I used this book once for an exam, and it's in good condition. There are traces of removed sticky notes in two places, and a single pencil mark. There is no other writing. Please consider purchasing if you don't mind these minor imperfections. This is the official problem book for the electrocardiogram (ECG) certification, with explanations, making it ideal for study. - Title: ECG Certification Official Problem Book & Guide - Edition: Revised 3rd Edition - Target Level: Level 2/3 - Publisher: Japanese Society of Arrhythmia - ISBN: 978-4-904510-6 - Price: 2800 yen Please understand that this is a used item that has been stored at home and used once. Thank you for looking.