CV

Question 1

Women’s early warning symptoms of Acute myocardial infarction

Answer 1

shortness of breath
weakness
unusual fatigue
diaphoresis

Question 2

Clinical presentation of acute coronary syndrome in the elder (age ≥75)

Answer 2

dyspnea
neuro symptoms (syncope, weakness, acute confusion)
chest pain or pressure (<50%)

Question 3

Displaced PMI to anterior axillary line indicates

Answer 3

increase left ventricular volume

pressure overload from hypertension

Question 4

S1 heart sound is produced by

Answer 4

the closure of the mitral and tricuspid valve
best heard at apex with diaphragm
heard simultaneously with carotid upstroke

Question 5

S2 heart sound is produced by

Answer 5

the closure of aortic and pulmonic valve

best heard at base with diaphragm

Question 6

S2 split that increases/opens on patient inspiration

Answer 6

Physiologic/Benign

found in adults age <30

Question 7

S2 split with no change with patient inspiration

Answer 7

fixed split

often found in uncorrected atrial septal defect

Question 8

S2 split that narrows or closes with inspiration

Answer 8

paradoxical split

found with delayed aortic closure such as left bundle branch block

Question 9

S3 heart sound indicates what

Answer 9

ventricular overload and/or systolic dysfunction
heard in early diastole hooked onto back of S2
low pitch
present in heart failure with symptoms

Question 10

Heart failure symptoms

Answer 10

dyspnea
tachycardia
crackles

Question 11

S4 heart sound indicates what

Answer 11

poor diastolic function

poorly controlled hypertension or recurrent myocardial ischemia

Question 12

S4 is heard best

Answer 12

late in diastole or presystolic

Question 13

Common systolic murmurs

Answer 13

(hint: MR. PASS MVP)
mitral regurgitation
physiologic 
aortic stenosis
mitral valve prolapse

Question 14

Common diastolic murmurs

Answer 14

(hint: MS. ARD)
mitral stenosis
aortic regurgitation

Question 15

Physiologic systolic murmurs are likely benign if

Answer 15

negative history
lower grade of 3 or less
no radiation beyond precordium
S1 & S2 intact
no heave or thrill
PMI in 5th intercostal space midclavicular line
softens or disappears with supine to standing

Question 16

Systolic murmur is considered pathologic if

Answer 16

>1 of the following is present
abnormal history
higher grade of 4-6
radiation beyond precordium
S1 & S2 obliterated
with thrill or heave
PMI displaced
increases in intensity with supine to standing

Question 17

A harsh systolic murmur with radiation to the neck

Answer 17

aortic stenosis

Question 18

Exam findings of calcific aortic stenosis

Answer 18

harsh systolic murmur with radiation to the neck
delayed carotid upstroke
narrow pulse pressure

Question 19

differences between carotid bruit and radiating murmur

Answer 19

carotid bruit is usually softer, unilateral

radiating murmur is louder, bilateral, and same sound and timing as found in chest

Question 20

Exam findings of displaced PMI, blowing holosystolic murmur radiating to axilla, accentuated when rolled to left side, and no S2

Answer 20

mitral regurgitation caused by left ventricular dysfunction in hypertension

Question 21

Exam findings of pectus excavatum (funnel chest), midsystolic click with late systolic murmur

Answer 21

mitral valve prolapse - when one leaflet is longer than the other and prolapses into left atrium

Question 22

A midsystolic murmur that increases with supine to standing accompanied by S4 indicates what

Answer 22

diastolic dysfunction in hypertrophic cardiomyopathy

common in young athletes