SHARP ECG TEST — COMPLETE QUESTIONS &
ANSWERS (2025/2026)
Introduction
The SHARP ECG test is a high-stakes assessment of rhythm and 12-lead interpretation
competence required of clinicians who may encounter acute cardiac presentations.
Accurate recognition of lethal arrhythmias, conduction blocks, ischemic changes,
metabolic disturbances and device rhythms directly reduces morbidity and mortality by
shortening door-to-decision and door-to-balloon times. The 2025/2026 blueprint
emphasises rapid pattern recognition, axis quantification, artifact exclusion and correct
escalation (e.g., PCI activation, electrolyte correction, pacing). The 60 original items
below mirror the live examination’s distribution, difficulty and decision-making tempo
while remaining fully original.
Question 1
A 72-year-old man presents with chest pain. The monitor strip shows regular P-QRS
complexes at 98/min, PR 180 ms, QRS 100 ms, with 3 mm ST elevation in leads II, III and
aVF and reciprocal ST depression in I and aVL. Which diagnosis is most appropriate?
A. Inferior STEMI
B. Posterior NSTEMI
C. Early repolarisation
D. Pericarditis
Answer: A. Inferior STEMI
Rationale: Concordant ST elevation in the inferior leads with reciprocal changes in
lateral leads localises the ischaemia to the inferior wall supplied by the RCA/LCX,
fulfilling STEMI criteria. Posterior MI would show V1-V3 ST depression; early repol is
usually <1 mm and lacks reciprocal change; pericarditis has diffuse PR depression and
no reciprocal pattern.
Question 2
The tracing reveals a wide-complex tachycardia at 180/min, QRS 160 ms, extreme axis
deviation, AV dissociation (P waves unrelated), and capture beats. What is the rhythm?
A. SVT with aberrancy
B. Atrial flutter 2:1
pg. 1
,C. Monomorphic ventricular tachycardia
D. Polymorphic VT
Answer: C. Monomorphic ventricular tachycardia
Rationale: AV dissociation, extreme axis, QRS >140 ms and capture beats are classic VT
signs. SVT with aberrancy would show either 1:1 P:QRS or typical bundle-branch
morphology; flutter has regular saw-tooth; polymorphic VT varies beat-to-beat.
Question 3
A monitor displays irregular narrow-complex beats at 130-170/min with no discernible P
waves. The baseline appears fibrillatory. What is the rhythm?
A. Atrial flutter
B. Atrial fibrillation
C. Multifocal atrial tachycardia
D. Sinus tachycardia with frequent PACs
Answer: B. Atrial fibrillation
Rationale: Irregularly irregular narrow QRS without discrete P waves and a fibrillating
baseline defines AF. Flutter has regular or regularly irregular conduction with saw-tooth;
MAT has ≥3 distinct P morphologies; sinus tach is regular.
Question 4
ECG shows regular P waves at 70/min, QRS 40/min, no relationship between P and
QRS, QRS wide >120 ms. What is the conduction abnormality?
A. 1st degree AV block
B. 2nd degree Mobitz I
C. 3rd degree AV block with ventricular escape
D. Sinus bradycardia
Answer: C. 3rd degree AV block with ventricular escape
Rationale: Complete AV dissociation with atrial rate > ventricular rate and wide QRS
indicates infra-nodal block and a ventricular escape rhythm. 1st degree has prolonged
PR; Mobitz I has grouped beating; sinus bradycardia would have 1:1 conduction.
Question 5
Rhythm strip shows grouped beating with progressive PR prolongation followed by a
dropped QRS; cycle repeats. Ventricular rate 60/min. What is the diagnosis?
A. Mobitz II
pg. 2
, B. Mobitz I (Wenckebach)
C. Complete heart block
D. Junctional rhythm
Answer: B. Mobitz I (Wenckebach)
Rationale: Progressive PR lengthening with eventual dropped beat in a repeating pattern
is characteristic of Mobitz I, usually benign. Mobitz II has fixed PR with sudden drops;
complete block shows dissociation; junctional has no P waves.
Question 6
12-lead ECG: sinus rhythm 90/min, QRS +120°, S wave in I, R wave in aVR, R’ in V1.
Which conduction disturbance is present?
A. Left anterior fascicular block
B. Right bundle-branch block
C. Left bundle-branch block
D. WPW
Answer: B. Right bundle-branch block
Rationale: QRS >120 ms, terminal R’ in V1, deep S in I and V6, plus right axis ≥+120°
fulfil criteria for RBBB. LAFB would have left axis deviation; LBBB shows broad
monophasic R; WPW has delta waves.
Question 7
Tracing reveals peaked T waves, shortened QT interval, absent P waves, wide QRS
merging with T (“sine wave”) at 70/min. Hyperkalaemia is suspected. What is the
immediate priority?
A. Adenosine 6 mg IV
B. Calcium gluconate 10 % 10 mL IV
C. Magnesium sulphate 2 g IV
D. Atropine 0.5 mg IV
Answer: B. Calcium gluconate 10 % 10 mL IV
Rationale: Sine-wave pattern with peaked Ts indicates severe hyperkalaemia risking
asystole; calcium stabilises cardiac membranes within minutes. Adenosine treats SVT;
magnesium for torsades; atropine for bradycardia without electrolyte cause.
Question 8
pg. 3
ANSWERS (2025/2026)
Introduction
The SHARP ECG test is a high-stakes assessment of rhythm and 12-lead interpretation
competence required of clinicians who may encounter acute cardiac presentations.
Accurate recognition of lethal arrhythmias, conduction blocks, ischemic changes,
metabolic disturbances and device rhythms directly reduces morbidity and mortality by
shortening door-to-decision and door-to-balloon times. The 2025/2026 blueprint
emphasises rapid pattern recognition, axis quantification, artifact exclusion and correct
escalation (e.g., PCI activation, electrolyte correction, pacing). The 60 original items
below mirror the live examination’s distribution, difficulty and decision-making tempo
while remaining fully original.
Question 1
A 72-year-old man presents with chest pain. The monitor strip shows regular P-QRS
complexes at 98/min, PR 180 ms, QRS 100 ms, with 3 mm ST elevation in leads II, III and
aVF and reciprocal ST depression in I and aVL. Which diagnosis is most appropriate?
A. Inferior STEMI
B. Posterior NSTEMI
C. Early repolarisation
D. Pericarditis
Answer: A. Inferior STEMI
Rationale: Concordant ST elevation in the inferior leads with reciprocal changes in
lateral leads localises the ischaemia to the inferior wall supplied by the RCA/LCX,
fulfilling STEMI criteria. Posterior MI would show V1-V3 ST depression; early repol is
usually <1 mm and lacks reciprocal change; pericarditis has diffuse PR depression and
no reciprocal pattern.
Question 2
The tracing reveals a wide-complex tachycardia at 180/min, QRS 160 ms, extreme axis
deviation, AV dissociation (P waves unrelated), and capture beats. What is the rhythm?
A. SVT with aberrancy
B. Atrial flutter 2:1
pg. 1
,C. Monomorphic ventricular tachycardia
D. Polymorphic VT
Answer: C. Monomorphic ventricular tachycardia
Rationale: AV dissociation, extreme axis, QRS >140 ms and capture beats are classic VT
signs. SVT with aberrancy would show either 1:1 P:QRS or typical bundle-branch
morphology; flutter has regular saw-tooth; polymorphic VT varies beat-to-beat.
Question 3
A monitor displays irregular narrow-complex beats at 130-170/min with no discernible P
waves. The baseline appears fibrillatory. What is the rhythm?
A. Atrial flutter
B. Atrial fibrillation
C. Multifocal atrial tachycardia
D. Sinus tachycardia with frequent PACs
Answer: B. Atrial fibrillation
Rationale: Irregularly irregular narrow QRS without discrete P waves and a fibrillating
baseline defines AF. Flutter has regular or regularly irregular conduction with saw-tooth;
MAT has ≥3 distinct P morphologies; sinus tach is regular.
Question 4
ECG shows regular P waves at 70/min, QRS 40/min, no relationship between P and
QRS, QRS wide >120 ms. What is the conduction abnormality?
A. 1st degree AV block
B. 2nd degree Mobitz I
C. 3rd degree AV block with ventricular escape
D. Sinus bradycardia
Answer: C. 3rd degree AV block with ventricular escape
Rationale: Complete AV dissociation with atrial rate > ventricular rate and wide QRS
indicates infra-nodal block and a ventricular escape rhythm. 1st degree has prolonged
PR; Mobitz I has grouped beating; sinus bradycardia would have 1:1 conduction.
Question 5
Rhythm strip shows grouped beating with progressive PR prolongation followed by a
dropped QRS; cycle repeats. Ventricular rate 60/min. What is the diagnosis?
A. Mobitz II
pg. 2
, B. Mobitz I (Wenckebach)
C. Complete heart block
D. Junctional rhythm
Answer: B. Mobitz I (Wenckebach)
Rationale: Progressive PR lengthening with eventual dropped beat in a repeating pattern
is characteristic of Mobitz I, usually benign. Mobitz II has fixed PR with sudden drops;
complete block shows dissociation; junctional has no P waves.
Question 6
12-lead ECG: sinus rhythm 90/min, QRS +120°, S wave in I, R wave in aVR, R’ in V1.
Which conduction disturbance is present?
A. Left anterior fascicular block
B. Right bundle-branch block
C. Left bundle-branch block
D. WPW
Answer: B. Right bundle-branch block
Rationale: QRS >120 ms, terminal R’ in V1, deep S in I and V6, plus right axis ≥+120°
fulfil criteria for RBBB. LAFB would have left axis deviation; LBBB shows broad
monophasic R; WPW has delta waves.
Question 7
Tracing reveals peaked T waves, shortened QT interval, absent P waves, wide QRS
merging with T (“sine wave”) at 70/min. Hyperkalaemia is suspected. What is the
immediate priority?
A. Adenosine 6 mg IV
B. Calcium gluconate 10 % 10 mL IV
C. Magnesium sulphate 2 g IV
D. Atropine 0.5 mg IV
Answer: B. Calcium gluconate 10 % 10 mL IV
Rationale: Sine-wave pattern with peaked Ts indicates severe hyperkalaemia risking
asystole; calcium stabilises cardiac membranes within minutes. Adenosine treats SVT;
magnesium for torsades; atropine for bradycardia without electrolyte cause.
Question 8
pg. 3
