Cardiology/ Cardiovascular Examination

Question 1

In order to obtain an accurate blood pressure (BP) reading, what percentage of a patient’s arm circumference should be encircled by the BP cuff bladder?

Answer 1

80%

Question 2

In the office setting, BP measurements are usually obtained while the patient is resting and seated upright. Describe the proper patient preparation as well as cuff and stethoscope positioning which is most likely to produce an accurate reading.

Answer 2

Patient has rested for at least 5 minutes. Legs are uncrossed and well-supported (not hanging from exam table). Clothing removed from upper arm where bladder cuff is placed. Arm is supported. Cuff is at the level of the heart. Patient is relaxed (not talking). Stethoscope bell placed over brachial artery in antecubital fossa.

Question 3

When auscultating for Korotkoff sounds, why is it preferable to use the stethoscope bell (versus diaphragm)?

Answer 3

Korotkoff sounds are low-pitched

Question 4

Surface anatomy of hear sounds - which heart sound?

Left 5th or 6th intercostal space at the mid-clavicular line (apex of heart)

Answer 4

Mitral valve

Question 5

Surface anatomy of heart sound - which heart sounds?2nd or 3rd intercostal space at the right upper sternal border

Answer 5

Aortic valve

Question 6

Which heart sound? 4th or 5th intercostal space at left lower sternal border

Answer 6

Tricuspid valve

Question 7

Which heart sound? 2nd or 3rd intercostal space at the left upper sternal border

Answer 7

Pulmonic valve

Question 8

Likely abdnormality or disease?

Laterally and/or inferiorly displaced PMI

Answer 8

• Enlarged left ventricle, most often caused by hypertension (HTN)

Question 9

Likely abdnormality or disease?

Pericardial friction rub

Answer 9

Pericarditis

Question 10

Likely abdnormality or disease?

Split S2 during inspiration

Answer 10

None (this is a physiologic split S2)

Question 11

Likely abdnormality or disease?

Split S2 during expiration (paradoxical split)

Answer 11

• Left bundle branch block (most common cause)
• aortic stenosis

Question 12

Likely abdnormality or disease?

Wide split S2 (that varies with respiration)

Answer 12

• Pulmonic stenosis
• right bundle branch block
• mitral regurgitation

Question 13

Likely abdnormality or disease?

Fixed wide split S2 (not varying with respiration)

Answer 13

• Atrial septal defect (ASD) or right ventricular failure

Question 14

Likely abdnormality or disease?

Narrow splitting of S2 (increased P2)

Answer 14

Pulmonary HTN

Question 15

Likely abdnormality or disease?

Physiologic S3

Answer 15

Children, young adults, pregnant women

Question 16

Likely abdnormality or disease?

Nonphysiologic S3

Answer 16

• CHF
• enlarged ventricles
• mitral or tricuspid regurgitation

Question 17

Likely abdnormality or disease?

Physiologic S4

Answer 17

Athletes

Question 18

Nonphysiologic S4

Answer 18

HTN, coronary artery disease (CAD), aortic stenosis

Question 19

Continuous machine-like murmur (congenital)

Answer 19

Patent ductus arteriosus

Question 20

Mid-systolic click with late systolic murmur

Answer 20

Mitral valve prolapsed

Question 21

Loud S1, opening snap, mid-diastolic rumble l

Answer 21

Mitral valve stenosis

Question 22

Bounding pulse, wide pulse pressure, soft but high-pitched early diastolic decrescendo murmur, best heard if patient leans forward

Answer 22

Aortic regurgitation

Question 23

Harsh systolic murmur, increased with Valsalva, often with S3 and S4

Answer 23

Hypertrophic cardiomyopathy

Question 24

Decreased pulse pressure, paradoxical split S2, harsh ejection murmur radiating to carotids

Answer 24

Aortic stenosis

Question 25

Holosystolic blowing murmur at the apex radiating to the axilla

Answer 25

Mitral regurgitation

Question 26

Holosystolic blowing murmur at the lower left sternal border radiating to the sternum; inspiration increases intensity

Answer 26

Tricuspid regurgitation

Question 27

Diminished P2 with widely split S2 (or inaudible P2 and thus, no split), harsh mid-systolic murmur, most often found in children

Answer 27

Pulmonic stenosis

Question 28

Harsh holosystolic murmur, very loud and often with thrill (congenital)

Answer 28

Ventral septal defect

Question 29

HTN in the upper extremities with decreased pressure in the lower extremities, femoral pulse is slight or delayed, rib-notching on CXR

Answer 29

Coarctation of the aorta

Question 30

Carotid bruit

Answer 30

• Arteriosclerosis
• arterial aneurysm
• thyroid artery dilation
• AV fistula

Question 31

Roth spots are …

Answer 31

Retinal hemorrhages with white centers seen by fundoscopy

Question 32

Splinter hemorrhages are …

Answer 32

Narrow and straight lines of hemorrhage underneath the finger and toenail

Question 33

Janeway lesions are ….

Answer 33

Nontender, hemorrhagic macules, or nodules on the palms and soles

Question 34

Osler nodes are …

Answer 34

Tender, red, raised lesions on the finger pads

Question 35

What is pulsus paradoxus?

Answer 35

A patient’s systolic BP falls more than 10 mm Hg (and causes weakening of the pulse) during inspiration.

Question 36

What causes pulsus paradoxus?

Answer 36

• Pericardial tamponade
• asthma, shock
• pulmonary embolism

Question 37

What is Beck triad of cardiac tamponade?

Answer 37

1. Jugular venous distension (JVD)
2. Hypotension
3. Muffled/distant heart sounds