Examination

Question 1

Position of bed

Answer 1

45°

Question 2

General inspection of patients

Answer 2

Chest wall deformities - Pectus excavatum
sternotomy scar
Lateral thoratocomy scar
Visible pulsation
Prominent venous collaterals
Anemia
Cyanosis
Pyrexia
Pedal edema

Question 3

Median sternotomy scar Indicates

Answer 3

Previous coronary artery bypass graft
Cardiac bypass

Question 4

Lateral thoracotomy scar indicates

Answer 4

Previous mitral valvotomy

Question 5

Hands exam

Answer 5

Clubbing
Cyanosis
Pallor
Splinter hemorrhages
Oslers nodes
Leukonychia
Pulse

Question 6

Only cardiac cause of clubbing

Answer 6

Infective endocarditis

Question 7

Signs of infective endocarditis

Answer 7

Vasculitic rash
Splinter hemorrhages
Oslers nodes
Janeway lesions
Roths spots

Question 8

Evaluation of pulse includes

Answer 8

Rate
Rythm
Character
symmetry

Question 9

Character of radial pulse

Answer 9

Volume
Waveform

Question 10

When is pulse volume low

Answer 10

In heart failure

Question 11

When is pulse volume high

Answer 11

In aortic regurgitation

Question 12

When is pulse waveform slow rising

Answer 12

Aortic stenosis

Question 13

In which case is there a pulse waveform rapidly rising which then collapse in early diastole

Answer 13

In aortic regurgitation due to high volume in LV (normal pulmonary venous return + blood back flow ) being ejected

Question 14

When do you have collapsing pulse

Answer 14

In aortic regurgitation

Question 15

When do you have alternating pulse high and low systolic

Answer 15

Severe left ventricular failure

Question 16

In inspiration , blood venous return increases or decreases

Answer 16

Increaes

Question 17

Pulses to feel in cardiac exam

Answer 17

Radial brachial
Carotid
Femoral
Popliteal
Pedal

Question 18

Normal upper limit of JVP

Answer 18

4 cm

Question 19

Kussmauls sign

Answer 19

Paradoxical increase in JVP during inspiration in constrictive pericarditis and tamponade due to inability to accommodate venous return

Question 20

Type of waveform in JVP

Answer 20

Double waveform

Question 21

Causes of elevated JVP

Answer 21

Congestive heart failure
Cor pulmonale
Pulmonary embolism
RV infarction
Tricuspid valve dx
Tamponade
Constrictive pericarditis
Hypertrophic/restrictive cardiomyopathy
SVCO
Iatrogenic fluid overload

Question 22

What is apex beat

Answer 22

Lowest most lateral point at which impulse can be palpated

Question 23

Characteristics of JVP

Answer 23

Double waveform
Varies with respiration
Varies with posture
Non palpable
Obliterated by pressure
Hepatojugular reflux

Question 24

Normal location of apex beat

Answer 24

Fifth intercostal
Midclavicular line

Question 25

When can you have ventricular dilatation

Answer 25

In mitral or aortic regurgitation

Question 26

When do you have left ventricular hypertrophy

Answer 26

Hypertension Aortic stenosis

Question 27

Can LV hypertrophy lead to displacement of apex beat

Answer 27

No

Question 28

In which case is there an apical double thrust

Answer 28

Palpable 3rd and 4th sounds

Question 29

Where can you palpate LV aneurysm

Answer 29

Medial to cardiac apex

Question 30

What do you feel in right ventricular enlargement

Answer 30

Systolic heave in left parasternal

Question 31

What is a thrill

Answer 31

Turbulent flow leading to palpable vibrations

Question 32

When do you feel thrills

Answer 32

Aortic stenosis VSD Patent ductus arteriosus

Question 33

What is first heart sound

Answer 33

Mitral and tricuspid valves closure

Question 34

What is Second heart sound

Answer 34

Aortic and pulmonary valve closure

Question 35

What sound is characteristics to 3rd and 4th sound

Answer 35

Gallop sound to cardiac rythm

Question 36

When is S3 normal

Answer 36

Children and young adults High output states - anemia, pregnancy, thyrotoxicosis

Question 37

What disease does S3 indicate

Answer 37

LV failure Mitral regurgitation Constrictive pericarditis

Question 38

What causes S4

Answer 38

Hypertension Aortic stenosis Hypertrophic cardiomyopathy

Question 39

When can you hear early systole clicking due to valve opening being loud

Answer 39

Aortic stenosis when pliant and on calcified

Question 40

When can you hear later systole clicking due to valve opening being loud

Answer 40

Mitral valve prolapse

Question 41

When can you hear early diastole clicking due to valve opening being loud

Answer 41

Mitral stenosis

Question 42

Grading of loudness of murmurs

Answer 42

1 -6 1 is barely audible 6 is audible even without stethoscope application

Question 43

Quality of murmur

Answer 43

Low Medium High pitched