NR547 CEA Exam 2026
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1. During a post-hospital discharge visit, you notice your 71-year-old female
patient has been diagnosed with a "new murmur" found by the hospitalist during
their recent hospitalization for CHF exacerbation. In evaluating the patient, during
which phase of the cardiac cycle would you anticipate auscultation of a S3 or S4
heart sound?
A) Diastole
B) S3 in systole while S4 in diastole
C) Systole
D) S4 in diastole while S3 in systole
Correct Answer: A
Rationale: Both S3 and S4 heart sounds are diastolic events. S3 occurs during early
diastole (ventricular filling phase) and is associated with rapid ventricular filling. It is
often heard in conditions of volume overload such as heart failure. S4 occurs during late
diastole (atrial systole) and is associated with reduced ventricular compliance. S3 and S4
are both auscultated during diastole, not systole. In a patient with CHF exacerbation, a
new S3 gallop would be a significant finding indicating decompensated heart failure.
,2. The point of maximum impulse (PMI) is MOST often palpable in healthy adults
when positioned in the supine or left lateral decubitus position. Which one of the
following locations is most commonly described as the PMI in a healthy adult?
A) Left 2nd intercostal space, midaxillary line
B) Left 5th intercostal space, midclavicular line
C) Right 4th intercostal space, midaxillary line
D) Right 2nd intercostal space, midclavicular line
Correct Answer: B
Rationale: The point of maximum impulse (PMI), also known as the apical impulse, is
normally located at the left 5th intercostal space at the midclavicular line. This
corresponds to the apex of the left ventricle. In a healthy adult, the PMI should be
palpable and approximately the size of a quarter (1-2 cm in diameter). Displacement of
the PMI laterally or inferiorly may indicate left ventricular enlargement. The PMI is best
palpated with the patient in the left lateral decubitus position, which brings the heart
closer to the chest wall.
3. A 65-year-old male with a history of hypertension presents for a routine
physical examination. On cardiac auscultation, you hear a systolic ejection murmur
at the right upper sternal border that radiates to the carotids. What is the MOST
likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Tricuspid regurgitation
D) Pulmonic stenosis
Correct Answer: B
Rationale: Aortic stenosis classically presents with a systolic ejection murmur best heard
at the right upper sternal border (aortic area) that radiates to the carotids. The murmur
is often described as harsh, crescendo-decrescendo, and may be associated with a
delayed carotid upstroke (pulsus parvus et tardus). Mitral regurgitation (A) is heard best
at the apex and radiates to the axilla. Tricuspid regurgitation (C) is best heard at the left
lower sternal border. Pulmonic stenosis (D) is best heard at the left upper sternal border.
,4. A 72-year-old female with a history of chronic heart failure presents with
increasing shortness of breath and peripheral edema. On auscultation, you hear an
S3 gallop. What is the clinical significance of this finding?
A) Normal finding in elderly patients
B) Indicates increased left ventricular compliance
C) Indicates decreased left ventricular compliance
D) Indicates volume overload and decreased left ventricular function
Correct Answer: D
Rationale: An S3 gallop (ventricular gallop) is an abnormal heart sound heard in early
diastole and indicates rapid ventricular filling. In the setting of heart failure, an S3
suggests volume overload and decreased left ventricular function. It is associated with
increased left ventricular end-diastolic pressure and is a poor prognostic sign in heart
failure patients. S3 is normal in children and young adults but is always pathologic in
older adults. Decreased ventricular compliance (C) is associated with S4, not S3.
5. A 55-year-old male presents with a holosystolic murmur best heard at the apex
with radiation to the left axilla. What is the MOST likely diagnosis?
A) Aortic stenosis
B) Mitral regurgitation
C) Aortic regurgitation
D) Mitral stenosis
Correct Answer: B
Rationale: Mitral regurgitation classically presents as a holosystolic (pansystolic)
murmur best heard at the apex and radiating to the left axilla. The murmur is high-
pitched and may be associated with a displaced PMI and an S3 gallop in severe cases.
Aortic stenosis (A) is a systolic ejection murmur at the right upper sternal border. Aortic
regurgitation (C) is an early diastolic murmur. Mitral stenosis (D) is a diastolic murmur
with an opening snap.
, 6. Which of the following maneuvers would INCREASE the intensity of a murmur
due to hypertrophic cardiomyopathy?
A) Squatting
B) Handgrip
C) Valsalva maneuver
D) Leg raising
Correct Answer: C
Rationale: The Valsalva maneuver (forced expiration against a closed glottis) decreases
venous return and left ventricular volume, increasing the left ventricular outflow tract
(LVOT) obstruction in hypertrophic cardiomyopathy. This maneuver increases the
intensity of the systolic ejection murmur. Squatting (A) and leg raising (D) increase
venous return and ventricular volume, which would decrease the murmur. Handgrip (B)
increases afterload, which also decreases the murmur.
7. A patient presents with an early diastolic decrescendo murmur best heard at the
left sternal border. What is the MOST likely diagnosis?
A) Aortic stenosis
B) Mitral stenosis
C) Aortic regurgitation
D) Pulmonic stenosis
Correct Answer: C
Rationale: Aortic regurgitation presents as an early diastolic decrescendo murmur best
heard at the left 3rd-4th intercostal space (left sternal border). It may also be heard at
the right upper sternal border. Associated findings include wide pulse pressure,
bounding pulses, and Quincke's sign. Mitral stenosis (B) presents with a mid-diastolic
murmur with an opening snap. Aortic stenosis (A) and pulmonic stenosis (D) are systolic
murmurs.
8. On auscultation of the carotid arteries, you hear a bruit. What is the clinical
significance of this finding in an asymptomatic patient?
Actual Questions and Correct Answers | Latest
Update
Complete Review with Detailed Rationales | Graded A+ | 100%
Guarantee Verified by Experts
1. During a post-hospital discharge visit, you notice your 71-year-old female
patient has been diagnosed with a "new murmur" found by the hospitalist during
their recent hospitalization for CHF exacerbation. In evaluating the patient, during
which phase of the cardiac cycle would you anticipate auscultation of a S3 or S4
heart sound?
A) Diastole
B) S3 in systole while S4 in diastole
C) Systole
D) S4 in diastole while S3 in systole
Correct Answer: A
Rationale: Both S3 and S4 heart sounds are diastolic events. S3 occurs during early
diastole (ventricular filling phase) and is associated with rapid ventricular filling. It is
often heard in conditions of volume overload such as heart failure. S4 occurs during late
diastole (atrial systole) and is associated with reduced ventricular compliance. S3 and S4
are both auscultated during diastole, not systole. In a patient with CHF exacerbation, a
new S3 gallop would be a significant finding indicating decompensated heart failure.
,2. The point of maximum impulse (PMI) is MOST often palpable in healthy adults
when positioned in the supine or left lateral decubitus position. Which one of the
following locations is most commonly described as the PMI in a healthy adult?
A) Left 2nd intercostal space, midaxillary line
B) Left 5th intercostal space, midclavicular line
C) Right 4th intercostal space, midaxillary line
D) Right 2nd intercostal space, midclavicular line
Correct Answer: B
Rationale: The point of maximum impulse (PMI), also known as the apical impulse, is
normally located at the left 5th intercostal space at the midclavicular line. This
corresponds to the apex of the left ventricle. In a healthy adult, the PMI should be
palpable and approximately the size of a quarter (1-2 cm in diameter). Displacement of
the PMI laterally or inferiorly may indicate left ventricular enlargement. The PMI is best
palpated with the patient in the left lateral decubitus position, which brings the heart
closer to the chest wall.
3. A 65-year-old male with a history of hypertension presents for a routine
physical examination. On cardiac auscultation, you hear a systolic ejection murmur
at the right upper sternal border that radiates to the carotids. What is the MOST
likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Tricuspid regurgitation
D) Pulmonic stenosis
Correct Answer: B
Rationale: Aortic stenosis classically presents with a systolic ejection murmur best heard
at the right upper sternal border (aortic area) that radiates to the carotids. The murmur
is often described as harsh, crescendo-decrescendo, and may be associated with a
delayed carotid upstroke (pulsus parvus et tardus). Mitral regurgitation (A) is heard best
at the apex and radiates to the axilla. Tricuspid regurgitation (C) is best heard at the left
lower sternal border. Pulmonic stenosis (D) is best heard at the left upper sternal border.
,4. A 72-year-old female with a history of chronic heart failure presents with
increasing shortness of breath and peripheral edema. On auscultation, you hear an
S3 gallop. What is the clinical significance of this finding?
A) Normal finding in elderly patients
B) Indicates increased left ventricular compliance
C) Indicates decreased left ventricular compliance
D) Indicates volume overload and decreased left ventricular function
Correct Answer: D
Rationale: An S3 gallop (ventricular gallop) is an abnormal heart sound heard in early
diastole and indicates rapid ventricular filling. In the setting of heart failure, an S3
suggests volume overload and decreased left ventricular function. It is associated with
increased left ventricular end-diastolic pressure and is a poor prognostic sign in heart
failure patients. S3 is normal in children and young adults but is always pathologic in
older adults. Decreased ventricular compliance (C) is associated with S4, not S3.
5. A 55-year-old male presents with a holosystolic murmur best heard at the apex
with radiation to the left axilla. What is the MOST likely diagnosis?
A) Aortic stenosis
B) Mitral regurgitation
C) Aortic regurgitation
D) Mitral stenosis
Correct Answer: B
Rationale: Mitral regurgitation classically presents as a holosystolic (pansystolic)
murmur best heard at the apex and radiating to the left axilla. The murmur is high-
pitched and may be associated with a displaced PMI and an S3 gallop in severe cases.
Aortic stenosis (A) is a systolic ejection murmur at the right upper sternal border. Aortic
regurgitation (C) is an early diastolic murmur. Mitral stenosis (D) is a diastolic murmur
with an opening snap.
, 6. Which of the following maneuvers would INCREASE the intensity of a murmur
due to hypertrophic cardiomyopathy?
A) Squatting
B) Handgrip
C) Valsalva maneuver
D) Leg raising
Correct Answer: C
Rationale: The Valsalva maneuver (forced expiration against a closed glottis) decreases
venous return and left ventricular volume, increasing the left ventricular outflow tract
(LVOT) obstruction in hypertrophic cardiomyopathy. This maneuver increases the
intensity of the systolic ejection murmur. Squatting (A) and leg raising (D) increase
venous return and ventricular volume, which would decrease the murmur. Handgrip (B)
increases afterload, which also decreases the murmur.
7. A patient presents with an early diastolic decrescendo murmur best heard at the
left sternal border. What is the MOST likely diagnosis?
A) Aortic stenosis
B) Mitral stenosis
C) Aortic regurgitation
D) Pulmonic stenosis
Correct Answer: C
Rationale: Aortic regurgitation presents as an early diastolic decrescendo murmur best
heard at the left 3rd-4th intercostal space (left sternal border). It may also be heard at
the right upper sternal border. Associated findings include wide pulse pressure,
bounding pulses, and Quincke's sign. Mitral stenosis (B) presents with a mid-diastolic
murmur with an opening snap. Aortic stenosis (A) and pulmonic stenosis (D) are systolic
murmurs.
8. On auscultation of the carotid arteries, you hear a bruit. What is the clinical
significance of this finding in an asymptomatic patient?
