Deck 9: The Cardiovascular System

Question 1

You are performing a thorough cardiac examination. Which of the following chambers of the heart can you assess by palpation?

A) Left atrium
B) Right atrium
C) Right ventricle
D) Sinus node

Answer 1

Right ventricle

Question 2

What is responsible for the inspiratory splitting of S2?

A) Closure of aortic, then pulmonic valves
B) Closure of mitral, then tricuspid valves
C) Closure of aortic, then tricuspid valves
D) Closure of mitral, then pulmonic valves

Answer 2

Closure of aortic, then pulmonic valves

Question 3

A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur?

A) Mitral
B) Tricuspid
C) Aortic
D) Pulmonic

Answer 3

Mitral

Question 4

A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?

A) Abdominal pain
B) Orthopnea
C) Hematochezia
D) Tenesmus

Question 5

You are screening people at the mall as part of a health fair. The first person who comes for screening has a blood pressure of 132/85. How would you categorize this?

A) Normal
B) Prehypertension
C) Stage 1 hypertension
D) Stage 2 hypertension

Question 6

You are participating in a health fair and performing cholesterol screens. One person has a cholesterol of 225. She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease?

A) Ethnicity
B) Alcohol intake
C) Gender
D) Asthma

Question 7

You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a history of hypertension, which is well-controlled on his current medications. He does not smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his 10-year coronary heart disease risk. Which of the following conditions is considered to be a coronary heart disease risk equivalent?

A) Hypertension
B) Peripheral arterial disease
C) Systemic lupus erythematosus
D) Chronic obstructive pulmonary disease (COPD)

Question 8

You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure that they can distinguish between the jugular venous pulsation and the carotid pulse. Which one of the following characteristics is typical of the carotid pulse?

A) Palpable
B) Soft, rapid, undulating quality
C) Pulsation eliminated by light pressure on the vessel
D) Level of pulsation changes with changes in position

Question 9

A 68-year-old mechanic presents to the emergency room for shortness of breath. You are concerned about a cardiac cause and measure his jugular venous pressure (JVP). It is elevated. Which one of the following conditions is a potential cause of elevated JVP?

A) Left-sided heart failure
B) Mitral stenosis
C) Constrictive pericarditis
D) Aortic aneurysm

Question 10

You are palpating the apical impulse in a patient with heart disease and find that the amplitude is diffuse and increased. Which of the following conditions could be a potential cause of an increase in the amplitude of the impulse?

A) Hypothyroidism
B) Aortic stenosis, with pressure overload of the left ventricle
C) Mitral stenosis, with volume overload of the left atrium
D) Cardiomyopathy

Question 11

You are performing a cardiac examination on a patient with shortness of breath and palpitations. You listen to the heart with the patient sitting upright, then have him change to a supine position, and finally have him turn onto his left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position?

A) Aortic
B) Pulmonic
C) Mitral
D) Tricuspid

Question 12

You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?

A) Upright
B) Upright, but leaning forward
C) Supine
D) Left lateral decubitus

Question 13

A 68-year-old retired waiter comes to your clinic for evaluation of fatigue. You perform a cardiac examination and find that his pulse rate is less than 60. Which of the following conditions could be responsible for this heart rate?

A) Second-degree A-V block
B) Atrial flutter
C) Sinus arrhythmia
D) Atrial fibrillation

Question 14

Where is the point of maximal impulse (PMI) normally located?

A) In the left 5th intercostal space, 7 to 9 cm lateral to the sternum
B) In the left 5th intercostal space, 10 to 12 cm lateral to the sternum
C) In the left 5th intercostal space, in the anterior axillary line
D) In the left 5th intercostal space, in the midaxillary line

Question 15

Which of the following events occurs at the start of diastole?

A) Closure of the tricuspid valve
B) Opening of the pulmonic valve
C) Closure of the aortic valve
D) Production of the first heart sound (S1)

Question 16

Which is true of a third heart sound (S3)?

A) It marks atrial contraction.
B) It reflects normal compliance of the left ventricle.
C) It is caused by rapid deceleration of blood against the ventricular wall.
D) It is not heard in atrial fibrillation.

Question 17

Which is true of splitting of the second heart sound?

A) It is best heard over the pulmonic area with the bell of the stethoscope.
B) It normally increases with exhalation.
C) It is best heard over the apex.
D) It does not vary with respiration.

Question 18

Which of the following is true of jugular venous pressure (JVP) measurement?

A) It is measured with the patient at a 45-degree angle.
B) The vertical height of the blood column in centimeters, plus 5 cm, is the JVP.
C) A JVP below 9 cm is abnormal.
D) It is measured above the sternal notch.

Question 19

Which of the following regarding jugular venous pulsations is a systolic phenomenon?

A) The "y" descent
B) The "x" descent
C) The upstroke of the "a" wave
D) The downstroke of the "v" wave

Question 20

How much does cardiovascular risk increase for each increment of 20 mm Hg systolic and 10 mm Hg diastolic in blood pressure?

A) 25%
B) 50%
C) 75%
D) 100%

Question 21

In healthy adults over 20, how often should blood pressure, body mass index, waist circumference, and pulse be assessed, according to American Heart Association guidelines?

A) Every 6 months
B) Every year
C) Every 2 years
D) Every 5 years

Question 22

Which of the following is a clinical identifier of metabolic syndrome?

A) Waist circumference of 38 inches for a male
B) Waist circumference of 34 inches for a female
C) BP of 134/88 for a male
D) BP of 128/84 for a female

Question 23

Mrs. Adams would like to begin an exercise program and was told to exercise as intensely as necessary to obtain a heart rate 60% or greater of her maximum heart rate. She is 52. What heart rate should she achieve?

A) 80
B) 100
C) 120
D) 140

Question 24

In measuring the jugular venous pressure (JVP), which of the following is important?

A) Keep the patient's torso at a 45-degree angle.
B) Measure the highest visible pressure, usually at end expiration.
C) Add the vertical height over the sternal notch to a 5-cm constant.
D) Realize that a total value of over 12 cm is abnormal.

Question 25

You find a bounding carotid pulse on a 62-year-old patient. Which murmur should you search out?

A) Mitral valve prolapse
B) Pulmonic stenosis
C) Tricuspid insufficiency
D) Aortic insufficiency

Question 26

To hear a soft murmur or bruit, which of the following may be necessary?

A) Asking the patient to hold her breath
B) Asking the patient in the next bed to turn down the TV
C) Checking your stethoscope for air leaks
D) All of the above

Question 27

Which of the following may be missed unless the patient is placed in the left lateral decubitus position and auscultated with the bell?

A) Mitral stenosis murmur
B) Opening snap of the mitral valve
C) S3 and S4 gallops
D) All of the above

Question 28

How should you determine whether a murmur is systolic or diastolic?

A) Palpate the carotid pulse.
B) Palpate the radial pulse.
C) Judge the relative length of systole and diastole by auscultation.
D) Correlate the murmur with a bedside heart monitor.

Question 29

Which of the following correlates with a sustained, high-amplitude PMI?

A) Hyperthyroidism
B) Anemia
C) Fever
D) Hypertension

Question 30

You are examining a patient with emphysema in exacerbation and are having difficulty hearing his heart sounds. What should you do to obtain a good examination?

A) Listen in the epigastrium.
B) Listen to the patient in the left lateral decubitus position.
C) Ask the patient to hold his breath for 30 seconds.
D) Listen posteriorly.

Question 31

You are listening carefully for S2 splitting. Which of the following will help?

A) Using the diaphragm with light pressure over the 2nd right intercostal space
B) Using the bell with light pressure over the 2nd left intercostal space
C) Using the diaphragm with firm pressure over the apex
D) Using the bell with firm pressure over the lower left sternal border

Question 32

Which of the following is true of a grade 4-intensity murmur?

A) It is moderately loud.
B) It can be heard with the stethoscope off the chest.
C) It can be heard with the stethoscope partially off the chest.
D) It is associated with a "thrill."

Question 33

Which valve lesion typically produces a murmur of equal intensity throughout systole?

A) Aortic stenosis
B) Mitral insufficiency
C) Pulmonic stenosis
D) Aortic insufficiency

Question 34

You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely?

A) Emphysema
B) Asthma exacerbation
C) Severe left heart failure
D) Cardiac tamponade

Question 35

Suzanne is a 20-year-old college student who complains of chest pain. This is intermittent and is located to the left of her sternum. There are no associated symptoms. On examination, you hear a short, high-pitched sound in systole, followed by a murmur which increases in intensity until S2. This is heard best over the apex. When she squats, this noise moves later in systole along with the murmur. Which of the following is the most likely diagnosis?

A) Mitral stenosis
B) Mitral insufficiency
C) Mitral valve prolapse
D) Mitral valve papillary muscle ischemia