Medicine — Cardiology, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
1. State the order in which an ECG should be read, and give one reason the order matters.
Answer: Rate, rhythm, axis, intervals, then ST segments and T waves. The order matters because ST changes are usually the most visually striking finding, so an eye drawn there first will miss a rate or rhythm abnormality that does not announce itself.
2. A regular rhythm shows four large squares between successive R waves. What is the approximate rate?
Answer: 300 ÷ 4 = 75 per minute.
3. A trace is irregularly irregular with no discernible P waves and narrow QRS complexes. What is the rhythm, and what does the narrow complex tell you?
Answer: Atrial fibrillation. The narrow QRS shows the impulse reached the ventricles through the normal conducting system, so the rhythm originates above the ventricles — the disorganised atrial activity explains both the absent P waves and the irregularity.
4. Why can the 300 rule not be used to report a rate in atrial fibrillation?
Answer: Because it assumes every R–R interval is the same. In atrial fibrillation they differ, so the number depends entirely on which pair happens to be measured. Counting complexes over a known length of strip and scaling gives an average that means something.
5. A patient has regular P waves at one rate and regular QRS complexes at a slower rate, with no fixed relationship between them. What does this indicate?
Answer: Complete heart block — the atria and ventricles are depolarising independently because no impulse is crossing between them. The ventricular rate depends on an escape rhythm, which may fail, so this needs monitoring and senior involvement immediately.
6. A broad-complex tachycardia is seen in a patient who is alert and comfortable. Why is it still treated as ventricular tachycardia?
Answer: Because the alternatives — supraventricular tachycardia with aberrant conduction, for instance — are less dangerous, and being wrong in that direction costs little, whereas treating true ventricular tachycardia as benign can be fatal. Comfort does not exclude it; a patient can be haemodynamically stable and deteriorate abruptly.
7. An ECG shows ST elevation. Give three causes other than myocardial infarction, and state what feature most helps distinguish infarction from them.
Answer: Pericarditis, ventricular strain or hypertrophy, and bundle branch block; electrolyte disturbance also alters the ST segment. Infarction typically shows elevation confined to leads sharing a coronary territory with reciprocal depression elsewhere, whereas pericarditis tends to be widespread without that reciprocal pattern. Comparison with a previous ECG adds more than any single feature.
8. A monitor shows an alarming rhythm in a patient sitting up and talking normally. What should be considered before treating?
Answer: Artefact — movement or a loose electrode produces traces that mimic serious arrhythmias. Checking the patient and the leads before acting prevents treatment of a recording problem. The converse also holds: a normal-looking trace in a grey, clammy patient does not reassure, it redirects the search.
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