cardiovascular exam #2 Flashcards

1
Q

aortic stenosis, what kind of murmur?

A

ejection systolic murmur
crescendo - decrescendo

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2
Q

mitral regurgitation… what kind of murmur?

A

pan-systolic murmur
loudest at apex
parasternal heave
peripheral edema

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3
Q

mitral stenosis… what kind of murmur?

A

the mid-diastolic murmur
loudest at apex
malar flush
tapping apex beat

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4
Q

aortic regurgitation

A

the early diastolic murmur
collapsing pulse
wide pulse pressure
displaced apex beat

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5
Q

know the “APT M” pneumonic

A

Aortic - right 2nd intercostal space
Pulmonic - left 2nd intercostal space
Tricuspid - left 4th intercostal space
Mitral - Apex

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6
Q

pulses alternans

A

“alternans” think alteration
there’s an alteration of the pressure pulse amplitude
associated with very poor LV systolic function

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7
Q

pulses bisferiens

A

see the prefix, “bi”
characterized by two systolic peaks
associated with severe aortic regurg or HOCM

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8
Q

pulsus paradoxus

A

exaggeration of normal decrease in systolic blood pressure. to be considered abnormal, drop must be greater than 10mmHg
associated with cardiac tamponade

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9
Q

pulsus parvus et tardus

A

small, weak, late peaking pulse.. associated with valvular aortic stenosisd

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10
Q

displacement of point of maximal impulse

A

point of maximal impulse measures less than 2 to 3 cm in diameter and confined to single intercostal space. Displacement downward and to left indicates usu an enlarged heart

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11
Q

edema

A

rated from 1+ to 4+
peripheral edema is associated with right heart failure
pulmonary edema is associated with left heart failure

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12
Q

left parasternal lift

A

due to anterior displacement of the right ventricle due to a large left atrium; may be found in patients with severe, chronic mitral regurg

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13
Q

left ventricular thrust

A

left ventricular hypertrophy results in exaggerated amplitude and duration of normal left ventricular thrust. associated with aortic stenosis, hypertrophic cardiomyopathy, systemic hypertension

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14
Q

left ventricular systolic bulge

A

a left ventricular systolic bulge is a larger than normal area of pulsation of the left ventricular apex. Associated with left ventricular aneurysm

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15
Q

Thrills

A

palpable manifestation of loud, harsh murmurs with low frequency components. Asssociated with aortic stenosis, pulmonic stenosis, and VSD

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16
Q

Angina

A

cheat pain due to myocardial ischemia. Chest pain in general may indicate presence of pericarditis, dissecting aortic aneurysm, pulmonary embolus, pneumothorax, gastrointestinal problems or acute anxiety

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17
Q

cachexia

A

state of ill health, malnutrition and wasting; associated with long standing heart dz

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18
Q

clubbing

A

condition that affects fingers and toes; lateral and longitudinal curvature of the nails accompanied by soft tissue enlargement. Associated with cyanotic heart dz

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19
Q

congestive heart failure

A

from failure of heart to maintain adequate circulation of blood. Causes of congestive heart failure include myocardial dysfunction, pressure overload, volume overload, diastolic dysfunction, increased metabolic demands

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20
Q

cor pulmonale

A

defined as combo of hypertrophy and dilatation of right ventricle caused by pulmonary hypertension that results from process intrinsic to lungcy

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21
Q

cyanosis

A

blush discoloration of skin/mucuos membranes. Associated with right to left cardiac shunts or pulmonary dz

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22
Q

Dyspnea

A

Abnormal uncomfortable awareness of breathing; main symptom for cardiac and pulmonary dz. 2 types that may indicate cardiac origin:
1. orthopnea - dyspnea while lying flat (associated with congestive heart failure)
2. paroxysmal nocturnal dyspnea (dyspnea that interrupts sleep) usually caused by pulmonary edema secondary to left ventricular failure

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23
Q

edema

A

accumulation of fluid in cells, tissues or cavities. Hypertension, left ventricular failure, and increased venous pressure secondary to right heart failure are possible causes of cardiac related edema

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24
Q

fever/chills

A

history of fever and chills is common in patients with history of infective endocarditishe

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25
Q

hepatomegaly

A

enlargement of liver and assoc with right heart failure

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26
Q

hemoptysis

A

appearance of blood in sputum due to pulmonary hemorrhage.. associated with mitral stenosis

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27
Q

jugular venous distention

A

indicates high pressure in right heart

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28
Q

nocturia

A

excessive urination at night and associated with congestive heart failure

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29
Q

palpitations

A

cardiac arrhythmias, smoking, exercise, stress, excessive consumption of caffeine

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30
Q

pectus excavatum/carinatum

A

forward projection of sternum; is backward displacement of lower sternum and xiphoid cartilage causing a hollow area over lower sternum. Thoracic cage abnormalities are associated with Marfan’s syndromee and mitral valve prolapse

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31
Q

Syncope

A

fainting, light headedness, problems in pts with cardiac dz… includes arrhythmias, angina, myocardial infarction, left ventricular outflow tract obstruction, hypotension, pacemaker failure

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32
Q

Which of the following is incorrect when describing the auscultation areas for the cardiac valves?
a. aortic: right upper sternal border
b. pulmonic: left upper sternal border
c. mitral: lower left sternal border
d. tricuspid: xiphoid area

A

mitral: lower left sternal border

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33
Q

A grade 1 murmur is a murmur that is

A

barely heard

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34
Q

a grade 2 murmur is a murmur that is

A

faintly heard

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35
Q

a grade 3 murmur is a murmur that is

A

moderately loud

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36
Q

a grade 4 murmur is a murmur that is

A

loud

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37
Q

a grade 5 murmur is a murmur that is

A

very loud

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38
Q

a grade 6 murmur is a murmur that is

A

loud with a thrill

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39
Q

A _________ murmur is one that begins softly and becomes louder

A

crescendo

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40
Q

A ___________ murmur begins loud, becomes softer, and then increases in loudness

A

decrescendo-crescendo

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41
Q

A low pitched murmur is best heard with the stethoscopes

A

bell

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42
Q

A medium pitched murmur is best heard with the stethoscopes

A

both bell and diaphragm

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43
Q

a high pitched murmur is best heard with the stethoscopes

A

diaphragm

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44
Q

Which of the following murmurs begin with the first heart sound and end in mid systole?

A

early systolic

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45
Q

all of the following are possible causes of early systolic murmurs except:
a. valvular aortic stenosis
b. small ventricular septal defect
c. large ventricular septal defect with pulmonary hypertension
d. severe acute mitral/tricuspid regurgitation

A

valvular aortic stenosis

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46
Q

which of the following murmurs begins after the semilunar valves open?

A

systolic ejection

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47
Q

all of the following are associated with a systolic ejection murmur except

A

ventricular septal defect

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48
Q

which of the following murmurs is present when there is flow between two chambers that have widely different pressures throughout systole

A

pansystolic

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49
Q

all of the following are considered associated with a pan systolic murmur except :
a. mitral/tricuspid regurg
b. ventricle septal defect
c. aorticopulmonary shunts
d. mitral valve prolapse

A

mitral valve prolapse

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50
Q

which of the following murmurs start well after ejection?

A

late systolic

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51
Q

all of the following are associated with a late systolic murmur except:
a. papillary muscle dysfunction
b. myocardial ischemia/infarction
c. valvular pulmonic stenosis
d. mitral valve prolapse

A

valvular pulmonic stenosis

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52
Q

which of the following murmurs begins immediately after the second heart sound?

A

early diastolic

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53
Q

which of the following is most likely to cause an early diastolic murmur?
a. aortic valve regurgitation
b. mitral valve prolapse
c. patent ductus arteriosus
d. ventricular septal defect

A

aortic valve regurgitation

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54
Q

which of the following murmurs is caused by forward flow across an AV valve?

A

mid-diastolic

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55
Q

all of the following are associated with a mid-diastolic or late diastolic murmur except

A

aortic regurgitation

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56
Q

which of the following murmurs may result from blood flow constantly moving from a high pressure to a low pressure area

A

continuous

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57
Q

all of the following are associated with a continuous murmur except:
a. patent ductus arteriosus
b. systemic arteriovenous fistula
c. severe mitral regurgitation
d. coronary artery from the pulmonary artery

A

severe mitral regurg

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58
Q

which effect will the strain phase of the Vasalva maneuver have on venous return?
a. increase
b. decrease
c. varies
d. cannot be predicted

A

decrease

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59
Q

all of the following murmurs will decrease in intensity during the strain phase of the Vasalva maneuver except:
a. valvular aortic stenosis
b. mitral stenosis
c. hypertrophic obstructive cardiomyopathy
d. tricuspid regurgitation

A

hypertrophic obstructive cardiomyopathy

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60
Q

what effect will the isometric handgrip have on mitral regurgitation

A

increase

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61
Q

what effect will the isometric handgrip have on valvular aortic stenosis

A

decrease

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62
Q

what effect will the inhalation of amyl nitrite have on a ventricular septal defect murmur

A

decrease

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63
Q

what effect will the inhalation of amyl nitrite have on left heart regurgitant murmurs?

A

decrease

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64
Q

what effect will the inhalation of amyl nitrite have on the murmur of hypertrophic obstructive cardiomyopathy

A

increase

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65
Q

what effect will the inhalation of amyl nitrite have on mitral valve prolapse

A

increase

66
Q

what is used to evaluate the cardiovascular response to exercise?

A

exercise stress test

67
Q

What does this EKG strip represent

A

Normal sinus rhythm

68
Q

What does this EKG represent?

A

Sinus bradycardia

69
Q

EKG strip

A

Sinus tachycardia

70
Q

EKG strip

A

Sinus pause

71
Q

EKG strip

A

Premature atrial contraction

72
Q

EKG strip

A

Atrial flutter

73
Q

EKG strip

A

Atrial fibrillation

74
Q

EKG Strip

A

Premature Ventricular Contractions

75
Q

EKG Strip

A

Ventricular Tachycardia

76
Q

EKG strip

A

Ventricular fibrillation

77
Q

EKG strip

A

First degree AV block

78
Q

EKG Strip

A

2nd Degree AV block

79
Q

EKG strip

A

2nd degree AV block

2 types
- in mobitz 1, PR interval gets longer and longer until beat is blocked
- in mobitz 2, some beats are conducted while others are not

80
Q

EKG strip

A

3rd degree AV block
- p waves and QRS complexes occur independent of each other (atrial impulses don’t activate the ventricles)

81
Q

EKG strip

A

Artificial pacemaker

82
Q

All of these are indications for an exercise stress test…
- chest pain
- arrhythmias
- assessment of cardiovascular function
The following would NOT be an example

A

valvular aortic stenosis

83
Q

Which of the following is the most reliable indicator of myocardial ischemia during an exercise stress test examination?
- ST segment depression
- hypotension
- decrease in R wave voltage
- arrhythmias

A

ST segment depression

84
Q

which of the following is a positive inotrope and positive chronotrope?
- dipyridamole
- persantine
- adenosine
- dobutamine

A

dobutamine

85
Q

all of the following may induce myocardial ischemia via dilatation of the coronary arteries except:
- dipyridamole
- persantine
- adenosine
- dobutamine

A

dobutamine

86
Q

which of the following examinations is an invasive procedure used to visualize cardiac chambers. and the coronary arterial system:
-echocardiography
-electrocardiography
-electrocephalogram
-cardiac catheterization

A

cardiac catheterization

87
Q

Identify

A

MR

88
Q

Identify

A

Mitral stenosis

89
Q

Identify

A

AS

90
Q

Identify

A

AR

91
Q

all of the following may be assessed during a cardiac catheterization except :
-intracardiac pressures
-oxygen saturations
-ventricular function
-pericardial thickness

A

pericardial thickness

92
Q

all of the following may be assessed during a. right heart. catheterization. except:
-vena cava
-pulmonary veins
-right atrium
-pulmonary artery

A

pulmonary veins

93
Q

all of the following pressures may be measured during a right heart catheterization except
- right atrium
- right ventricle
- main pulmonary artery
- mean aortic

A

mean aortic

94
Q

the most common method of determining cardiac output during a right heart cardiac catheterization procedure is the

A

thermodilution

94
Q

during a right heart catheterization, oxygen saturations may be obtained in each of the following except
- vena cava
- pulmonary veins
- right atrium
- right ventricle

A

pulmonary veins

95
Q

the cardiac catheterization procedure that allows calculation of pressures on either side of the aortic valve is the

A

left heart catheterization

96
Q

all of the following pressures may be measured during a left heart catheterization except

A

pulmonary artery wedge

97
Q

the left heart cardiac catheterization procedure that allows for the evaluation of mitral regurgitation is

A

ventriculogram

98
Q

the cardiac catheterization procedure. that allows for the evaluation. of the coronary arterial system is

A

arteriogram

99
Q

significant coronary artery disease is considered present when the coronary artery diameter is reduced by at least

A

70%

100
Q

which of the following cardiac catheterization procedures is used to determine the percent stenosis of a coronary a artery

A

arteriogram

101
Q

which percent stenosis is considered significant coronary artery dz?

A

70%

102
Q

which of the following coronary arteries provides blood flow to the. anterior interventricular septum and the anterior wall of the left ventricle?

A

left anterior descending

103
Q

which of the following coronary arteries provides blood flow to the anterolateral and lateral walls of the left ventricle?

A

left. circumflex

104
Q

which of the following coronary arteries provides blood flow to the right ventricle?

A

right coronary

105
Q

which of the following coronary arteries provides blood flow to the inferior walls of the ventricles and the inferior interventricular septum in a right dominant system?

A

posterior descending

106
Q

in a left dominant coronary artery system, which of the following coronary arteries provides the posterior descending coronary artery?

A

left circumflex

107
Q

the formula used to determine valve area in the cardiac catheterization is

A

Gorlin

108
Q

The formula used to determine mitral valve area in the cardiac Cath lab is MVA (cm2) =

A

CO/DFP/38 x square root of MPG

109
Q

The formula used to determine the aortic. valve area. in the cardiac cath lab is

A

CO/SFP/44.5 x square root of MPG

110
Q

the most COMMON invasive method of determining cardiac output is

A

thermodilation

111
Q

Which invasive method to determine cardiac output measures the concentration of dye that has been injected into the right heart and measured at a distal arterial site

A

indicator dilution

112
Q

which of the following invasive methods used to determine cardiac output is considered THE MOST ACCURATE

A

Fick

113
Q

Which. of the following invasive techniques determine cardiac output by injecting dye into. the left ventricle and measuring ventricular volumes?

A

angiography

114
Q

which of. the following procedures during a cardiac. catheterization allows. for. the. detection of. an intracardiac shunt?

A

oximetry

115
Q

the following oxygen saturations have been recorded:
SVC: 72%
IVC: 78%
RA: 87%
RV: 87%
Main pulmonary artery: 87%
the diagnosis is

A

atrial septal defect

116
Q

the following oxygen saturations have been recorded:
SVC: 72%
IVC: 78%
RA: 75%
RV: 85%
main pulmonary artery: 85%
diagnosis is?

A

VSD

117
Q

the following oxygen saturations have been recorded:
SVC: 72%
IVC: 78%
RA: 75%
RV: 75%
Main pulmonary artery: 89%
diagnosis is?

A

patent ductus arteriosus

118
Q

the forward flow across a normal valve is determined to be 60 cc. The total volume across a regurgitant valve is 120 cc. The regurgitant volume is

A

60 cc

119
Q

The regurgitant fraction for question number 5 is

A

50%

120
Q

The cardiac catheterization examination that injects a radioplaque dye into cardiac chambers great vessels and is recorded on cine film is a

A

angiography

121
Q

Which of the following cardiac catheterization exams allows for the evaluation of ventricular function parameters (ie ejection fraction, stroke volume, cardiac output, cardiac index), regional wall motion abnormalities and atrioventricular regurgitation?

A

angiography

122
Q

Which. of. the following cardiac catheterization exams allows for the evaluation of aortic regurgitation?

A

aortography

123
Q

which of. the following cardiac catheterization exams allows for the. evaluation of pulmonary artery stenosis and pulmonary thrombosis?

A

angiography

124
Q

the difference in pressures between two cardiac chambers is called a pressure

A

gradient

125
Q

the cardiac cath lab may express a pressure gradient all of the following ways except:
- peak to peak
- peak to mean
- peak instantaneous
- mean

A

-peak to mean

126
Q

the pressure gradient measurement that expresses the difference between the peak systolic pressure of a ventricle and a great artery is the

A

peak to peak

127
Q

the pressure gradient that expresses an average pressure gradient between two chambers is

A

mean

128
Q

the pressure gradient that expresses the maximum gradient between two chambers is

A

peak instantaneous.

129
Q

which of the following cardiac Doppler measurements would correlate best with the. cardiac catheterization gradient measurement?

A

mean

130
Q

A. patient with valvular aortic stenosis has a peak instantaneous gradient of 100 mm Hg. The cardiac cath peak to peak gradient is 60 mm Hg. The reason fro the difference in the gradient is:

A

the Doppler peak instantaneous gradient will always be greater than the catheterization peak to peak

131
Q
A
132
Q

The pressure waveform below demonstrates

A

Mitral stenosis

133
Q

The pressure waveform below is demonstrating

A

Tricuspid stenosis

134
Q

The pressure waveform below represents

A

Mitral regurgitation

135
Q

The pressure waveform below represents

A

Tricuspid regurgitation

136
Q

The pressure waveform below is demonstrating

A

Aortic stenosis

137
Q

The pressure waveform below is demonstrating

A

Pulmonic stenosis

138
Q

The pressure waveform below demonstrates

A

Aortic regurgitation

139
Q

The pressure waveform below demonstrates

A

Pulmonic regurgitation

140
Q

which of the following chest x-rays projections is useful in evaluating the heart?
- posterior-anterior
- lateral
- anterior oblique
- right lateral

A

posterior-anterior

141
Q

cardiomegaly on chest x-rays is associated with all of the following except:
-pericardial. effusion
-ventricular hypertrophy/dilatation
-acute myocardial infarction
-dilated cardiomyopathy

A

acute myocardial infarction

142
Q

all of the following are types of increased pulmonary vascularity as seen on chest x-ray except:
-pulmonary artery hypertension
-shunt vascularity
-pulmonary venous hypertensio
-pulmonary embolism

A

pulmonary embolism

143
Q

the chest x-ray findings for coronary artery disease is/are:
-left atrial enlargement
-right ventricular enlargement
-figure 3 sign
-nonspecific

A

nonspecific

144
Q

A left ventricular bulge on chest x-ray may indicate the presence of a left ventricular

A

aneurysm

145
Q

all of the following chambers may appear enlarged on a chest x-ray of a patient with mitral valve stenosis except:
-left atrium
-left ventricle
-right ventricle
-right atrium

A

left ventricle

146
Q

Which of the following cardiac chambers would most likely appear enlarged on chest x-ray in a patient with mitral regurgitation?
-left atrium, right atrium,
-left ventricle, right ventricle
-left atrium, left ventricle
-right atrium, right ventricle

A

left atrium, left ventricle

147
Q

The most likely chest x-ray finding in a patient with significant chronic aortic regurgitation is enlargement of the

A

left ventricle

148
Q

The chest x-ray finding of left ventricular enlargement due to concentric left ventricular hypertrophy, blunting of the cardiac apex and post stenotic dilatation of the ascending aorta most likely indicates

A

valvular aortic stenosis

149
Q

All of the following are possible chest x-ray findings for atrial septal. defect except
-right ventricular enlargement
-main pulmonary artery enlargement
-figure 3 sign
-increased pulmonary vascularity

A

figure 3 sign

150
Q

all of the following are possible chest. x ray findings for patent ductus arteriosus except:
-increased pulmonary vascularity
-left atrial enlargement
-left ventricular enlargement
-rib notching

A

rib notching

151
Q

right ventricular enlargement due to right ventricular hypertrophy and post stenotic. dilatation of the main pulmonary artery on chest X-ray is most likely associated with

A

valvular pulmonic stenosis

152
Q

all of the following chest x-ray findings are associated with coarctation of. the aorta except:
-left ventricular enlargement
-right ventricular enlargement
-figure three sign
-rib notching

A

right ventricular enlargement

153
Q

which of the following is associated with. an increase of the cardiac silhouette as seen on chest x-ray

A

pericardial effusion

154
Q

all of the following may be diagnosed by chest x-ray except :
-aortic dilatation/aortic. dissection
-pleural effusion
-myocardial ischemia
-calcified pericardium

A

myocardial ischemia

155
Q

which of the following nuclear cardiology isotopes would be best to use to rule out a decrease in myocardial perfusion?
-Thallium-201
-technetium-99
-pyrophosphate
-Albunex

A

thallium-201

156
Q

which of the following nuclear cardiology isotopes would be best to use to evaluate ejection fraction?
-Thallium-201
-technetium-99
-Cardiolyte
-Albunex

A

technetium-99

157
Q

which of the following nuclear cardiology isotopes would be best to use to image infarcted myocardium?
-Thallium-201
-technetium-99
-Cardiolyte
-pyrophosphate

A

pyrophosphate

158
Q

which of the following noninvasive examinations is also called cold spot scanning?
-myocardial perfusion
-infarct avid imaging
-radionuclide angiography
-MUGA

A

myocardial perfusion

159
Q

Which of the f following nuclear studies is also referred to as hot spot scanning?
-myocardial perfusion
-infarct avid imaging
-radionuclide angiography
-MUGA

A

infarct avid imaging

160
Q

EKG

A

Sinus arrhythmia