LE 3

Question 1

1What is your first step if you are alone and find a potential victim?
A. Ensure scene safety
B. Check for responsiveness
C. Open the airway and give 2 breaths
D. Begin chest compressions

Answer 1

A. Ensure scene safety.

Safety for the rescuer and the victim is always the priority. Before approaching or touching the victim, it’s crucial to ensure that the environment is safe.

Question 2

2. You have noticed a potential victim and ensured the scene is safe. What is your next step?
   A. Call the victim’s doctor
   B. Check for the victim’s responsiveness
   C. Begin chest compressions
   D. Provide rescue breathing

Answer 2

B Check for the victim’s responsiveness

Question 3

3. What is the correct rate of compressions?
   A. 40
   B. 60
   C. 80
   D. 100

Answer 3

D. 100 compressions per minute.

Question 4

4What is the correct depth for these chest compressions in an adult?
A. At least 2 inches
B. At least 3 inches
C. At least 2.5 inches
D. At least 1.5 inches

Answer 4

A. At least 2 inches

Question 5

5. During CPR on a victim, the compression-to-breath ratio is
   A. Give 2 breaths after every 30 compressions
   B. Give 2 breaths after every 50 compressions
   C. Give 2 breaths after every 15 compressions
   D. Give 2 breaths after every 10 compressions

Answer 5

A. Give 2 breaths after every 30 compressions

Question 6

6. You are performing CPR on an adult victim. The second rescuer has arrived with the AED and turned it on. What is the next step?
   A. Shock the victim
   B. Place the pads on the victim’s bare chest
   C. Wait for advanced care to arrive before continuing use of the AED
   D. Place the pads over the victim’s clothes

Answer 6

B Place the pads on the victim’s bare chest

Question 7

7. When giving adequate breaths you know they are effective when you see chest rise and fall.
   A. Not all the time
   B. Maybe
   C. False
   D. TRUE

Answer 7

D. TRUE

Question 8

8. Use abdominal thrusts to relieve choking in a conscious adult
   A. False
   B. Maybe
   C. True
   D. Not all the time

Answer 8

C True

Question 9

9. Rescue breathing is used for a victim who is unconscious but has a pulse. What is the correct rate for rescue breathing in an adult?
   A 1 breath every 5 minutes
   B 2 breaths every 5 to 6 seconds
   C 2 breaths every 3 to 5 seconds
   D 1 breath every 5 seconds

Answer 9

D 1 breath every 5 seconds

Question 10

10. Use a head tilt chin lift to open the airway in an adult victim when you do not suspect a cervical spine injury.
    A. True
    B. FALSE
    C. sometimes
    D. maybe

Answer 10

A. True.

If you do not suspect a cervical spine injury in an adult victim, the head tilt-chin lift technique is used to open the airway. If a cervical spine injury is suspected, the jaw-thrust technique is preferred.

Question 11

11 Which of the following describes the proper sequences of BLS?
A. Airway, breathing, compression
B. Pulse check, rescue breath, compression
C. Compression, airway, breathing
D. Compression, airway, pulse check, rescue breathing

Answer 11

C Compression, airway, breathing

Question 12

12. The pulse assessed in an adult cardiac arrest victim is called the ____ pulse?
    A. Temporal
    B. Femoral
    C. Jugular
    D. Carotid

Answer 12

D. Carotid pulse.

In adults, during cardiac arrest or when checking for unresponsiveness, the carotid pulse is the commonly assessed pulse due to its proximity to the heart and ease of access.

Question 13

13. You are treating an adult choking victim. They initially can cough, but now are grasping their throat and turning blue. What is the next step?
    A. Heimlich maneuver
    B. check the pulse
    C. Begin CPR
    D. Rescue breathing

Answer 13

Heimlich maneuver

Question 14

14 The critical characteristics of high quality CPR include which of the following
A. Start chest compressions within 10 seconds of recognition of cardiac arrest
B. Minimize interruptions
C. AOTA
D. Pushing hard and fast

Answer 14

C AOTA

Question 15

15. which of the following are signs of airway obstruction?
    A. inability to speak
    B. all of the above
    C. poor air exchange
    D. high pitched noise while inhaling

Answer 15

B all of the above

Question 16

16. How long should a pulse check last?
    A. Not more than 5 minutes
    B. Until you feel the pulse of the patient
    C. Not more than 2 minutes
    D. Not more than 10 seconds

Answer 16

D Not more than 10 seconds

Question 17

17. Efforts to relieve choking should be stopped when:
    A. the obstruction is removed
    B. victim becomes unresponsive
    C. the victim begins breathing normally
    D. any of the above

Answer 17

D any of the above

Question 18

18. Where should you place your hands on the chest of a victim when you are performing chest compressions?
    A. over the heart on the left side of the chest at the nipple line
    B. on the lower half of the breastbone at the center of the chest
    C. on top of the breastbone
    D. over the very bottom of the breastbone on the xyphoid

Answer 18

B on the lower half of the breastbone at the center of the chest

Question 19

19. You respond to a swimming pool where a person is floating facedown and is unresponsive. Which action do you perform first?
    A. Apply AED
    B. High-quality CPR
    C. Heimlich Maneuver to clear airway
    D. Sunctioning

Answer 19

C. Heimlich Maneuver to clear airway

Question 20

20.You are treating a cardiac arrest patient. The AED is having problems analyzing the rhythm. Which of the following is the correct response?
A. Go find another AED
B. Continue chest compressions
C. Read the owner’s manual
D. Pause CPR to troubleshoot

Answer 20

B Continue chest compressions

Question 21

21. How do you give mouth to mouth breaths
    A. Place a breathing tube in their airway
    B. Intubate immediately
    C. Seal your lips around the outside of the victim’s lips
    D. Put your lips in the victim’s lips

Answer 21

C Seal your lips around the outside of the victim’s lips

Question 22

22. What is/are the most critical component(s) of CPR?
    A. Chest compressions
    B. Rescue breathing
    C. AOTA
    D. Airway management

Answer 22

C. AOTA

Question 23

23 When is it the right time to make sure the scene of an accident is safe?
A. Immediately upon seeing the victim.
B. As soon as emergency medical professionals arrive.
C. After delivering a shock with an AED device.
D. After getting the emergency response started.

Answer 23

A Immediately upon seeing the victim

Question 24

24. In order to protect your safety while providing CPR, you should:
    A. AOTA
    B. Use disposable gloves.
    C. Use a one-way mouth guard.
    D. Check the area for dangers such as gas fumes or chemical spills

Answer 24

A. AOTA

Question 25

25. “Agonal breathing” is a form of struggling breathing that sounds like gasping or gurgling. A person who shows signs of agonal breathing should get CPR right away.
    A. TRUE
    B. False

Answer 25

A TRUE

Question 26

26. Approximately 50% of deaths from cardiovascular disease occur as SUDDEN CARDIAC ARREST.
    A. True
    B. False

Answer 26

B. False

Question 27

27. Majority of sudden cardiac arrest victims survive because majority of those witnessing the arrest do not know how to perform CPR.
    True
    FALSE

Answer 27

FALSE.

The majority of sudden cardiac arrest victims do not survive, and one of the reasons is that bystanders often do not know how to perform CPR or are hesitant to do so. Immediate CPR can double or triple a victim’s chance of survival.

Question 28

28. SUDDEN CARDIAC DEATH only strike people with history of cardiac disease or cardiac symptoms.
    A. False
    B. True

Answer 28

A False

Question 29

29.Effective CPR done immediately after cardiac arrest can double a victim’s chance of survival.
A. True
B. False

Answer 29

A. True

Question 30

30.Pulseless electrical activity is a shockable rhythm.
A. True
B. False

Answer 30

B. False

Question 31

31Ventricular tachycardia is a shockable rhythm..
A. True
B. False

Answer 31

A. True

Question 32

32.Ventricular fibrillation is a shockable rhythm.
A. True
B. False

Answer 32

A. True

Question 33

33. Asystole is a shockable rhythm..
    A. True
    B. False

Answer 33

B. False

Question 34

34. The following are true statements regarding blood pressure determination except:
    A. An inappropriate cuff size (smaller cuff) would give a spuriously higher blood pressure readings.
    B. We should inflate the cuff to a pressure about 30 mmHg above the point where the palpable pulse disappear
    C. Cuff size must be at least 10 cm wide for the arm.
    D. In obtaining blood pressure measurement from the posterior tibial artery, the chest piece of the stethoscope is placed in front of the medial malleolus

Answer 34

D In obtaining blood pressure measurement from the posterior tibial artery, the chest piece of the stethoscope is placed in front of the medial malleolus

Question 35

35. Normal clinical CVP.
    A. < 8 cm
    B. <10 cm
    C. <9cm
    D. <7cm

Answer 35

A. < 8 cm

Typically, the normal range for CVP is 2-8 cmH2O (or approximately 2-10 cm of blood). However, it’s important to note that the exact “normal” range can vary based on the source and the clinical context.

Question 36

36.Differential diagnosis for chest pain
A. Anxiety states
B. Pulmonary embolism
C. Esophageal disorders
D. AOTA

Answer 36

D. AOTA

Question 37

37. Chest pain of cardiac origin is described as
    A. May spread to both sides or the arms, shoulders, neck, jaw, teeth, and back
    B. Pressure, squeezing or tightness on the chest
    C. All of the above
    D. None of the above

Answer 37

All of the above

Question 38

38. The following may present with sudden onset of chest pain
    A. Dilated cardiomyopathy
    B. Aortic dissection
    C. Tuberculous Pericarditis
    D. Left ventricular Failure

Answer 38

B. Aortic dissection.

Aortic dissection is a medical emergency where there’s a tear in the wall of the main artery carrying blood out of the heart (aorta). This can cause severe, sudden chest or back pain.

Question 39

39. Chest pain in acute pericarditis is described as
    A. Pain radiates to the jaw and neck
    B. Aggravated by sitting up and leaning forward
    C. Relieved by lying on a decubitus position
    D. None of the above

Answer 39

B. Aggravated by sitting up and leaning forward.

Rationale: In acute pericarditis, the typical chest pain is often described as sharp or stabbing and can be relieved by leaning forward. The pain can be aggravated or intensified when lying flat or during inspiration.

Question 40

40. A 45 years old patient previously well came in due to palpitations of more than 3 months duration. She also noted weight loss and tremors of the hands. Which is the most likely diagnosis?
    A. gastroesophageal reflux disease
    B. hyperthyroidism
    C. none of the above
    D. anxiety disorder

Answer 40

B hyperthyroidism

Question 41

41. In a patient with a normal CVP whom you suspect to have elevated right ventricular pressure, what maneuver will you do to detect this abnormality.
    A. Examination of the carotid arteries
    B. Blood Pressure Measurement
    C. Inspection of the Apex impulse
    D. Abdominojugular Reflux Test

Answer 41

D. Abdominojugular Reflux Test.

The abdominojugular reflux test (also known as hepatojugular reflux) is used to assess right heart function by observing the jugular venous pressure while applying pressure to the abdomen. An exaggerated or sustained rise in jugular venous pressure during this test can suggest right ventricular dysfunction or failure.

Question 42

42. Edema of cardiac origin is unilateral
    A. False
    B. True

Answer 42

A. False

Edema of cardiac origin is typically bilateral, affecting both legs, especially when related to conditions like congestive heart failure. Unilateral edema is more commonly due to local causes such as venous obstruction or lymphatic obstruction on one side.

Question 43

43. Edema of cardiac origin usually ascends to involve the feet, legs, thighs and abdomen.
    A. False
    B. True

Answer 43

B True

Question 44

44. Edema of cardiac origin usually presents with periorbital edema.
    A. False
    B. True

Answer 44

B. True

Question 45

45. Edema of cardiac origin is bipedal and always precedes ascites.
    A. True
    B. FALSE

Answer 45

True

Question 46

46. Which of the following are possible causes of palpitations
    A. Electrolyte abnormalities
    B. All of the above
    C. Hyperthyroidism
    D. Mitral valve prolapse

Answer 46

B. All of the above

Question 47

A. Pulseless electrical activity
B. Ventricular fibrillation
C. Sinus rhythm
D. Ventricular tachycardia

Answer 47

B Ventricular fibrillation

Question 48

A. Sinus rhythm
B. Ventricular fibrillation
C. Ventricular tachycardia
D. Pulseless electrical activity

Answer 48

C Ventricular tachycardia

Question 49

A. Sinus rhythm
B. Ventricular fibrillation
C. Ventricular tachycardia
D. Pulseless electrical activity

Answer 49

B. Ventricular fibrillation

Question 50

A. Sinus rhythm
B. Ventricular fibrillation
C. Ventricular tachycardia
D. Pulseless electrical activity

Answer 50

D. Pulseless electrical activity

Question 51

True of third heart sound (S3) EXCEPT:
A. a normal finding in children, adolescents and young adults, but signifies heart failure in older patients
B. All of the above
C. occurs during the rapid filling phase of the ventricular diastole
D. S3 is more prevalent among heart failure patients without left ventricular systolic dysfunction

Answer 51

D. S3 is more prevalent among heart failure patients without left ventricular systolic dysfunction.

S3 is often associated with left ventricular systolic dysfunction and can be a sign of heart failure. In older adults, its presence is typically pathological, while in younger individuals, it can be a normal finding.

Question 52

52. True of the fourth heart sound
    A. occurs during the atrial filling of the ventricular diastole and indicates presystolic expansion
    B. S4 is not present in atrial fibrillation
    C. common among patients who derive significant atrial contribution to ventricular filling such as chronic LV hypertrophy or active myocardial ischemia
    D. all of the above

Answer 52

D. all of the above

All the statements given are true regarding the fourth heart sound (S4). S4 occurs due to the vibration of the ventricular wall with atrial contraction and is often associated with conditions that cause decreased ventricular compliance. An S4 is not present in atrial fibrillation because there’s a lack of coordinated atrial contraction in this arrhythmia.

Question 53

53. The most common cause of mid- systolic murmur in an adult is:
    A. hypertrophic obstructive cardiomyopathy (HCOM)
    B. aortic sclerosis
    C. large atrial septal defect with left-to-right shunting
    D. aortic stenosis

Answer 53

aortic stenosis

Question 54

54. Conditions associated with accelerated blood flow in the absence of a structural
    heart disease that may cause mid-systolic murmur EXCEPT:
    A. fever
    B. anemia and thyrotoxicosis
    C. pulmonic valve stenosis with or without an ejection sound
    D. normal childhood/adolescen ce; pregnancy

Answer 54

C. Pulmonic valve stenosis with or without an ejection sound.

A. Fever - Accelerated blood flow can occur with fever, leading to a mid-systolic murmur.
B. Anemia and thyrotoxicosis - Both conditions can lead to increased cardiac output and therefore can cause a mid-systolic murmur.
D. Normal childhood/adolescence; pregnancy - Both states can have increased cardiac output without structural heart disease, leading to a mid-systolic murmur.

C. Pulmonic valve stenosis with or without an ejection sound - This is a structural heart disease. Pulmonic valve stenosis is a condition where there is a narrowing at the pulmonic valve, leading to an obstruction of blood flow out of the right ventricle into the pulmonary artery. This would cause a mid-systolic murmur due to the structural abnormality, not just accelerated blood flow.

Question 55

55. The murmur of hypertrophic obstructive cardiomyopathy (HCOM)
    A. None of the above
    B. maneuvers that increase LV preload or afterload (passive leg raising and squatting) will cause a decrease in murmur intensity
    C. maneuvers that decrease LV preload (strain phase of Valsalva and standing from squatting) will intensify the murmur
    D. All of the above

Answer 55

D. All of the above

In HOCM, the murmur’s intensity is related to the degree of outflow tract obstruction.

• Maneuvers that increase left ventricular (LV) preload or afterload, such as passive leg raising and squatting, will cause an increase in LV volume, which can reduce the degree of outflow tract obstruction and thus decrease the intensity of the murmur.
• Conversely, maneuvers that decrease LV preload, like the strain phase of Valsalva and suddenly standing from squatting, will reduce LV volume and exacerbate the outflow tract obstruction, making the murmur louder.

So both statements B and C are correct, which means the answer is D. All of the above.

Question 56

56. The murmur of mitral valve prolapse (MVP) :
    A. All of the above
    B. maneuvers that decrease LV preload (strain phase of Valsalva and standing from squatting) will intensify the murmur
    C. None of the above
    D. maneuvers that increase LV preload or afterload (passive leg raising and squatting) will cause a decrease in murmur intensity

Answer 56

All of the above

Question 57

57. Holosystolic murmurs may be seen in chronic mitral regurgitation.
    A. TRUE
    B. FALSE

Answer 57

A. TRUE

Holosystolic (or pansystolic) murmurs can indeed be seen in chronic mitral regurgitation.

Holosystolic (or pansystolic) murmurs are seen or associated with:

•	Chronic Mitral Regurgitation (MR): Best heard at the apex and radiates to the axilla.
•	Ventricular Septal Defect (VSD): Best heard along the left parasternal border and may be associated with a palpable thrill.
•	Chronic Tricuspid Regurgitation (TR): Best heard along the lower parasternal border, and its intensity typically increases with inspiration (known as Carvallo’s sign).

Question 58

58. Holosystolic murmurs may be seen in ventricular septal defect.
    A. TRUE
    B. FALSE

Answer 58

TRUE

•	Chronic Mitral Regurgitation (MR): Best heard at the apex and radiates to the axilla.
•	Ventricular Septal Defect (VSD): Best heard along the left parasternal border and may be associated with a palpable thrill.
•	Chronic Tricuspid Regurgitation (TR): Best heard along the lower parasternal border, and its intensity typically increases with inspiration (known as Carvallo’s sign).

Question 59

59 Holosystolic murmurs may be seen in tricuspid regurgitation.
A. TRUE
B. FALSE

Answer 59

TRUE

•	Chronic Mitral Regurgitation (MR): Best heard at the apex and radiates to the axilla.
•	Ventricular Septal Defect (VSD): Best heard along the left parasternal border and may be associated with a palpable thrill.
•	Chronic Tricuspid Regurgitation (TR): Best heard along the lower parasternal border, and its intensity typically increases with inspiration (known as Carvallo’s sign).

Question 60

60 Holosystolic murmurs may be seen in aortic stenosis.
A. TRUE
B. FALSE

Answer 60

FALSE

MID-SYSTOLIC MURMUR

Timing:

•	Starts after the first heart sound (S1) and concludes before the second heart sound (S2).

Clinical Conditions:

1.	Aortic Stenosis (AS):
•	Most common cause.
•	Interestingly, the severity of AS does not necessarily correlate with the intensity of the murmur.
•	Best heard at the 2nd intercostal space (ICS) on the right side of the sternum.
2.	Other Causes:
•	Pulmonic Stenosis (PS): Heard best in the 2nd left ICS.
•	Hypertrophic Obstructive Cardiomyopathy (HOCM): Best heard over the left sternal border and apex.
•	Large Atrial Septal Defect (ASD) with left-to-right shunting: Best heard in the 2nd ICS near the upper left sternal border.
•	Aortic Valve Sclerosis: Sounds similar to AS but without the associated symptoms; best heard in the 2nd right ICS.

Question 61

61. lower extremity or presacral edema in the setting of an elevated JVP defines volume overload and may be a feature of chronic heart failure or constrictive pericarditis
    A. TRUE
    B. FALSE

Answer 61

A. TRUE

Lower extremity or presacral edema in conjunction with elevated jugular venous pressure (JVP) does indicate volume overload. Both chronic heart failure and constrictive pericarditis can present with these clinical findings.

Question 62

62. Lower extremity edema in the absence of jugular venous hypertension may be due to lymphatic or venous obstruction or venous insufficiency as suggested bythe appearance of varicosities, venous ulcers and eburnation.
    A. TRUE
    B. FALSE

Answer 62

A. TRUE

Question 63

63. Pitting edema can also be drug- induced as seen among patients using dihydropyridine calcium channel blockers.
    A. TRUE
    B. FALSE

Answer 63

A. TRUE

Question 64

64. Homan’s sign, which is pain elicited on the posterior calf on active dorsiflexion of the foot against resistance, is a very specific and very sensitive sign for deep venous thrombosis.
    A. TRUE
    B. FALSE

Answer 64

B. FALSE

Homan’s sign is neither very specific nor very sensitive for deep venous thrombosis (DVT). While it’s a traditional clinical sign, relying on it alone for the diagnosis of DVT can lead to missed or false diagnoses. Modern diagnostic approaches, such as Doppler ultrasonography, are more accurate and reliable for diagnosing DVT.

Question 65

65. Muscular atrophy or the absence of hair along an extremity is consistent with severe arterial insufficiency or a primary neuromuscular disorder.
    A. TRUE
    B. FALSE

Answer 65

A. TRUE

Question 66

66In advanced obstructive lung disease, the point of maximal cardiac impulse may be displaced in the epigastrium.
A. TRUE
B. FALSE

Answer 66

A. TRUE

Question 67

67. Systolic pulsations over the liver signify severe tricuspid regurgitation.
    A. True
    B. False

Answer 67

A. True

Question 68

68. Splenomegaly may be a feature of infective endocarditis particularly when symptoms have persisted for weeks or months
    A. False
    B. True

Answer 68

B. True

Question 69

69.A young patient was seen with cyanotic lower extremities but not of the upper extremities with shortness of breath and easy fatigability. The patient has
A. Chronic severe aortic regurgitation
B. Patent ductus arteriosus
C. Tetralogy of Fallot
D. Premature atherosclerosis

Answer 69

B. Patent ductus arteriosus

The described clinical picture suggests differential cyanosis, where the lower extremities are cyanotic but not the upper extremities. This can be seen in conditions where there’s a right-to-left shunt after the blood has supplied the upper body.

The most classic condition that fits this presentation is:

B. Patent ductus arteriosus

In some cases of Patent Ductus Arteriosus (PDA), especially when it is large and there is increased pulmonary vascular resistance, oxygen-poor (deoxygenated) blood from the pulmonary artery can flow into the descending aorta, causing the lower body to receive deoxygenated blood. This results in cyanosis of the lower extremities but not the upper extremities.

Question 70

70.A patient sought consultation due to cobblestone like skin lesions otherwise known as pseudoxanthoma elasticum. This is associated with what disease?
A. Chronic severe aortic regurgitation
B. Premature atherosclerosis
C. Patent ductus arteriosus
D. Tetralogy of Fallot

Answer 70

B. Premature atherosclerosis

Pseudoxanthoma elasticum is a genetic disorder that affects connective tissues, leading to fragmentation and calcification of elastic fibers in the skin, retina, and blood vessels. This can cause the blood vessels to become narrowed or blocked, leading to premature atherosclerosis.

Question 71

71. On physical examination of a young patient with shortness of breath, the finger nails were bulbous with disappearance of the Schamroth sign. Which of the following diseases below could be the culprit of this physical finding?
    A. Infective endocarditis
    B. Tetralogy of Fallot
    C. Marfan’s syndrome
    D. Osteogenesis imperfecta

Answer 71

B. Tetralogy of Fallot

Rationale:
Tetralogy of Fallot is a congenital heart defect that consists of four anatomical abnormalities. One of these abnormalities, the right-to-left shunt, can lead to decreased oxygen levels in the blood, resulting in chronic hypoxemia. Chronic hypoxemia is one of the causes of finger clubbing.

The disappearance of the Schamroth sign is a clinical test for clubbing. Given the described clinical findings and the provided options, Tetralogy of Fallot is the most likely culprit for the patient’s physical finding.

Question 72

72. A young patient was examined and found to have bluish discoloration of the sclerae. The parents denied any history of trauma or exposure to any chemicals. What disease is associated with this finding?
    A. patent ductus arteriosus
    B. osteogenesis imperfecta
    C. marfan’s syndrome
    D. tetralogy of fallot

Answer 72

B. osteogenesis imperfecta

Rationale:
Osteogenesis imperfecta, also known as “brittle bone disease,” is a genetic disorder characterized by fragile bones that break easily. One of the characteristic features of osteogenesis imperfecta is the presence of a blue sclera, which results from the underlying choroidal veins being visible through the thin sclera.

Question 73

73. A patient was seen at the out-patient department with shortness of breath. Patient had clear breath sounds. Lower extremities revealed (picture as shown). What is the most likely cause of the findings?
    A. Decompensated heart failure
    B. Marfan’s syndrome
    C. Infective endocarditis
    D. Cardiac tamponade

Answer 73

A. Decompensated heart failure

Question 74

74. A patient with shortness of breath and easy fatigability was found to have bounding pulsating carotids known as Corrigan’s pulse on examination. Which of the following is the most likely cause?
    A. Cardiac tamponade
    B. Infective endocarditis
    C. Marfan’s syndrome
    D. Chronic severe aortic regurgitation

Answer 74

D. Chronic severe aortic regurgitation

Rationale:
Corrigan’s pulse (or “water-hammer” pulse) is a rapid and forceful distention of the arterial pulse followed by a rapid fall, typically associated with chronic severe aortic regurgitation. This is due to the rapid ejection of a large stroke volume during systole into a noncompliant aorta, followed by a rapid runoff of blood back into the left ventricle during diastole due to the regurgitation.

Question 75

75.A young patient with a murmur was given a complete physical examination and was found to have long limbs and fingers. He was asked to do wrap his fingers around the wrist. This wrist sign is otherwise called Walker-Murdoch sign is seen in which of the following diseases?
A. Osteogenesis imperfecta
B. Cardiac tamponade
C. Marfan’s syndrome
D. Patent ductus arteriosus

Answer 75

C. Marfan’s syndrome

Rationale:
Marfan’s syndrome is a genetic disorder affecting the body’s connective tissue. One of its hallmark features is the presence of disproportionately long limbs and fingers. The wrist sign, or Walker-Murdoch sign, is positive when the thumb and fifth finger of one hand overlap when wrapped around the opposite wrist. This sign indicates excessive joint mobility and is suggestive of Marfan’s syndrome.

Question 76

76. During BP measurement, the nurse noted a drop of more than 20mmHg in the systolic blood pressure of the patient during inspiration. This finding is found in which disease?
    A. Chronic obstructive lung disease and asthma
    B. none of the above
    C. All of the above
    D. pericarditis with cardiac tamponade

Answer 76

C. All of the above

Question 77

77. An IV drug user sought consultation due to undocumented fever. There were multiple red spots on his hands (as shown in the picture). What is the most likely cause of this finding?
    A. Acute decompensated heart failure
    B. Infective endocarditis
    C. Scabies
    D. Patent ductus arteriosus

Answer 77

B. Infective endocarditis

Question 78

78A cardiac patient sought an early follow- up due to multiple bruises. She denies any trauma. Which of the following drugs could have caused this problem?
A. Warfarin
B. Spironolactone
C. Digoxin
D. Ranolazine

Answer 78

A. Warfarin

Question 79

79A patient with extensive lentiginoses was diagnosed to have an autosomal dominant disease called Carney’s syndrome. This is associated with what cardiac finding?
A. decompensated heart failure
B. chronic aortic regurgitation
C. atrial myxoma
D. mitral valve prolapse

Answer 79

C. atrial myxoma

Rationale:
Carney’s syndrome, also known as Carney complex, is an autosomal dominant condition characterized by multiple lentigines and other skin manifestations. Cardiac-wise, it is most notably associated with cardiac myxomas, especially atrial myxomas. These tumors can lead to various complications if not diagnosed and treated promptly.

Question 80

80. A patient sought dermatologic consultation due to multiple reddish lesions with pale center and erythematous borders. This is called ___ and associated with _____.
    A. erythema nodosum; sarcoidosis of the heart
    B. lupus pernio; sarcoidosis of the heart
    C. erythema multiforme; rheumatic heart disease
    D. Erythema marginatum ; rheumatic heart disease

Answer 80

D. Erythema marginatum ; rheumatic heart disease.

Rationale: Erythema marginatum is a skin manifestation characterized by reddish lesions with a pale center and erythematous borders. It is one of the major Jones criteria for the diagnosis of rheumatic fever and can be associated with rheumatic heart disease.

Question 81

81.A patient with orange tonsils was seen. This patient is at risk of early atherosclerosis. The blood chemistry is expected to have
A. low HDL
B. none of the above
C. normal lipid profile
D. increased HDL

Answer 81

A. low HDL

Question 82

82. A patient with palpitations, weight loss and shortness of breath was seen with the following ocular findings. What is the most likely cause of her cardiac symptoms?
    A. Hyperthyroidism
    B. Hypothyroidism
    C. Hashimoto’s thyroiditis
    D. AOTA

Answer 82

A. Hyperthyroidism

Question 83

83. A patient with sore throat was found out to have (see picture) on oral examination. This patient should be evaluated for which of the following cardiac problems?
    A. premature hypertension
    B. Aortic aneurysms
    C. mitral stenosis
    D. early atherosclerosis

Answer 83

B. Aortic aneurysms

Question 84

84. A young thin patient was diagnosed with straight back syndrome. What cardiac problem is associated with this disease?
    A. Mitral valve prolapse
    B. Mitral stenosis
    C. pulmonary hypertension
    D. aortic stenosis

Answer 84

A. Mitral valve prolapse.

Rationale: Straight back syndrome is a condition where the thoracic spine is straightened, reducing the anteroposterior diameter of the thorax. This can lead to the heart being positioned more anteriorly in the chest. As a result, there can be a mechanical compression or distortion of the heart structures, leading to associated conditions like mitral valve prolapse.

Question 85

85. A patient with shortness of breath was seen at the ER. His extremities showed multiple needle marks on both arms. Examination of the abdomen revealed splenomegaly. What is the most likely cause of the splenomegaly?
    A. uncontrolled diabetes
    B. COPD
    C. chronic infective endocarditis
    D. heart failure

Answer 85

C. chronic infective endocarditis

Rationale:
Intravenous drug users are at a higher risk for infective endocarditis. Chronic infective endocarditis can lead to septic emboli, which can subsequently cause splenomegaly. The presence of multiple needle marks on the patient’s arms suggests a history of intravenous drug use, making this the most likely cause of the observed splenomegaly.

Question 86

6. Elevated JVP is a prognosticator in symptomatic heart failure stage C to D and asymptomatic left ventricular systolic dysfunction.
   A. True
   B. False

Answer 86

A. True

Rationale:
Elevated Jugular Venous Pressure (JVP) is a sign of right heart dysfunction and elevated central venous pressure. It indicates fluid overload or congestion, which is commonly seen in heart failure. An elevated JVP has been associated with worse outcomes in patients with symptomatic heart failure (stages C to D) and in those with asymptomatic left ventricular systolic dysfunction.

Question 87

87 Physician-recorded BP is higher than both nurse-recorded and self-recorded BP at home
A. True
B. False

Answer 87

A. True

Question 88

88. Cuff length should be 70% of the arm and cuff width should be 40% of the arm.
    A. False
    B. True

Answer 88

A. False

Cuff length should be 80% of the arm and cuff width should be 40% of the arm.

Question 89

89 Very low diastolic blood pressure is expected in chronic severe aortic regurgitation or large AV fistula because of enhanced diastolic run-off.
A. True
B. False

Answer 89

A. True

Rationale:
In conditions such as chronic severe aortic regurgitation or a large arteriovenous (AV) fistula, there is increased diastolic run-off. This means that during diastole, there’s a significant flow of blood either backward into the left ventricle (in the case of aortic regurgitation) or directly from arteries to veins (in the case of an AV fistula). This increased flow during diastole can result in a lower diastolic blood pressure.

Question 90

90. The true diastolic BP is the last Korotkoff sound during BP measurement and not the 5th Korotkoff sound.
    A. False
    B. True

Answer 90

A. False

Rationale:
The true diastolic blood pressure is determined by the fifth Korotkoff sound, which is when the sounds disappear entirely during blood pressure measurement. The fourth Korotkoff sound represents the point at which the sound becomes muffled, and the fifth is when it disappears. The disappearance of the sound (fifth Korotkoff sound) is used to determine diastolic pressure in adults.

Question 91

91. A difference of greater than 10mmHg is seen in:
    A. Aortic dissection
    B. All of the above
    C. Atherosclerotic subclavian artery disease
    D. Supravalvular aortic stenosis

Answer 91

B. All of the above

Question 92

92. Ankle brachial index is a predictor of long term cardiovascular mortality.
    A. False
    B. True

Answer 92

B. True

The Ankle-Brachial Index (ABI) is a non-invasive diagnostic test used to assess peripheral arterial disease (PAD). An abnormal ABI is indicative of atherosclerosis in the peripheral arteries and has been associated with an increased risk of cardiovascular events and mortality.

Question 93

93 Equal or greater than 20mmHg difference in leg and arm systolic blood pressure can be seen in:
A. none of the above
B. chronic severe aortic regurgitation
C. Extensive and calcified peripheral arterial disease
D. all of the above

Answer 93

D. all of the above

Question 94

94. White coat hypertension is defined as at least 2 separate clinic measurements >150/90 and at least 1 non-clinic measurement of <140/90 without evidence of target organ damage.
    A. True
    B. False

Answer 94

B. False

white coat hypertension” : at least 3 separate clinic-based measurements >140/90 and at least 2 non-clinic based measurements <140/90 without evidence of target end- organ damage
➤ 24-hour ambul

Question 95

95. Orthostatic hypotension is a drop in SBP of >30mmHg or drop in DBP >20mmHg from supine to upright position in 5 minutes.
    A. True
    B. False

Answer 95

B. False

Orthostatic hypotension is traditionally defined as a decrease in systolic blood pressure (SBP) of at least 20 mmHg or a decrease in diastolic blood pressure (DBP) of at least 10 mmHg within (3) three minutes of standing or head-up tilt on a tilt table.
The values given in the statement (SBP >30mmHg or DBP >20mmHg) are not standard thresholds for defining orthostatic hypotension, though they do indicate a significant drop in blood pressure.

Question 96

96. Lack of compensatory tachycardia due to hypotension can be seen in autonomic insufficiency among diabetics and parkinson’s disease.
    A. True
    B. False

Answer 96

A. True

Question 97

97.Triggers for orthostatic hypertension include
A. Advanced age
B. All of the above
C. Medications
D, Dehydration

Answer 97

B. All of the above

Question 98

98. test to check for integrity of the arcuate system of the hand is called:
    A. all of the above
    B. none of the above
    C. Allen’s test
    D. Tinnel sign

Answer 98

C. Allen’s test.

Rationale: The Allen’s test is used to evaluate the patency (or openness) of the radial and ulnar arteries in the hand. It helps ensure that both arteries are supplying blood to the hand, which is critical for procedures that might compromise blood flow through one of these arteries. The arcuate system refers to the network of arterial anastomoses in the hand, and Allen’s test can provide information about its integrity.

Question 99

99. Parts of complete cardiac diagnosis:
    A. Etiology
    B. anatomic and physiologic
    C. functional capacity using new york heart association classification
    D. all of the above

Answer 99

D. all of the above

Question 100

100. Kausmall’s sign is specific for restrictive cardiomyopathy
     A. True
     B. False

Answer 100

B. False

Kussmaul’s sign is an increase in jugular venous pressure (JVP) during inspiration. While it can be seen in restrictive cardiomyopathy, it is more classically associated with constrictive pericarditis. However, it’s worth noting that not all patients with constrictive pericarditis will demonstrate Kussmaul’s sign, and not everyone with Kussmaul’s sign has constrictive pericarditis.

Question 101

A 40-year-old male is brought into the ER unconscious with a BP, HR, and RR of zero. Upon connecting him to a cardiac monitor, you observe the following rhythm. What should be your immediate next step?

A) Administer IV fluids
B) Intubate the patient
C) Start an IV line of epinephrine
D) Defibrillate the patient

Answer 101

D) Defibrillate the patient

Ventricular fibrillation is a life-threatening heart rhythm that results from rapid, chaotic electrical impulses causing the heart to quiver or tremble instead of contracting normally.

Ventricular fibrillation is considered a shockable rhythm, meaning that a defibrillator should be used to deliver an electrical shock to the heart in an attempt to restore a normal rhythm.

Question 102

Which is a Normal Rhythm?
A. Sinus rhythm
B. Ventricular fibrillation
C. Ventricular tachycardia
D. Pulseless electrical activity

Answer 102

A. Sinus rhythm

Question 103

Which is a Normal Rhythm?
A. Sinus rhythm
B. Ventricular fibrillation
C. Ventricular tachycardia
D. Pulseless electrical activity

Answer 103

A. Sinus rhythm

Question 104

1. Which of the following rhythms is show?

A. Ventricular fibrillation
B. Pulseless ventricular tachycardia
C. Asystole
D. Pulseless electrical activity

Answer 104

C. Asystole

Asystole, often referred to as a flatline, is a state of no cardiac electrical activity. It’s vital to recognize that defibrillating asystole is not beneficial and can be detrimental. Instead, the focus should be on providing effective chest compressions and addressing reversible causes.

Non-shockable rhythms, like asystole and pulseless electrical activity, do not benefit from defibrillation.

This suggests that the immediate intervention for a non-shockable rhythm is to initiate chest compressions. High-quality chest compressions are a fundamental component of cardiopulmonary resuscitation (CPR) and can significantly improve the chance of survival and neurological recovery in cardiac arrest patients.