This is a test I gave to PA students here in Buffalo NY. My advice is to take the quiz. Really take it. THEN, go to the answers as an active learning tool.

Here’s the quiz: CLICK HERE

12 Lead EKG Answers:

There are some answers that require a more detailed explanation than can be provided here. Look me up on YouTube for answers, or visit

1) NSR at ~ 110. Treat the cause. What causes sinus tach?
2) SVT. Treat with vagal maneuvers or adenosine.
3) A Fib. You have to know this one. COMMON. Three issues here – rate control, anti-coagulation (use the CHADS2 tool) and can they be converted back to NSR.
4) Junctional Tach.
5) V. Tach. There are three different treatments for VT.
a. Are they dead? Unsynchronized shock.
b. If alive…. Unstable? Synchronized shock.
c. If alive…. And stable? Meds.
6) NSR w/ PVC.
7) NSR w/ 11 beat run VT.
8) Paced rhythm.
9) V. Fib. This patient is dead. They need to be shocked.
10) Sinus Brady.
11) What would be the 12 lead EKG criteria for an inferior wall STEMI?

“2 up and 2 down”: elevation in leads II/III and AVF with depressions in the lateral leads

12) What is the EKG criteria for ST segment elevation consistent
with early repolarization?

It’s a diagnosis of exclusion.
Rule out the other 5 causes of ST segment elevation.

13) What is the EKG criteria for pericarditis?

Elevation in all leads… no depressions of the ST segment.
Remember, PR depression is a key here.

14) What is the EKG criteria for a left ventricular aneurysm?

ST segment elevation in V1-V4 with Q waves.

15) What are the causes of a flipped t wave? (Remember the mnemonic “SLIP”)

Stroke, Left Ventricle Strain, Ischemia and PE.

16) What are the EKG criteria for hyperkalemia?

Peaked T wave, wide QRS and a flat P wave.

17) What conduction problems cause a wide complex QRS?

BBB, WPW and a pacemaker.

18) How will ischemia of the anterior wall represent itself on a 12 lead EKG?

ST segment depression in leads V3 and V4.

19) What is the EKG criteria for a left bundle branch?

Per my system, the terminal deflection of V6 is elevated and wide complex with the terminal deflection of V1 being negative.

The bundle branch model works great here.

20) What is the EKG criteria for WPW? Wide complex, short PR interval and a delta wave.

Remember the mnemonic: “WPW.”

W=Wide Complex
P=PR Short
W=Wave (delta wave)

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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.