Deck 14: Heart

Question 1

Ms. Sharpe is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She reports a recent severe sore throat. You suspect:

A) angina.
B) acute rheumatic fever.
C) cardiac amyloidosis.
D) aortic sclerosis.

Answer 1

acute rheumatic fever.

Question 2

Which two heart chambers are most anterior in the chest?

A) Both atria
B) Both ventricles
C) The right atrium and ventricle
D) The left atrium and ventricle

Answer 2

The right atrium and ventricle

Question 3

Which ECG change would not be expected as an age-related pattern?

A) First-degree block
B) Bundle branch block
C) Left ventricular hypertrophy
D) Ventricular fibrillation

Answer 3

Ventricular fibrillation

Question 4

Which cardiac structure is responsible for the heart's pumping action?

A) Pericardium
B) Epicardium
C) Myocardium
D) Endocardium

Question 5

Contraction of the ventricles causes:

A) closure of the atrioventricular valves.
B) closure of the pulmonic and aortic valves.
C) opening of the auricular septa.
D) opening of the mitral and tricuspid valves.

Question 6

Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the:

A) P wave.
B) PR interval.
C) QRS complex.
D) ST segment.

Question 7

The apex of a 2-month-old baby's heart typically lies closest to the:

A) fourth left intercostal space.
B) midsternal area.
C) midthoracic spinal area.
D) sixth left intercostal space.

Question 8

In what age group are the right and left ventricles equal in weight and muscle mass?

A) Newborns
B) School-age children
C) Adolescents
D) Older adults

Question 9

Normal cardiac changes that occur during pregnancy include:

A) decreased cardiac output.
B) increased thickness and mass of the left ventricle.
C) decreased heart rate.
D) dilation of the ventricles.

Question 10

Closure of the ductus arteriosus usually occurs:

A) 24 to 48 hours after birth.
B) after 7 days of life.
C) between the second and third month.
D) during the toddler period.

Question 11

The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the:

A) P wave.
B) QRS complex.
C) PR interval.
D) T wave.

Question 12

Purkinje fibers are located in the:

A) sinoatrial node.
B) atrioventricular node.
C) myocardium.
D) aortic arch.

Question 13

In the fetus, the right ventricle pumps blood through the:

A) left atrium.
B) ductus arteriosus.
C) lungs.
D) foramen ovale.

Question 14

The pacing structure of the heart's electrical activity is the:

A) AV node.
B) bundle of His.
C) Purkinje fibers.
D) sinoatrial (SA) node.

Question 15

A grade IV mitral regurgitation murmur would:

A) be described as a diastolic murmur.
B) not be expected to have a thrill.
C) radiate to the axilla.
D) be heard best at the base.

Question 16

The major heart sounds are normally created by:

A) valves opening.
B) valves closing.
C) the rapid movement of blood.
D) rubbing together of the cardiac walls.

Question 17

The condition in which a patient's heart is rotated or displaced to the right or is situated as a mirror image of the expected position is called:

A) amyloidosis.
B) coarctation.
C) dextrocardia.
D) situs inversus.

Question 18

Mr. O, age 50 years, comes for his annual health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O mentions that he routinely engages in light exercise. At this time, you should:

A) ask if he makes his own bed daily.
B) have the patient describe his exercise.
C) make a note that he walks each day.
D) record "light exercise" in the history.

Question 19

Which two structures together form the primary muscle mass of the heart?

A) Right and left ventricles
B) Left ventricle and the aorta
C) Right and left atria
D) Left atrium and the pulmonary vein

Question 20

Heart position can vary depending on body habitus. In a short stocky individual, you would expect the heart to be located:

A) more to the right and hanging more vertically.
B) more to the left and lying more horizontally.
C) riding higher in the chest and pushed anteriorly.
D) hanging lower in the chest and riding more vertically.

Question 21

The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing:

A) a pericardial friction rub.
B) high-pitched murmurs.
C) presystolic gallops.
D) systolic ejection sounds.

Question 22

A split second heart sound is:

A) abnormal.
B) greatest at the peak of inspiration.
C) heard best after forceful expiration.
D) supposed to disappear with deep inspiration.

Question 23

A lift along the left sternal border is most likely the result of:

A) aortic stenosis.
B) atrial septal defect.
C) pulmonary hypertension.
D) right ventricular hypertrophy.

Question 24

Which one of the following is a common symptom of cardiovascular disorders in the older adult?

A) Fatigue
B) Joint pain
C) Poor night vision
D) Weight gain

Question 25

An example of a functional heart murmur is one that is caused by:

A) anemia.
B) a ventricular septal defect.
C) an atrial septal defect.
D) mitral valve prolapse.

Question 26

An apical PMI palpated beyond the fifth intercostal space may indicate:

A) decreased cardiac output.
B) obesity.
C) left ventricular hypertrophy.
D) hyperventilation.

Question 27

Mr. Jones and his wife have brought in their infant daughter for a routine visit. A holosystolic murmur in an infant that is best heard along the left sternal border, is in the third to fifth intercostal spaces, and does not radiate to the neck is indicative of:

A) a ventricular septal defect.
B) patent ductus arteriosus.
C) pulmonary stenosis.
D) dextrocardia.

Question 28

To estimate heart size by percussion, you should begin tapping at the:

A) anterior axillary line.
B) left sternal border.
C) midclavicular line.
D) midsternal line.

Question 29

A grade I or II murmur, without radiation and of medium pitch, is a common variation found in:

A) school-age children.
B) older women.
C) middle-age men.
D) older adults.

Question 30

A palpable rushing vibration over the base of the heart at the second intercostal space is called a:

A) heave.
B) lift.
C) thrill.
D) thrust.

Question 31

You are conducting an examination of Mr. Curtis's heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is:

A) barely discernible.
B) moderately loud.
C) loud with palpable thrill.
D) very loud without a stethoscope.

Question 32

Which of the following information belongs in the past medical history section related to heart and blood vessel assessment?

A) Adolescent inguinal hernia
B) Childhood mumps
C) History of bee stings
D) Previous unexplained fever

Question 33

To hear diastolic heart sounds, you should ask patients to:

A) lie on their back.
B) lie on their left side.
C) lie on their right side.
D) sit up and lean forward.

Question 34

A patient you are seeing in the emergency department for chest pain is believed to be having a myocardial infarction. During the health history interview of his family history, he relates that his father had died of "heart trouble." The most important follow-up question you should pose is which of the following?

A) "Did your father have coronary bypass surgery?"
B) "Did your father's father have heart trouble also?"
C) "What were your father's usual dietary habits?"
D) "What age was your father at the time of his death?"

Question 35

You are listening to a patient's heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound in this area is most likely:

A) S₁.
B) S₂.
C) S₃.
D) S₄.

Question 36

If the apical impulse is more vigorous than expected, it is called a:

A) lift.
B) thrill.
C) bruit.
D) murmur.

Question 37

In the adult, the apical impulse should be most visible when the patient is in what position?

A) Supine
B) Upright
C) Lithotomy
D) Right lateral recumbent

Question 38

Normal heart sounds are best heard:

A) directly over the semilunar and bicuspid heart valves.
B) over areas where blood flows after it passes through a valve.
C) near the carotid vessels.
D) over the central sternum.

Question 39

A third heart sound is created by:

A) atrial contraction.
B) ventricular contraction.
C) diastolic filling.
D) regurgitation between the right and left ventricles.

Question 40

Pleural pain differs from chest discomfort caused by other conditions in that it is:

A) precipitated by coughing.
B) eased with deep breathing.
C) usually described as dull in nature.
D) related to time of day.

Question 41

A condition that is likely to present with dizziness and syncope is:

A) bacterial endocarditis.
B) hypertension.
C) sick sinus syndrome.
D) pericarditis.

Question 42

The most helpful finding in determining left-sided heart failure is:

A) dyspnea.
B) orthopnea.
C) jugular vein distention.
D) an S₃ heart sound.

Question 43

During the auscultation of heart tones, you are uncertain whether the sound you hear is an S₂ split. You should ask the patient to inhale deeply while listening at the ______ area.

Question 44

The earliest sign of heart failure in an infant is frequently:

A) liver enlargement.
B) fluid in the lungs.
C) enlarged thyroid.
D) clubbing of the fingers.

Question 45

The thin-walled reservoirs of the heart are the:

A) atria.
B) pericardium.
C) sinuses.
D) ventricles.

Question 46

Which dysrhythmia is a physiologic event during childhood?

A) First-degree AV block
B) Mobitz type II
C) Multifocal PVCs
D) Sinus arrhythmia

Question 47

Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of:

A) rheumatic fever.
B) cor pulmonale.
C) pericarditis.
D) endocarditis.

Question 48

The heart sound that coincides with the carotid pulse is ________.

Question 49

An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an expected finding in:

A) adults under stress.
B) 4-year-old children.
C) pregnant women.
D) premature infants.

Question 50

Chest pain with an organic cause in a child is most likely the result of:

A) cardiac disease.
B) asthma.
C) esophageal reflux.
D) arthritis.

Question 51

Fat deposits in the circulatory system of an older adult can lead to:

A) diffuse conduction disturbances.
B) exaggerated contractility.
C) heart failure.
D) thinning of the ventricles.

Question 52

The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to suspect:

A) congestive heart failure.
B) pericarditis.
C) endocarditis.
D) cardiac tamponade.