Deck 7: Cardiac and Peripheral Vascular Systems

Question 1

An S₃ gallop is commonly heard in:

A) Children with fever
B) Adults with heart failure
C) Children with aortic stenosis
D) Adults with hypertension

Answer 1

Adults with heart failure

Question 2

Which of the following heart sounds is commonly heard after myocardial infarction?

A) Friction rub
B) S₄
C) S₃
D) Opening snap

Answer 2

Friction rub

Question 3

According to the 2017 American College of Cardiology/American Heart Association guidelines, which of the following blood pressure measurements is categorized as prehypertension?

A) 110/78 mm Hg
B) 128/79 mm Hg
C) 142/80 mm Hg
D) 145/92 mm Hg

Answer 3

128/79 mm Hg

Question 4

The second heart sound (S₂) occurs because of the closure of the:

A) Aortic valve
B) Tricuspid valve
C) Aortic and pulmonic valves
D) A and B

Question 5

Which of the following is the most important question to ask during a cardiovascular health history?

A) Number of offspring
B) Last physical examination
C) Sudden death of a family member
D) Use of caffeine

Question 6

An S₄ sound is commonly heard in:

A) Children with fever
B) Adults with atrial fibrillation
C) Adults with hypertension
D) Children with pulmonic stenosis

Question 7

Which is the most specific and sensitive test for validating a myocardial infarction?

A) 12-lead electrocardiogram
B) Troponin
C) CK-MB
D) Computed tomography scan

Question 8

On inspecting the patient, you find jugular venous distension. This is a sign of:

A) Left ventricular hypertrophy
B) Right ventricular failure
C) Hypertension
D) Valve disease

Question 9

Your patient has a dysrhythmia and has been on a diuretic for 2 months. Which of the following should be suspected?

A) Potassium imbalance
B) Sodium deficit
C) Calcium imbalance
D) Insufficient diuretic

Question 10

The first heart sound (S₁) occurs because of the closure of the:

A) Aortic and mitral valves
B) Mitral and tricuspid valves
C) Pulmonic valve
D) Aortic valve

Question 11

To distinguish a physiological split S₂ heart sound, it is best to listen with the stethoscope at the:

A) Left fifth intercostal space midclavicular line
B) Fourth intercostal space left sternal border with patient holding his or her breath
C) Second intercostal space left sternal border with inspiration
D) Fourth intercostal space right sternal border with expiration

Question 12

Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of:

A) Anemia
B) Anxiety
C) Hyperthyroidism
D) All of the above

Question 13

A pulse rate of 56 beats per minute can be normal in:

A) Elderly patients
B) Newborns
C) Athletic individuals
D) Hypertensive patients

Question 14

Cardiac chest pain is most often described as:

A) Stabbing, piercing pain
B) Pain with inhalation
C) Crushing, squeezing pain
D) Burning, gnawing pain

Question 15

On an electrocardiogram, you see a deepened Q wave that is greater than one-third the height of the QRS complex. This is indicative of:

A) Acute myocardial infarction
B) Acute myocardial ischemia
C) Left ventricular hypertrophy
D) Past myocardial infarction

Question 16

Cardiovascular disease risk increases in women after age:

A) 30
B) 40
C) 45
D) 55

Question 17

On an electrocardiogram (EKG), an anterior wall myocardial infarction is demonstrated on leads:

A) II, III, AVR
B) II, III, AVF
C) V1, V2, V3, V4
D) I, AVL, V5, V6

Question 18

Xanthelasma is a skin condition that should alert the clinician to _________________ in a patient.

A) Familial hyperlipidemia
B) Type 2 diabetes
C) Congenital heart disease
D) Peripheral arterial disease

Question 19

When palpating the chest, you find the point of maximal impulse (PMI) in the left midaxillary region. This can be indicative of:

A) Normal PMI
B) Congenital heart disease
C) Ventricular hypertrophy
D) Hypertension

Question 20

Your patient has suffered an inferior wall myocardial infarction. This is most commonly due to an obstruction in the:

A) Posterior branch of the right coronary artery
B) Circumflex branch of the left coronary artery
C) Right main coronary artery
D) Left main coronary artery

Question 21

It is important for clinicians to recognize that individuals with _______________ often sustain silent myocardial infarction.

A) Diabetes mellitus
B) Hypertension
C) Valvular disorders
D) Congenital heart defects

Question 22

The pain of costochondritis typically:

A) Mimics cardiac crushing and squeezing pain
B) Worsens with movement and full inspiration
C) Radiates from the epigastrium into the back
D) Is a tearing and ripping pain

Question 23

The medical record of your patient lists a grade III systolic murmur. This indicates the patient has a heart murmur that is:

A) Soft and after S₂
B) Loud and crescendo in quality
C) Moderately loud and after S₁
D) Loud and after S₂

Question 24

The radiation of a mitral valve murmur is commonly heard in the:

A) Carotid arteries
B) Left midaxillary line
C) Base of the heart
D) Left midclavicular line

Question 25

Classically in mitral valve prolapse, the clinician can hear a(n):

A) Midsystolic click followed by a grade I murmur that crescendos up to S₂
B) Opening snap followed by a grade III holosystolic murmur
C) Crescendo-decrescendo grade I diastolic murmur after S₂
D) Rough grade III holosystolic murmur that obscures S₁ and S₂

Question 26

Due to increased left atrial pressure, a patient with mitral stenosis often suffers from:

A) Pulmonary congestion
B) Hepatomegaly
C) Jugular venous distension
D) Ventricular tachycardia

Question 27

From Erb's point, all the heart valves can be heard equally. Erb's point is located over the:

A) Third intercostal space left sternal border
B) Fifth intercostal space right sternal border
C) Fourth intercostal space left sternal border
D) Third intercostal space right sternal border

Question 28

The pain of pancreatitis is described as:

A) Abdominal sharp and piercing pain in the left upper quadrant
B) Dull and cramping pain in the right upper quadrant
C) Severe, epigastric pain radiating straight into the back
D) Sharp pain radiating to the shoulder

Question 29

In mitral stenosis, the murmur can be best heard with the patient in the:

A) Squatting position
B) Seated position
C) Left lateral recumbent position
D) Supine position

Question 30

On examination of a child, an innocent systolic murmur is heard at the second intercostal space left sternal border. This is usually due to:

A) Atrial septal defect
B) Patent foramen ovale
C) Low flow velocity
D) High flow turbulence

Question 31

The best diagnostic test that allows analysis of a heart murmur is:

A) Computed tomography scan
B) Echocardiogram
C) Magnetic resonance imaging
D) Electrocardiogram

Question 32

The key sign(s) of aortic stenosis are:

A) Syncope
B) Dyspnea
C) Angina
D) All of the above

Question 33

In mitral stenosis, the murmur occurs:

A) From S₁ through S₂ as a holosystolic murmur
B) After an opening snap that is heard after S₂ during diastole
C) As a soft midsystolic click
D) As a loud crescendo-decrescendo systolic murmur

Question 34

The murmur of aortic stenosis is best heard in the:

A) Left second intercostal space left sternal border
B) Left fifth intercostal space midclavicular line
C) Right fourth intercostal space right sternal border
D) Right second intercostal space right sternal border

Question 35

The pain associated with pericarditis is _________________________.

A) Crushing and squeezing
B) Constant
C) Worse with inspiration
D) Only present with fever

Question 36

Pain associated with a dissecting thoracic aortic aneurysm is commonly described as:

A) Retrosternal crushing and squeezing
B) Chest stabbing and sharp
C) Ripping and tearing in the chest or thoracic back
D) Worse with inspiration

Question 37

The pulmonary valve is best heard over the:

A) Left second intercostal space left sternal border
B) Left fifth intercostal space midclavicular line
C) Right fourth intercostal space right sternal border
D) Right second intercostal space right sternal border

Question 38

The tricuspid valve is best heard over the:

A) Third intercostal space left sternal border
B) Fifth intercostal space right sternal border
C) Fourth intercostal space left sternal border
D) Third intercostal space right sternal border

Question 39

The most common cause of tricuspid regurgitation is:

A) Left ventricular hypertrophy
B) Left atrial enlargement
C) Aortic stenosis
D) Pulmonary hypertension

Question 40

The pain of ___________________ can frequently be mistaken for cardiac chest pain.

A) Gastroesophageal reflux disease
B) Peptic ulcer disease
C) Cholecystitis
D) All of the above

Question 41

A 23-year-old patient presents to the emergency department with high fever, chills, extreme fatigue, and arthralgias. Your physical examination reveals grade II heart murmur heard loudest over the fourth intercostal space left sternal border. The arms of the patient reveal past IV drug abuse. The clinician should recognize these are signs and symptoms of:

A) Pulmonary embolism
B) Right ventricular failure
C) Functional heart murmur
D) Bacterial endocarditis

Question 42

After multiple pregnancies, the following vascular disorder is common:

A) Deep venous thrombosis
B) Varicose veins
C) Peripheral arterial disease
D) Aortic aneurysm

Question 43

A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination, you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms?

A) Arterial insufficiency
B) Femoral vein thrombus
C) Venous insufficiency
D) Peripheral neuropathy

Question 44

Your patient complains of worsening ankle edema and weight gain over the last week. On physical examination, you note jugular venous distension, ascites, hepatomegaly, and splenomegaly. These conditions are indicative of:

A) Left ventricular failure
B) Pulmonary embolism
C) Right ventricular failure
D) Myocardial infarction

Question 45

The target body mass index for women is:

A) 27 kg/m²
B) 25 kg/m²
C) 22 kg/m²
D) 16 kg/m²

Question 46

The murmur of a ventricular septal defect occurs when the ventricle contracts and blood flows from the left ventricle into the right ventricle. This creates a ____________ heart murmur.

A) Holodiastolic
B) Early diastolic
C) Holosystolic
D) Late systolic

Question 47

Which of the following conditions is/are part of metabolic syndrome?

A) Hypertension
B) Hyperlipidemia
C) Insulin resistance
D) All of the above

Question 48

Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms?

A) Femoral vein thrombosis
B) Femoral artery thrombus
C) Venous insufficiency
D) Musculoskeletal injury

Question 49

Your patient has had hypertension for 10 years, a myocardial infarction 5 years ago, and now complains of dyspnea on exertion, cough, and three-pillow orthopnea. Which of the following conditions is likely?

A) Right ventricular failure
B) Pulmonary embolism
C) Cor pulmonale
D) Left ventricular failure

Question 50

A patient with significant aortic stenosis often suffers from:

A) Pulmonary hypertension
B) Jugular venous distention
C) Peripheral vascular disease
D) Left-sided heart failure

Question 51

A patient with hypertension who has hyperlipidemia should aim for an LDL measurement of:

A) 130 mg/dL or less
B) 40 mg/dL or less
C) 100 mg/dL or less
D) 60 mg/dL or less

Question 52

When an examiner presses on the liver and elicits hepato-jugular reflux, which of the following conditions is likely?

A) Left ventricular failure
B) Right ventricular failure
C) Hepatomegaly
D) Pulmonary edema

Question 53

An atrial septal defect (ASD) causes a left to right shunt, which enlarges the right atrium. Because of this effect, which of the following conditions often occur with ASD?

A) Asthma
B) Jugular venous distension
C) Atrial fibrillation
D) B and C

Question 54

Your 47-year-old female patient has a waist to hip ratio of 0.1. In terms of cardiovascular disease risk, this is considered:

A) Ideal
B) Greater than acceptable limits
C) Less than acceptable limits
D) Within acceptable limits

Question 55

Dyspnea, cough, and pulmonary crackles are symptoms that can occur in left ventricular failure and respiratory disorders, such as pneumonia. Which of the blood tests below can be used to differentiate cardiovascular from pulmonary disease?

A) Brain atriuretic peptide
B) Pulse oximetry
C) Arterial blood gases
D) High sensitivity C reactive protein (hs-CRP)

Question 56

Aortic regurgitation occurs after S₂ during ___________________ because there is turbulent flow that refluxes into the left ventricle after the aortic valve closes.

A) Early diastole
B) Late diastole
C) Early systole
D) Mid-systole