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1. Case One: 48 y/o male. Several hours chest discomfort. 25 years smoking and father CAD—The Diagnosis is:
c: coronary artery disease
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2. Case Two: 69 y/o female substernal chest pain. BP 133/75. 99 BPM. Treated Acute MI. Respiratory difficulty day3. No pulsus paradoxus or jugular venous distention. No EKG findings. The Diagnosis is:
c: ventricular septal defect
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3. Case Three: 10 y/o girl with fever and joint swelling 8days. Thin. 122/68 BP. 86 bpm HR. 3/6 Harsh systolic murmur at apex. 2/6 Early diastolic decresendo murmur at left sternal border. S3 present. EKG says 1st deg. AV block. CXR normal. The Diagnosis is:
c: acute rheumatic fever
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4. Case Four: 44 y/o male. 12 day fever w/ shortness of breath. BP 146/55. Pulse 122 bpm. 4/6 early diastolic decrescendo murmur at left upper and mid sternal border. 2/6 systolic ejection murmur at right upper sternal border. The Diagnosis is:
b: aortic valve endocarditis
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5. Case Five: 68 y/o male with heart murmur present. Complaint of fatigue and dyspnea. Leaky heart valve and click. BP 133/80. HR 92 bpm. No jugular distention 3/6 holosystolic murmur at apex to axilla. Left atrial enlargement. CXR is mild pectus excavatum and cardiomegaly. The Diagnosis is:
d: mitral valve prolapse
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6. Case Six: 21 y/o male. Fatigue and dyspnea with exertion.Palpitations and abnormal heart sounds. BP is 150/50 with 78 bpm. Grade II/VI systolic ejection murmur. Grade IV/Vi diastolic decrescendo murmur at left sternal border. The Diagnosis is:
c: congenital aortic stenosis/regurgitation
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7. Case Seven: 78 y/o retired steel worker with exertional fatigue and dyspnea. Chest pain and palpitations while working on house. Murmur 15 years ago and CXR w/ mild cardiomeglay. BP 120/80. Pulse 122 and irregular. 3/6 harsh holosystolic murmur at apex and decreases with Valsava. Mild Pedal edema. The Diagnosis is:
a: dilated cardiomyopathy
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8. Case Eight: 62 y/o male with syncope. Exertional chest pain for months. BP 112/83. HR 66 bpm. S1 normal. S2 soft. 4/6 late-peaking systolic ejection murmur at right upper sternal border. 2/6 holosystolic murmur and early diastolic murmur. EKG is LVH. CXR normal. —The Diagnosis is:
d: valvular aortic stenosis
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9. Case Nine: 57 y/o female with fatigue, extertional dyspnea, and hemoptysis. BP is 103/68. Irregular pulse 133 bpm. S1 & 2 normal. Weak LV impulse and RV lift. Opening snap after S2. EKG is atrial fibrillation. CXR is cephalization of flow in lungs.—The Diagnosis is:
a: rheumatic mitral stenosis
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10. Case Ten: 26 y/o female with sharp chest pain close to apex. Heart skips beats during stress. 130/80 BP with 88 BPM. II/VI apical end-systolic murmur. EKG after is multiple PVC's.—The Diagnosis is:
d: mitral valve prolapse.
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1. S1 is caused by:
A: mitral and tricuspid valve closure
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2. For cardiac auscultation, the mitral area is considered to be the:
B: cardiac apex
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3. For Cardiac auscultation, the tricuspid area is considered to be the:
A: lower left sternal border
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4. S2 is caused by:
C: aortic and pulmonic valve closure
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5. For cardiac auscultation, the aortic are is the:
C: right upper sternal border
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6. For cardiac auscultation the pulmonic area is the:
D: left upper sternal border
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7. With inspiration, the interval between the two componenets of S2, aortic and pulmonic valve closure is:
A: increased
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8. S3 occurs in:
B: early ventricular diastole
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9. Another term used to describe the S3 is:
C: protodiastolic gallup
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10. All of the following pathologies are associated with an S3 except:
B: mitral stenosis
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11. The S4 occurs in response to:
B: atrial systole
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12. S4 indicates:
C: decreased ventricular compliance
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13. A loud S1 may indicate the presence of:
B: mitral stenosis
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14. Ano opening snap is associated with:
A: atrioventricular valve stenosis
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15. An ejection sound or click is associated with:
C: semilunar valve stenosis
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16. The midsystolic click may indicate the presence of mitral valve:
B: prolapse
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17. Fixed split S2 is associated with:
A: atrial septal defect.
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18. Which of the following heart sounds is associated with pericarditis?
C: pericardia friction rub
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19. Which of the following heart sounds is associated with constrictive pericarditis?
D:pericardial knock
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1. Which of the following is incorrect when describing the auscultation areas for the cardiac valves?
C: mitral: lower left sternal border
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2. A grade I murmur is a murmur that is:
D: barely heard
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3. A grade II murmur is a murmur that is:
D: faintly heard
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4. A grade III murmur is a murmur that is:
C: moderately loud
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5. A grade IV murmur is a murmur that is:
D: loud
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6. A grade V murmur is a murmur that is:
C: very loud
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7. A grade VI murmur is a murmur that is:
D: loud with a trill
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8. A ___ murmur is one that begins softly and becomes louder:
A: crescendo
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9. A ___ murmur is a murmur that begins loud and becomes softer:
B: decrescendo
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10. A ___ murmur begins softly, becomes louder and then decreases in loudness:
B: crescendo-decrescendo
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11. A ___ murmur begins loud, becomes softer, and then increases in loudness:
A: decrescendo-crescendo
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12. A low pitched murmur is best heard with the stethoscope’s:
A: bell
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13. A medium pitched murmur is bed heard with the stethoscope’s:
C: both bell and diaphragm
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14. A high pitched murmur is best heard with the stethoscope’s:
B: diaphragm
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15. Which of the following murmurs begins with the first heart sound and end in mid-systole?
A: early systolic
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16. All of the following are possible causes of early systolic murmurs except:
A: valvular aortic stenosis
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17. Which of the following murmurs begins after the semilunar valves open?:
B: systolic ejection
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18. All of the following are associate with a systolic ejection murmur except:
D: ventricular septal defect
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19. Which of the following murmurs is present when there is flow between two chambers that have widely different pressure throughout systole?
C: pansystolic
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20. All of the following are considered to be associate with pansystolic murmur except:
D: mitral valve prolapse
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21. Which of the following murmurs star well after ejection?
B: late systolic
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22. All of the following are associated with a late systolic murmur except:
C: valvular pulmonic stenosis
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23. Which of the following murmurs begins immediately after the second heart sound?
A: early diastolic
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24. Which of the following is most likely to cause an early diastolic murmur?
A: aortic valve regurgitation
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25. Which of the following murmurs is caused by forward flow across an atrioventricular valve?
B: mid-diastolic
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26. All of the following are associated with a mid-diastolic or late diastolic murmur except:
D: aortic regurgitation
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27. Which of the following murmurs may result from blood flow constantly moving from a high pressure to a low pressure area?
D: continuous
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28. All of the following are associated with a continuous murmur except:
C: severe mitral regurgitation
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29. Which effect will the strain phase of the Valsalva maneuver have on venous return?
B: decrease
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30. All of the following murmurs will decrease in intensity during the strain phase of the Valsava except:
C: hypertrophic obstructive cardiomyopathy
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31. What effect with isometric handgrip have on mitral regurgitation?
A: increase
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32. What effect will isometric handgrip have on valvular aortic stenosis?
B: decrease
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33. What effect will the inhalation of amyl nitrite have on a ventricular septal defect murmur?
B: decrease
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34. What effect will the inhalation of amyl nitrite have on left heart regurgitant murmurs?
B: decrease
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35. What effect will the inhalation of amyl nitrite have on the murmur of hypertrophic obstructive cardiomyopathy?
A: increase
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36. What effect will the inhalation of amyl nitrite have on mitral valve prolapse?
A: increase
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1. Which of the following is used to evaluate the cardiovascular repsonse to exercise?
-a: exercise stress test
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2. All of the following are indications for an exercise stress test except:
-c: valvular aortic stenosis
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3. Which of the following is the most reliable indicator of myocardial ischemia during a exercise stress test examination:
-a: ST segment depression
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4. Which of the following is a positive inotripe and positive chronotrope?
-d: dobutamine
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5. All of the following may induce myocardial ischemia via dilation of the coronary arteries except:
-d: dobutamine
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1. A graphic recording of heart sounds are murmurs is the:
-b: phonocardiogram
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2. All of the following may be performed during a phonocardiographic examination except:
-d: atrial pressure tracing
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