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Quizzes > Health & Medicine > Human Anatomy & Medicine

Take the EKG Final Quiz - Test Your ECG Expertise

Think you can ace these ekg questions? Challenge yourself and review ekg test answers!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art ECG waveform and heart icons on coral background promoting free EKG final quiz

Welcome, future cardiology champions! Dive into our Master EKG Exam Questions: Free Final Quiz Challenge to sharpen your skills on ekg exam questions and interpret ECG waveforms like a pro. Designed for nursing students, paramedics, and healthcare pros gearing up for certifications, this engaging quiz offers realistic scenarios, instant feedback, and a chance to time yourself while mastering rhythm strips. Tackle targeted ekg questions, analyze a comprehensive ecg question paper with answers, and review your instant ekg test answers to pinpoint strengths and gaps. Ready to elevate your expertise? Jump into the free EKG quiz or take the ECG practice quiz today - click now and ace your certification with confidence!

Which waveform on the ECG represents atrial depolarization?
P wave
QRS complex
T wave
U wave
The P wave corresponds to atrial depolarization as electrical activity moves through the atria. It precedes the QRS complex, which represents ventricular depolarization. Normal P waves are smooth and upright in most leads. ECG Guide: Waveforms
What is the normal duration of the PR interval in a healthy adult?
120–200 ms
80–100 ms
200–300 ms
60–120 ms
The PR interval normally ranges from 120 to 200 milliseconds, reflecting conduction from the atria through the AV node. Intervals shorter than 120 ms suggest pre-excitation, while longer than 200 ms suggest AV block. AHA: ECG Intervals
In lead II, the QRS complex is predominantly positive. What does this indicate?
Mean QRS axis is between 0° and +90°
Right axis deviation
Left axis deviation
Extreme axis deviation
A predominantly positive QRS in lead II implies that the heart’s electrical axis is directed toward that lead, typically between 0° and +90°. Right axis deviation would show a negative QRS in lead II. LITFL: Axis Calculation
What is the rate for a ventricular escape rhythm seen on ECG?
20–40 beats per minute
60–100 beats per minute
100–150 beats per minute
150–250 beats per minute
A ventricular escape rhythm originates in the ventricles at 20–40 bpm if higher pacemakers fail. This slower rate is protective but insufficient for normal perfusion. AHA Rhythm Guide
Which lead is best for visualizing P waves?
Lead II
Lead V1
Lead aVR
Lead V6
Lead II aligns with the atrial depolarization vector and typically shows the clearest P waves. V1 can show biphasic P waves, but is less intuitive for rate and rhythm. ECG Primer: Lead II
True or False: The normal QRS duration is less than 120 milliseconds.
True
False
A normal QRS duration is under 120 ms, indicating coordinated ventricular depolarization. Prolongation suggests conduction delay such as bundle branch block. American Heart Association
Which interval reflects the time between depolarization and repolarization of the ventricles?
QT interval
PR interval
ST segment
RR interval
The QT interval spans from QRS onset to the end of the T wave, representing total ventricular depolarization and repolarization. It varies with heart rate. ESC: QT Interval
What does a U wave on ECG most commonly represent?
Late repolarization of Purkinje fibers
Early atrial depolarization
Delayed SA node discharge
Accessory pathway conduction
U waves follow the T wave and are thought to arise from late repolarization of Purkinje fibers or mid-myocardial M cells. Prominent U waves can be seen in hypokalemia. ScienceDirect U Waves
Which heart block is characterized by a progressively lengthening PR interval until a beat is dropped?
Second-degree Mobitz type I
First-degree AV block
Second-degree Mobitz type II
Third-degree AV block
Mobitz I (Wenckebach) shows progressive PR prolongation until a QRS is dropped. Mobitz II has constant PR intervals with sudden dropped beats. LITFL: AV Blocks
True or False: In atrial fibrillation, there are distinct P waves.
False
True
Atrial fibrillation shows chaotic atrial activity without discrete P waves, producing an irregularly irregular rhythm. AHA: Atrial Fibrillation
What is the typical heart rate in atrial flutter with 2:1 conduction?
150 bpm
75 bpm
100 bpm
200 bpm
Atrial flutter often has an atrial rate of ~300 bpm; with 2:1 AV conduction, the ventricular rate is ~150 bpm. NCBI: Atrial Flutter
Which lead pair is used to calculate the frontal plane axis?
Leads I and aVF
Leads V1 and V6
Leads II and III
Leads aVL and aVR
Axis determination commonly uses leads I and aVF to assess the mean QRS vector. Their polarity indicates axis quadrant. ECG Waves: Frontal Axis
What rhythm is indicated by a regular rate of 40–60 bpm with absent P waves and wide QRS complexes?
Junctional escape rhythm
Sinus bradycardia
Ventricular tachycardia
Atrial tachycardia
Junctional rhythms originate near the AV node, often have rates of 40–60 bpm, may lack visible P waves, and can have normal or narrow QRS. Wide QRS suggests concomitant bundle branch block. LITFL: Junctional Rhythm
True or False: ST elevation in leads V1–V4 suggests an anterior myocardial infarction.
True
False
ST elevation in precordial leads V1–V4 is indicative of acute anterior wall infarction, often due to left anterior descending artery occlusion. NCBI: MI ECG
Which electrolyte disturbance is most commonly associated with peaked T waves?
Hyperkalemia
Hypokalemia
Hypercalcemia
Hypomagnesemia
Hyperkalemia causes tall, peaked T waves due to accelerated repolarization. Progressively severe hyperkalemia widens QRS and can lead to sine-wave. LITFL: Hyperkalemia
What finding defines prolonged QT interval?
QTc > 450 ms in men or > 470 ms in women
QT > 400 ms
QT < 350 ms
PR > 200 ms
A prolonged QTc is defined as >450 ms in men and >470 ms in women after rate correction, risking torsades de pointes. ScienceDirect: QT Interval
Which segment follows the QRS complex and precedes the T wave?
ST segment
PR segment
QT segment
RR segment
The ST segment begins at the end of the QRS and ends at the start of the T wave, representing early ventricular repolarization. Elevation or depression indicates ischemia or injury. ECG Utah: ST Segment
What ECG finding is characteristic of Wolff–Parkinson–White syndrome?
Short PR interval and delta wave
Prolonged PR interval and U wave
ST depression and peaked T waves
Wide QRS and absent P waves
WPW syndrome shows an accessory pathway leading to a short PR interval and a slurred upstroke of the QRS called a delta wave. NCBI: WPW Syndrome
Which pattern on ECG indicates pericarditis rather than myocardial infarction?
Diffuse ST elevation with PR depression
Reciprocal ST depression only in inferior leads
Pathological Q waves in anterior leads
T wave inversion in V2–V4
Acute pericarditis often shows diffuse concave ST elevation and PR depression, unlike MI which has localized ST changes and reciprocal depressions. AHA: Pericarditis ECG
What does electrical alternans on ECG suggest?
Pericardial tamponade
Left bundle branch block
Hyperkalemia
Atrial flutter
Electrical alternans—beat-to-beat variation in QRS amplitude—indicates swinging of the heart in a fluid-filled pericardium, classic for tamponade. LITFL: Tamponade
Which sign on ECG indicates right ventricular hypertrophy?
R wave > S wave in V1
Deep S waves in V1 and V2
Tall R waves in V5 and V6
Low-voltage QRS in all leads
RV hypertrophy produces a tall R wave in V1 because the enlarged right ventricle dominates electrical forces. NCBI: RVH ECG
What is the classic ECG change seen in hypocalcemia?
Prolonged QT interval
Shortened QT interval
Peaked T waves
Wide QRS complexes
Hypocalcemia prolongs the ST segment, resulting in QT prolongation, as calcium influences plateau phase of action potential. LITFL: Hypocalcemia
Which condition can cause pseudo-infarct Q waves in V1–V3?
Left bundle branch block
Right axis deviation
Atrial fibrillation
Hyperthyroidism
LBBB produces deep Q waves in V1–V3 due to altered septal activation, mimicking anterior MI. Recognizing widened QRS and timing is key. AHA: LBBB ECG
Which ECG finding is most specific for digitalis effect?
Scooped ST segments
Prolonged QT interval
Large U waves
Peaked T waves
Digitalis effect classically causes a 'scooped' or 'reverse tick' ST depression, best seen in lateral leads. LITFL: Digitalis
Which arrhythmia shows a sawtooth pattern of atrial activity?
Atrial flutter
Atrial fibrillation
Multifocal atrial tachycardia
Junctional tachycardia
Atrial flutter produces regular flutter waves at ~250–350 bpm, giving a sawtooth pattern best seen in inferior leads. AHA: Atrial Flutter
What does a QS complex in lead V1 indicate?
Prior anteroseptal infarction
Left atrial enlargement
Hyperkalemia
Pericarditis
A pure QS complex in V1 suggests no initial R wave due to non-viable septal tissue, consistent with prior anteroseptal MI. LITFL: Q Waves
Which finding suggests left atrial enlargement on ECG?
Notched P waves in lead II >120 ms
Tall, peaked P waves in V1
Absent P waves
Delta waves
LA enlargement causes widened, notched P waves (>120 ms) in lead II and biphasic P in V1 with a larger negative component. AHA: Atrial Enlargement
True or False: A pseudonormal mitral inflow pattern on Doppler can mimic restrictive filling in grade II diastolic dysfunction.
True
False
Grade II diastolic dysfunction shows a pseudonormal pattern where impaired relaxation is hidden by elevated filling pressures, mimicking normal inflow. ACC: Diastolic Dysfunction
Which lead(s) is most sensitive for detecting posterior myocardial infarction?
Reciprocal changes in V1–V2
ST elevation in V5–V6
ST depression in III and aVF
Q waves in aVL
Posterior MI often shows ST depression in V1–V2 as reciprocal changes; true posterior leads V7–V9 would show ST elevation. LITFL: Posterior MI
Which ECG finding is diagnostic of acute hyperkalemia at moderate levels (6.5–8.0 mEq/L)?
Progressive QRS widening and peaked T waves
Prolonged PR interval and U waves
Short QT interval and tall P waves
Delta waves
Moderate hyperkalemia causes tall, peaked T waves and eventual QRS widening. Severe levels lead to sine-wave and asystole. LITFL: Hyperkalemia
Which ECG criterion is used to diagnose a left anterior fascicular block?
Left axis deviation with small Q in lead I and small R in lead III
Right axis deviation with RSR? in V1
Widened QRS >120 ms with terminal S in leads I and V6
Delta wave with short PR interval
Left anterior fascicular block shows left axis deviation (–45° to –90°), qR in lead I and rS in lead III, with QRS <120 ms. LITFL: Fascicular Blocks
In hyperkalemia, what change occurs to the PR interval as serum potassium rises?
Progressive prolongation
Progressive shortening
No change
Intermittent drop of beats
Hyperkalemia slows AV conduction, leading to PR prolongation. At very high levels, P waves may disappear and QRS widen. NCBI: Hyperkalemia ECG
Which feature distinguishes accelerated idioventricular rhythm from ventricular tachycardia?
Rate between 40–100 bpm with gradual onset/offset
Rate >150 bpm with AV dissociation
Fusion beats present
Capture beats present
Accelerated idioventricular rhythm has a ventricular rate of 40–100 bpm, often benign, with gradual start and stop. VT is >100–120 bpm, abrupt, with capture/fusion. LITFL: AIVR
What does a fragmented QRS complex indicate on ECG?
Myocardial scar or fibrosis
Electrolyte imbalance
Acute pericarditis
Left ventricular hypertrophy
Fragmented QRS (additional R’ or notches) suggests myocardial scar or fibrosis, associated with prior infarction and arrhythmic risk. JACC: Fragmented QRS
Which ECG finding is most suggestive of Brugada syndrome?
Coved ST elevation in V1–V3 with T-wave inversion
Diffuse ST depression in precordials
Delta waves in V4–V6
Prominent U waves
Brugada syndrome type 1 shows coved ST elevation ?2 mm in V1–V3 followed by inverted T waves, reflecting sodium channel dysfunction. ESC: Brugada
What is the significance of electrical alternans in a patient with a pericardial effusion?
Swinging of the heart in fluid causing beat-to-beat QRS voltage changes
Alternating bundle branch block
Atrial and ventricular bigeminy
Periodic ischemia
Electrical alternans arises when the heart swings in a fluid-filled pericardial sac, altering QRS amplitude each beat, a hallmark of tamponade. LITFL: Tamponade
Which ECG feature is diagnostic of an ectopic atrial tachycardia?
Abnormal P-wave morphology differing from sinus origin
Delta waves
Fusion beats
T wave inversion in inferior leads
Ectopic atrial tachycardia originates outside the SA node, producing P waves that differ in axis or morphology from sinus P waves. NCBI: Atrial Tachycardia
Which finding on ECG differentiates polymorphic ventricular tachycardia from monomorphic ventricular tachycardia?
Changing QRS morphology from beat to beat
Uniform wide QRS complexes
Rate <120 bpm
Presence of delta waves
Polymorphic VT exhibits varying QRS shapes and axes, as opposed to monomorphic VT which has uniform morphology. AHA: VTach
What does a geometrically increasing R-R interval with dropped beats on ECG signify?
Second-degree Mobitz type I block
Second-degree Mobitz type II block
Third-degree AV block
Sinus arrhythmia
Mobitz I (Wenckebach) shows progressive PR prolongation and a dropped beat, causing gradually increasing R–R intervals. LITFL: AV Block
Which ECG abnormality is most predictive of sudden cardiac death in hypertrophic cardiomyopathy?
Deep, narrow Q waves in lateral or inferior leads
Diffuse ST elevation
Low-voltage QRS
Prolonged PR interval
In HCM, pathological Q waves reflect hypertrophied septum but are also linked to myocardial disarray and arrhythmia risk. NCBI: HCM ECG
True or False: In de Winter’s T wave pattern, upsloping ST depression with tall, symmetrical T waves in the precordial leads indicates proximal LAD occlusion.
True
False
De Winter’s pattern presents with upsloping ST depression at the J-point and peaked T waves in V2–V4, a STEMI equivalent for proximal LAD occlusion. NCBI: de Winter’s T Waves
Which mutation is most commonly associated with congenital long QT syndrome type 1?
KCNQ1 potassium channel
SCN5A sodium channel
HERG potassium channel
CACNA1C calcium channel
LQT1 is due to loss-of-function mutations in KCNQ1 (IKs current), leading to QT prolongation. LQT3 involves SCN5A. NCBI: Long QT Syndrome
What ECG finding suggests digoxin toxicity rather than therapeutic effect?
Any degree of heart block or arrhythmia with scooped ST segments
Mild T-wave flattening alone
Shortened QT interval only
U waves enhancement
Digoxin toxicity produces arrhythmias including AV block, ventricular ectopy, in addition to the classic scooped ST segments; isolated scooping alone is normal effect. NCBI: Digoxin
Which ECG manifestation is seen in early repolarization variant?
Concave ST elevation in V2–V5 with prominent J-point notching
Flattened T waves and prolonged QT
Reciprocal ST depression in inferior leads
ST elevation only in aVR
Early repolarization shows benign concave ST elevation, J-point notching or slurring in precordial leads, common in healthy young adults. LITFL: Early Repolarization
Which criterion differentiates left ventricular aneurysm from acute anterior MI on ECG?
Persistent ST elevation with large Q waves and absence of reciprocal changes
Transient ST elevation resolving in hours
Diffuse ST depression
Tall R waves in V1
LV aneurysm presents with persistent ST elevation and deep Q waves long after MI, without reciprocal depression, distinguishing from acute injury. NCBI: LV Aneurysm
What ECG change is characteristic of hypothermia?
Osborn (J) waves after the QRS complex
Peaked T waves
Shortened QT interval
Delta waves
Osborn waves are positive deflections at the J-point seen in hypothermia, correlating with severity. LITFL: Hypothermia ECG
Which advanced ECG sign is most specific for diagnosing an acute left main coronary artery occlusion?
ST elevation in aVR with widespread ST depression
Isolated ST elevation in V5–V6
ST elevation in V2–V4 only
Tall U waves in V1–V3
Acute left main occlusion often presents with ST elevation in aVR and diffuse ST depression, reflecting global subendocardial ischemia. ACC: LMCA Occlusion
Which mutation underlies Brugada syndrome type 2?
CACNA1C calcium channel gene
SCN5A sodium channel gene
KCNH2 potassium channel gene
KCNQ1 potassium channel gene
Brugada type 2 involves mutations in calcium channel genes, especially CACNA1C, affecting I_Ca,L current. NCBI: Brugada Genetics
Which advanced measurement on high-resolution ECG predicts risk of ventricular arrhythmias in cardiomyopathy?
Late potentials on signal-averaged ECG
QT dispersion on standard ECG
PR segment depression
T wave alternans on rest ECG
Signal-averaged ECG can detect late potentials—low-amplitude signals after QRS—indicating slow conduction and arrhythmia risk in cardiomyopathy. NCBI: Late Potentials
Which ECG parameter best correlates with transmural dispersion of repolarization and arrhythmia risk?
Tpeak–Tend interval
QT interval
PR interval
QRS duration
The Tpeak–Tend interval reflects heterogeneity of repolarization. Prolongation is linked to ventricular arrhythmia risk. JACC: Tpeak–Tend
In patients with dextrocardia, how are the precordial leads best placed for accurate ECG recording?
Mirror-image placement on right chest
Standard left chest placement
All leads on left chest
Circular belt placement around chest
In dextrocardia, performing a right-sided ECG—mirroring precordial lead placement—provides correct orientation and avoids false findings. NCBI: Dextrocardia ECG
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Study Outcomes

  1. Analyze ECG Waveforms -

    Gain the ability to identify P waves, QRS complexes, and T waves to accurately interpret cardiac rhythms presented in ekg exam questions.

  2. Interpret Common EKG Rhythms -

    Develop proficiency in recognizing normal and abnormal rhythms such as atrial fibrillation, ventricular tachycardia, and sinus arrhythmia from ecg question paper with answers - style prompts.

  3. Apply a Systematic Approach -

    Use a step-by-step method to tackle ekg questions and ensure consistent, accurate results under exam conditions.

  4. Identify Arrhythmia Patterns -

    Differentiate between atrial and ventricular arrhythmias by evaluating rate, rhythm regularity, and waveform morphology.

  5. Evaluate Treatment Implications -

    Assess the clinical significance of detected EKG abnormalities and understand corresponding management strategies.

  6. Utilize Instant Feedback -

    Leverage real-time quiz results to reinforce learning, correct misunderstandings, and track progress toward mastering ekg test answers.

Cheat Sheet

  1. Master the Wave Intervals -

    Knowing the normal durations of the P wave (≤0.12 sec), PR interval (0.12 - 0.20 sec), QRS complex (≤0.10 sec), and QT interval (≤0.44 sec) is critical for ekg exam questions. Use the "P-P-R-Q" mnemonic to recall that the PR interval should never exceed one large box on ECG grid paper. Practice measuring intervals in an ecg question paper with answers to reinforce your ekg test answers.

  2. Calculate Heart Rate with the 300-Method -

    The 300-150-100-75-60-50 sequence lets you estimate rate by counting large boxes between R waves (300 divided by number of big boxes). For example, three big boxes equals 100 bpm, making it quick to answer ekg questions under time pressure (University of Washington School of Medicine). Drill this using sample strips in your ekg exam questions bank for fast recall.

  3. Differentiate Common Rhythms -

    Recognize sinus rhythm by a consistent P-wave before each QRS and regular R-R intervals; atrial fibrillation shows no distinct P waves and an irregularly irregular rhythm. Remember "IRREGULAR AF" to flag atrial fib fast when reviewing ecg question paper with answers. This distinction is fundamental for accurate ekg test answers and patient care decisions (American College of Cardiology).

  4. Determine Cardiac Axis -

    Use the quadrant method with leads I and aVF: positive in both means normal axis (−30° to +90°). If lead I is positive and aVF negative, check lead II to distinguish left axis deviation, a skill often tested in ekg questions. Refer to Medscape's axis tutorials and practice with ekg exam questions to solidify your understanding.

  5. Identify MI Patterns by Lead Groups -

    Memorize "Septal-Anterior-Lateral" for chest leads: V1 - V2 septal, V3 - V4 anterior, V5 - V6 lateral, each corresponding to specific coronary occlusions. Look for ST-elevation ≥1 mm in two contiguous leads and reciprocal depressions in opposite leads to confirm STEMI patterns. Working through ecg question paper with answers scenarios will sharpen your recognition and confidence when answering ekg exam questions.

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