Cleveland Clinic EKG Test Practice
Questions & Answers 2026 – ECG
Interpretation Study Guide with Verified
Answers, Rhythm Recognition & Exam Prep
CLEVELAND CLINIC EKG TEST PRACTICE QUESTIONS & ANSWERS 2026 – ECG
INTERPRETATION STUDY GUIDE
Document Overview:
• This comprehensive study guide contains 200 verified practice questions covering
rhythm recognition, conduction abnormalities, ischemia/infarction patterns, and
clinical EKG interpretation essential for Cleveland Clinic certification and medical
board exams.
• Study systematically by working through each question, reviewing EXPERT
RATIONALE carefully, and correlating findings with patient presentation to master
rapid and accurate ECG interpretation skills.
1. A 65-year-old male presents with palpitations. The EKG shows a regular
rhythm at 88 bpm with a PR interval of 0.16 seconds, QRS of 0.08 seconds, and
QT of 0.40 seconds. What is this rhythm?
A) Atrial fibrillation
B) Atrial flutter
C) Normal sinus rhythm
D) Sinus tachycardia
E) Sinus bradycardia
Correct Answer: C) Normal sinus rhythm
Normal sinus rhythm is defined by: regular rate 60–100 bpm, upright P waves in
II/III/aVF, PR interval 0.12–0.20 seconds, QRS ≤0.12 seconds. All criteria are met in
this case.
,2. A 72-year-old woman with atrial fibrillation presents with an irregular
rhythm on EKG. What is the characteristic finding?
A) Regular rhythm with sawtooth pattern
B) Irregularly irregular rhythm with absent P waves
C) Regular rhythm with visible P waves
D) Uniform QRS complexes throughout
E) Fixed PR interval
Correct Answer: B) Irregularly irregular rhythm with absent P waves
Atrial fibrillation is characterized by disorganized electrical activity, absent P waves,
irregular R-R intervals (irregularly irregular), and a variable ventricular response.
This differs from flutter's regular pattern.
3. An EKG shows a regular rhythm at 150 bpm with a sawtooth baseline and a
ventricular rate around 75–100 bpm with variable conduction. What
arrhythmia is this?
A) Atrial fibrillation
B) Atrial flutter with variable AV block
C) Paroxysmal supraventricular tachycardia
D) Sinus tachycardia
E) Ventricular tachycardia
Correct Answer: B) Atrial flutter with variable AV block
Atrial flutter has an atrial rate of 250–350 bpm (typically ~300), creating the
characteristic sawtooth or "F wave" pattern. The ventricular rate depends on AV
block (usually 2:1, 3:1, or variable conduction).
,4. A 58-year-old male with chest pain shows ST elevation in leads II, III, and
aVF. What coronary artery is likely occluded?
A) Left anterior descending
B) Left circumflex
C) Right coronary artery
D) Left main coronary artery
E) Diagonal branch
Correct Answer: C) Right coronary artery
Inferior MI (ST elevation in II, III, aVF) is typically supplied by the RCA (80–90% of
patients). LAD causes anterior MI (V1–V4), LCx causes lateral MI (I, aVL, V5–V6).
5. An EKG shows ST elevation in V1–V3 with reciprocal ST depression in II, III,
and aVF. Which coronary artery is occluded?
A) Right coronary artery
B) Left anterior descending artery
C) Left circumflex
D) Left main trunk
E) Obtuse marginal branch
Correct Answer: B) Left anterior descending artery
Anterior MI presents with ST elevation in V1–V4 (LAD) or V1–V3 (proximal LAD).
Reciprocal changes in the inferior leads confirm anterior MI with LAD occlusion.
, 6. A patient's EKG shows a QRS duration of 0.14 seconds with a broad, slurred
upstroke in the PR segment. What condition is suggested?
A) Atrial fibrillation
B) Atrioventricular block
C) Wolff-Parkinson-White syndrome
D) Bundle branch block
E) Hyperkalemia
Correct Answer: C) Wolff-Parkinson-White syndrome
WPW is characterized by a delta wave (slurred upstroke of QRS), short PR interval
(<0.12 seconds), and prolonged QRS (≥0.12 seconds) due to pre-excitation via an
accessory pathway.
7. An EKG shows a PR interval of 0.28 seconds with normal QRS duration. What
conduction abnormality is present?
A) Second-degree AV block (Mobitz I)
B) First-degree AV block
C) Third-degree AV block
D) Bundle branch block
E) Wolff-Parkinson-White syndrome
Correct Answer: B) First-degree AV block
First-degree AV block is defined by a prolonged PR interval (>0.20 seconds) with
normal QRS. Every P wave conducts to the ventricle, but conduction is delayed.
Questions & Answers 2026 – ECG
Interpretation Study Guide with Verified
Answers, Rhythm Recognition & Exam Prep
CLEVELAND CLINIC EKG TEST PRACTICE QUESTIONS & ANSWERS 2026 – ECG
INTERPRETATION STUDY GUIDE
Document Overview:
• This comprehensive study guide contains 200 verified practice questions covering
rhythm recognition, conduction abnormalities, ischemia/infarction patterns, and
clinical EKG interpretation essential for Cleveland Clinic certification and medical
board exams.
• Study systematically by working through each question, reviewing EXPERT
RATIONALE carefully, and correlating findings with patient presentation to master
rapid and accurate ECG interpretation skills.
1. A 65-year-old male presents with palpitations. The EKG shows a regular
rhythm at 88 bpm with a PR interval of 0.16 seconds, QRS of 0.08 seconds, and
QT of 0.40 seconds. What is this rhythm?
A) Atrial fibrillation
B) Atrial flutter
C) Normal sinus rhythm
D) Sinus tachycardia
E) Sinus bradycardia
Correct Answer: C) Normal sinus rhythm
Normal sinus rhythm is defined by: regular rate 60–100 bpm, upright P waves in
II/III/aVF, PR interval 0.12–0.20 seconds, QRS ≤0.12 seconds. All criteria are met in
this case.
,2. A 72-year-old woman with atrial fibrillation presents with an irregular
rhythm on EKG. What is the characteristic finding?
A) Regular rhythm with sawtooth pattern
B) Irregularly irregular rhythm with absent P waves
C) Regular rhythm with visible P waves
D) Uniform QRS complexes throughout
E) Fixed PR interval
Correct Answer: B) Irregularly irregular rhythm with absent P waves
Atrial fibrillation is characterized by disorganized electrical activity, absent P waves,
irregular R-R intervals (irregularly irregular), and a variable ventricular response.
This differs from flutter's regular pattern.
3. An EKG shows a regular rhythm at 150 bpm with a sawtooth baseline and a
ventricular rate around 75–100 bpm with variable conduction. What
arrhythmia is this?
A) Atrial fibrillation
B) Atrial flutter with variable AV block
C) Paroxysmal supraventricular tachycardia
D) Sinus tachycardia
E) Ventricular tachycardia
Correct Answer: B) Atrial flutter with variable AV block
Atrial flutter has an atrial rate of 250–350 bpm (typically ~300), creating the
characteristic sawtooth or "F wave" pattern. The ventricular rate depends on AV
block (usually 2:1, 3:1, or variable conduction).
,4. A 58-year-old male with chest pain shows ST elevation in leads II, III, and
aVF. What coronary artery is likely occluded?
A) Left anterior descending
B) Left circumflex
C) Right coronary artery
D) Left main coronary artery
E) Diagonal branch
Correct Answer: C) Right coronary artery
Inferior MI (ST elevation in II, III, aVF) is typically supplied by the RCA (80–90% of
patients). LAD causes anterior MI (V1–V4), LCx causes lateral MI (I, aVL, V5–V6).
5. An EKG shows ST elevation in V1–V3 with reciprocal ST depression in II, III,
and aVF. Which coronary artery is occluded?
A) Right coronary artery
B) Left anterior descending artery
C) Left circumflex
D) Left main trunk
E) Obtuse marginal branch
Correct Answer: B) Left anterior descending artery
Anterior MI presents with ST elevation in V1–V4 (LAD) or V1–V3 (proximal LAD).
Reciprocal changes in the inferior leads confirm anterior MI with LAD occlusion.
, 6. A patient's EKG shows a QRS duration of 0.14 seconds with a broad, slurred
upstroke in the PR segment. What condition is suggested?
A) Atrial fibrillation
B) Atrioventricular block
C) Wolff-Parkinson-White syndrome
D) Bundle branch block
E) Hyperkalemia
Correct Answer: C) Wolff-Parkinson-White syndrome
WPW is characterized by a delta wave (slurred upstroke of QRS), short PR interval
(<0.12 seconds), and prolonged QRS (≥0.12 seconds) due to pre-excitation via an
accessory pathway.
7. An EKG shows a PR interval of 0.28 seconds with normal QRS duration. What
conduction abnormality is present?
A) Second-degree AV block (Mobitz I)
B) First-degree AV block
C) Third-degree AV block
D) Bundle branch block
E) Wolff-Parkinson-White syndrome
Correct Answer: B) First-degree AV block
First-degree AV block is defined by a prolonged PR interval (>0.20 seconds) with
normal QRS. Every P wave conducts to the ventricle, but conduction is delayed.
