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Clinical Skills > CVS Exam > Flashcards

CVS Exam Flashcards

1
Q

A patient is admitted complaining of experiencing sudden weakness but without any loss of consciousness. The term used to describe this presentation is

a. Postural syncope
b. Vasovagal syncope
c. Presyncope
d. Tussive syncope

A

c. Presyncope

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2
Q

Which one of the following statements describes an arterial ulcer?

a. The ulcer has a regular margin and the surrounding skin is cold
b. The ulcer is painless and associated with reduced sensation in the surrounding skin
c. The ulcer has an irregular margin and the surrounding skin is warm with odema present
d. The ulcer has a hard, everted edge

A

a. The ulcer has a regular margin and the surrounding skin is cold

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3
Q

On examination of a patient’s JVP you observe Kussmauls sign. The correct definition for this sign is

a. A rise in the JVP on inspiration
b. A rise in the JVP on expiration
c. A fall in the JVP on inspiration
d. A fall in the JVP on expiration

A

a. A rise in the JVP on inspiration

Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity and the increased volume afforded to right ventricular expansion during diastole. Kussmaul sign suggests impaired filling of the right ventricle due to a poorly compliant myocardium or pericardium. This impaired filling causes the increased blood flow to back up into the venous system, causing the jugular vein distension (JVD) and is seen clinically in the internal jugular veins becoming more readily visible.

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4
Q

A patient complains that she feels ‘short of breath’ in the evenings. On specific questioning, she describes an inability to take a big enough breath to fill her lungs adequately. Which statement is most correct when identifying the cause of her breathlessness?

a. The patient is describing dyspnoea of chronic cardiac failure
b. The patient is describing orthopnea
c. The patient has paroxysmal nocturnal dyspnoea
d. The patient has dyspnoea due to anxiety

A

d. The patient has dyspnoea due to anxiety

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5
Q

A patient complains of feeling dizzy while she is lying down, and it is made worse when she moves her head. What is the most likely origin of her complaint?

a. Postural syncope
b. Vasovagal episode
c. Neurological condition
d. Cardiac disease

A

c. Neurological condition

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6
Q

A patient presents with postural hypotension. Which of the following is the most common cause of postural hypotension?

a. Cushing’s disease
b. Anti-hypertensive drugs
c. Hyperpituitarism
d. Vasovagal syncope

A

b. Anti-hypertensive drugs

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7
Q

Which of the following conditions is UNLIKELY to produce bilateral pitting edema of the lower limbs?

a. Calcium antagonist drugs
b. Hepatic cirrhosis causing hypoalbuminaemia
c. Malabsorption
d. Hypothyroidism

A

d. Hypothyroidism

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8
Q

In which one of the following cases are you most likely to find a bradycardia on examination of the patient?

a. Pregnancy
b. Hypothermia
c. Congestive cardiac failure
d. Anaemia

A

b. Hypothermia

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9
Q 
In which one of the following conditions would Kussmaul’s sign most likely be present?
a Hypertrophic cardiomyopathy
b. Acute pericarditis
c. Left ventricular failure
d. Right ventricular infarction
A

d. Right ventricular infarction

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10
Q

Which one of the following conditions most likely to be a cause of left ventricular failure?

a. Tricuspid regurgitation
b. Atrial septal defect with left to right shunt
c. Mitral stenosis with pulmonary hypertension
d. Systemic hypertension

A

d. Systemic hypertension

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11
Q

A patient with a history of previous heart disease complains of experiencing rapid palpitations followed by syncope. Which of the following conditions is MOST likely responsible for the palpitations?

a. Sinus tachycardia
b. Premature atrial or ventricular contraction
c. Ventricular tachycardia
d. Atrial fibrillation

A

c. Ventricular tachycardia

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12
Q

A 36 year old male patient presents in casualty complaining of a severe, heavy feeling in his chest which radiates to his left arm. What type of pain is he describing?

a. Gastrointestinal pain
b. Cardiac pain
c. Vascular pain
d. Airway pain

A

b. Cardiac pain

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13
Q

Which one of the following conditions is most likely associated with central cyanosis?

a. Heart failure
b. Acute renal failure
c. Hypotension
d. Hypertension

A

a. Heart failure

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14
Q

Which one of the following conditions is a likely cause of shock?

a. Anaemia
b. Hypertension
c. Polycythemia
d. Sepsis

A

d. Sepsis

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15
Q

Which one of the following conditions is a likely secondary cause of systemic hypertension?

a. COPD
b. Right ventricular failure
c. Left ventricular failure
d. Renal disease

A

d. Renal disease

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16
Q

The awareness of rapid palpitations followed by syncope is suggestive of

a. Atrial premature beat
b. Sinus tachycardia
c. Sinus bradycardia
d. Ventricular tachycardia

A

d. Ventricular tachycardia

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17
Q

On inspection of a patient’s oral mucosa you identify petechiae. Which one of the following conditions is the most likely cause of this sign?

a. Infective endocarditis
b. Pulmonary embolism
c. Aortic regurgitation
d. Pulmonary hypertension

A

a. Infective endocarditis

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18
Q

On examination of a patient you palpate increased vocal fremitus. Which one of the following conditions is the most likely cause of this sign?

a. Pneumothorax
b. Pneumonia
c. Haemothorax
d. Pleural effusion

A

b. Pneumonia

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19
Q

When assessing the JVP, which of the following statements is INCORRECT?

a. The JVP moves on respiration and normally increases on inspiration
b. A normal JVP reading is less than 8cms of water
c. The JVP is visible but not palpable
d. The JVP is first obliterated and then filled from above when light pressure is applied at the base of the neck.

A

a. The JVP moves on respiration and normally increases on inspiration

JVP normally decreases during inspiration because the inspiratory fall in intrathoracic pressure creates a “sucking effect” on venous return. Thus, the Kussmaul sign is a true physiologic paradox. This can be explained by the inability of the right side of the heart to handle an increased venous return.

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20
Q

While examining a patient, you notice that his pulse rate increases slightly with each inspiration and decreases with each expiration. This phenomena is called

a. Normal pulse
b. Pulsus alternans
c. Pulsus bisferiens
d. Pulsus paradoxus

A

a. Normal pulse

Pulsus paradoxus is defined as a fall of systolic blood pressure of >10 mmHg during the inspiratory phase.

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21
Q

In order to differentiate between carotid and jugular pulsations when measuring JVP, which sign is most likely associated with a JUGULAR venous pulse?

a. There are two peaks per heartbeat
b. The pulse is palpable
c. The pulse increases with inspiration
d. The pulse is independent of abdominal pressure

A

a. There are two peaks per heartbeat

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22
Q

When assessing the JVP, which one of the following findings is likely?

a. A normal JVP reading is less than 5cms of water
b. The JVP moves on respiration and normally decreases on inspiration
c. The JVP is palpable
d. The JVP is first obliterated and then filled from below when light pressure is applied at the base of the neck

A

b. The JVP moves on respiration and normally decreases on inspiration

The jugular venous pressure is usually assessed by observing the right side of the patient’s neck. The normal mean jugular venous pressure, determined as the vertical distance above the midpoint of the right atrium, is 6 to 8 cm H2O.

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23
Q

A patient describes episodes of a rapid heartbeat and is diagnosed as having supra-ventricular tachycardia. It is possible to terminate the arrhythmia by increasing vagal tone. Which one of the following manoeuvres is LEAST likely to increase vagal tone?
a . Sneezing through a blocked-off nose
b. Coughing
c. Massaging the neck over the carotid area
d. Swallowing hot tea

A

d. Swallowing hot tea

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24
Q

Which one of the following statements describes the first heart sound?

a. The sound indicates the beginning of ventricular systole
b. The sound arises from the closure of the Aortic and Pulmonary valves
c. The heart sound marks the end of ventricular systole.
d. It is a shorter, softer and higher pitched sound compared to the other heart sound.

A

a. The sound indicates the beginning of ventricular systole

25
Q

You are taking a detailed history to compile a patient’s cardiovascular risk profile. Which of the following risk factors is the MOST IMPORTANT predictor for further ischemia?

a. Previous ischemic heart disease
b. Smoking
c. Hypertension
d. Family history of coronary artery disease

A

a. Previous ischemic heart disease

26
Q

On history taking, which one of the following conditions is an important risk factor for peripheral vascular disease?

a. Cerebrovascular disease
b. Atrial fibrillation
c. Syncope
d. Palpitations

A

a. Cerebrovascular disease

27
Q

A patient presents with a diagnosis of coarctation of the Aorta. Which of the following findings is not part of the diagnostic criteria?

a. Presence of a radio-femoral delay
b. Upper limb hypertension
c. BP 10mmHg lower in the legs than in the arms
d. Radial-radial inequality in volume of pulses

A

d. Radial-radial inequality in volume of pulses

28
Q

Mr. Jones is a 30yr old man presenting with mitral stenosis. On palpating his chest, which is the most likely finding?

a. An apex beat that is not palpable
b. A double apex beat
c. A tapping apex beat
d. A volume-loaded apex beat

A

c. A tapping apex beat

Pressure-Loaded Apex Beat - LV hypertrophy
Volume-Loaded Apex Beat - Aortic regurgitation; Mitral Regurgitation

29
Q

A patient presents with aortic stenosis. On palpation of the apex beat you would expect to find:

a. A pressure loaded apex beat
b. A volume loaded apex beat
c. A dyskinetic apex beat
d. A double impulse apex beat

A

a. A pressure loaded apex beat

30
Q

A patient presents with pain due to a dissecting aneurism of the aorta. Which description of pain is NOT characteristic of this condition?

a. The pain starts gradually but escalates rapidly
b. The pain is described as a ‘tearing’ chest pain
c. The pain radiates towards the back
d. The pain is described as ‘very severe’

A

a. The pain starts gradually but escalates rapidly

A tear in the inner layer of the large blood vessel branching off the heart (aorta). An aortic dissection is a medical emergency in which the inner layer of the large blood vessel branching off the heart (aorta) tears.

31
Q

A patient presents with cor pulmonale and pulmonary hypertension. On examination, which of the following signs are you UNLIKELY to find?

a. A large ‘a’ wave in JVP
b. A left parasternal heave
c. A mid-systolic ejection murmur
d. A loud or palpable P2

A

b. A left parasternal heave

Parasternal heave occurs during right ventricular hypertrophy (i.e. enlargement) or very rarely severe left atrial enlargement.

32
Q

You examine a patient who presents with an ulcer on his leg. Which of the following signs would be most likely associated with a VENOUS ulcer?

a. The ulcer has a regular margin and is punched out, and the surrounding skin feels cold
b. The ulcer is painless and the surrounding skin has reduced sensation
c. The ulcer is irregular and the surrounding skin is pigmented
d. The ulcer has a central yellow area and the surrounding skin is red and inflamed

A

c. The ulcer is irregular and the surrounding skin is pigmented

33
Q

A patient presents with pericarditis, and on auscultation you hear a pericardial rub. Which of the following is NOT characteristic of a pericardial rub?

a. The rub coincides with systole
b. The sound may vary with respiration
c. It is louder when the patient is sitting up and breathing out
d. It is a crunching sound like walking on snow

A

a. The rub coincides with systole

34
Q

A 50yr old man is diagnosed with having a myocardial infarct. Which of the following descriptions is LEAST likely to be due to an ischemic event?

a. The patient has a choking sensation in the throat
b. The patient has retrosternal discomfort
c. The patient has no awareness of pain
d. The patient has a crushing pain that worsens on deep respirations

A

d. The patient has a crushing pain that worsens on deep respirations

35
Q

Pain that is typical of ischemia is LEAST likely to radiate to

a. The jaw
b. The left arm
c. The right arm
d. The umbilicus

A

d. The umbilicus

36
Q

A patient presents with symptoms of exertional chest pain, exertional dyspnoea and exertional syncopy. On auscultation he has an ejection systolic murmur in the right second intercostals space radiating to the carotids. When assessing arterial pulse character which one of the following types of pulse do you expect to find?

a. Anacrotic pulse
b. Pulsus alternans
c. Irregularly irregular pulse
d. Pulsus paradoxus

A

a. Anacrotic pulse
A slow-rising pulse tracing with a notch in the ascending portion.

Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.

An irregular irregular pulse is defined as a pulse in whihc the heart beats are spaced very irregularly with no discernable pattern.

37
Q

A patient presents with atrial fibrillation. Which one of the following signs are you most likely to find on examination?

a. A regularly irregular rhythm
b. Bigeminal rhythm
c. Pulse deficit
d. Sinus arrthymia

A

c. Pulse deficit

Pulse deficit is a clinical sign wherein, one is able to find a difference in count between heart beat (Apical beat or Heart sounds ) and peripheral pulse. This occurs even as the heart is contracting, the pulse is not reaching the periphery. This can occur in few clinical situations.

38
Q

On examination you palpate a pressure loaded apex beat. Which one of the following statements describes this symptom?

a. An apex beat that is displaced, diffuse and non-sustained
b. A palpable first heart sound at the apex
c. An apex beat that has an uncoordinated movement and felt over a larger than normal area
d. An apex beat that is forceful and sustained

A

d. An apex beat that is forceful and sustained

Volume-loaded - a forceful and non-sustained impulse with displacement of the apex

Pressure-loaded - a forceful and sustained apical impulse

39
Q

A patient is diagnosed with aortic stenosis. Which one of the following pulses do you expect to find on palpation?

a. Pulsus Alternans
b. Anacrotic pulse
c. Collapsing pulse
d. Bisferens pulse

A

b. Anacrotic pulse

40
Q

On examination of a patient with mitral stenosis, which characteristic of the apex beat do you expect to find?

a. Two distinct impulses felt with each systole
b. An uncoordinated impulse felt over a large area
c. A displaced, diffuse and non-sustained impulse
d. A palpable first heart sound

A

d. A palpable first heart sound

41
Q

A patient is diagnosed with air in the mediastinum. Which one of the following statements describes characteristics of the sound heard on auscultation?

a. A crunching sound heard in time with heartbeat and with systolic and diastolic components
b. A superficial scratching sound occurring at any time during the cardiac cycle
c. The sound may vary with respiration and posture
d. The sound is often louder when the patient is sitting up and breathing out

A

a. A crunching sound heard in time with heartbeat and with systolic and diastolic components

42
Q

A 28 year old woman visits her physician for a medical check up. He explains to her that she has a body mass index of 40 and needs to make some lifestyle changes. On palpation of the praecordium which one of the following characteristics of the apex beat could he likely find?

a. Double apical beat
b. Impalpable apex beat
c. Heaving apex beat
d. Tapping apex beat

A

b. Impalpable apex beat

43
Q

On examining a patient, you notice that the JVP is elevated during inspiration. Which of the following options is the most correct interpretation of this finding?

a. This is a normal finding
b. The patient may have limited right ventricular filling, such as constrictive pericarditis
c. The patient may have limited left ventricular filling, such as left ventricular failure
d. The patient may be demonstrating hepato-jugular reflux

A

b. The patient may have limited right ventricular filling, such as constrictive pericarditis

44
Q

Which statement describes an Austin Flint murmur?

a. A pan-systolic murmur that accompanies mitral regurgitation
b. An early diastolic murmur that accompanies mitral stenosis
c. A late systolic murmur that accompanies aortic stenosis
d. A mid-diastolic murmur that accompanies aortic regurgitation

A

d. A mid-diastolic murmur that accompanies aortic regurgitation

In cardiology, an Austin Flint murmur is a low-pitched rumbling heart murmur which is best heard at the cardiac apex. It can be a mid-diastolic or presystolic murmur It is associated with severe aortic regurgitation.

45
Q

On auscultation of the patient’s heart you hear a murmur that starts after the second heart sound and extends up to the first heart sound. The term to describe this murmur is

a. A pansystolic murmur
b. A continuous murmur
c. A mid-diastolic murmur
d. A mid-systolic murmur

A

c. A mid-diastolic murmur

46
Q

On auscultation of a patient’s heart you identify a soft first heart sound. Which one of the following statements supports this finding?

a. Most likely to be heard in mitral stenosis
b. Relates to a reduced diastolic filling time e.g. tachycardia
c. May be due to failure of valve leaflets to coapt normally
d. Occurs when valve cusps are wide open at the end of diastole and shut forcefully with onset of ventricular systole

A

c. May be due to failure of valve leaflets to coapt normally

Coapt - to fit together and make fast

47
Q

In which one of the following cases would you most likely to feel an irregularly irregular pulse?

a. Coarctation of the aorta
b. Sinus arrhythmia
c. Atrial fibrillation
d. Second degree type 1 AV heart block

A

c. Atrial fibrillation

48
Q

A patient presents with acute tachypnoea, anxiety and restlessness, and looks ill. On examination he has pulsus paradoxus and hypotension, a raised JVP, impalpable apex beat and soft heart sounds. Which is the MOST likely diagnosis?

a. Pericarditis
b. Cardiogenic shock
c. Pulmonary oedema (cardiac asthma)
d. Cardiac tamponade

A

d. Cardiac tamponade

Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the outer covering sac of the heart.

49
Q

A patient presents with non-pitting oedema. Which one of the following conditions is most likely to present with this sign?

a. Constrictive pericarditis
b. Deep veins thrombosis
c. Hypothyroidism
d. Hypoalbuminaemia

A

c. Hypothyroidism

50
Q

A 55yr old patient presents with sudden onset of severe chest pain. The pain is sharp, tearing and radiates to his back. Which of the following diagnoses are most likely?

a. Myocardial infarction
b. Massive pulmonary embolism
c. Cholecystitis
d. Dissecting aortic aneurism

A

d. Dissecting aortic aneurism

51
Q

A patient presents with exertional chest pain and dyspnoea. On examination the patient has a systolic thrill as well as a harsh midsystolic ejection murmur at the base of the heart, which spreads over the whole precordium and is loudest with the patient sitting up. What is the most likely diagnosis?

a. Aortic stenosis
b. Mitral valve prolapse
c. Mitral regurgitation
d. Tricuspid regurgitation

A

a. Aortic stenosis

52
Q

A 28 year old female with a history of rheumatic heart disease is admitted to the ward complaining of exertional dyspnoea, fatigue and says she has been experiencing intermittent palpitations. On examination she is found to have a characteristically collapsing pulse. Which one of the following is the most likely diagnosis?

a. Aortic stenosis
b. Aortic regurgitation
c. Hypertrophic cardiomyopathy
d. Atrial fibrillation

A

b. Aortic regurgitation

53
Q

On assessing the radial pulse you find it has an irregularly irregular rhythm with no pattern. Which one of the following conditions is most likely to present with this sign?

a. Sinus arrhythmia
b. Third degree AV block
c. Atrial flutter
d. Atrial fibrillation

A

d. Atrial fibrillation

54
Q

In which one of the following conditions would the patient most likely present with exertional syncope?

a. Mitral stenosis
b. Mitral regurgitation
c. Aortic stenosis
d. Aortic regurgitation

A

c. Aortic stenosis

55
Q

A patients presents with severe, central chest pain that started whilst at rest and has persisted for almost an hour. He is anxious, sweating and complains of dyspnoea. Your most likely diagnosis is

a. Dissecting aortic aneurysm
b. Pericarditis
c. Myocardial infarction
d. Pleurisy

A

c. Myocardial infarction

56
Q

A patient presents with a blood pressure of 170/70 mm/Hg. Which one of the following conditions is the most likely diagnosis?

a. Acute pericarditis
b. Pulmonary hypertension
c. Cardiac tamponade
d. Aortic regurgitation

A

d. Aortic regurgitation

57
Q

Chest pain that is described as severe, tearing and radiating to the back is suggestive of

a. A spontaneous pneumothorax
b. A pulmonary embolism
c. A dissecting aortic aneurysm
d. Pericarditis

A

c. A dissecting aortic aneurysm

58
Q

On examination you find that the patient has radial-femoral delay and upper limb hypertension. Your differential diagnosis would be

a. Aortic regurgitation
b. Mitral valve stenosis
c. Subclavian artery stenosis
d. Co-arctation of the aorta

A

d. Co-arctation of the aorta

59
Q

A patient is experiencing attacks of supra-ventricular tachycardia. Which of the following manoeuvres is LEAST likely to terminate the palpitations?

a. Coughing
b. Swallowing warm liquids
c. Carotid sinus massage
d. Valsalva maneuver

A

b. Swallowing warm liquids

Clinical Skills (5 decks)

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