SHARP ECG TEST — ADVANCED
ELECTROCARDIOGRAM INTERPRETATION Actual
Exam 2026/2027 Complete Questions and Answers
Detailed Rationales Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Normal ECG & Rhythm Recognition | Q1 – Q10
Section 2 | Supraventricular Arrhythmias | Q11 – Q20
Section 3 | Ventricular Arrhythmias | Q21 – Q30
Section 4 | Ischemia, Injury & Infarction Patterns | Q31 – Q40
Section 5 | Conduction Blocks & Pacemaker Rhythms | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 correct in 90 minutes.
══════════════════════════════════════
SECTION 1: NORMAL ECG & RHYTHM RECOGNITION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 42-year-old marathon runner presents for a routine sports physical. His resting
12-lead ECG shows a heart rate of 52 beats per minute, upright P waves in lead II
preceding every QRS complex, a PR interval of 0.16 seconds, and narrow QRS
complexes. His blood pressure is 118/72 mmHg and he feels entirely well.
A. Atropine should be administered immediately due to symptomatic bradycardia
B. This tracing represents a junctional escape rhythm with retrograde conduction
C. The findings are consistent with normal sinus rhythm in a trained athlete ✓
CORRECT
D. Emergent transcutaneous pacing is indicated given the risk of asystole
Correct Answer: C
Rationale: A heart rate of 52 bpm with normal sinus P waves, normal PR interval, and
narrow QRS complexes in an asymptomatic athlete is simply sinus bradycardia, a
,normal physiologic adaptation to cardiovascular training. Option A is incorrect because
atropine is reserved for hemodynamically significant bradycardia, not an incidental
finding in a healthy runner. Well-conditioned athletes often develop increased vagal tone
that lowers resting heart rate without any pathologic significance.
Question 2 of 50
During preoperative screening for elective knee arthroscopy, a 68-year-old woman with
hypertension is found to have an ECG with a regular rhythm at 38 bpm. There are visible
upright P waves in lead II occurring at a regular rate of 72 per minute, but only every
other P wave is followed by a QRS complex. The PR interval in conducted beats is
constant at 0.18 seconds.
A. First-degree AV block with 2:1 conduction ratio
B. Mobitz type I second-degree AV block with progressive PR prolongation
C. Complete heart block with junctional escape rhythm
D. Mobitz type II second-degree AV block with fixed PR interval ✓ CORRECT
Correct Answer: D
Rationale: Mobitz type II is characterized by intermittent non-conducted P waves
without preceding PR interval prolongation, and the constant PR interval in conducted
beats confirms this diagnosis. Option A is incorrect because first-degree block shows
only PR prolongation without dropped beats, while option B is wrong because
Wenckebach requires progressive PR lengthening before the dropped beat. Mobitz type
II often indicates infra-nodal conduction disease and may warrant permanent pacing
even if asymptomatic.
Question 3 of 50
A 29-year-old medical student measures her own ECG during a physiology lab. The
rhythm is regular with a rate of 75 bpm. Each QRS complex is preceded by an upright P
,wave in lead II, the PR interval measures 0.14 seconds, and the QRS duration is 0.08
seconds. The QT interval spans 9 small boxes.
A. All intervals are within normal limits for standard calibration ✓ CORRECT
B. The PR interval indicates accelerated AV conduction requiring further workup
C. The QT interval is dangerously prolonged and suggests acquired long QT syndrome
D. The QRS duration meets criteria for incomplete bundle branch block
Correct Answer: A
Rationale: A PR interval of 0.14 seconds is within the normal range of 0.12–0.20
seconds, and a QT interval of 9 small boxes (0.36 seconds) is normal for a heart rate of
75 bpm. Option B is incorrect because a PR of 0.14 seconds is not short enough to
suggest preexcitation or accelerated conduction. Standard ECG calibration uses 25
mm/s paper speed, making each small box 0.04 seconds.
Question 4 of 50
A 55-year-old man with no cardiac history undergoes ECG monitoring after a syncopal
episode. The tracing shows a regular rhythm at 68 bpm with normal P waves, but the PR
interval is measured at 0.24 seconds and remains fixed across all beats with no
dropped QRS complexes.
A. This is Mobitz type I second-degree AV block and requires permanent pacing
B. The findings represent a normal variant seen in healthy young adults
C. First-degree AV block with prolonged but stable PR interval ✓ CORRECT
D. The patient has complete heart block with atrioventricular dissociation
Correct Answer: C
Rationale: First-degree AV block is defined by a PR interval greater than 0.20 seconds
with consistent 1:1 atrioventricular conduction, which matches this tracing exactly.
Option A is incorrect because Mobitz type I requires progressive PR prolongation and
intermittent dropped beats, neither of which is present here. First-degree block is
, usually benign in isolation and rarely progresses to higher-grade blocks without
underlying conduction system disease.
Question 5 of 50
A 6-year-old child has an ECG recorded during a routine pediatric visit. The rhythm is
slightly irregular, varying by roughly 0.08 seconds between the shortest and longest R-R
intervals. There are normal upright P waves before every QRS, the rate ranges from 78
to 92 bpm, and all intervals and morphologies are otherwise normal.
A. Atrial flutter with variable AV block and changing flutter waves
B. Normal sinus arrhythmia with respiratory variation ✓ CORRECT
C. Multifocal atrial tachycardia due to multiple atrial pacemaker sites
D. Sinus node dysfunction requiring electrophysiology evaluation
Correct Answer: B
Rationale: Sinus arrhythmia is a normal finding characterized by phasic variation in the
R-R interval corresponding with respiration, commonly seen in children and young
adults. Option A is incorrect because atrial flutter would show characteristic sawtooth
flutter waves rather than normal sinus P waves. This physiologic variation typically
disappears with breath-holding or increasing heart rate.
Question 6 of 50
A 35-year-old woman presents with palpitations that began suddenly while she was
drinking coffee. Her ECG shows a regular narrow-complex tachycardia at 180 bpm. No
distinct P waves are visible before the QRS complexes, but close inspection reveals
small pseudo-S waves in the inferior leads and terminal notching in lead aVR.
A. AV nodal reentrant tachycardia with retrograde P waves buried near QRS ✓ CORRECT
B. Atrial flutter with 2:1 conduction and concealed flutter waves
C. Orthodromic atrioventricular reentrant tachycardia via accessory pathway
D. Sinus tachycardia with rate-dependent bundle branch block aberrancy
ELECTROCARDIOGRAM INTERPRETATION Actual
Exam 2026/2027 Complete Questions and Answers
Detailed Rationales Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Normal ECG & Rhythm Recognition | Q1 – Q10
Section 2 | Supraventricular Arrhythmias | Q11 – Q20
Section 3 | Ventricular Arrhythmias | Q21 – Q30
Section 4 | Ischemia, Injury & Infarction Patterns | Q31 – Q40
Section 5 | Conduction Blocks & Pacemaker Rhythms | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 correct in 90 minutes.
══════════════════════════════════════
SECTION 1: NORMAL ECG & RHYTHM RECOGNITION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 42-year-old marathon runner presents for a routine sports physical. His resting
12-lead ECG shows a heart rate of 52 beats per minute, upright P waves in lead II
preceding every QRS complex, a PR interval of 0.16 seconds, and narrow QRS
complexes. His blood pressure is 118/72 mmHg and he feels entirely well.
A. Atropine should be administered immediately due to symptomatic bradycardia
B. This tracing represents a junctional escape rhythm with retrograde conduction
C. The findings are consistent with normal sinus rhythm in a trained athlete ✓
CORRECT
D. Emergent transcutaneous pacing is indicated given the risk of asystole
Correct Answer: C
Rationale: A heart rate of 52 bpm with normal sinus P waves, normal PR interval, and
narrow QRS complexes in an asymptomatic athlete is simply sinus bradycardia, a
,normal physiologic adaptation to cardiovascular training. Option A is incorrect because
atropine is reserved for hemodynamically significant bradycardia, not an incidental
finding in a healthy runner. Well-conditioned athletes often develop increased vagal tone
that lowers resting heart rate without any pathologic significance.
Question 2 of 50
During preoperative screening for elective knee arthroscopy, a 68-year-old woman with
hypertension is found to have an ECG with a regular rhythm at 38 bpm. There are visible
upright P waves in lead II occurring at a regular rate of 72 per minute, but only every
other P wave is followed by a QRS complex. The PR interval in conducted beats is
constant at 0.18 seconds.
A. First-degree AV block with 2:1 conduction ratio
B. Mobitz type I second-degree AV block with progressive PR prolongation
C. Complete heart block with junctional escape rhythm
D. Mobitz type II second-degree AV block with fixed PR interval ✓ CORRECT
Correct Answer: D
Rationale: Mobitz type II is characterized by intermittent non-conducted P waves
without preceding PR interval prolongation, and the constant PR interval in conducted
beats confirms this diagnosis. Option A is incorrect because first-degree block shows
only PR prolongation without dropped beats, while option B is wrong because
Wenckebach requires progressive PR lengthening before the dropped beat. Mobitz type
II often indicates infra-nodal conduction disease and may warrant permanent pacing
even if asymptomatic.
Question 3 of 50
A 29-year-old medical student measures her own ECG during a physiology lab. The
rhythm is regular with a rate of 75 bpm. Each QRS complex is preceded by an upright P
,wave in lead II, the PR interval measures 0.14 seconds, and the QRS duration is 0.08
seconds. The QT interval spans 9 small boxes.
A. All intervals are within normal limits for standard calibration ✓ CORRECT
B. The PR interval indicates accelerated AV conduction requiring further workup
C. The QT interval is dangerously prolonged and suggests acquired long QT syndrome
D. The QRS duration meets criteria for incomplete bundle branch block
Correct Answer: A
Rationale: A PR interval of 0.14 seconds is within the normal range of 0.12–0.20
seconds, and a QT interval of 9 small boxes (0.36 seconds) is normal for a heart rate of
75 bpm. Option B is incorrect because a PR of 0.14 seconds is not short enough to
suggest preexcitation or accelerated conduction. Standard ECG calibration uses 25
mm/s paper speed, making each small box 0.04 seconds.
Question 4 of 50
A 55-year-old man with no cardiac history undergoes ECG monitoring after a syncopal
episode. The tracing shows a regular rhythm at 68 bpm with normal P waves, but the PR
interval is measured at 0.24 seconds and remains fixed across all beats with no
dropped QRS complexes.
A. This is Mobitz type I second-degree AV block and requires permanent pacing
B. The findings represent a normal variant seen in healthy young adults
C. First-degree AV block with prolonged but stable PR interval ✓ CORRECT
D. The patient has complete heart block with atrioventricular dissociation
Correct Answer: C
Rationale: First-degree AV block is defined by a PR interval greater than 0.20 seconds
with consistent 1:1 atrioventricular conduction, which matches this tracing exactly.
Option A is incorrect because Mobitz type I requires progressive PR prolongation and
intermittent dropped beats, neither of which is present here. First-degree block is
, usually benign in isolation and rarely progresses to higher-grade blocks without
underlying conduction system disease.
Question 5 of 50
A 6-year-old child has an ECG recorded during a routine pediatric visit. The rhythm is
slightly irregular, varying by roughly 0.08 seconds between the shortest and longest R-R
intervals. There are normal upright P waves before every QRS, the rate ranges from 78
to 92 bpm, and all intervals and morphologies are otherwise normal.
A. Atrial flutter with variable AV block and changing flutter waves
B. Normal sinus arrhythmia with respiratory variation ✓ CORRECT
C. Multifocal atrial tachycardia due to multiple atrial pacemaker sites
D. Sinus node dysfunction requiring electrophysiology evaluation
Correct Answer: B
Rationale: Sinus arrhythmia is a normal finding characterized by phasic variation in the
R-R interval corresponding with respiration, commonly seen in children and young
adults. Option A is incorrect because atrial flutter would show characteristic sawtooth
flutter waves rather than normal sinus P waves. This physiologic variation typically
disappears with breath-holding or increasing heart rate.
Question 6 of 50
A 35-year-old woman presents with palpitations that began suddenly while she was
drinking coffee. Her ECG shows a regular narrow-complex tachycardia at 180 bpm. No
distinct P waves are visible before the QRS complexes, but close inspection reveals
small pseudo-S waves in the inferior leads and terminal notching in lead aVR.
A. AV nodal reentrant tachycardia with retrograde P waves buried near QRS ✓ CORRECT
B. Atrial flutter with 2:1 conduction and concealed flutter waves
C. Orthodromic atrioventricular reentrant tachycardia via accessory pathway
D. Sinus tachycardia with rate-dependent bundle branch block aberrancy
