ATI - The Cardiovascular Exam 2024
A 68-year-old woman presents with shortness of breath, fatigue, dry cough, and
swelling in her ankles. Symptoms started around the time of her son's wedding 6
weeks ago. She dismissed them as stress-related, but symptoms have worsened in
intensity and frequency. Now she becomes very short of breath with any exertion,
such as climbing stairs in her home. She feels like she may pass out and has to sit
when she gets lightheaded. Her breathing is more difficult when lying down. She
denies productive cough, fever, or chest pain. She has had no medical care for
several years. Her past medical history is unremarkable, with no known medical
conditions and no surgeries. She is menopausal and does not take any
medications, nor does she have any allergies. She denies the use of tobacco,
alcohol, and drugs.
Vitals are shown in the table. Physical exam was performed by the provider on an
earlier shift, and the patient's care was <<<100%CorreCtanswers>>5.
Untreated hypertension
A 5-day-old female newborn was born 5 weeks prematurely and presents to her
first pediatrician's appointment. She did not have any feeding or breathing issues,
so mother and child had only a 2-day stay at the hospital. During the
cardiovascular examination, the pediatrician notes that the newborn has a distinct
murmur with a rough machine-like quality that is maximal at the second
intercostal space at the left sternal border. The murmur starts after S1 and passes
through S2 into diastole.
,Question
What study is the first choice to confirm it the most likely diagnosis?
1 Electrocardiography
2 Chest X-ray
3 Cardiac catheterization
4 Chest CT scan
5 Echocardiography <<<100%CorreCtanswers>>5. Echocardiography
A 62-year-old man with a 15-year history of hypertension presents with severe
tearing chest pain radiating through to the back. Blood pressure is 180/110 mm
Hg, heart rate is 120 bpm, and respiratory rate is 34/min. Physical examination
findings include neck negative for bruits/JVD, lungs clear to auscultation, regular
heart rhythm, normal S1/S2 with an S4 present, and a grade III/IV diastolic
rumbling murmur noted with the patient leaning forward. Radial pulses are 1+ on
right and 3+ on left. EKG reveals a sinus tachycardia and evidence of left
ventricular hypertrophy. A STAT chest X-ray is obtained.
,Question
What finding is most consistent with the presumptive diagnosis?
1 Prominent pulmonary hila
2 Widening of the superior mediastinum
3 Kerley B lines
4 Right-sided pulmonary effusion
5 Prominent right cardiac shadowing <<<100%CorreCtanswers>>2.
Widening of the superior mediastinum
A 78-year-old woman is an inpatient status post-colectomy for colon cancer. On
postoperative day 3, her oral temperature is noted to be elevated to 100.6°F.
Chest X-ray and urinalysis are both negative for signs of infection. An infectious
disease consult is placed in order to better define the patient's new fever. You
suspect superficial thrombophlebitis.
Question
What physical examination findings would support your suspicion?
1 Abdominal tenderness in the right upper quadrant
, 2 Positive Homans sign in left calf
3 Abdominal tenderness in the left lower quadrant
4 Erythema and tenderness along the vein with IV insertion
5 Erythema and tenderness along her incision site
<<<100%CorreCtanswers>>4. Erythema and tenderness along the vein with
IV insertion
A 65-year-old man presents to the office due to 6 months of bilateral buttock and
thigh cramping pain. It occurs after walking 20 feet and is completely and quickly
relieved with resting. His past medical history includes hypertension treated with
atenolol, and he had a stroke 3 years ago. He also reports impotence for
approximately the same duration of time.
Question
What is the patient's physical exam likely to include?
1 Absent femoral, popliteal, pedal pulses
2 Absent popliteal and pedal pulses; normal femoral pulses
3 Absent pedal pulses; normal femoral and popliteal pulses
A 68-year-old woman presents with shortness of breath, fatigue, dry cough, and
swelling in her ankles. Symptoms started around the time of her son's wedding 6
weeks ago. She dismissed them as stress-related, but symptoms have worsened in
intensity and frequency. Now she becomes very short of breath with any exertion,
such as climbing stairs in her home. She feels like she may pass out and has to sit
when she gets lightheaded. Her breathing is more difficult when lying down. She
denies productive cough, fever, or chest pain. She has had no medical care for
several years. Her past medical history is unremarkable, with no known medical
conditions and no surgeries. She is menopausal and does not take any
medications, nor does she have any allergies. She denies the use of tobacco,
alcohol, and drugs.
Vitals are shown in the table. Physical exam was performed by the provider on an
earlier shift, and the patient's care was <<<100%CorreCtanswers>>5.
Untreated hypertension
A 5-day-old female newborn was born 5 weeks prematurely and presents to her
first pediatrician's appointment. She did not have any feeding or breathing issues,
so mother and child had only a 2-day stay at the hospital. During the
cardiovascular examination, the pediatrician notes that the newborn has a distinct
murmur with a rough machine-like quality that is maximal at the second
intercostal space at the left sternal border. The murmur starts after S1 and passes
through S2 into diastole.
,Question
What study is the first choice to confirm it the most likely diagnosis?
1 Electrocardiography
2 Chest X-ray
3 Cardiac catheterization
4 Chest CT scan
5 Echocardiography <<<100%CorreCtanswers>>5. Echocardiography
A 62-year-old man with a 15-year history of hypertension presents with severe
tearing chest pain radiating through to the back. Blood pressure is 180/110 mm
Hg, heart rate is 120 bpm, and respiratory rate is 34/min. Physical examination
findings include neck negative for bruits/JVD, lungs clear to auscultation, regular
heart rhythm, normal S1/S2 with an S4 present, and a grade III/IV diastolic
rumbling murmur noted with the patient leaning forward. Radial pulses are 1+ on
right and 3+ on left. EKG reveals a sinus tachycardia and evidence of left
ventricular hypertrophy. A STAT chest X-ray is obtained.
,Question
What finding is most consistent with the presumptive diagnosis?
1 Prominent pulmonary hila
2 Widening of the superior mediastinum
3 Kerley B lines
4 Right-sided pulmonary effusion
5 Prominent right cardiac shadowing <<<100%CorreCtanswers>>2.
Widening of the superior mediastinum
A 78-year-old woman is an inpatient status post-colectomy for colon cancer. On
postoperative day 3, her oral temperature is noted to be elevated to 100.6°F.
Chest X-ray and urinalysis are both negative for signs of infection. An infectious
disease consult is placed in order to better define the patient's new fever. You
suspect superficial thrombophlebitis.
Question
What physical examination findings would support your suspicion?
1 Abdominal tenderness in the right upper quadrant
, 2 Positive Homans sign in left calf
3 Abdominal tenderness in the left lower quadrant
4 Erythema and tenderness along the vein with IV insertion
5 Erythema and tenderness along her incision site
<<<100%CorreCtanswers>>4. Erythema and tenderness along the vein with
IV insertion
A 65-year-old man presents to the office due to 6 months of bilateral buttock and
thigh cramping pain. It occurs after walking 20 feet and is completely and quickly
relieved with resting. His past medical history includes hypertension treated with
atenolol, and he had a stroke 3 years ago. He also reports impotence for
approximately the same duration of time.
Question
What is the patient's physical exam likely to include?
1 Absent femoral, popliteal, pedal pulses
2 Absent popliteal and pedal pulses; normal femoral pulses
3 Absent pedal pulses; normal femoral and popliteal pulses
