2313 Exam 4

1. Case One: 48 y/o male. Several hours chest discomfort. 25 years smoking and father CAD—The Diagnosis is:

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:

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:

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:

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:

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:

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:

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:

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:

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:

1. S1 is caused by:

2. For cardiac auscultation, the mitral area is considered to be the:

3. For Cardiac auscultation, the tricuspid area is considered to be the:

4. S2 is caused by:

5. For cardiac auscultation, the aortic are is the:

6. For cardiac auscultation the pulmonic area is the:

7. With inspiration, the interval between the two componenets of S2, aortic and pulmonic valve closure is:

8. S3 occurs in:

9. Another term used to describe the S3 is:

10. All of the following pathologies are associated with an S3 except:

11. The S4 occurs in response to:

12. S4 indicates:

13. A loud S1 may indicate the presence of:

14. Ano opening snap is associated with:

15. An ejection sound or click is associated with:

16. The midsystolic click may indicate the presence of mitral valve:

17. Fixed split S2 is associated with:

18. Which of the following heart sounds is associated with pericarditis?

19. Which of the following heart sounds is associated with constrictive pericarditis?

1. Which of the following is incorrect when describing the auscultation areas for the cardiac valves?

2. A grade I murmur is a murmur that is:

3. A grade II murmur is a murmur that is:

4. A grade III murmur is a murmur that is:

5. A grade IV murmur is a murmur that is:

6. A grade V murmur is a murmur that is:

7. A grade VI murmur is a murmur that is:

8. A ___ murmur is one that begins softly and becomes louder:

9. A ___ murmur is a murmur that begins loud and becomes softer:

10. A ___ murmur begins softly, becomes louder and then decreases in loudness:

11. A ___ murmur begins loud, becomes softer, and then increases in loudness:

12. A low pitched murmur is best heard with the stethoscope’s:

13. A medium pitched murmur is bed heard with the stethoscope’s:

14. A high pitched murmur is best heard with the stethoscope’s:

15. Which of the following murmurs begins with the first heart sound and end in mid-systole?

16. All of the following are possible causes of early systolic murmurs except:

17. Which of the following murmurs begins after the semilunar valves open?:

18. All of the following are associate with a systolic ejection murmur except:

19. Which of the following murmurs is present when there is flow between two chambers that have widely different pressure throughout systole?

20. All of the following are considered to be associate with pansystolic murmur except:

21. Which of the following murmurs star well after ejection?

22. All of the following are associated with a late systolic murmur except:

23. Which of the following murmurs begins immediately after the second heart sound?

24. Which of the following is most likely to cause an early diastolic murmur?

25. Which of the following murmurs is caused by forward flow across an atrioventricular valve?

26. All of the following are associated with a mid-diastolic or late diastolic murmur except:

27. Which of the following murmurs may result from blood flow constantly moving from a high pressure to a low pressure area?

28. All of the following are associated with a continuous murmur except:

29. Which effect will the strain phase of the Valsalva maneuver have on venous return?

30. All of the following murmurs will decrease in intensity during the strain phase of the Valsava except:

31. What effect with isometric handgrip have on mitral regurgitation?

32. What effect will isometric handgrip have on valvular aortic stenosis?

33. What effect will the inhalation of amyl nitrite have on a ventricular septal defect murmur?

34. What effect will the inhalation of amyl nitrite have on left heart regurgitant murmurs?

35. What effect will the inhalation of amyl nitrite have on the murmur of hypertrophic obstructive cardiomyopathy?

36. What effect will the inhalation of amyl nitrite have on mitral valve prolapse?

1. Which of the following is used to evaluate the cardiovascular repsonse to exercise?

2. All of the following are indications for an exercise stress test except:

3. Which of the following is the most reliable indicator of myocardial ischemia during a exercise stress test examination:

4. Which of the following is a positive inotripe and positive chronotrope?

5. All of the following may induce myocardial ischemia via dilation of the coronary arteries except:

1. A graphic recording of heart sounds are murmurs is the:

2. All of the following may be performed during a phonocardiographic examination except: