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Electrocardiography by John H. Dirckx, M.D.
Questions by Susan Dooley, CMT, AHDI-F
1. Electrocardiography was developed by Dutch physician Willem Einthoven around what year?
A. 1850
B. 1900
C. 1930
D. 1950
2. Prior to that time there were only a few ways to gather diagnostic information about the heart.
Which of the following is NOT a diagnostic method in use prior to the first electrocardiogram?
A. Feeling the pulse
B. Listening to heart sounds with a stethoscope
C. Viewing the heart’s size and position with an x-ray
D. Injecting dye into the heart with a catheter
3. By applying an appropriate instrument to the outer surface of the body, what can be detected?
A. Small, transitory electrical waves generated by the heart’s action
B. Electricity generated by the brain’s function
C. Peristaltic action created by digestion in the intestines
D. Oxygen and carbon dioxide exchange at the blood cell level
4. The string galvanometer was used to do what?
A. Measure the length of heart muscle fibers
B. Stimulate nerves and muscles
C. Discern when a subject was lying
D. Detect the voltage and electrical activity of the heart
5. Which of the following is TRUE about the earliest electrocardiographic tracings?
A. A needle, dipped in ink, directly traced the heart’s electrical rhythm
B. Because the electrical potentials shifted so rapidly, there was no way to capture them graphically
C. The galvanometric needle deflected light onto a moving strip of photographic film, which later
was developed
D. The electricity of the heart was recorded with radio waves and played as audio
6. Which of the following is the name coined by Einthoven for the tracing of cardiac electrical
activity?
A. Electrocardiogram
B. Written record of the heart’s electricity
C. Electroencephalogram
D. Elektrokardiogramm
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed.
Health Professions Institute
www.hpisum.com
7. Which of the following is the name of the machine that makes the tracing we now call an ECG?
A. Electrocardiograph
B. Electrocardiogram
C. Echocardiograph
D. Electroencephalogram
8. Physiologically, which of the following best describes cardiac nerve and myocardial cells?
A. heart muscle
B. bundles or sheets of microscopic fibers
C. highly specialized conducting system of the heart
D. all of these
E. none of these
9. Which of the following best defines polarization?
A. The inside of the cell is electrically positive with respect to the outside.
B. The outside of the cell is electrically positive with respect to the inside.
C. The inside of the cell is electrically negative with respect to the outside.
D. The outside of the cell is electrically negative with respect to the inside.
10. If a wave of depolarization is defined as travel of an impulse along the course of a nerve or muscle
fiber, which of the following is the best definition for a wave of repolarization?
A. Travel of an impulse along the course of a nerve or muscle fiber
B. Release of ions and protons through the cell membrane
C. A return to normal polarity that follows depolarization by a fraction of a second.
D. Free electrons of the conductor are forced to drift toward the positive terminal under the
influence of this field.
11. Which of the following statements is INCORRECT?
A. It is possible to record the passage of an electrical impulse through a single fiber of heart muscle
from outside the body.
B. The electrocardiograph detects the net effect of electrical activity going on in the heart from one
instant to the next
C. Electricity measured in an ECG is diffused by body tissues between the heart and the electrodes
affixed to the skin
D. The electrocardiograph tests the difference of potential between two points
12. Which of the following statements is INCORRECT?
A. In Einthoven’s original electrocardiographic process, the patient sat with his arms and his left
leg immersed in buckets of salt water.
B. Today’s leads I, II, and III are the same designations originally used by Einthoven.
C. The leads produce bipolar tracings, which record the heart from different angles.
D. Einthoven also devised an EEG machine that required the subject’s head to be immersed in
saline solution.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed.
Health Professions Institute
www.hpisum.com
13. Which of the following is correct about the standard limb leads of the electrocardiograph?
A. Lead I is for the left arm and right leg.
B. Lead II is for the left and right legs.
C. Lead III is for the left arm and left leg.
D. Lead IV is for the left and right arms.
14. Which of the following is INCORRECT?
A. Any one lead can supply information about the rate and rhythm of ventricular contractions.
B. Any one lead can show abnormalities of impulse formation, conduction, or evidence of
ischemia or infarction.
C. A single lead can only supply limited data about the size, shape, and position of the heart.
D. A single lead can show signs of disease affecting all parts of the heart.
15. Which of the following statements is INCORRECT?
A. Einthoven won the Nobel Prize in Physiology or Medicine in 1924 for his discovery of the
mechanism of the electrocardiogram.
B. Einthoven’s three-electrode positioning system is still the basis of all electrocardiography.
C. The electrode positions Einthoven chose form a circle around the heart.
D. Later researchers built on Einthoven’s work to devise the unipolar limb leads and precordial
leads, allowing the ECG to “view” the heart from additional positions.
16. Which of the following is NOT a name for a unipolar limb lead?
A. V6
B. aVF
C. aVL
D. aVR
17. Which of the following statements about unipolar limb lead is INCORRECT?
A. In the name aVR, a stands for augmented and V for vector.
B. In the name aVL, L stands for left arm.
C. In the name aVF, F stands for Foot, but it really refers to the left leg.
D. In the name aVR, R stands for Radial.
18. The precordial or chest lead electrodes are placed
A. on the chest in front of the heart
B. at approximately equal intervals around the front of the chest
C. starting from the right sternal border and ending in the left midaxillary line
D. none of these
E. all of these
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed.
Health Professions Institute
www.hpisum.com
19. A 12-lead ECG consists of
A. limb leads I, II, and III
B. augmented bipolar limb leads aVR, aVL, and aVF
C. precordial leads V1 through V6
D. none of these
E. all of these
20. Which of the following is CORRECT about the 12-lead ECG?
A. Leads aVR, aVL, and aVF and leads I, II, and III, which are bipolar and unipolar,
respectively, give a composite view of the heart in the frontal plane, like on a standard PA chest
x-ray.
B. Leads V1 through V6, which are precordial, give a composite view of the heart in a transverse
plane, as one would see on a CT or MRI.
C. Both A and B are correct.
D. Neither A nor B is correct.
21. Which of the following are INCORRECT statements about variations of the standard ECG in
modern practice?
A. Esophageal leads are implanted via an incision in the upper abdomen and are used to gauge
swallowing motility.
B. A Holter monitor is a compact ECG machine worn by a patient for 24 hours or more to gain a
continuous sampling of the heart’s electrical activity.
C. Exercise ECG, or stress testing, involves patients working on a treadmill while tracing standard
limb lead II for presence of myocardial ischemia.
D. Injection of chemicals into the bloodstream done in the electrophysiology lab induce changes in
heart rhythm and function.
22. The pacemaker of the heart is the
A. Bundle of His (atrioventricular bundle)
B. Sinoatrial (SA) node
C. Atrioventricular (AV) node
D. Purkinje fibers
23. The depolarization wave triggered by the heart’s pacemaker next reaches the
A. Bundle of His (atrioventricular bundle)
B. Sinoatrial (SA) node
C. Atrioventricular (AV) node
D. Purkinje fibers
24. The bundle of His, or atrioventricular bundle
A. is located in the interventricular septum
B. receives the depolarization impulse from the AV node
C. is made of specialized conducting fibers
D. none of these
E. all of these
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed.
Health Professions Institute
www.hpisum.com
25. The bundle of His passes the depolarization wave to the
A. Atrioventricular (AV) node
B. Sinoatrial (SA) node
C. Right and left bundle branches
D. Purkinje fibers
26. Which of the following does the ECG tracing detect?
A. Muscular movement
B. Muscle contraction
C. Sinoatrial nodes
D. Electrical activity
27. Which of the following is INCORRECT about the waves (P, Q, R, S, T, and U) of the cardiac
cycle?
A. All of the waves appear in every lead’s tracing.
B. The waves vary in size and polarity (above or below the baseline) from one lead to another.
C. The P wave is always upright in leads I, II, and aVF.
D. In lead V1, the S wave goes farther from the baseline than the R wave.
28. ECG waves can vary in size, shape, and polarity as a result of disease and cardiac abnormalities.
Which of the following statements regarding this is INCORRECT?
A. Inverted T waves in lead I or lead II usually indicate deficient blood supply to the heart muscle.
B. A deep, wide Q wave in any lead is usually indicative of a heart attack (myocardial infarction).
C. A predominant R wave in V6 indicates malfunction of the bundle of His.
D. The absence of P waves from all leads means that the SA node is not functioning as a
pacemaker.
29. List 6 principal uses of electrocardiography.
30. List 4 values that physicians determine from ECG tracings,
31. The electrical axis, also called the axis, of the heart is
A. an imaginary line representing the direction of maximum electrical activity
B. on the normal heart, between 0° and 90°.
C. determined by looking at the tracings of the first 6 ECG leads—it will be the one with the
highest R waves
D. none of these
E. all of these
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed.
Health Professions Institute
www.hpisum.com
32. Which of the following statements is INCORRECT?
A. If the electrical axis lies above the horizontal 0° line, it shows left axis deviation.
B. If the electrical axis lies above the vertical 90° line it shows right axis deviation.
C. Significant axis deviation can indicate abnormality in the heart’s shape, such as right or left
ventricular hypertrophy.
D. Significant axis deviation can indicate a blockage in the heart’s conduction system.
E. Axis deviation means the heart is upside down.
33. The rhythm of the heart in its normal state is
A. Normal sinus rhythm (or regular sinus rhythm)
B. Ventricular fibrillation
C. Atrial flutter
D. V tach
34. Which of the following are arrhythmias?
A. Bradycardia (heart rhythm below 60 beats per minute)
B. Tachycardia (heart rate above 100 beats per minute)
C. Bradyarrhythmia (heart rhythm 60 to 100 beats per minute, with an irregular pulse)
D. A chaotic heart rhythm (irregular irregularity)
E. All of these are arrhythmias.
F. None of these are arrhythmias.
35. Which of the following is INCORRECT about Wolff-Parkinson-White syndrome?
A. It occurs when an accessory band of muscle fibers called the bundle of Kent connects the atria
directly to the ventricles, bypassing the normal pathway.
B. It causes an abnormally short PR interval and a prolonged R wave (a delta wave).
C. People with WPW are prone to paroxysmal atrial tachycardia.
D. WPW is a rare condition.
36. Which of the following is INCORRECT about heart block?
A. Refers to delay of the passage of an impulse through the heart’s conduction system
B. Not directly reflected in the ECG, so it must be inferred from indirect evidence
C. Always results in myocardial infarction
D. Classified as sinoatrial, atrioventricular, and intraventricular
37. Which of the following is INCORRECT about first-degree block?
A. PR intervals are prolonged.
B. There is a delay of impulse transmission.
C. This kind of block is the most serious and difficult to treat.
D. Every impulse gets through to the ventricles and causes a beat.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed.
Health Professions Institute
www.hpisum.com
38. Which of the following is INCORRECT about third-degree block?
A. It causes the heart to stop and the patient to die without immediate CPR.
B. In the presence of sinus arrest, some ectopic foci in the atria or ventricles often take over the
pacemaker rhythm.
C. With an idioventricular rhythm, the pulse is 40 to 50 and the QRS complexes are wide and
bizarre.
D. With a junctional or nodal rhythm, the pulse is 50 to 60 and QRS complexes are normal.
39. List and define the 3 levels or grades of severity of reduction of coronary blood flow as found on an
ECG.
Matching Exercise
Instructions: Match the definitions (1 through 21, below) with the names of the diseases and conditions
that follow (letters A through T).
DEFINITIONS
1. Repeated travel of impulses in a circular path, as seen in Wolff-Parkinson-White syndrome
2. Cardiac impulse is conducted normally to the left ventricle but not to the right ventricle, with
delayed polarization of the RV until the impulse spreads to it from the LV
3. Cardiac standstill; absence of ventricular activity.
4. A group of ECG changes caused by administration of cardiac glycosides, including bradycardia, AV
block, and distortion of ST segment
5. A runaway artificial pacemaker firing at an inappropriately rapid rate
6. Asymptomatic myocardial infarction diagnosed only on the basis of ECG findings
7. An R wave from a PVC that appears immediately on top of the T wave of the previous contraction.
8. Syncopal episode caused by transitory ventricular asystole
9. Jaggedness or fuzziness of the ECG baseline due to tremors or tension of the subject’s muscles
10. A deflection in an ECG tracing representing the return to the baseline after the peak of the R wave.
11. Regular 1:1 alternation of normal cardiac contractions and ectopic beats, usually of ventricular
origin
12. A premature heartbeat, also called an extra systole
13. A heartbeat that is able to “escape” the usual pacemaking dominance of the SA node due to some
disturbance in the conducting system
14. The point in an ECG tracing where the QRS complex ends and the ST segment begins
15. A large P wave due to right atrial enlargement, occurring in right heart disease due to pulmonary
disease such as emphysema
16. An ECG pattern suggesting MI but actually due to a conduction defect or similar abnormality
17. Ventricular tachycardia in which variations in the height of R waves cause an undulating or
scalloped contour on the tracing; literally, “twisting of points”
18. Pulse in which every other beat is stronger; alternating strong and weak pulses during a sinus
rhythm.
19. An ECG wave that goes below the baseline (records a negative voltage)
20. A narrow spike in the ECG tracing indicating an electrical impulse from an artificial pacemaker
21. Caused by left atrial hypertrophy due to mitral stenosis, this is a large, notched P wave
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed.
Health Professions Institute
www.hpisum.com
DISEASE NAMES AND CONDITIONS
A. asystole
B. bigeminy
C. circus movement
D. digitalis effect
E. escape beat
F. extrasystole
G. intrinsicoid deflection
H. inverted, inversion
I. J point, junction point
J. P pulmonale
K. P mitrale
L. pacemaker artifact
M. pseudoinfarct pattern
N. pulsus alternans
O. R on T
P. racemaker
Q. right bundle branch block (RBBB)
R. silent MI
S. somatic tremor or muscle artifact
T. Stokes-Adams attack
U. torsade de pointes
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed.
Health Professions Institute
www.hpisum.com