cardiovascular exam #2

Question 1

aortic stenosis, what kind of murmur?

Answer 1

ejection systolic murmur
crescendo - decrescendo

Question 2

mitral regurgitation… what kind of murmur?

Answer 2

pan-systolic murmur
loudest at apex
parasternal heave
peripheral edema

Question 3

mitral stenosis… what kind of murmur?

Answer 3

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

Question 4

aortic regurgitation

Answer 4

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

Question 5

know the “APT M” pneumonic

Answer 5

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

Question 6

pulses alternans

Answer 6

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

Question 7

pulses bisferiens

Answer 7

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

Question 8

pulsus paradoxus

Answer 8

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

Question 9

pulsus parvus et tardus

Answer 9

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

Question 10

displacement of point of maximal impulse

Answer 10

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

Question 11

edema

Answer 11

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

Question 12

left parasternal lift

Answer 12

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

Question 13

left ventricular thrust

Answer 13

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

Question 14

left ventricular systolic bulge

Answer 14

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

Question 15

Thrills

Answer 15

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

Question 16

Angina

Answer 16

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

Question 17

cachexia

Answer 17

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

Question 18

clubbing

Answer 18

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

Question 19

congestive heart failure

Answer 19

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

Question 20

cor pulmonale

Answer 20

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

Question 21

cyanosis

Answer 21

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

Question 22

Dyspnea

Answer 22

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

Question 23

edema

Answer 23

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

Question 24

fever/chills

Answer 24

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

Question 25

hepatomegaly

Answer 25

enlargement of liver and assoc with right heart failure

Question 26

hemoptysis

Answer 26

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

Question 27

jugular venous distention

Answer 27

indicates high pressure in right heart

Question 28

nocturia

Answer 28

excessive urination at night and associated with congestive heart failure

Question 29

palpitations

Answer 29

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

Question 30

pectus excavatum/carinatum

Answer 30

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

Question 31

Syncope

Answer 31

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

Question 32

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

Answer 32

mitral: lower left sternal border

Question 33

A grade 1 murmur is a murmur that is

Answer 33

barely heard

Question 34

a grade 2 murmur is a murmur that is

Answer 34

faintly heard

Question 35

a grade 3 murmur is a murmur that is

Answer 35

moderately loud

Question 36

a grade 4 murmur is a murmur that is

Answer 36

loud

Question 37

a grade 5 murmur is a murmur that is

Answer 37

very loud

Question 38

a grade 6 murmur is a murmur that is

Answer 38

loud with a thrill

Question 39

A _________ murmur is one that begins softly and becomes louder

Answer 39

crescendo

Question 40

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

Answer 40

decrescendo-crescendo

Question 41

A low pitched murmur is best heard with the stethoscopes

Answer 41

bell

Question 42

A medium pitched murmur is best heard with the stethoscopes

Answer 42

both bell and diaphragm

Question 43

a high pitched murmur is best heard with the stethoscopes

Answer 43

diaphragm

Question 44

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

Answer 44

early systolic

Question 45

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

Answer 45

valvular aortic stenosis

Question 46

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

Answer 46

systolic ejection

Question 47

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

Answer 47

ventricular septal defect

Question 48

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

Answer 48

pansystolic

Question 49

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

Answer 49

mitral valve prolapse

Question 50

which of the following murmurs start well after ejection?

Answer 50

late systolic

Question 51

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

Answer 51

valvular pulmonic stenosis

Question 52

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

Answer 52

early diastolic

Question 53

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

Answer 53

aortic valve regurgitation

Question 54

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

Answer 54

mid-diastolic

Question 55

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

Answer 55

aortic regurgitation

Question 56

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

Answer 56

continuous

Question 57

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

Answer 57

severe mitral regurg

Question 58

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

Answer 58

decrease

Question 59

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

Answer 59

hypertrophic obstructive cardiomyopathy

Question 60

what effect will the isometric handgrip have on mitral regurgitation

Answer 60

increase

Question 61

what effect will the isometric handgrip have on valvular aortic stenosis

Answer 61

decrease

Question 62

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

Answer 62

decrease

Question 63

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

Answer 63

decrease

Question 64

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

Answer 64

increase

Question 65

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

Answer 65

increase

Question 66

what is used to evaluate the cardiovascular response to exercise?

Answer 66

exercise stress test

Question 67

What does this EKG strip represent

Answer 67

Normal sinus rhythm

Question 68

What does this EKG represent?

Answer 68

Sinus bradycardia

Question 69

EKG strip

Answer 69

Sinus tachycardia

Question 70

EKG strip

Answer 70

Sinus pause

Question 71

EKG strip

Answer 71

Premature atrial contraction

Question 72

EKG strip

Answer 72

Atrial flutter

Question 73

EKG strip

Answer 73

Atrial fibrillation

Question 74

EKG Strip

Answer 74

Premature Ventricular Contractions

Question 75

EKG Strip

Answer 75

Ventricular Tachycardia

Question 76

EKG strip

Answer 76

Ventricular fibrillation

Question 77

EKG strip

Answer 77

First degree AV block

Question 78

EKG Strip

Answer 78

2nd Degree AV block

Question 79

EKG strip

Answer 79

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

Question 80

EKG strip

Answer 80

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

Question 81

EKG strip

Answer 81

Artificial pacemaker

Question 82

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

Answer 82

valvular aortic stenosis

Question 83

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

Answer 83

ST segment depression

Question 84

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

Answer 84

dobutamine

Question 85

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

Answer 85

dobutamine

Question 86

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

Answer 86

cardiac catheterization

Question 87

Identify

Answer 87

MR

Question 88

Identify

Answer 88

Mitral stenosis

Question 89

Identify

Answer 89

AS

Question 90

Identify

Answer 90

AR

Question 91

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

Answer 91

pericardial thickness

Question 92

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

Answer 92

pulmonary veins

Question 93

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

Answer 93

mean aortic

Question 94

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

Answer 94

thermodilution

Question 94

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

Answer 94

pulmonary veins

Question 95

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

Answer 95

left heart catheterization

Question 96

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

Answer 96

pulmonary artery wedge

Question 97

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

Answer 97

ventriculogram

Question 98

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

Answer 98

arteriogram

Question 99

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

Answer 99

70%

Question 100

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

Answer 100

arteriogram

Question 101

which percent stenosis is considered significant coronary artery dz?

Answer 101

70%

Question 102

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

Answer 102

left anterior descending

Question 103

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

Answer 103

left. circumflex

Question 104

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

Answer 104

right coronary

Question 105

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?

Answer 105

posterior descending

Question 106

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

Answer 106

left circumflex

Question 107

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

Answer 107

Gorlin

Question 108

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

Answer 108

CO/DFP/38 x square root of MPG

Question 109

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

Answer 109

CO/SFP/44.5 x square root of MPG

Question 110

the most COMMON invasive method of determining cardiac output is

Answer 110

thermodilation

Question 111

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

Answer 111

indicator dilution

Question 112

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

Answer 112

Fick

Question 113

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

Answer 113

angiography

Question 114

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

Answer 114

oximetry

Question 115

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

Answer 115

atrial septal defect

Question 116

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

Answer 116

VSD

Question 117

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

Answer 117

patent ductus arteriosus

Question 118

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

Answer 118

60 cc

Question 119

The regurgitant fraction for question number 5 is

Answer 119

50%

Question 120

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

Answer 120

angiography

Question 121

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?

Answer 121

angiography

Question 122

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

Answer 122

aortography

Question 123

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

Answer 123

angiography

Question 124

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

Answer 124

gradient

Question 125

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

Answer 125

-peak to mean

Question 126

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

Answer 126

peak to peak

Question 127

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

Answer 127

mean

Question 128

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

Answer 128

peak instantaneous.

Question 129

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

Answer 129

mean

Question 130

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:

Answer 130

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

Question 132

The pressure waveform below demonstrates

Answer 132

Mitral stenosis

Question 133

The pressure waveform below is demonstrating

Answer 133

Tricuspid stenosis

Question 134

The pressure waveform below represents

Answer 134

Mitral regurgitation

Question 135

The pressure waveform below represents

Answer 135

Tricuspid regurgitation

Question 136

The pressure waveform below is demonstrating

Answer 136

Aortic stenosis

Question 137

The pressure waveform below is demonstrating

Answer 137

Pulmonic stenosis

Question 138

The pressure waveform below demonstrates

Answer 138

Aortic regurgitation

Question 139

The pressure waveform below demonstrates

Answer 139

Pulmonic regurgitation

Question 140

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

Answer 140

posterior-anterior

Question 141

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

Answer 141

acute myocardial infarction

Question 142

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

Answer 142

pulmonary embolism

Question 143

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

Answer 143

nonspecific

Question 144

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

Answer 144

aneurysm

Question 145

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

Answer 145

left ventricle

Question 146

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

Answer 146

left atrium, left ventricle

Question 147

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

Answer 147

left ventricle

Question 148

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

Answer 148

valvular aortic stenosis

Question 149

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

Answer 149

figure 3 sign

Question 150

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

Answer 150

rib notching

Question 151

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

Answer 151

valvular pulmonic stenosis

Question 152

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

Answer 152

right ventricular enlargement

Question 153

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

Answer 153

pericardial effusion

Question 154

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

Answer 154

myocardial ischemia

Question 155

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

Answer 155

thallium-201

Question 156

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

Answer 156

technetium-99

Question 157

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

Answer 157

pyrophosphate

Question 158

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

Answer 158

myocardial perfusion

Question 159

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

Answer 159

infarct avid imaging

Question 160

EKG

Answer 160

Sinus arrhythmia