PCCN CARDIAC EXAMS TEST PAPER QUESTIONS
AND ANSWERS SET A+
✔✔Your pt was admitted for malaise, severe dyspnea and had a syncopal episode at
work. He states he has a midline burning sensation in his chest that worsens when he is
supine. You suspect?
• Pleural effusion
• Pericardial tamponade
• GERD
• Myocarditis - ✔✔MYOCARDITIS
It can also present as inspiratory pain. The pain when supine is a cardinal sign of
myocarditis. Other findings may include respiratory infection and an S3, S4, and
pericardial friction rub.
✔✔A definitive diagnosis of myocarditis can be made via?
• Endomyocardial biopsy
• Transesophageal ultrasound
• Transmural catheterization
• Chest X-ray - ✔✔ENDOMYOCARDIAL BIOPSY
A biopsy is the ONLY definitive way to diagnose myocarditis.
✔✔The volume of fluid required to cause a pericardial tamponade is?
• 25-50 ml
• 50-75 ml
• 100-150 ml
• 200-300 ml - ✔✔50-75 ml of blood
Although 50-75 mls is a small amount, the pressure in the intrapericardial space may
equal or exceed atrial and vertricular pressures causing an acute tamponade.
,✔✔Beck's triad is a combination of symptoms useful in diagnosing cardiac tamponade.
They are?
• Pericardial friction rub, hypertension, RV failure
• Increased pulse pressure, increased JVD, tachycardia
• Tachycardia, hypertension, LV failure
• Distended neck veins, muffled heart sounds, hypotension - ✔✔Distended neck veins
Muffled heart sounds
Hypotension
Tachycardia is an early sign of tamponade. A narrowed pulse pressure occurs, and fluid
cannot be ejected from the heart. The muffled heart sounds occur because the fluid in
the sac minimized the transmission of sound waves.
✔✔Which of the following hemodynamic changes will occur with cardiac tamponade?
• Increased cardiac output
• Stroke volume decrease
• Contractility increases
• Decreased heart rate - ✔✔STROKE VOLUME DECREASE
Because the heart cannot adequately fill or eject its contents, stroke volume (SV)
decreases and causes a decreased cardiac output (CO). Contractility decreases
because the muscles cannot stretch and, therefore, cannot contract effectively.
✔✔If your pt had a cardiac tamponade, which of the following would you expect to see
on a CXR?
• A dilated superior vena cava
• Increased JVD
• Narrowed mediastinum
• Delineation of the pericardium and epicardium - ✔✔A DILATED SUPERIOR VENA
CAVA
The vena cava is dilated because blood couldn't flow into the right atrium.
JVD would not be visible on a CXR.
The mediastinum would be widened.
Delineation of the pericardium or epicardium would not be visible on a CXR.
✔✔Your pt was admitted for severe dyspnea, dysphagia, palpitations and an intractable
cough. On auscultation, you hear a loud S1 and a right sided S3 and S4. This pt
probably has?
• Mitral insufficiency
• Myocarditis
• Atrial stenosis
• Mitral stenosis - ✔✔MITRAL STENOSIS
,These symptoms could be caused by mitral stenosis, an ischemic left ventricle, or
failure of a left ventricle. The S3 and S4 sounds suggest both a fluid problem and a
pressure problem.
✔✔Quincke's sign is usually seen in which of the following conditions?
• Mitral Stenosis
• Endocarditis
• Aortic insufficiency
• Pericarditis - ✔✔AORTIC INSUFFICIENCY
Quincke's sign is elicited by pressing down on he finger top; a visible pulsation is seen
in the nail bed. The sign results from a pulse with a rapid, initial hard pulsation, followed
by a sudden collapse as blood flows back through the incompetent valve.
✔✔In pts with aortic insufficiency, the popliteal BP is often higher than the brachial BP
by at least 40 mm HG. This discrepancy between the measurements is known as?
• DeMusset's Sign
• Hill's Sign
• Holmes' Sign
• Rochelle's Sign - ✔✔HILL'S SIGN
Hills's sign reflects the rapid rise in pulsation.
DeMusset's sign is also found in aortic insufficiency; it consists of the bobbing of the
head in time with the forceful pulse.
Holmes' and Rochelle's signs are not diagnostic signs.
✔✔In stable angina, which of the following is true?
• A positive treadmill test will indicate CAD
• A thallium test (myocardial scintigraphy) will not diagnose LV dysfunction
• The treadmill test will miss as many as 20% of cases of single-vessel disease
• CK-MB isoenzymes and troponins will not increase - ✔✔CK-MB ISOENZYMES AND
TROPONINS WILL NOT INCREASE
A positive treadmill test may not be positive for CAD.
LV dysfunction may be diagnosed with a thallium test (myocardial scintigraphy).
Treadmill stress tests miss as many as 40% of cases of single-vessel disease.
✔✔Actions of beta blockers include?
• Increased myocardial oxygen demand
• Increased heart rate
• Increased diastolic filling time
• Increased afterload - ✔✔INCREASED DIASTOLIC FILLING TIME
✔✔If the inferior wall of the heart is infracted, the leads that will most directly reflect the
injury are?
, • II, aVF
• I, aVL
• V1 - V2
• V5 - V6 - ✔✔II, a VF - inferior heart
I, aVL - lateral wall
V1 - V2 --septal wall
V5 - V6 - apical area
✔✔An anterior wall infarct may be seen in leads?
• V4, R
• V5, V6
• V7, V9
• V2, V4 - ✔✔V2, V4 -anterior wall
V4, R -right ventricular damage
V5, V6 -apical injury
V7, V9 - posterior wall
✔✔Pulsus alternans is most often noted with?
• Mitral Stenosis
• Constrictive pericarditis
• Aortic stenosis
• LV failure - ✔✔LV failure
Pulsus alternans occurs when a weakened myocardium cannot maintain an even
pressure with each contraction. The pulses alternate between strong and weak. This
phenomenon is also seen in CHF.
✔✔Which of the heart valves is most commonly affected by infective endocarditis?
• Aortic
• Pulmonic
• Mitral
• Tricuspid - ✔✔MITRAL
Aortic valve - is the next most common affected
Pulmonic valve - least likely to be affected
Tricuspid valve - often involved secondarily as a result of IV drug abuse
✔✔Alpha-adrenergic effects of norepinephrine include?
• Increased force of myocardial contraction
• Increased SA node firing
• Increase AV conduction time
• Peripheral arteriolar vasoconstriction - ✔✔Peripheral arteriolar vasoconstriction
AND ANSWERS SET A+
✔✔Your pt was admitted for malaise, severe dyspnea and had a syncopal episode at
work. He states he has a midline burning sensation in his chest that worsens when he is
supine. You suspect?
• Pleural effusion
• Pericardial tamponade
• GERD
• Myocarditis - ✔✔MYOCARDITIS
It can also present as inspiratory pain. The pain when supine is a cardinal sign of
myocarditis. Other findings may include respiratory infection and an S3, S4, and
pericardial friction rub.
✔✔A definitive diagnosis of myocarditis can be made via?
• Endomyocardial biopsy
• Transesophageal ultrasound
• Transmural catheterization
• Chest X-ray - ✔✔ENDOMYOCARDIAL BIOPSY
A biopsy is the ONLY definitive way to diagnose myocarditis.
✔✔The volume of fluid required to cause a pericardial tamponade is?
• 25-50 ml
• 50-75 ml
• 100-150 ml
• 200-300 ml - ✔✔50-75 ml of blood
Although 50-75 mls is a small amount, the pressure in the intrapericardial space may
equal or exceed atrial and vertricular pressures causing an acute tamponade.
,✔✔Beck's triad is a combination of symptoms useful in diagnosing cardiac tamponade.
They are?
• Pericardial friction rub, hypertension, RV failure
• Increased pulse pressure, increased JVD, tachycardia
• Tachycardia, hypertension, LV failure
• Distended neck veins, muffled heart sounds, hypotension - ✔✔Distended neck veins
Muffled heart sounds
Hypotension
Tachycardia is an early sign of tamponade. A narrowed pulse pressure occurs, and fluid
cannot be ejected from the heart. The muffled heart sounds occur because the fluid in
the sac minimized the transmission of sound waves.
✔✔Which of the following hemodynamic changes will occur with cardiac tamponade?
• Increased cardiac output
• Stroke volume decrease
• Contractility increases
• Decreased heart rate - ✔✔STROKE VOLUME DECREASE
Because the heart cannot adequately fill or eject its contents, stroke volume (SV)
decreases and causes a decreased cardiac output (CO). Contractility decreases
because the muscles cannot stretch and, therefore, cannot contract effectively.
✔✔If your pt had a cardiac tamponade, which of the following would you expect to see
on a CXR?
• A dilated superior vena cava
• Increased JVD
• Narrowed mediastinum
• Delineation of the pericardium and epicardium - ✔✔A DILATED SUPERIOR VENA
CAVA
The vena cava is dilated because blood couldn't flow into the right atrium.
JVD would not be visible on a CXR.
The mediastinum would be widened.
Delineation of the pericardium or epicardium would not be visible on a CXR.
✔✔Your pt was admitted for severe dyspnea, dysphagia, palpitations and an intractable
cough. On auscultation, you hear a loud S1 and a right sided S3 and S4. This pt
probably has?
• Mitral insufficiency
• Myocarditis
• Atrial stenosis
• Mitral stenosis - ✔✔MITRAL STENOSIS
,These symptoms could be caused by mitral stenosis, an ischemic left ventricle, or
failure of a left ventricle. The S3 and S4 sounds suggest both a fluid problem and a
pressure problem.
✔✔Quincke's sign is usually seen in which of the following conditions?
• Mitral Stenosis
• Endocarditis
• Aortic insufficiency
• Pericarditis - ✔✔AORTIC INSUFFICIENCY
Quincke's sign is elicited by pressing down on he finger top; a visible pulsation is seen
in the nail bed. The sign results from a pulse with a rapid, initial hard pulsation, followed
by a sudden collapse as blood flows back through the incompetent valve.
✔✔In pts with aortic insufficiency, the popliteal BP is often higher than the brachial BP
by at least 40 mm HG. This discrepancy between the measurements is known as?
• DeMusset's Sign
• Hill's Sign
• Holmes' Sign
• Rochelle's Sign - ✔✔HILL'S SIGN
Hills's sign reflects the rapid rise in pulsation.
DeMusset's sign is also found in aortic insufficiency; it consists of the bobbing of the
head in time with the forceful pulse.
Holmes' and Rochelle's signs are not diagnostic signs.
✔✔In stable angina, which of the following is true?
• A positive treadmill test will indicate CAD
• A thallium test (myocardial scintigraphy) will not diagnose LV dysfunction
• The treadmill test will miss as many as 20% of cases of single-vessel disease
• CK-MB isoenzymes and troponins will not increase - ✔✔CK-MB ISOENZYMES AND
TROPONINS WILL NOT INCREASE
A positive treadmill test may not be positive for CAD.
LV dysfunction may be diagnosed with a thallium test (myocardial scintigraphy).
Treadmill stress tests miss as many as 40% of cases of single-vessel disease.
✔✔Actions of beta blockers include?
• Increased myocardial oxygen demand
• Increased heart rate
• Increased diastolic filling time
• Increased afterload - ✔✔INCREASED DIASTOLIC FILLING TIME
✔✔If the inferior wall of the heart is infracted, the leads that will most directly reflect the
injury are?
, • II, aVF
• I, aVL
• V1 - V2
• V5 - V6 - ✔✔II, a VF - inferior heart
I, aVL - lateral wall
V1 - V2 --septal wall
V5 - V6 - apical area
✔✔An anterior wall infarct may be seen in leads?
• V4, R
• V5, V6
• V7, V9
• V2, V4 - ✔✔V2, V4 -anterior wall
V4, R -right ventricular damage
V5, V6 -apical injury
V7, V9 - posterior wall
✔✔Pulsus alternans is most often noted with?
• Mitral Stenosis
• Constrictive pericarditis
• Aortic stenosis
• LV failure - ✔✔LV failure
Pulsus alternans occurs when a weakened myocardium cannot maintain an even
pressure with each contraction. The pulses alternate between strong and weak. This
phenomenon is also seen in CHF.
✔✔Which of the heart valves is most commonly affected by infective endocarditis?
• Aortic
• Pulmonic
• Mitral
• Tricuspid - ✔✔MITRAL
Aortic valve - is the next most common affected
Pulmonic valve - least likely to be affected
Tricuspid valve - often involved secondarily as a result of IV drug abuse
✔✔Alpha-adrenergic effects of norepinephrine include?
• Increased force of myocardial contraction
• Increased SA node firing
• Increase AV conduction time
• Peripheral arteriolar vasoconstriction - ✔✔Peripheral arteriolar vasoconstriction
