguous leads to diagnose acute STEMI, and distinguish it from reciprocal ST depression - traits commonly tested in ECG quiz multiple choice questions. T wave inversions or peaked T waves signal ischemia or hyperkalemia, respectively, so practice differentiating these patterns in your ekg quiz practice. The American College of Cardiology's case library offers real tracings to help you master these critical findings.

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