Cardiovascular System

Question 1

Diastolic murmur represent

Answer 1

Valvular heart disease→aortic regurgitation

→mitral stenosis

Question 2

Systolic murmur represent

Answer 2

1. Vascular heart disease →aortic, pul. Stenosis and hypertrophic cardiomyopathy
2. Physiologic flow murmur

Question 3

Murmur doing pregnancy suggests

Answer 3

Risk to mother/ fetus of aortic stenosis/ pulmonary hypertension

Question 4

Midsystolic murmur

Answer 4

Blood flow across the semilunar valve

Question 5

Pansystolic murmur

Answer 5

Regurgitant flow across AV valve

Question 6

Late systolic murmur that may /may not be preceded by systolic clicks

Answer 6

1. Mitral valve prolapse or

2. Mitral regurgitation

Question 7

PMI diameter of >2.5 cm evidence of

Answer 7

Hypertension/ aortic stenosis→LVH

Question 8

Displaced PMI >10cm lateral to midsternal line occurs in

Answer 8

• LVH
• ventricular dilation- MI
  - HF

Question 9

COPD PMI displacement

Answer 9

RVH→In xiphoid/epigastric area

Question 10

Pathophysiology of S3 and S4

Answer 10

S3→ abrupt deceleration of inflow across the mitral valve (s3 gallop)
S4 →↑LV end diastolic stiffness which ↓ complianc
→ marks atrial contraction

Question 11

Pressure of resting LV

Answer 11

<5mmHg

Question 12

Opening snap OS

Answer 12

Mitral stenosis→maybe heard in diastole during MV opening(usually silent)

Question 13

Systolic ejection sound

Answer 13

Pathologic condition accompanying Aortic/pulmonic valve opening

Question 14

Where to search s2 splitting

Answer 14

Only in Left 2nd and 3rd interspace during inspiration

Question 15

S1 splitting

Answer 15

Only at left sternal border di not vary with respiration

Question 16

Sinus arrhythmias

Answer 16

Speed up with inspiration and slow with expiration

Question 17

Atrial /nodal premature contraction

Answer 17

Early atrial/nodal beat then pause then rhythm continue

S1 greater intensity and s2 lesser

Question 18

Nirmal arterial pulse

Answer 18

30-40mmhg

Question 19

Small weak pulse causes

Answer 19

↑PVR

↓ SV

Question 20

Larger bounding pressure causes

Answer 20

1. ↑ Sv, ↓ PVR

↓Ccompliance

Question 21

Pulses during Aortic regurgitation-

Answer 21

bisferiens pulse and large bounding pulse

Question 22

Pulses during L.Ventricular failure-

Answer 22

pulus alternans and L. sided S3

Question 23

Ventricular premature contraction-

Answer 23

regularly irregular bears, early ventricular beat then pause then rhythm continue. S1 normal s2 decreased

Question 24

Atrial fib and flutter with varying av block-

Answer 24

no p wave ventricular rhythm(fibrillation) totally irregular and short, s1 intensity changes

Question 25

Palpable dec of systolic pressure by >10-12mmhg during inspiration

Answer 25

Paradoxical pulse

Question 26

Causes of ↑JVP

Answer 26

Acute/chronic HF
SVC obstruction
Pul. Hypertension
Cardiac temponade
Pericarditis
Tricuspid stenosis

Question 27

↑ JVP is specific for

Answer 27

↑ L.V end diastolic pressure

↓ L. Ventricule EF

Question 28

Abnormal prominent a wave of JV pulsation

Answer 28

Pulmonic stenosis
Aortic regurgitation
Av block 
Tricuspid stenosis
Supraventricular tachycardia
Junctional tachycardia
Pul. Hypertension

Question 29

Absent a wave

Answer 29

Atrial fibrillation

Question 30

↑v wave cause

Answer 30

Tricuspid regurgitation
Atrial septal defect
Constructive pericarditis

Question 31

Paradoxical pulses occurs:

Answer 31

Acute asthma
Obstructive pul. Diseases
Acute pulmonary embolism
Pericardial temponade
Constructive pericarditis

Question 32

When does pmi displace upward and to the left

Answer 32

Pregnancy and high left diaphragm