ECG Quiz

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By March 7,
2011

Check out geekyquiz.com to access over 1700 free MCQs

Once on the ward, you’ll be asked to comment on ECGs regularly, therefore it’s really
important to understand how to read an ECG effectively. If you want to learn more
about ECGs, you can check out our ECG guides.

Take our ECG quiz to put your knowledge to the test.

Check out our brand new FREE quiz platform, with over 1700 MCQs
at geekyquiz.com

ECG quiz
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Question
1

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The absence of P-waves and an irregular rhythm would suggest a diagnosis of...

A 1st degree heart block

B Atrial fibrillation

C 2nd degree heart

block

D Ventricular tachycardia

Question 1 Explanation:
In atrial fibrillation the atria no longer conduct electricity from the SA in an orderly
fashion. Therefore P-waves are lost. As a result of disordered atrial activity only
occasional waves of depolarisation pass through to the AV node and cause ventricular
activation. This causes the typical irregular rhythm.

Question
2

What does ST-elevation suggest?

A Heart murmur

B Myocardial infarction

C Heart block - Mobitz type

II

D Bundle Branch Block

Question
3

What is the most common cause of left axis deviation?

A Right ventricular hypertrophy

B Left ventricular hypertrophy

C Defects of the conduction

system

D Atrial septal defects

Question 3 Explanation:
Left axis deviation is rarely the result of left ventricular hypertrophy and more often due
to defects in the conduction system of the heart.

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 Question
4

What is a common cause of right axis deviation?

A Left ventricular hypertrophy

B Right ventricular
hypertrophy

C Atrial septal defect

D Ventricular septal defect

Question 4 Explanation:
In right ventricular hypertrophy the increased muscle mass of the right ventricle causes
increased signal on the ECG. As a result the axis of the heart is shifted to the right with
lead III becoming more positive and lead I and II becoming less positive.

Question
5

Which artery is most likely to be affected if ST elevation in present in leads V3 and

V4?

A Right coronary artery

B Left circumflex coronary artery

C All of the above

D Left anterior descending coronary

artery

Question 5 Explanation:
Leads V3 and V4 related to the anterior portion of the heart. Therefore ST elevation in
these leads suggests an anterior infarct. The anterior portion of the heart is supplied
mainly by the left anterior descending artery therefore this is most likely to have been
affected.

Question
6

What would it suggest if lead I became negative and lead III became more positive

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than lead II?

A Right axis
deviation

B Left axis deviation

Question
7

What is often the earliest ECG change seen during

myocardial infarction?

A ST-elevation

B Tall peaked T-
waves

C ST-depression

D Tall P-waves

Question 7 Explanation:
Tall peaked T-waves can suggest a number of abnormalities. If seen in all leads then they
usually suggest the individual has hyperkalaemia. However if tall T waves are seen in a
particular group of leads it suggests early MI. The tall T waves are due to potassium
leaking through the damaged membrane over the infarcted area.

Question
8

If a rhythm is described as sinus, what does this indicate?

A P-waves are present

B QRS-complexes are present

C A P-wave precedes each QRS-

complex

D A QRS-complex precedes each T-

wave

Question 8 Explanation:
If a rhythm is described as sinus it indicates that a P-wave precedes each QRS-complex.
However a rhythm can still be irregular even if it's sinus.

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 Question
9

What is the normal duration of a QRS complex?

A 0.12 seconds (3 small

squares)

B 0.04 seconds (1 small square)

C 0.16 seconds (4 small

squares)

D 0.08 seconds (2 small

squares)

Question 9 Explanation:
In most healthy individuals you would expect QRS complexes to be around 0.12 seconds
or slightly less. If a QRS complex lasts longer it is described as a "wide QRS" and can be a
sign of inefficient conduction of the ventricles such as bundle branch block.

Question 10

What view of the heart do leads V3 & V4 represent?

A Anterior

B Lateral

C Inferior

D Septal

Question 11

The duration of the PR interval is noted to be increasingly prolonged. In addition

QRS complexes appear to be dropped at regular intervals. What diagnosis would
this suggest.

A Second degree - Mobitz Type 2 - Heart

Block

B Hyperkalaemia

C First degree Heart Block

D Second degree - Mobitz Type 1 - Heart

Block

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Question 11 Explanation:
Second degree - Mobitz Type 1 - Heart Block is a disease of the AV node. It is seen as
progressive prolongation of the PR-interval with associated regular dropping of the QRS
complex.

Question 12

If ST-elevation was noted in leads II, III and aVF what would it suggest?

A A posterior myocardial infarction

B An anterior myocardial infarction

C An inferior myocardial infarction

D A septal myocardial infarction

Question 12 Explanation:
Leads II, III and aVF all look at the heart in the inferior plane. Therefore ST-elevation in
only these leads suggests an inferior myocardial infarction.

Question 13

What view of the heart do leads V1 & V2 represent?

A Lateral

B Anterior

C Septal

D Inferior

Question 14

What would it suggest if lead I became more positive than lead II and lead III
became negative?

A Left axis deviation

B Right axis
deviation

Question 15

What is the duration of a normal PR-interval?

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 A 0.04 - 0.12 seconds (1-3 small
squares)

B 0.12 - 0.2 seconds (3-5 small squares)

C 0.08 -0.12 seconds (2-3 small squares)

D 0.04 - 0.08 seconds (1-2 small

squares)

Question 15 Explanation:
n normal individuals the PR-interval is between 0.12-0.2 seconds. A PR
interval longer than this can suggest the presence of heart block and a
short PR-interval can suggest an accessory pathway between the atria &
ventricles e.g. WPW syndrome

Question 16

What view of the heart do leads I, aVL, V5 and V6 represent?

A Septal

B Anterior

C Inferior

D Lateral

Question 17

If there were 3 large squares in an R-R interval what would the heart rate be?

A 90 bpm

B 70 bpm

C 100 bpm

D 80 bpm

Question 17 Explanation:
To calculate heart rate from an ECG you count the number of large squares in an R-R
interval then divide 300 by this number. Therefore 300/3 = 100 bpm.

Question 18

What view of the heart do leads II, III and aVF represent?

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 A Lateral

B Inferior

C Anterior

D Septal

Question 19

A patient is noted to have an abnormally shortened PR-interval on their ECG.

Which of the following is the most likely cause?

A AV nodal fibrosis

B Left bundle branch block

C Wolf Parkinson White

Syndrome

D Right bundle branch block

Question 19 Explanation:
A short PR-interval indicates abnormally short conduction time between the atria and
ventricles. This is caused by the presence of an accessory pathway between the atria and
ventricles. Wolf parkinson white syndrome is an example of this kind of disorder. In WPW
the an accessory pathway known as "the bundle of kent" is present. Most individuals are
asymptomatic however there is a risk of sudden death without treatment.
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