Download 1. Which of the following valvular conditions would be associated

1. Which of the following valvular conditions would be associated with left lateral
displacement of the PMI (point of maximum impulse)?
A) Mitral insufficiency
B) Aortic insufficiency
C) Both of the above
D) Neither of the above
2. All of the following make up a mogul of the mediastinum on the PA (frontal) view of the
chest except:
A) Superior vena cava and right atrium
B) Right ventricle
C) Pulmonary trunk (main pulmonary artery)
D) left atrium
E) left ventricle
3. A 40 year old man with a long history of alcoholism presents with dyspnea. The
preliminary admitting diagnosis is dilated cardiomyopathy. A Chest Xray is performed. The
findings that would be most consistent with this diagnosis would be;
A) A cardio-thoracic ratio of less than 50%
B) Alveolar consolidation with air bronchogram
C) Kerley B lines (interstitial edema)
D) Bronchiectasis (dilatation of the bronchi)
E) Narrowing of the trachea
4. A 12 year old boy complains of dyspnea on exertion. On examination of the heart, you
notice a 3/6 diastolic murmur along the left sternal border heard best with the patient sitting
forward after exhaling. This murmur most likely represents;
A) Aortic Stenosis
B) Aortic Insufficiency
C) Pulmonary Stenosis
D) Tricuspid Insufficiency
E) Mitral Insufficiency
5. A 42 year old man presents to the emergency room complaining of the sudden onset of
palpitations. The resident immediately orders an electrocardiogram which he says demonstrates
atrial fibrillation. On auscultation of the heart, you would most likely hear;
A) a regularly irregular rhythm
B) an irregularly irregular rhythm
C) a regular rhythm with an extra beat every 2-3 beats
D) absence of splitting of the second heart sound
E) no heart sounds
6. A 35 year old woman presents with dyspnea. On exam she has a right ventricular lift and
you hear an accentuated 2nd component of the second heart sound. Her lungs are clear to
auscultation. The most likely diagnosis is?
A) Tricuspid stenosis
B) Pulmonary hypertension
C) Systemic hypertension
D) Congestive heart failure
E) Mitral stenosis
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7. A 77 year old man presents with orthopnea. You raise his right hand above his body and
the veins in his hand collapse when it is 15 cm above his chest. The best interpretation of this is,
A) He is dehydrated
B) He has atherosclerosis of the veins
C) He has elevated central venous pressure
D) This is a normal finding
8. A 28 year old woman presents with frequent chest pains that are not associated with
exertion. She states that they are stabbing, sharp, and not associated with dyspnea or diaphoresis.
She is able to point to the location of the pain with one finger and states that it does not radiate.
Her sister has similar symptoms. She does not smoke, has never been told she had diabetes or
hypertension, has no family history of premature death, and her cholesterol was not elevated
when last checked. She runs about 2 miles several times a week without problems. On
examination you would most likely hear;
A) Opening snap
B) Midsystolic click
C) Ejection sound
D) Continuous systolic-diastolic murmur
E) Fixed splitting of second heart sound
9. The cardiac valve that sits in the center of the heart in both axial and coronal section is
A) Tricuspid valve
B) Pulmonic valve
C) Mitral valve
D) Aortic valve
E) None of the above
10. A 64 year old woman went to bed breathing normally, but awoke at 2 AM gasping for
breath. She sat at the side of her bed and felt better, but every time she tried to lay down, the
dyspnea returned. The symptoms have been occurring nightly for the past 2 weeks and she has
had to sleep in a chair. This history is most characteristic of which of the following;
A) Chronic obstructive lung disease
B) Recurrent pulmonary emboli
C) Congestive heart failure
D) Recurrent myocardial infarction
E) Recurrent ventricular arrythmias
11. In taking the blood pressure, the best reason why it is important to check the systolic
pressure by palpation before auscultation is,
A) to make sure the manometer is working correctly
B) to let the patient relax before really taking the pressure
C) to avoid underestimating the systolic pressure because of an auscultatory gap
D) to check for arrythmias
E) to check for leaks in the cuff
12) Normally, the second heart sound, S2, splits during inspiration and is single during
expiration. The splitting is due to:
A) A delay in tricuspid valve closure
B) A delay in pulmonic valve closure
C) A delay in mitral valve closure
D) A delay in aortic valve closure
E) None of the above
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13) The most posterior chamber of the normal heart (closest to the spine) is the:
A) Right atrium
B) Left atrium
C) Right ventricle
D) Left ventricle
E) Aorta
MATCH THE FOLLOWING CARDIAC SOUNDS WITH THE PHYSIOLOGIC EVENTS:
14) S1
15) S2
16) OS (Opening Snap)
17) Ejection sound
A) Opening of mitral valve
B) Opening of aortic valve
C) Closure of mitral valve
D) Closure of aortic valve
E) atrial contraction
MATCH THE AREA OF AUSCULTATION WITH THE BEST PLACE TO LISTEN FOR
THE FOLLOWING MURMURS:
18) Mitral Stenosis
19) Pulmonary insufficiency
20) Aortic stenosis
21) Tricuspid insufficiency
A) 2nd right interspace
B) 2nd left interspace
C) Apex
D) Lower left sternal border
E) Supraclavicular fossa
22) A 72 year old gentleman presents with syncope. On exam you notice a harsh systolic
crescendo-decrescendo murmur that radiates to the carotids. The most likely diagnosis is;
A) Tricuspid insufficiency
B) Mitral stenosis
C) Mitral insufficiency
D) Aortic stenosis
E) Pulmonary stenosis
23) On chest X-ray, a lung opacity would least likely be;
A) Emphysema
B) Lobar collapse
C) Interstitial lung disease
D) Alveolar consolidation
E) Tumor
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MATCH THE FOLLOWING HEART MURMURS WITH THE BEST TECHNIQUE FOR
HEARING THEM
24) Mitral Stenosis
25) Tricuspid insufficiency
A) Ask patient to sit and to bend forward. Auscultate preferably after expiration
B) Ask patient to roll on left side, use bell of stethoscope with light pressure
C) Ask patient to sit up and listen along infrascapular area
D) Ask patient to take a deep breath and listen during inspiration
26) Radiologic criteria for alveolar lung disease would least likely be described as;
A) Linear
B) Miliary
C) Focal
D) Reticulonodular
E) Diffuse
27) Which of the following valvular disorders is associated with a prominent PMI (point of
maximal impulse);
A) Mitral stenosis
B) Aortic stenosis
C) Both of the above
E) Neither of the above
28) A 30 year old woman with a history of rheumatic fever as a child presents to you with
complaints of getting easily fatigued. On examination of the heart, you hear an accentuated S 1, a
murmur that starts with S 1 and continues with the same intensity to S2, and then abruptly stops.
This murmur is best described as;
A) Crescendo-Decrescendo murmur
B) Ejection murmur
C) Holosystolic murmur
D) Continuous machinery murmur
E) Diastolic rumble
Questions 29 and 30 refer to the same patient:
29) A 68-year-old man presents to the emergency room and is found to have a blood pressure
of 170/40. A pulse pressure such as this is consistent with which of the following states:
A) Mitral insufficiency
B) Aortic insufficiency
C) Both of the above
D) Neither of the above
30) Regarding the above patient, which of the following signs would you expect him to
exhibit;
A) Waterhammer pulse (also known as Corrigan's or Collapsing pulse)
B) Pulsus Tardus and Parvus (or plateau pulse)
C) Pulsus paradoxus
D) Pulsus alternans
E) Bigeminal pulse
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31) During a physical diagnosis practice session, you take the blood pressure of a classmate
and find it to be 150/100. He states that his blood pressure has always been 120/80 before and
that you are using the wrong cuff. An artifactual elevation of blood pressure readings can be
caused by choosing;
A) A blood pressure cuff that is too large for the student's arm
B) A blood pressure cuff that is too small for the student's arm
C) Both of the above
D) Neither of the above
32) Of the following, the most common cause of focal alveolar consolidation is;
A) Viral pneumonia
B) Bacterial pneumonia
C) Metastatic disease to the lungs
D) Primary lung cancer
33) On examining a patient, jugular veins were noted to be distended to the angle of the mandible
with the patient sitting upright. The best interpretation of this is;
A) The patient has increased preload
B) The height of the jugular veins above the clavicle is a measure of left atrial pressure.
C) The patient has increased afterload
D) Neck veins distension is diagnostic of cardiac disease
E) The neck vein distension would likely decrease if the patient was to lay flat
34) A 68 year old man is admitted with chest pain. A presumptive diagnosis of dissecting aortic
aneurysm is made from the history, examination, and review of the Chest X-ray (widened
mediastinum). Of the following, which history is most consistent with this diagnosis;
A) Chest pain that worsens on inspiration
B) Chest pain that worsens with exertion
C) Chest pain that is "tearing" in quality
D) Chest pain that worsens on eating
E) Chest pain that can be pointed to with one finger
Questions 35 and 36 are related to the same patient
35) A 16 year old boy complains of acute onset of chest pain which is worse on deep inspiration
and improves on sitting up and leaning forward. On physical examination, a scratchy, three
component sound is heard along the left sternal border. The most likely diagnosis is;
A) acute bacterial endocarditis
B) acute pulmonary embolus
C) acute pericarditis
D) acute myocardial infarction
E) acute costochondritis
36) On further examination of the above patient, it is noticed that his blood pressure drops 30
mm/hg when he takes a deep breath. This phenomenon is called:
A) Orthostatic hypotension
B) Sinus arrythmia
C) Pulsus paradoxes
D) Pulsus alternans
E) Auscultatory gap
37) A 44 year old man is found to have severe aortic stenosis due to a bicuspid aortic valve.
On examination, you would most likely find;
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A) Slow and delayed upstroke of the carotid artery
B) Accentuated first component of the second heart sound
C) Both of the above
D) Neither of the above
38) A 33 year old woman presents with palpitations. In writing up a history and physical,
which of the following would be best placed in the Review of Systems;
A) Appendectomy at age 12
B) Normal Chest Xray on admission
C) smoked 3 packs/day for 20 years
D) Works as a chemist
E) Developed an earache yesterday
39) A 22 year old man with a history of intravenous drug use presents with dyspnea. On exam
e has a 3/6 holosystolic murmur at the lower left sternal border that increases with inspiration.
His liver is pulsatile. On examination of his jugular veins, you would most likely find;
A) No jugular venous distension
B) Prominent systolic waves (c-v merger)
C) Kussmaul' sign (increased jugular venous distension on inspiration)
D) Absence of hepatojugular reflex (decrease in jugular venous distension on
compression of the liver)
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ANSWERS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
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21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
C
B
C
B
B
B
C
B
D
C
C
B
B
C
D
A
B
C
B
A
D
D
C
B
D
C
B
C
B
A
B
B
A
C
C
C
A
E
B
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