Question 1

Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting, and is often associated with focal tenderness is most likely

Accepted Answer

The description given is a classic example of musculoskeletal chest pain.

Question 2

The earliest sign of heart failure in an infant is frequently

Accepted Answer

If heart failure is suspected, note that the infant's liver may enlarge before there is any suggestion of moisture in the lungs, and the left lobe of the liver may be more distinctly enlarged than the right. An apical impulse in the fourth intercostal space is a normal finding.

Question 3

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

Accepted Answer

Sinus arrhythmia is a physiologic event during childhood. The heart rate of a child varies in a cyclic pattern, usually faster on inspiration and slow on expiration.

Question 4

Which dysrhythmia is a physiologic event during childhood?

Accepted Answer

Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension.

Question 5

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

Accepted Answer

Chest pain is the usual initial symptom in acute pericarditis, which is the inflammation of the pericardium. The key physical finding is the triphasic friction rub, which is comprised of ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole. It is heard just to the left of the sternum in the third and fourth intercostal spaces and is characteristically scratchy.

Question 6

Ms. S. 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

Accepted Answer

Acute rheumatic fever is a systemic connective tissue disease that occurs after a streptococcal pharyngitis or a skin infection. It may result in serious cardiac valvular involvement of the mitral or aortic valve. Often the valve becomes stenotic and regurgitant. Prevention is adequate treatment of streptococcal pharyngitis or skin infections. The other possible answers do not have the presenting manifestations and occur mostly in older adults.

Question 7

A holosystolic murmur in an infant that is best heard along the left sternal border in the third to fifth intercostal spaces and does not radiate to the neck is indicative of

Accepted Answer

Regurgitation through the ventricular septal defect results in a holosystolic murmur as described.

Question 8

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

Accepted Answer

Unlike chest pain in adults, chest pain in children and adolescents seldom is caused by a cardiac problem. More likely the case is related to trauma, exercise-induced asthma, or cocaine use.

Question 9

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

Accepted Answer

Atherosclerosis is a disease in which fat deposits (cholesterol) accumulate in the walls of the arteries, which can lead to heart failure or stroke.

Question 10

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

Accepted Answer

Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention. The other choices are not as reliable.

Question 11

A grade IV mitral regurgitation murmur would

Accepted Answer

A grade IV murmur would have a thrill, and a mitral regurgitation murmur is best heard at the apex, is holosystolic, and would radiate to the axilla.

Question 12

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

Accepted Answer

Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and a sudden onset of congestive heart symptoms. The lesions described are Janeway lesions.

Question 13

A condition that is likely to present with dizziness and fainting is

Accepted Answer

Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes arrhythmias with subsequent fainting, transient dizzy spells, lightheadedness, seizures, palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of neurologic dysfunctions, and sudden onset of CHF. Chest pain is an initial symptom in acute pericarditis along with a triphasic friction rub. Hyperlipidemia is a risk factor for myocardial infarction that commonly presents with chest pain.

Quiz 14: Heart