BARKLEY 3P EXAM AND PRACTICE EXAM Questions with Correct
Answers & Rationales Updated for 2026 Verified A+ Content
SECTION 1: CARDIOVASCULAR SYSTEM
Question 1
You are auscultating Jon's chest. When he sits up and leans forward, you can hear a
high-pitched, blowing murmur at S2. What does this type of murmur most likely
indicate?
A) Mitral stenosis
B) Aortic stenosis
C) Mitral regurgitation
D) Aortic regurgitation
Rationale: Aortic regurgitation produces a soft, high-pitched, blowing diastolic
decrescendo murmur best heard at the 3rd left interspace at the base. The murmur is
initiated with S2 and is best heard when the patient sits up and leans forward. Mitral
stenosis is a low-pitched diastolic rumble best heard at the apex in the left lateral position.
Aortic stenosis is a loud, harsh midsystolic murmur radiating to the neck. Mitral
regurgitation is a loud, blowing pansystolic murmur at the apex.
Question 2
Which of the following is NOT part of Virchow's Triad?
A) Hypercoagulability
B) Damage to endothelial cells
,C) Sympathetic tone
D) Turbulent blood flow
Rationale: Virchow's triad describes the three main factors that lead to thrombosis:
hypercoagulability, endothelial cell damage, and turbulent blood flow (circulatory stasis).
Sympathetic tone is not a component of Virchow's triad and does not directly affect blood
clotting.
Question 3
Regarding the split S2 heart sound, which of these is false?
A) It is a normal phenomenon
B) The aortic valve closes significantly earlier than the pulmonic valve
C) It is noted only in the aortic auscultatory area
D) It occurs on end inspiration
Rationale: A split S2 is a normal phenomenon that can be heard throughout the
precordium, not just in the aortic area. During inspiration, increased venous return to the
right ventricle delays pulmonic valve closure, causing the split.
Question 4
Upon percussion of the chest, you notice hyperresonance. Which of the following
choices would most likely be the cause?
A) Atelectasis
B) Normal lung
C) Pneumothorax
D) Pulmonary embolism
Rationale: Hyperresonance on chest percussion is a classic finding in pneumothorax due
to air trapped in the pleural space. Atelectasis produces dullness, normal lung produces
resonance, and pulmonary embolism typically does not alter percussion notes.
,Question 5
Your colleague's patient experiences a sudden onset of pain in her lower leg. The area is
erythematous and warm to the touch but not swollen. Your colleague suggests
elevating the leg, applying warm compresses, prescribing an NSAID, and ordering bed
rest for at least a week. Based on these findings, which measure is NOT a correct form of
treatment?
A) Elevating the leg
B) Applying warm compresses
C) Prescribing non-steroidal anti-inflammatory drugs
D) Ordering bed rest
Rationale: Based on the sudden presentation of pain, heat, and erythema in the affected
leg with lack of swelling, the patient is most likely experiencing superficial thrombosis.
Superficial thrombosis is generally NOT treated with bed rest—rather, mobility is
encouraged. Bed rest is a standard treatment for deep thrombosis, not superficial
thrombosis.
Question 6
Which of the following is NOT a common finding of acute left-sided heart failure?
A) Coarse rales in all lung fields
B) Hepatomegaly
C) Wheezing, frothy cough
D) An S3 gallop sound
Rationale: Hepatomegaly is common in chronic right-sided heart failure but is much less
common in acute heart failure. Coarse rales over all lung fields, a wheezing frothy cough,
and an S3 gallop are all common findings in acute left-sided heart failure due to
pulmonary congestion and increased ventricular filling pressures.
, Question 7
A patient has a blood pressure of 162/94 in the right arm and 148/88 in the left arm.
What is the most appropriate next step?
A) Record the higher reading
B) Repeat BP in both arms after 5 minutes
C) Assume equipment error
D) Use the lower reading for treatment
Rationale: A difference >10-15 mmHg between arms suggests possible subclavian
stenosis or aortic dissection. This is a red flag finding requiring careful repeat
measurement before proceeding. In an acute presentation, assume dissection until ruled
out.
Question 8
A patient reports chest pain that worsens when lying flat and improves when leaning
forward. This is most characteristic of:
A) Pericarditis
B) Myocardial ischemia
C) Aortic dissection
D) Pulmonary embolism
Rationale: Pericarditis pain is characteristically positional—worse when supine (as
inflamed pericardial layers approximate) and relieved by sitting up or leaning forward.
This finding helps distinguish pericarditis from other causes of chest pain.
Question 9
Which murmur is best heard with the patient leaning forward in expiration?
A) Mitral stenosis
B) Aortic regurgitation
Answers & Rationales Updated for 2026 Verified A+ Content
SECTION 1: CARDIOVASCULAR SYSTEM
Question 1
You are auscultating Jon's chest. When he sits up and leans forward, you can hear a
high-pitched, blowing murmur at S2. What does this type of murmur most likely
indicate?
A) Mitral stenosis
B) Aortic stenosis
C) Mitral regurgitation
D) Aortic regurgitation
Rationale: Aortic regurgitation produces a soft, high-pitched, blowing diastolic
decrescendo murmur best heard at the 3rd left interspace at the base. The murmur is
initiated with S2 and is best heard when the patient sits up and leans forward. Mitral
stenosis is a low-pitched diastolic rumble best heard at the apex in the left lateral position.
Aortic stenosis is a loud, harsh midsystolic murmur radiating to the neck. Mitral
regurgitation is a loud, blowing pansystolic murmur at the apex.
Question 2
Which of the following is NOT part of Virchow's Triad?
A) Hypercoagulability
B) Damage to endothelial cells
,C) Sympathetic tone
D) Turbulent blood flow
Rationale: Virchow's triad describes the three main factors that lead to thrombosis:
hypercoagulability, endothelial cell damage, and turbulent blood flow (circulatory stasis).
Sympathetic tone is not a component of Virchow's triad and does not directly affect blood
clotting.
Question 3
Regarding the split S2 heart sound, which of these is false?
A) It is a normal phenomenon
B) The aortic valve closes significantly earlier than the pulmonic valve
C) It is noted only in the aortic auscultatory area
D) It occurs on end inspiration
Rationale: A split S2 is a normal phenomenon that can be heard throughout the
precordium, not just in the aortic area. During inspiration, increased venous return to the
right ventricle delays pulmonic valve closure, causing the split.
Question 4
Upon percussion of the chest, you notice hyperresonance. Which of the following
choices would most likely be the cause?
A) Atelectasis
B) Normal lung
C) Pneumothorax
D) Pulmonary embolism
Rationale: Hyperresonance on chest percussion is a classic finding in pneumothorax due
to air trapped in the pleural space. Atelectasis produces dullness, normal lung produces
resonance, and pulmonary embolism typically does not alter percussion notes.
,Question 5
Your colleague's patient experiences a sudden onset of pain in her lower leg. The area is
erythematous and warm to the touch but not swollen. Your colleague suggests
elevating the leg, applying warm compresses, prescribing an NSAID, and ordering bed
rest for at least a week. Based on these findings, which measure is NOT a correct form of
treatment?
A) Elevating the leg
B) Applying warm compresses
C) Prescribing non-steroidal anti-inflammatory drugs
D) Ordering bed rest
Rationale: Based on the sudden presentation of pain, heat, and erythema in the affected
leg with lack of swelling, the patient is most likely experiencing superficial thrombosis.
Superficial thrombosis is generally NOT treated with bed rest—rather, mobility is
encouraged. Bed rest is a standard treatment for deep thrombosis, not superficial
thrombosis.
Question 6
Which of the following is NOT a common finding of acute left-sided heart failure?
A) Coarse rales in all lung fields
B) Hepatomegaly
C) Wheezing, frothy cough
D) An S3 gallop sound
Rationale: Hepatomegaly is common in chronic right-sided heart failure but is much less
common in acute heart failure. Coarse rales over all lung fields, a wheezing frothy cough,
and an S3 gallop are all common findings in acute left-sided heart failure due to
pulmonary congestion and increased ventricular filling pressures.
, Question 7
A patient has a blood pressure of 162/94 in the right arm and 148/88 in the left arm.
What is the most appropriate next step?
A) Record the higher reading
B) Repeat BP in both arms after 5 minutes
C) Assume equipment error
D) Use the lower reading for treatment
Rationale: A difference >10-15 mmHg between arms suggests possible subclavian
stenosis or aortic dissection. This is a red flag finding requiring careful repeat
measurement before proceeding. In an acute presentation, assume dissection until ruled
out.
Question 8
A patient reports chest pain that worsens when lying flat and improves when leaning
forward. This is most characteristic of:
A) Pericarditis
B) Myocardial ischemia
C) Aortic dissection
D) Pulmonary embolism
Rationale: Pericarditis pain is characteristically positional—worse when supine (as
inflamed pericardial layers approximate) and relieved by sitting up or leaning forward.
This finding helps distinguish pericarditis from other causes of chest pain.
Question 9
Which murmur is best heard with the patient leaning forward in expiration?
A) Mitral stenosis
B) Aortic regurgitation
