©THEBRIGHT EXAM SOLUTIONS
11/7/2024 12:35 PM
Essential revision notes for MRCP. Exam
Questions With Correct Answers
What is the importance of jugular venous pressure? - answer✔This is an essential clinical sign
that reflects patient filling status and is essential to detect for fluid management.
How can we evaluate fluid management? - answer✔Assessing jugular venous level.
What does the jugular venous pressure reflect? - answer✔The jugular venous pressure reflects
high atrial pressure, and in healthy individuals at 45 is 3 cm in vertical height above the sternal
angle (the angle of Louis, the manubristernal junction)
What is the jugular venous pressure in normal individual? - answer✔in healthy individuals at
degree 45 is 3 cm in vertical height above the sternal angle (the angle of Louis, the
manubristernal junction)
What is the other name of the sternal angle? - answer✔the angle of Louis, the manubristernal
junction
How is inspiration affects the jugular venous pressure? - answer✔Inspiration generates
negative intrathoracic pressure and a suction of venous blood towards heart, causing the JVP to
fall.
What are the normal waves in the JVP? - answer✔a wave
c wave
x descent
v wave
y descent
What are the characteristics of the a wave? - answer✔The a wave
Due to atrial contraction--actively pushes up superior vena cava (SVC) and into the right
ventricles (may cause an audible S4)
, ©THEBRIGHT EXAM SOLUTIONS
11/7/2024 12:35 PM
What is the cause of the a wave? - answer✔Due to atrial contraction--actively pushes superior
vena cava (SVC) and into the right ventricles (may cause an audible S4)
What is happening in the SVC with the atrial contraction? - answer✔Superior vena cava is
pushed up.
Which heart sound is associated with a wave? - answer✔may cause an audible S4
What are the pathological changes in the a wave? - answer✔Absent, Large, and Cannon
What are the causes of Absent a wave? - answer✔Atrial fibrillation...no co-ordinated
contraction.
What are the causes of large a wave? - answer✔Tricuspid stenosis.
Right heart failure.
Pulmonary hypertension.
What is the relationship between increase pulmonary artery pressure and a wave? -
answer✔Large a wave is associated with pulmonary hypertension.
What is the valvular lesions associated with increased a wave? - answer✔High a wave is
associated with tricuspid stenosis.
What is the change of a wave in patient with right sided heart failure? - answer✔Raised JVP
with normal or large a wave.
What is the cause of Cannon a wave - answer✔Cannon.
Caused by atrioventricular dissociation-allowing the atria and ventricles to contract at same
time.
What is the meaning of atrioventricular dissociation - answer✔Caused by atrioventricular
dissociation-allowing the atria and ventricles to contract at same time.
What are the causes of the Cannon a wave - answer✔Atrial flutter and atrial tachycardia.
Third degree (complete) heart block.
Ventricular tachycardia and ventricular ectopics.
Which atrial arrhythmia causes Cannon a waves - answer✔Atrial flutter and atrial tachycardia.
Which degree of heart block causes Cannon a wave - answer✔Third degree (complete) heart
block.
, ©THEBRIGHT EXAM SOLUTIONS
11/7/2024 12:35 PM
Which ventricular arrhythmia causes cannon a wave - answer✔Ventricular tachycardia and
ventricular ectopics
What is the association between the heart rate and Cannon a wave - answer✔increased as in
Atrial flutter, atrial tachycardia, and Ventricular tachycardia.
What are the characteristics of the C wave? - answer✔The C wave
An invisible flicker in the x descent due to closure of the tricuspid valve, before the start of
ventricular systole.
What is the relationship between C wave and X descent? - answer✔An invisible flicker in the x
descent
What is the cause of C wave - answer✔Closure of the tricuspid valve
What is the timing of the C wave - answer✔before the start of ventricular systole.
What are the characteristics of the X descent - answer✔The X descent
Downward movement of the heart causing atrial stretch and a drop in pressure.
What is the effect of X descent in the position of the heart? - answer✔Downward movement of
the heart
What is the effect of the X descent on the atrium - answer✔causing atrial stretch
What is the effect of the X descent on the Atrial pressure - answer✔a drop in pressure.
What are the pathological change in the X descent - answer✔Steep--Tamponade and cardiac
constriction
If steep X descent only, then tamponade.
What is the effect of tampnade and cardiac constriction - answer✔Kaussmaul sign and descent
in the X descent
What is the cause of steep X descent only - answer✔If steep X descent only, then tamponade.
What are the characteristic of the V wave - answer✔The V wave
Due to passive filling of blood into the atrium against closed tricuspid valve.
What is the cause of the V wave - answer✔Due to passive filling of blood into the atrium
against closed tricuspid valve.
11/7/2024 12:35 PM
Essential revision notes for MRCP. Exam
Questions With Correct Answers
What is the importance of jugular venous pressure? - answer✔This is an essential clinical sign
that reflects patient filling status and is essential to detect for fluid management.
How can we evaluate fluid management? - answer✔Assessing jugular venous level.
What does the jugular venous pressure reflect? - answer✔The jugular venous pressure reflects
high atrial pressure, and in healthy individuals at 45 is 3 cm in vertical height above the sternal
angle (the angle of Louis, the manubristernal junction)
What is the jugular venous pressure in normal individual? - answer✔in healthy individuals at
degree 45 is 3 cm in vertical height above the sternal angle (the angle of Louis, the
manubristernal junction)
What is the other name of the sternal angle? - answer✔the angle of Louis, the manubristernal
junction
How is inspiration affects the jugular venous pressure? - answer✔Inspiration generates
negative intrathoracic pressure and a suction of venous blood towards heart, causing the JVP to
fall.
What are the normal waves in the JVP? - answer✔a wave
c wave
x descent
v wave
y descent
What are the characteristics of the a wave? - answer✔The a wave
Due to atrial contraction--actively pushes up superior vena cava (SVC) and into the right
ventricles (may cause an audible S4)
, ©THEBRIGHT EXAM SOLUTIONS
11/7/2024 12:35 PM
What is the cause of the a wave? - answer✔Due to atrial contraction--actively pushes superior
vena cava (SVC) and into the right ventricles (may cause an audible S4)
What is happening in the SVC with the atrial contraction? - answer✔Superior vena cava is
pushed up.
Which heart sound is associated with a wave? - answer✔may cause an audible S4
What are the pathological changes in the a wave? - answer✔Absent, Large, and Cannon
What are the causes of Absent a wave? - answer✔Atrial fibrillation...no co-ordinated
contraction.
What are the causes of large a wave? - answer✔Tricuspid stenosis.
Right heart failure.
Pulmonary hypertension.
What is the relationship between increase pulmonary artery pressure and a wave? -
answer✔Large a wave is associated with pulmonary hypertension.
What is the valvular lesions associated with increased a wave? - answer✔High a wave is
associated with tricuspid stenosis.
What is the change of a wave in patient with right sided heart failure? - answer✔Raised JVP
with normal or large a wave.
What is the cause of Cannon a wave - answer✔Cannon.
Caused by atrioventricular dissociation-allowing the atria and ventricles to contract at same
time.
What is the meaning of atrioventricular dissociation - answer✔Caused by atrioventricular
dissociation-allowing the atria and ventricles to contract at same time.
What are the causes of the Cannon a wave - answer✔Atrial flutter and atrial tachycardia.
Third degree (complete) heart block.
Ventricular tachycardia and ventricular ectopics.
Which atrial arrhythmia causes Cannon a waves - answer✔Atrial flutter and atrial tachycardia.
Which degree of heart block causes Cannon a wave - answer✔Third degree (complete) heart
block.
, ©THEBRIGHT EXAM SOLUTIONS
11/7/2024 12:35 PM
Which ventricular arrhythmia causes cannon a wave - answer✔Ventricular tachycardia and
ventricular ectopics
What is the association between the heart rate and Cannon a wave - answer✔increased as in
Atrial flutter, atrial tachycardia, and Ventricular tachycardia.
What are the characteristics of the C wave? - answer✔The C wave
An invisible flicker in the x descent due to closure of the tricuspid valve, before the start of
ventricular systole.
What is the relationship between C wave and X descent? - answer✔An invisible flicker in the x
descent
What is the cause of C wave - answer✔Closure of the tricuspid valve
What is the timing of the C wave - answer✔before the start of ventricular systole.
What are the characteristics of the X descent - answer✔The X descent
Downward movement of the heart causing atrial stretch and a drop in pressure.
What is the effect of X descent in the position of the heart? - answer✔Downward movement of
the heart
What is the effect of the X descent on the atrium - answer✔causing atrial stretch
What is the effect of the X descent on the Atrial pressure - answer✔a drop in pressure.
What are the pathological change in the X descent - answer✔Steep--Tamponade and cardiac
constriction
If steep X descent only, then tamponade.
What is the effect of tampnade and cardiac constriction - answer✔Kaussmaul sign and descent
in the X descent
What is the cause of steep X descent only - answer✔If steep X descent only, then tamponade.
What are the characteristic of the V wave - answer✔The V wave
Due to passive filling of blood into the atrium against closed tricuspid valve.
What is the cause of the V wave - answer✔Due to passive filling of blood into the atrium
against closed tricuspid valve.
