Seidel's CH 15

Question 1

The condition in which a patient’s heart is either rotated or displaced to the right or is situated as a mirror image of the expected position is called

a. amyloidosis.
b. cardiomyopathy.
c. dextrocardia.
d. situs inversus.
e. coarctation.

Answer 1

ANS: C
Dextrocardia occurs when the heart is displaced or rotated to the right or is a complete mirror image of the expected finding. Amyloidosis is a metabolic disorder marked by amyloid deposits in organs and tissues. Cardiomyopathy is the deterioration of heart muscle function. Coarctation is the compression of the walls of a vessel such as an aortic coarctation. Situs inversus occurs when the heart and stomach are displaced to the right and the liver is located to the left.

Question 2

Heart position can vary depending on body habitus. In a short, stocky individual, you would expect the heart to be located

a. more to the right and hanging more vertically.
b. more to the left and lying more horizontally.
c. riding higher in the chest and pushed anteriorly.
d. hanging lower in the chest and riding more vertically.
e. more to the right and lying more horizontally.

Answer 2

ANS: B
The position of the heart varies depending on body build, configuration of the chest, and level of the diaphragm. A tall, slender person’s heart tends to hang vertically and is positioned centrally. A stocky, short person’s heart tends to lie more to the left and more horizontally.

Question 3

Thin-walled reservoirs of the heart are the

a. atria.
b. pericardia.
c. sinuses.
d. ventricles.
e. septa.

Answer 3

ANS: A
The atria are small, thin-walled structures that act primarily as reservoirs for the blood returning to the heart from the venous system. The pericardium is a double-walled membranous fibroserous sac enclosing the heart and the bases of the great vessels. A sinus is a dilated channel for venous blood. The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The ventricles are the primary muscle mass of the heart. The left heart and right heart are divided by a blood-tight partition called the cardiac septum.

Question 4

Which cardiac structure is responsible for the heart’s pumping action?

a. Pericardium
b. Epicardium
c. Myocardium
d. Endocardium
e. Atria

Answer 4

ANS: C
The myocardium is the thick muscular middle layer that is responsible for the pumping action of the heart. The pericardium is the tough, double-walled, fibrous sac that protects the heart. The epicardium is the thin outermost muscle layer that covers the heart and extends onto the great vessels. The endocardium is the innermost layer that lines the chambers of the heart and covers heart valves. The atria are small, thin-walled structures that act primarily as reservoirs for the blood returning to the heart from the veins throughout the body.

Question 5

Which two heart structures are most anterior in the chest?

a. Both atria
b. Both ventricles
c. The right atrium and ventricle
d. The left atrium and ventricle
e. Superior and inferior venae cavae

Answer 5

ANS: C
The most anterior surface of the heart is formed by the right ventricle. The heart is turned ventrally on its axis, putting its right side more forward. The left atrium is above the left ventricle, forming the most posterior aspect of the heart. The superior and inferior venae cava lie posteriorly.

Question 6

Contraction of the ventricles causes

a. closure of the atrioventricular valves.
b. closure of the pulmonic and aortic valves.
c. opening of the mitral valve and closure of the tricuspid valve.
d. opening of the mitral and tricuspid valves.
e. opening of the auricular septa.

Answer 6

ANS: A
When the ventricles contract, the semilunar, pulmonic, and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time, the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles.

Question 7

Which two structures together form the primary muscle mass of the heart?

a. Right atria and left ventricle
b. Left ventricle and the aorta
c. Right and left atria
d. Left atrium and the pulmonary vein
e. Right and left ventricles

Answer 7

ANS: E
The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The right and left ventricles together form the primary muscle mass of the heart. The left ventricle pumps blood through the aortic valve into the aorta, which provides blood to the rest of the body. The right and left atrium pumps blood through the tricuspid and mitral valves to the ventricles. The pulmonary vein pumps oxygenated blood from the lungs to the left atria.

Question 8

The major heart sounds are normally created by

a. valves opening.
b. valves closing.
c. the rapid movement of blood.
d. rubbing together of the cardiac walls.
e. pulmonic veins.

Answer 8

ANS: B
At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1 “lubb.” When the pressure in the ventricles falls, below that of the aorta and pulmonary artery, and when the ventricles are almost empty, the aortic and pulmonic valves close, producing the second heart sound S2 “dubb.” Valve opening is usually a silent event.

Question 9

Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the

a. P wave.
b. PR interval.
c. QRS complex.
d. ST segment.
e. T wave.

Answer 9

ANS: A
The P wave represents the spread of a stimulus through the atria (atrial depolarization). The PR interval is the time from the initial stimulation of the atria to the initial stimulation of the ventricles, usually 0.12 to 0.20 second. The QRS complex is the spread of a stimulus through the ventricles (ventricular depolarization), less than 0.10 second. The ST segment and T wave are the return of stimulated ventricular muscle to a resting state (ventricular repolarization).

Question 10

A third heart sound is created by

a. atrial contraction.
b. ventricular contraction.
c. diastolic filling.
d. regurgitation between the right and left ventricles.
e. blood in the pericardium.

Answer 10

ANS: C
Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria, and the filling sometimes produces a third heart sound S3.

Question 11

The “pacing” structure of the heart’s electrical activity is the

a. atrioventricular (AV) node.
b. bundle of His.
c. Purkinje fibers.
d. coronary sinus.
e. sinoatrial (SA) node.

Answer 11

ANS: E
An electrical impulse stimulates each myocardial contraction, and this impulse originates in and is paced by the SA node.

Question 12

Purkinje fibers are located in the

a. sinoatrial node.
b. atrioventricular node.
c. myocardium.
d. aortic arch.
e. pericardium.

Answer 12

ANS: C

The Purkinje fibers are located in the ventricular myocardium.

Question 13

The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the

a. P wave.
b. QRS complex.
c. PR interval.
d. T wave.
e. U wave.

Answer 13

ANS: B
The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to the initiation of stimulation of the ventricles. The T wave is the return of the stimulated ventricular muscle to a resting state. The U wave is a small deflection sometimes seen just after the T wave.

Question 14

In a fetus, the right ventricle pumps blood through the

a. left atrium.
b. ductus arteriosus.
c. lungs.
d. foramen ovale.
e. septum primum.

Answer 14

ANS: B

The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs.

Question 15

In what group are the right and left ventricles equal in weight and muscle mass?

a. Newborns
b. School-age children
c. Adolescents
d. Older adults
e. Pregnant women

Answer 15

ANS: A
At the time of birth, the right and left ventricles are equal in weight and muscle mass because they both pump blood into the systemic circulation. Within 24 to 48 hours, closure of the ductus arteriosus and the interatrial foramen ovale cause pressure in the left atrium to increase. At this time, the right ventricles demand changes as the pulmonary circulation develops, and the left ventricle assumes total responsibility for providing systemic circulation. This results in an increase in the mass of the left ventricle. In older adults, the left ventricle wall thickens, and the valves become fibrotic and calcified. In pregnant women, the left ventricle increases in both wall thickness and mass.

Question 16

Closure of the ductus arteriosus usually occurs

a. just before the initiation of labor.
b. 24 to 48 hours after birth.
c. after 7 days of life.
d. between the second and third months of life.
e. during the toddler stage.

Answer 16

ANS: B

Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth. MSC: Organ System: Cardiovascular

Question 17

The apex of a 2-month-old baby’s heart typically lies closest to the

a. left midsternal area.
b. fourth left intercostal space.
c. midthoracic spinal area.
d. sixth left intercostal space.
e. right midsternal area.

Answer 17

ANS: B
In infants and young children, the heart lies more horizontally in the chest. The apex of the heart is located higher, sometimes well out into the fourth left intercostal space.

Question 18

Normal cardiac changes that occur during pregnancy include

a. decreased cardiac output.
b. increased thickness and mass of the left ventricle.
c. decreased heart rate.
d. dilation of the ventricles.
e. heart is shifted more vertical.

Answer 18

ANS: B
The maternal blood volume increases by 40% to 50% because of an increase in plasma volume. The heart works harder to accommodate the increased heart rate and stroke volume (both equal cardiac output), resulting in the increase in left ventricle wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally, and there is a slight axis rotation.

Question 19

Which ECG change would not be expected as an age-related pattern?

a. First-degree block
b. Bundle branch block
c. Left ventricular hypertrophy
d. Ventricular fibrillation
e. Atrial fibrillation

Answer 19

ANS: D
Common ECG changes in older adults include first-degree atrioventricular block, bundle branch blocks, ST-T wave abnormalities, premature systole (atrial and ventricular), left anterior hemiblock, left ventricular hypertrophy, and atrial fibrillation.

Question 20

Mr. O, age 50 years, comes for his yearly health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O mentions that he routinely engages in light exercise. At this time, you should

a. ask if he makes his own bed daily.
b. have the patient describe his exercise.
c. make a note that he walks each day. d. record “light exercise” in the history.
e. record “questionable exercise” in the history.

Answer 20

ANS: B
When Mr. O says he engages in light exercise, have him describe his exercise. To qualify his use of the term “light,” ask him the type, length of time, frequency, and intensity of his activities.

Question 21

Pleural pain differs from chest discomfort caused by other conditions in that it is

a. precipitated by breathing.
b. eased with deep breathing.
c. usually described as dull in nature.
d. related to the time of day.
e. eased with coughing.

Answer 21

ANS: A
Pleural pain is precipitated by breathing and coughing and is usually described as a sharp pain that is present during respirations and absent during breath-holding. Angina is substernal and is provoked by effort, emotion, or eating; it is relieved by rest or nitroglycerin. Angina is usually accompanied by diaphoresis and occasionally by nausea.

Question 22

Which of the following information belongs in the past medical history section related to heart and blood vessel assessment?

a. Adolescent inguinal hernia
b. Childhood mumps
c. Past incidence of bee stings
d. Previous unexplained fever
e. Parents with a history of cardiac problems

Answer 22

ANS: D
Previous unexplained fever should be included in the past medical history of a heart and blood vessel assessment. This incidence may be related to acute rheumatic fever, with potential heart valve damage.

Question 23

A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history interview of his family history, he relates that his father died of heart trouble. The most important follow-up question you should pose is which of the following?

a. “Did your father have coronary bypass surgery?”
b. “Did your father’s father have heart trouble also?”
c. “What were your father’s usual dietary habits?”
d. “What age was your father at the time of his death?”
e. “Did your mother also have heart trouble?”

Answer 23

ANS: D
A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one’s chance of a similar occurrence.

Question 24

Which one of the following is a common symptom of cardiovascular disorders in an older adult?

a. Fatigue
b. Joint pain
c. Poor night vision
d. Urticaria
e. Fevers

Answer 24

ANS: A
Common symptoms of cardiovascular disorders in older adults include confusion, dizziness, blackouts, syncope, palpitations, coughs and wheezes, hemoptysis, shortness of breath, chest pains or tightness, impotence, fatigue, and leg edema.

Question 25

In an adult, the apical impulse should be most visible when the patient is in which position?

a. Supine
b. Leaning backward
c. Lithotomy
d. Right lateral recumbent
e. Upright

Answer 25

ANS: E
In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem.

Question 26

If the apical impulse is more vigorous than expected to the chest wall, it is called

a. a lift.
b. a thrill.
c. a bruit.
d. a murmur.
e. crepitus.

Answer 26

ANS: A
The apical impulse is more vigorous than expected; it is referred to as a heave or lift. A thrill is a palpable murmur. A bruit is an auscultated arterial murmur. A murmur is an auscultated sound that is caused by turbulent blood flow into, through, or out of the heart. Crepitus is air in the subcutaneous tissue from respirations.

Question 27

A palpable rushing vibration over the base of the heart at the second intercostal space is called a

a. heave.
b. lift.
c. thrill.
d. thrust.
e. murmur.

Answer 27

ANS: C
A thrill is a fine, palpable, rushing vibration, or a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A thrust is a movement forward suddenly and forcibly. A murmur is an auscultated sound caused by turbulent blood flow.

Question 28

An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may indicate

a. decreased cardiac output.
b. dextrocardia.
c. left ventricular hypertrophy.
d. hyperventilation.
e. obesity.

Answer 28

ANS: C
An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. In dextrocardia, the PMI would be displaced to the right.

Question 29

A lift along the left sternal border is most likely the result of

a. aortic stenosis.
b. atrial septal defect.
c. pulmonary hypertension.
d. right ventricular hypertrophy.
e. left ventricular hypertrophy.

Answer 29

ANS: D
A lift along the left sternal border may be caused by right ventricular hypertrophy. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect.

Question 30

To estimate heart size by percussion, you should begin tapping at the

a. apex.
b. left sternal border.
c. midclavicular line.
d. midsternal line.
e. anterior axillary line.

Answer 30

ANS: E
Estimating the size of the heart can be done by percussion. Begin tapping at the anterior axillary line, moving medially along the intercostal spaces toward the sternal border. The change from a resonant to a dull note marks the cardiac border.

Question 31

Normal heart sounds are best heard

a. directly over the semilunar and bicuspid heart valves.
b. over areas where blood flows after it passes through a valve.
c. near the carotid vessels.
d. over the central sternum.
e. over the ribs.

Answer 31

ANS: B
Normal heart sounds are best heard in areas where blood flows after it passes through a valve in the direction of blood flow.

Question 32

To hear diastolic heart sounds, you should ask patients to

a. lie on their backs.
b. lie on their left sides.
c. lie on their right sides.
d. sit up and lean forward.
e. lie prone.

Answer 32

ANS: B
The left lateral recumbent position is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. The right lateral recumbent position is the best position for evaluating a right rotated heart of dextrocardia.

Question 33

The carotid pulse should coincide with which heart sound?

a. S1
b. S2
c. S3
d. S4
e. S3-4

Answer 33

ANS: A
S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole. S3-4 is an abnormal summation gallop sound.

Question 34

You are listening to a patient’s heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following?

a. S1
b. S2
c. S3
d. S4
e. S3-4

Answer 34

ANS: B
S2 marks the closure of the semilunar valves, which indicates the end of systole, and is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration.

Question 35

During auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split. You should ask the patient to inhale deeply while listening at the _____ area.

a. aortic
b. pulmonic
c. tricuspid
d. mitral
e. apex

Answer 35

ANS: B
Splitting results from the failure of the mitral and tricuspid valves or the pulmonic and aortic valves to close simultaneously. Splitting of S1 is usually not heard because the closing of the tricuspid valve is too faint. Rarely, it may be audible in the tricuspid area on deep inspiration. Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site.

Question 36

The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing

a. the splitting of S2.
b. high-pitched murmurs.
c. presystolic gallops.
d. systolic ejection sounds.
e. pericardial friction rub.

Answer 36

ANS: C
Using the bell of the stethoscope at the apex is more useful for low-pitched presystolic gallops. The patient should lie in the supine or left lateral recumbent position.

Question 37

You are conducting an examination of Mr. C’s heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is

a. barely discernible.
b. quiet but audible.
c. moderately loud.
d. loud with palpable thrill.
e. very loud without a stethoscope.

Answer 37

ANS: C
The intensity of a grade III murmur is described as moderately loud. Barely loud is a grade I murmur, quiet but clearly audible is a grade II, loud with a palpable thrill is a grade IV, and very loud without a stethoscope is a grade VI.

Question 38

A grade I or II murmur, without radiation and of medium pitch, is a common variation found in

a. school-age children.
b. older women.
c. middle-aged men.
d. sedentary individuals.
e. older adults.

Answer 38

ANS: A
Many murmurs, particularly in children, adolescents, and especially young athletes, have no apparent cause. These are generally grade I or II murmurs that are usually midsystolic and without radiation, are medium pitched, and are blowing, brief, and often accompanied by splitting of S2.

Question 39

An example of a functional heart murmur is one that is caused by

a. anemia.
b. a ventricular septal defect.
c. an atrial septal defect.
d. mitral valve prolapse.
e. a leaking aortic valve.

Answer 39

ANS: A
Not all murmurs are the result of valvular defects made by a healthy heart beating strongly, high-output demands that increase the speed of blood flow can cause murmurs. Anemia, pregnancy, and thyrotoxicosis can cause these functional heart murmurs.

Question 40

A split second heart sound is

a. abnormal.
b. greatest at the peak of inspiration.
c. heard best after forceful expiration.
d. supposed to disappear with deep
inspiration.
e. always accompanied by a thrill.

Answer 40

ANS: B
Splitting of S2 is an expected event because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill.

Question 41

The earliest sign of heart failure in an infant is frequently

a. an apical impulse in the fourth intercostal space.
b. moisture in the lungs.
c. enlarged thyroid.
d. clubbing of the fingers.
e. liver enlargement.

Answer 41

ANS: E
If heart failure is suspected, note that the infant’s liver may enlarge before there is any suggestion of moisture in the lungs, and the left lobe of the liver may be more distinctly enlarged than the right. An apical impulse in the fourth intercostal space is a normal finding.

Question 42

Chest pain in a child with an organic cause is more likely the result of

a. cardiac disease.
b. asthma.
c. esophageal reflux.
d. arthritis.
e. peptic ulcer disease.

Answer 42

ANS: B
Unlike chest pain in adults, chest pain in children and adolescents seldom is caused by a cardiac problem. More likely the case is related to trauma, exercise-induced asthma, or cocaine use.

Question 43

Which dysrhythmia is a physiologic event during childhood?

a. First-degree AV block
b. Mobitz type II
c. Multifocal PVCs
d. Sinus arrhythmia
e. Third-degree AV block

Answer 43

ANS: D
Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension.

Question 44

An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an expected finding in

a. adults under stress.
b. 4-year-old children.
c. pregnant women.
d. older adults.
e. premature infants.

Answer 44

ANS: B
Sinus arrhythmia is a physiologic event during childhood. The heart rate of a child varies in a cyclic pattern, usually faster on inspiration and slow on expiration.

Question 45

A condition that is likely to present with dizziness and fainting is

a. bacterial endocarditis.
b. hypertension.
c. sick sinus syndrome.
d. pericarditis.
e. hyperlipidemia.

Answer 45

ANS: C
Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes arrhythmias with subsequent fainting, transient dizzy spells, lightheadedness, seizures, palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of neurologic dysfunctions, and sudden onset of CHF. Chest pain is an initial symptom in acute pericarditis along with a triphasic friction rub. Hyperlipidemia is a risk factor for myocardial infarction that commonly presents with chest pain.

Question 46

The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to suspect

a. congestive heart failure.
b. mitral stenosis.
c. endocarditis.
d. cardiac tamponade.
e. pericarditis.

Answer 46

ANS: E
Chest pain is the usual initial symptom in acute pericarditis, which is the inflammation of the pericardium. The key physical finding is the triphasic friction rub, which is comprised of ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole. It is heard just to the left of the sternum in the third and fourth intercostal spaces and is characteristically scratchy.

Question 47

Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of

a. rheumatic fever.
b. cor pulmonale.
c. pericarditis.
d. endocarditis.
e. cardiac tamponade.

Answer 47

ANS: D
Endocarditis is a bacterial infection of the endothelial layer of the heart. It should be suspected with at-risk patients (e.g., IV drug abusers) who present with fever and a sudden onset of congestive heart symptoms. The lesions described are Janeway lesions.

Question 48

48. Fat deposits in the circulatory system of an older adult can lead to
    a. diffuse conduction disturbances.
    b. exaggerated contractility.
    c. heart failure.
    d. thinning of the ventricles.
    e. amyloidosis.

Answer 48

ANS: C
Atherosclerosis is a disease in which fat deposits (cholesterol) accumulate in the walls of the arteries, which can lead to heart failure or stroke.

Question 49

A holosystolic murmur in an infant that is best heard along the left sternal border in the third to fifth intercostal spaces and does not radiate to the neck is indicative of

a. a ventricular septal defect.
b. patent ductus arteriosus.
c. pulmonary stenosis.
d. aortic sclerosis.
e. dextrocardia.

Answer 49

ANS: A

Regurgitation through the ventricular septal defect results in a holosystolic murmur as described.

Question 50

Ms. S. is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She reports a recent severe sore throat. You suspect

a. angina.
b. acute rheumatic fever.
c. cardiac amyloidosis.
d. aortic sclerosis.
e. sick sinus syndrome.

Answer 50

ANS: B
Acute rheumatic fever is a systemic connective tissue disease that occurs after a streptococcal pharyngitis or a skin infection. It may result in serious cardiac valvular involvement of the mitral or aortic valve. Often the valve becomes stenotic and regurgitant. Prevention is adequate treatment of streptococcal pharyngitis or skin infections. The other possible answers do not have the presenting manifestations and occur mostly in older adults.

Question 51

A grade IV mitral regurgitation murmur would

a. be described as a diastolic murmur.
b. not be expected to have a thrill.
c. radiate to the axilla.
d. be heard best at the base.
e. radiate to the neck.

Answer 51

ANS: C
A grade IV murmur would have a thrill, and a mitral regurgitation murmur is best heard at the apex, is holosystolic, and would radiate to the axilla.

Question 52

The most helpful finding in determining left-sided heart failure is

a. dyspnea.
b. orthopnea.
c. jugular vein distention.
d. an S4 heart sound.
e. tachycardia.

Answer 52

ANS: C
Evidence-based research has shown that the most helpful clinical examination finding supportive of left-sided heart failure is jugular vein distention. The other choices are not as reliable.

Question 53

Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting, and is often associated with focal tenderness is most likely

a. cardiac.
b. pleural.
c. esophageal.
d. musculoskeletal.
e. psychoneurotic.

Answer 53

ANS: D

The description given is a classic example of musculoskeletal chest pain.