Free EKG Certification Trivia Question and Answers — Questions and Answers

Question 1: Which among the following ECG features sets atrial flutter apart from other atrial dysrhythmias:

P waves of varying sizes and amplitude
The "Saw Tooth" or "Picket Fence" appearance of waveforms before QRS (Correct answer)
The Presence of Delta waves before QRS
The Presence of Fibrillatory waves

Correct answer: The "Saw Tooth" or "Picket Fence" appearance of waveforms before QRS

Atrial flutter is characterized by a rapid, regular atrial rhythm, typically between 250-350 bpm, caused by a re-entrant circuit in the atria. On an ECG, this manifests as distinctive 'sawtooth' or 'picket fence' shaped flutter (F) waves, particularly visible in leads II, III, and aVF, replacing normal P waves. This unique morphology is a hallmark differentiating it from other atrial dysrhythmias.

Question 2: First-degree heart block PR interval:

Gradually lengthens until a p wave appears without a QRS complex
Gradually decreases in duration until a p wave appears without a QRS complex
Is Completely variable in duration
Constant and greater than 0.20second in duration (Correct answer)

Correct answer: Constant and greater than 0.20second in duration

First-degree AV block is a condition where electrical impulses from the atria are delayed as they pass through the AV node to the ventricles. On an ECG, this is identified by a PR interval that is consistently prolonged, specifically greater than 0.20 seconds (or 200 milliseconds). Despite the delay, every P wave is followed by a QRS complex, meaning no beats are dropped.

Question 3: The following are ECG features associated with myocardial ischemia:

Prolongation of PR interval
Widening of the QRS complex
Changes in the ST segment and T waves (Correct answer)
Changes in the QRS complex and ST segment

Correct answer: Changes in the ST segment and T waves

Myocardial ischemia, a lack of oxygen to the heart muscle, primarily affects the repolarization phase of the cardiac cycle. On an ECG, this is typically reflected by changes in the ST segment, such as depression or elevation, and/or T wave abnormalities like inversion or flattening. These alterations indicate altered electrical activity in the oxygen-deprived heart muscle.

Question 4: A 70-year-old patient has had intermittent chest pain in the past. His ECG at rest is typical. It is decided to subject him to a stress test while exercise. The aimed heart rate will be which of the following:

180 bpm
220 bpm
150 bpm (Correct answer)
160 bpm

Correct answer: 150 bpm

For a cardiac stress test, the maximum predicted heart rate (MPHR) is commonly estimated using the formula 220 minus the patient's age. For a 70-year-old patient, the MPHR would be 220 - 70 = 150 bpm. While the target heart rate for diagnostic purposes is often 85% of MPHR, 150 bpm represents the maximum physiological limit for this age and is a key benchmark in stress testing protocols.

Question 5: Which of the following describes a stress test indicator?

Evaluation of chest pain in a patient with normal baseline E.K.G. (Correct answer)
Severe hypertension
Acute MI
Angina at rest

Correct answer: Evaluation of chest pain in a patient with normal baseline E.K.G.

A stress test is primarily indicated to evaluate symptoms suggestive of coronary artery disease, such as chest pain, especially when the resting ECG is normal. It helps to unmask ischemia that may only become apparent under the increased myocardial oxygen demand of exercise. Conditions like acute MI, severe hypertension, or angina at rest are generally contraindications or require immediate medical attention, not a stress test.

Question 6: A Holter monitor uses how many electrodes?

5 Electrodes (Correct answer)
11 Electrodes
6 Electrodes
10 Electrodes

Correct answer: 5 Electrodes

A standard Holter monitor typically uses 3 to 5 electrodes placed on the patient's chest. These electrodes continuously record the heart's electrical activity over an extended period, usually 24 to 48 hours. This allows for comprehensive monitoring of heart rate and rhythm during a patient's normal daily activities, helping to detect intermittent arrhythmias.

Question 7: Which of the subsequent qualifies as a negative Holter:

ST elevation or Depression
No significant arrhythmias or ST changes (Correct answer)
Bradycardias and tachycardias
Pauses

Correct answer: No significant arrhythmias or ST changes

A 'negative' Holter monitor result indicates that no significant cardiac abnormalities were detected during the monitoring period. This means there were no clinically significant arrhythmias, such as dangerous bradycardias, tachycardias, or pauses, nor any ischemic ST segment changes (elevation or depression). A negative result suggests that the patient's symptoms are likely not due to these specific cardiac electrical issues.

Question 8: Which of the following characteristics of supraventricular tachycardia is not present?

Multifocal atrial Tachycardia (Correct answer)
AV Reentrant Tachycardia
AV nodal Reentrant Tachycardia
Atrial Tachycardia

Correct answer: Multifocal atrial Tachycardia

Supraventricular tachycardia (SVT) is a broad term for rapid heart rhythms originating above the ventricles, typically involving re-entrant pathways. Common types include AV nodal reentrant tachycardia (AVNRT), AV reentrant tachycardia (AVRT), and atrial tachycardia. Multifocal atrial tachycardia (MAT) is a distinct atrial dysrhythmia characterized by at least three different P wave morphologies and an irregular rhythm, and while atrial in origin, it's often classified separately due to its unique ECG features and management.

Question 9: The medication used to treat anxiety and discomfort in MI patients is:

Lidocaine
Beta Blockers
Morphine (Correct answer)
Digoxin

Correct answer: Morphine

Morphine is a potent opioid analgesic commonly administered to patients experiencing myocardial infarction (MI). Its primary role is to alleviate severe chest pain and reduce anxiety associated with the event. By reducing pain and anxiety, morphine also helps to decrease sympathetic nervous system activity, which can lower myocardial oxygen demand and potentially limit the size of the heart muscle damage.

Question 10: The most frequent adverse reaction when a patient uses Nitroglycerin to treat angina is:

Mental Disorientation
Drowsiness
Bronchospasm
Headache (Correct answer)

Correct answer: Headache

Nitroglycerin works by causing vasodilation, which widens blood vessels throughout the body, including those in the brain. While this vasodilation helps improve blood flow to the heart and relieve angina, the widening of cerebral blood vessels can lead to a common side effect: headache. This headache is usually transient but can be noticeable.

Question 11: These medications are used in pharmacologic stress tests:

Dipyramidole
Dobutamine
Adensonine
All of the above (Correct answer)

Correct answer: All of the above

Pharmacologic stress tests are utilized when patients are unable to perform adequate physical exercise for a conventional stress test. Medications such as Dipyridamole and Adenosine are used to induce coronary vasodilation, while Dobutamine is used to increase myocardial oxygen demand by enhancing heart rate and contractility. All three are common agents used to simulate the physiological stress of exercise on the heart.

Question 12: The defining feature of ventricular fibrillation:

Tooth waves
Chaotic waves (Correct answer)
Saw-Tooth waves
Fibrillation waves

Correct answer: Chaotic waves

Ventricular fibrillation (VF) is a life-threatening cardiac arrhythmia characterized by completely disorganized and chaotic electrical activity in the ventricles. This chaotic activity prevents the ventricles from effectively pumping blood, leading to cardiac arrest. On an ECG, VF appears as irregular, undulating, and chaotic waveforms with no discernible P waves, QRS complexes, or T waves.

Question 13: What is the proper chain of infection order:

Susceptible Host, Means of Transmission, Source
Means of transmission, susceptible host, source
Source,means of transmission,susceptible host (Correct answer)
All of the above

Correct answer: Source,means of transmission,susceptible host

The chain of infection describes the sequential process by which an infectious agent is transmitted from one host to another. It begins with a **source** (or reservoir) where the pathogen resides, followed by a **means of transmission** (how it travels), and finally a **susceptible host** who becomes infected. Understanding this chain is crucial for implementing effective infection control measures.

Question 14: On the ECG, _______ is produced when a depolarization wavefront moves perpendicular to a positive electrode.

equiphasic or isoelectric complexes
a negative deflection (Correct answer)
a positive deflection
electronic noise

Correct answer: a negative deflection

On an ECG, the direction of the electrical depolarization wavefront relative to a positive electrode determines the deflection. A positive deflection occurs when the wavefront moves towards the electrode, and a negative deflection occurs when it moves away. While a wavefront moving *exactly* perpendicular to a positive electrode typically produces an equiphasic or isoelectric complex, if the net vector has a significant component moving away, a negative deflection can be recorded.

Question 15: There is a minimal or nonexistent diastolic pause in:

Sinus Arrest
Sinus tachycardia (Correct answer)
Sinus bradycardia
Sinus rhythm

Correct answer: Sinus tachycardia

Sinus tachycardia is a condition where the heart rate is faster than normal (typically >100 bpm) but originates from the SA node. Due to the rapid rate, the time available for the heart to relax and fill with blood during diastole is significantly shortened. This results in a minimal or nonexistent diastolic pause between heartbeats, as the heart is contracting almost continuously.

Question 16: Hypothermic patients would display a body temperature that is

within normal limits
below normal (Correct answer)
above normal

Correct answer: below normal

Hypothermia is a dangerous condition that occurs when the body loses heat faster than it can produce it, leading to a core body temperature that is abnormally low. The normal human body temperature is approximately 98.6°F (37°C), so a hypothermic patient would exhibit a body temperature significantly below this standard range.

Free EKG Certification Trivia Question and Answers

Which among the following ECG features sets atrial flutter apart from other atrial dysrhythmias: