Exam 3

Question 1

Grade of murmurs associated with a thrill?

Answer 1

IV, V, VI

Question 2

A physiologic S2 split is wider/closer on inspiration and wider/closer on expiration

Answer 2

Wider on inspiration; closer on expiration

Question 3

A paradoxical S2 split is found in ?

Answer 3

LBBB, aortic stenosis

Question 4

A wide S2 split is found in?

Answer 4

VSD, mitral regurg, RBBB, pulmonic stenosis

Question 5

An S3 gallop is MC associated with

Answer 5

CHF

Question 6

an S3 gallop can be normal in

Answer 6

children and young adults; NEVER normal in older adults

Question 7

S3 gallop is heard best with bell or diaphragm??

Answer 7

Bell - in L lateral decubitus @ apex

Question 8

S4 can be found in

Answer 8

HTN, aortic or pulmonic stenosis

Question 9

S4 can be best heard with

Answer 9

Bell @ apex

Question 10

Opening snap

Answer 10

Mitral stenosis (rheumatic heart dz)

Question 11

Ejection sound/click

Answer 11

diseased aortic or pulmonic valves

Question 12

Mid-systolic click

Answer 12

a/w SCD; snapping of chordae tendineae of mitral valve
Prosthetic valves, older pacemakers

Question 13

JVP reflects

Answer 13

Right atrial pressure; internal jugulars best for evaluation

Question 14

Abnormal JVP

Answer 14

> 3-4 cm at 30 degrees

Question 15

3 layers of the arteries

Answer 15

Adventitia, Media, Intima

Question 16

Normal pulse grade is

Answer 16

2+

Question 17

A PMI > 2.5cm diameter is evidence of

Answer 17

LVH from HTN or aortic stenosis

Question 18

Pathologic S3 and S4 in adults > 40yo are correlated w/

Answer 18

HF and acute myocardial ischemia

Question 19

Heart sound that corresponds to an abrupt deceleration of inflow across the mitral valve

Answer 19

S3

Question 20

Heart sound that corresponds to increased LV end diastolic stiffness which decreases compliance

Answer 20

S4

Question 21

Causes of chest pain in the absence of CAD on angiogram

Answer 21

Microvascular coronary dysfunction and abnormal cardiac nocioception

Question 22

Causes of Edema

Answer 22

Frequently cardiac or pulmonary, but can also be nutritional and/or positional

Question 23

What is anasarca?

Answer 23

severe generalized edema extending to the sacrum & abdomen

Question 24

An enlarged waistline can indicate

Answer 24

Ascites and liver failure

Question 25

An elevated JVP is highly correlated with:

Answer 25

Acute & chronic HF; it is also seen with TS, chronic pulm HTN, SVC obstruction, cardiac tamponade, and constrictive pericarditis

Question 26

Alternately loud and soft Korotkoff sounds or a sudden doubling of the apparent heart rate as the cuff pressure declines signals

Answer 26

Pulsus alternans

Question 27

Bruits are caused by

Answer 27

Atherosclerotic luminal stenosis, tortuous carotid artery, external carotid arterial disease, aortic stenosis, the hypervascularity of hyperthyroidism, and external compression from thoracic outlet syndrome

Question 28

What can shift the apical impulse upward and to the left?

Answer 28

pregnancy or a high left diaphragm

Question 29

A hyp___kinetic _____-amplitude impulse may occur in hyperthyroidism, severe anemia, pressure overload of the LV from HTN or aortic stenosis, or volume overload of the LV from aortic regurgitation

Answer 29

hyperkinetic high-amplitude

Question 30

A hy__kinetic ____-amplitude impulse is seen in HF and dilated cardiomyopathy

Answer 30

Diffuse hypokinetic low-amplitude

Question 31

A prominent pulsation in the Pulmonic area often accompanies

Answer 31

dilation or increased flow in the pulmonary artery

Question 32

A palpable S2 point to increased

Answer 32

pulmonary artery pressure from pulmonary HTN (in the pulmonic area); can also accompany systemic HTN (in the aortic area)

Question 33

A pulsation at the aortic area suggests

Answer 33

a dilated or aneurysmal aorta

Question 34

____ is louder at more rapid HR, and PR intervals are shorter

Answer 34

S1

Question 35

Expiratory splitting suggests

Answer 35

a valvular abnormality

Question 36

Persistent splitting results from

Answer 36

delayed closure of the pulmonic valve or early closure of the aortic valve

Question 37

Most common extra heart sound

Answer 37

Systolic click of MVP

Question 38

Which murmurs are more likely to be pathologic?

Answer 38

Diastolic - represent valvular heart disease

Question 39

____________ murmurs typically arise from blood flow across the semilunar valves

Answer 39

Midsystolic

Question 40

___________ murmurs often occur with regurgitant flow across the AV valves

Answer 40

Pansystolic

Question 41

The murmur of ________________ often radiates to the neck in the direction of arterial flow, especially on the right side

Answer 41

Aortic Stenosis

Question 42

The murmur of _________________ often radiates to the axilla, supporting transmission by bone conduction

Answer 42

mitral regurgitation

Question 43

Which sided heart murmurs increase with inspiration?

Answer 43

Right sided

Question 44

Which sided heart murmurs increase with expiration?

Answer 44

Left sided

Question 45

What is the only murmur that increases during the "strain phase" of the valsalva maneuver due to increased outflow tract obstruction?

Answer 45

HOCM