EKG TEST FOR HOUSTON METHODIST EXAM WITH
CORRECT ANSWERS 2025 - 100 Questions
This exam assesses advanced understanding of basic EKG interpretation and waveform analysis, including
normal and abnormal patterns, axis determination, hypertrophy, and conduction abnormalities. It is designed for
graduate-level healthcare professionals seeking certification in EKG interpretation. It contains 100
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 9 focused sections: Basic EKG Interpretation and Waveform Analysis,
Heart Rate and Rhythm Determination, Ischemia, Injury, and Infarction Patterns, Atrial and Ventricular
Enlargement, Conduction Abnormalities and Blocks, Arrhythmias: Supraventricular and Ventricular, Electrolyte
and Drug Effects on EKG, Pacemaker and Implantable Cardioverter-Defibrillator (ICD) Assessment, Clinical
Correlation and Case Studies. Targeted learning outcomes include: Accurately identify normal and pathological
EKG waveforms; Determine electrical axis using quadrant and degree methods; Distinguish between atrial and
ventricular hypertrophy patterns; Recognize conduction blocks and their clinical significance. Every item has
been reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence and
self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
writing time is 3 hours, with a passing score of 85%. Aligned with This examination meets the rigorous standards
Section 1: Basic EKG Interpretation and Waveform Analysis (Questions 1-12)
1 In a patient with a tall, peaked P wave in lead II and a biphasic P wave in
lead V1 with a prominent negative component, which of the following is the
most likely diagnosis?
A) Left atrial enlargement
B) Right atrial enlargement
C) Biatrial enlargement
D) Normal atrial activation
Answer: A
Rationale: A tall, peaked P wave in lead II suggests right atrial enlargement, but
the biphasic P wave in V1 with a prominent negative terminal component is
classic for left atrial enlargement. The combination of criteria for both atria
indicates biatrial enlargement. Isolated right atrial enlargement would not
produce a prominent negative P wave in V1.
2 A 12-lead EKG shows a QRS axis of -45 degrees. Which of the following is
the most likely cause?
A) Normal variant in a tall individual
B) Left anterior fascicular block
C) Inferior myocardial infarction
D) Right ventricular hypertrophy
,Answer: B
Rationale: A QRS axis between -30 and -90 degrees is left axis deviation. Left
anterior fascicular block is a common cause, with axis typically between -45
and -60 degrees. Normal variant can cause left axis but rarely beyond -30
degrees. Inferior MI may cause axis shifts but not specifically -45. Right
ventricular hypertrophy causes right axis deviation.
3 Which of the following EKG findings is most consistent with left ventricular
hypertrophy (LVH) using the Cornell criteria?
A) R wave in aVL > 11 mm
B) S wave in V3 + R wave in aVL > 28 mm in men
C) R wave in V5 + S wave in V1 > 35 mm
D) R wave in V6 > 25 mm
Answer: B
Rationale: The Cornell criteria for LVH are based on the sum of S wave in V3
and R wave in aVL, with >28 mm in men and >20 mm in women being
positive. Option A is part of the Romhilt-Estes criteria. Option C is the
Sokolow-Lyon criteria. Option D is not a standard criterion.
4 An EKG reveals a PR interval of 0.28 seconds with a normal QRS duration.
Which of the following is the most likely diagnosis?
A) First-degree AV block
B) Second-degree AV block type I
C) Second-degree AV block type II
D) Third-degree AV block
Answer: A
Rationale: First-degree AV block is defined as a PR interval >0.20 seconds with
every P wave conducted. Second-degree blocks have dropped QRS complexes,
and third-degree has complete dissociation. A prolonged PR interval alone,
without dropped beats, is first-degree AV block.
5 In which of the following conditions would you expect to see a QRS
duration of 0.14 seconds with a left axis deviation and an rSR' pattern in V1?
A) Left bundle branch block
B) Right bundle branch block
C) Left anterior fascicular block
,D) Bifascicular block (RBBB + LAFB)
Answer: D
Rationale: A wide QRS ("e0.12 sec) with rSR' in V1 is typical of right bundle
branch block (RBBB). Left axis deviation indicates left anterior fascicular
block (LAFB). The combination of RBBB and LAFB is bifascicular block.
Isolated RBBB would not cause left axis deviation, and LAFB alone has
narrow QRS.
6 An EKG shows ST segment elevation in leads II, III, and aVF with
reciprocal ST depression in aVL. Which of the following is the most likely
diagnosis?
A) Anterior ST-elevation myocardial infarction
B) Inferior ST-elevation myocardial infarction
C) Lateral ST-elevation myocardial infarction
D) Pericarditis
Answer: B
Rationale: ST elevation in the inferior leads (II, III, aVF) with reciprocal
changes in aVL is classic for inferior STEMI. Anterior MI involves V1-V4,
lateral MI involves I, aVL, V5-V6. Pericarditis typically shows diffuse ST
elevation without reciprocal depression.
7 Which of the following EKG findings is most consistent with hyperkalemia?
A) Peaked T waves, widened QRS, loss of P wave
B) Prolonged QT interval, flattened T wave, prominent U wave
C) ST segment depression, inverted T waves, pathological Q waves
D) Short PR interval, delta wave, wide QRS
Answer: A
Rationale: Hyperkalemia classically causes peaked T waves, followed by QRS
widening and P wave flattening/disappearance as potassium increases. Option
B describes hypokalemia. Option C suggests ischemia. Option D is
pre-excitation (WPW).
8 An EKG shows a regular wide-complex tachycardia at 150 bpm with
atrioventricular dissociation. Which of the following is the most likely
diagnosis?
A) Supraventricular tachycardia with aberrancy
, B) Atrial fibrillation with Wolff-Parkinson-White syndrome
C) Ventricular tachycardia
D) Sinus tachycardia with bundle branch block
Answer: C
Rationale: Atrioventricular dissociation (independent P waves and QRS
complexes) is a hallmark of ventricular tachycardia. SVT with aberrancy
usually maintains a 1:1 relationship. Atrial fibrillation with WPW is irregularly
irregular. Sinus tachycardia has P waves before each QRS.
9 Which of the following is the most likely cause of a prolonged QT interval
on EKG?
A) Hypocalcemia
B) Hypercalcemia
C) Hypokalemia
D) Hyperkalemia
Answer: A
Rationale: Hypocalcemia prolongs the QT interval by lengthening the ST
segment. Hypercalcemia shortens the QT. Hypokalemia causes U waves and
prolonged QU interval, but not QT prolongation per se. Hyperkalemia causes
peaked T waves and QRS widening, not QT prolongation.
10 An EKG shows a P wave with a duration of 0.14 seconds and a biphasic
morphology in lead V1 with a prominent negative terminal component.
Which of the following is the most likely diagnosis?
A) Right atrial enlargement
B) Left atrial enlargement
C) Biatrial enlargement
D) Intra-atrial conduction delay
Answer: B
Rationale: Left atrial enlargement is characterized by a prolonged P wave
duration (>0.12 sec) and a biphasic P wave in V1 with a prominent negative
terminal component (terminal force). Right atrial enlargement shows tall,
peaked P waves in II without biphasic V1. Intra-atrial conduction delay also
prolongs P wave but typically without the prominent negative V1 component.
CORRECT ANSWERS 2025 - 100 Questions
This exam assesses advanced understanding of basic EKG interpretation and waveform analysis, including
normal and abnormal patterns, axis determination, hypertrophy, and conduction abnormalities. It is designed for
graduate-level healthcare professionals seeking certification in EKG interpretation. It contains 100
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 9 focused sections: Basic EKG Interpretation and Waveform Analysis,
Heart Rate and Rhythm Determination, Ischemia, Injury, and Infarction Patterns, Atrial and Ventricular
Enlargement, Conduction Abnormalities and Blocks, Arrhythmias: Supraventricular and Ventricular, Electrolyte
and Drug Effects on EKG, Pacemaker and Implantable Cardioverter-Defibrillator (ICD) Assessment, Clinical
Correlation and Case Studies. Targeted learning outcomes include: Accurately identify normal and pathological
EKG waveforms; Determine electrical axis using quadrant and degree methods; Distinguish between atrial and
ventricular hypertrophy patterns; Recognize conduction blocks and their clinical significance. Every item has
been reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence and
self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
writing time is 3 hours, with a passing score of 85%. Aligned with This examination meets the rigorous standards
Section 1: Basic EKG Interpretation and Waveform Analysis (Questions 1-12)
1 In a patient with a tall, peaked P wave in lead II and a biphasic P wave in
lead V1 with a prominent negative component, which of the following is the
most likely diagnosis?
A) Left atrial enlargement
B) Right atrial enlargement
C) Biatrial enlargement
D) Normal atrial activation
Answer: A
Rationale: A tall, peaked P wave in lead II suggests right atrial enlargement, but
the biphasic P wave in V1 with a prominent negative terminal component is
classic for left atrial enlargement. The combination of criteria for both atria
indicates biatrial enlargement. Isolated right atrial enlargement would not
produce a prominent negative P wave in V1.
2 A 12-lead EKG shows a QRS axis of -45 degrees. Which of the following is
the most likely cause?
A) Normal variant in a tall individual
B) Left anterior fascicular block
C) Inferior myocardial infarction
D) Right ventricular hypertrophy
,Answer: B
Rationale: A QRS axis between -30 and -90 degrees is left axis deviation. Left
anterior fascicular block is a common cause, with axis typically between -45
and -60 degrees. Normal variant can cause left axis but rarely beyond -30
degrees. Inferior MI may cause axis shifts but not specifically -45. Right
ventricular hypertrophy causes right axis deviation.
3 Which of the following EKG findings is most consistent with left ventricular
hypertrophy (LVH) using the Cornell criteria?
A) R wave in aVL > 11 mm
B) S wave in V3 + R wave in aVL > 28 mm in men
C) R wave in V5 + S wave in V1 > 35 mm
D) R wave in V6 > 25 mm
Answer: B
Rationale: The Cornell criteria for LVH are based on the sum of S wave in V3
and R wave in aVL, with >28 mm in men and >20 mm in women being
positive. Option A is part of the Romhilt-Estes criteria. Option C is the
Sokolow-Lyon criteria. Option D is not a standard criterion.
4 An EKG reveals a PR interval of 0.28 seconds with a normal QRS duration.
Which of the following is the most likely diagnosis?
A) First-degree AV block
B) Second-degree AV block type I
C) Second-degree AV block type II
D) Third-degree AV block
Answer: A
Rationale: First-degree AV block is defined as a PR interval >0.20 seconds with
every P wave conducted. Second-degree blocks have dropped QRS complexes,
and third-degree has complete dissociation. A prolonged PR interval alone,
without dropped beats, is first-degree AV block.
5 In which of the following conditions would you expect to see a QRS
duration of 0.14 seconds with a left axis deviation and an rSR' pattern in V1?
A) Left bundle branch block
B) Right bundle branch block
C) Left anterior fascicular block
,D) Bifascicular block (RBBB + LAFB)
Answer: D
Rationale: A wide QRS ("e0.12 sec) with rSR' in V1 is typical of right bundle
branch block (RBBB). Left axis deviation indicates left anterior fascicular
block (LAFB). The combination of RBBB and LAFB is bifascicular block.
Isolated RBBB would not cause left axis deviation, and LAFB alone has
narrow QRS.
6 An EKG shows ST segment elevation in leads II, III, and aVF with
reciprocal ST depression in aVL. Which of the following is the most likely
diagnosis?
A) Anterior ST-elevation myocardial infarction
B) Inferior ST-elevation myocardial infarction
C) Lateral ST-elevation myocardial infarction
D) Pericarditis
Answer: B
Rationale: ST elevation in the inferior leads (II, III, aVF) with reciprocal
changes in aVL is classic for inferior STEMI. Anterior MI involves V1-V4,
lateral MI involves I, aVL, V5-V6. Pericarditis typically shows diffuse ST
elevation without reciprocal depression.
7 Which of the following EKG findings is most consistent with hyperkalemia?
A) Peaked T waves, widened QRS, loss of P wave
B) Prolonged QT interval, flattened T wave, prominent U wave
C) ST segment depression, inverted T waves, pathological Q waves
D) Short PR interval, delta wave, wide QRS
Answer: A
Rationale: Hyperkalemia classically causes peaked T waves, followed by QRS
widening and P wave flattening/disappearance as potassium increases. Option
B describes hypokalemia. Option C suggests ischemia. Option D is
pre-excitation (WPW).
8 An EKG shows a regular wide-complex tachycardia at 150 bpm with
atrioventricular dissociation. Which of the following is the most likely
diagnosis?
A) Supraventricular tachycardia with aberrancy
, B) Atrial fibrillation with Wolff-Parkinson-White syndrome
C) Ventricular tachycardia
D) Sinus tachycardia with bundle branch block
Answer: C
Rationale: Atrioventricular dissociation (independent P waves and QRS
complexes) is a hallmark of ventricular tachycardia. SVT with aberrancy
usually maintains a 1:1 relationship. Atrial fibrillation with WPW is irregularly
irregular. Sinus tachycardia has P waves before each QRS.
9 Which of the following is the most likely cause of a prolonged QT interval
on EKG?
A) Hypocalcemia
B) Hypercalcemia
C) Hypokalemia
D) Hyperkalemia
Answer: A
Rationale: Hypocalcemia prolongs the QT interval by lengthening the ST
segment. Hypercalcemia shortens the QT. Hypokalemia causes U waves and
prolonged QU interval, but not QT prolongation per se. Hyperkalemia causes
peaked T waves and QRS widening, not QT prolongation.
10 An EKG shows a P wave with a duration of 0.14 seconds and a biphasic
morphology in lead V1 with a prominent negative terminal component.
Which of the following is the most likely diagnosis?
A) Right atrial enlargement
B) Left atrial enlargement
C) Biatrial enlargement
D) Intra-atrial conduction delay
Answer: B
Rationale: Left atrial enlargement is characterized by a prolonged P wave
duration (>0.12 sec) and a biphasic P wave in V1 with a prominent negative
terminal component (terminal force). Right atrial enlargement shows tall,
peaked P waves in II without biphasic V1. Intra-atrial conduction delay also
prolongs P wave but typically without the prominent negative V1 component.
