NSG 6020 / NSG6020 study guide week 4 quiz (QUESTIONS , CORRECT ANSWERS)

Study guide week 4 quiz Cardiovascular (Bickley) 35 Questions 1. You are performing a thorough cardiac examination. Which of the following chambers of the heart can you assess by palpation? A) Left atrium B) Right atrium C) Right ventricle D) Sinus node 2. What is responsible for the inspiratory splitting of S2? A) Closure of aortic, then pulmonic valves B) Closure of mitral, then tricuspid valves C) Closure of aortic, then tricuspid valves D) Closure of mitral, then pulmonic valves 3. A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur? A) Mitral B) Tricuspid C) Aortic D) Pulmonic 4. A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems? A) Abdominal pain B) Orthopnea C) Hematochezia D) Tenesmus 5. You are screening people at the mall as part of a health fair. The first person who comes for screening has a blood pressure of 132/85. How would you categorize this? A) Normal B) Prehypertension C) Stage 1 hypertension D) Stage 2 hypertension 6. You are participating in a health fair and performing cholesterol screens. One person has a cholesterol of 225. She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease? A) Ethnicity B) Alcohol intake C) Gender D) Asthma 7. You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a history of hypertension, which is well-controlled on his current medications. He does not smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his 10-year coronary heart disease risk. Which of the following conditions is considered to be a coronary heart disease risk equivalent? A) Hypertension B) Peripheral arterial disease C) Systemic lupus erythematosus D) Chronic obstructive pulmonary disease (COPD) 8. You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure that they can distinguish between the jugular venous pulsation and the carotid pulse. Which one of the following characteristics is typical of the carotid pulse? A) Palpable B) Soft, rapid, undulating quality C) Pulsation eliminated by light pressure on the vessel D) Level of pulsation changes with changes in position 9. A 68-year-old mechanic presents to the emergency room for shortness of breath. You are concerned about a cardiac cause and measure his jugular venous pressure (JVP). It is elevated. Which one of the following conditions is a potential cause of elevated JVP? A) Left-sided heart failure B) Mitral stenosis C) Constrictive pericarditis D) Aortic aneurysm 10. You are palpating the apical impulse in a patient with heart disease and find that the amplitude is diffuse and increased. Which of the following conditions could be a potential cause of an increase in the amplitude of the impulse? A) Hypothyroidism B) Aortic stenosis, with pressure overload of the left ventricle C) Mitral stenosis, with volume overload of the left atrium D) Cardiomyopathy 11. You are performing a cardiac examination on a patient with shortness of breath and palpitations. You listen to the heart with the patient sitting upright, then have him change to a supine position, and finally have him turn onto his left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position? A) Aortic B) Pulmonic C) Mitral D) Tricuspid 12. You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur? A) Upright B) Upright, but leaning forward C) Supine D) Left lateral decubitus 13. A 68-year-old retired waiter comes to your clinic for evaluation of fatigue. You perform a cardiac examination and find that his pulse rate is less than 60. Which of the following conditions could be responsible for this heart rate? A) Second-degree A-V block B) Atrial flutter C) Sinus arrhythmia D) Atrial fibrillation 14. Where is the point of maximal impulse (PMI) normally located? A) In the left 5th intercostal space, 7 to 9 cm lateral to the sternum B) In the left 5th intercostal space, 10 to 12 cm lateral to the sternum C) In the left 5th intercostal space, in the anterior axillary line D) In the left 5th intercostal space, in the midaxillary line 15. Which of the following events occurs at the start of diastole? A) Closure of the tricuspid valve B) Opening of the pulmonic valve C) Closure of the aortic valve D) Production of the first heart sound (S1) 16. Which is true of a third heart sound (S3)? A) It marks atrial contraction. B) It reflects normal compliance of the left ventricle. C) It is caused by rapid deceleration of blood against the ventricular wall. D) It is not heard in atrial fibrillation. 17. Which is true of splitting of the second heart sound? A) It is best heard over the pulmonic area with the bell of the stethoscope. B) It normally increases with exhalation. C) It is best heard over the apex. D) It does not vary with respiration. 18. Which of the following is true of jugular venous pressure (JVP) measurement? A) It is measured with the patient at a 45-degree angle. B) The vertical height of the blood column in centimeters, plus 5 cm, is the JVP. C) A JVP below 9 cm is abnormal. D) It is measured above the sternal notch. 19. Which of the following regarding jugular venous pulsations is a systolic phenomenon? A) The “y” descent B) The “x” descent C) The upstroke of the “a” wave D) The downstroke of the “v” wave 20. How much does cardiovascular risk increase for each increment of 20 mm Hg systolic and 10 mm Hg diastolic in blood pressure? A) 25% B) 50% C) 75% D) 100% 21. In healthy adults over 20, how often should blood pressure, body mass index, waist circumference, and pulse be assessed, according to American Heart Association guidelines? A) Every 6 months B) Every year C) Every 2 years D) Every 5 years 22. Which of the following is a clinical identifier of metabolic syndrome? A) Waist circumference of 38 inches for a male B) Waist circumference of 34 inches for a female C) BP of 134/88 for a male D) BP of 128/84 for a female 23. Mrs. Adams would like to begin an exercise program and was told to exercise as intensely as necessary to obtain a heart rate 60% or greater of her maximum heart rate. She is 52. What heart rate should she achieve? A) 80 B) 100 C) 120 D) 140 24. In measuring the jugular venous pressure (JVP), which of the following is important? A) Keep the patient's torso at a 45-degree angle. B) Measure the highest visible pressure, usually at end expiration. C) Add the vertical height over the sternal notch to a 5-cm constant. D) Realize that a total value of over 12 cm is abnormal. 25. You find a bounding carotid pulse on a 62-year-old patient. Which murmur should you search out? A) Mitral valve prolapse B) Pulmonic stenosis C) Tricuspid insufficiency D) Aortic insufficiency 26. To hear a soft murmur or bruit, which of the following may be necessary? A) Asking the patient to hold her breath B) Asking the patient in the next bed to turn down the TV C) Checking your stethoscope for air leaks D) All of the above 27. Which of the following may be missed unless the patient is placed in the left lateral decubitus position and auscultated with the bell? A) Mitral stenosis murmur B) Opening snap of the mitral valve C) S3 and S4 gallops D) All of the above 28. How should you determine whether a murmur is systolic or diastolic? A) Palpate the carotid pulse. B) Palpate the radial pulse. C) Judge the relative length of systole and diastole by auscultation. D) Correlate the murmur with a bedside heart monitor. 29. Which of the following correlates with a sustained, high-amplitude PMI? A) Hyperthyroidism B) Anemia C) Fever D) Hypertension 30. You are examining a patient with emphysema in exacerbation and are having difficulty hearing his heart sounds. What should you do to obtain a good examination? A) Listen in the epigastrium. B) Listen to the patient in the left lateral decubitus position. C) Ask the patient to hold his breath for 30 seconds. D) Listen posteriorly. 31. You are listening carefully for S2 splitting. Which of the following will help? A) Using the diaphragm with light pressure over the 2nd right intercostal space B) Using the bell with light pressure over the 2nd left intercostal space C) Using the diaphragm with firm pressure over the apex D) Using the bell with firm pressure over the lower left sternal border 32. Which of the following is true of a grade 4-intensity murmur? A) It is moderately loud. B) It can be heard with the stethoscope off the chest. C) It can be heard with the stethoscope partially off the chest. D) It is associated with a “thrill.” 33. Which valve lesion typically produces a murmur of equal intensity throughout systole? A) Aortic stenosis B) Mitral insufficiency C) Pulmonic stenosis D) Aortic insufficiency 34. You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely? A) Emphysema B) Asthma exacerbation C) Severe left heart failure D) Cardiac tamponade 35. Suzanne is a 20-year-old college student who complains of chest pain. This is intermittent and is located to the left of her sternum. There are no associated symptoms. On examination, you hear a short, high-pitched sound in systole, followed by a murmur which increases in intensity until S2. This is heard best over the apex. When she squats, this noise moves later in systole along with the murmur. Which of the following is the most likely diagnosis? A) Mitral stenosis B) Mitral insufficiency C) Mitral valve prolapse D) Mitral valve papillary muscle ischemia The Thorax and Lungs (Bickley) 22 Questions 1. A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and she has recently started a job as a bartender in town. On examination she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and a high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs. Which disorder of the thorax or lung does this best describe? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia 2. A 47-year-old receptionist comes to your office, complaining of fever, shortness of breath, and a productive cough with golden sputum. She says she had a cold last week and her symptoms have only gotten worse, despite using over-the-counter cold remedies. She denies any weight gain, weight loss, or cardiac or gastrointestinal symptoms. Her past medical history includes type 2 diabetes for 5 years and high cholesterol. She takes an oral medication for both diseases. She has had no surgeries. She denies tobacco, alcohol, or drug use. Her mother has diabetes and high blood pressure. Her father passed away from colon cancer. On examination you see a middle-aged woman appearing her stated age. She looks ill and her temperature is elevated, at 101. Her blood pressure and pulse are unremarkable. Her head, eyes, ears, nose, and throat examinations are unremarkable except for edema of the nasal turbinates. On auscultation she has decreased air movement, and coarse crackles are heard over the left lower lobe. There is dullness on percussion, increased fremitus during palpation, and egophony and whispered pectoriloquy on auscultation. What disorder of the thorax or lung best describes her symptoms? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia 3. A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths he states he was at home finishing his homework when he suddenly began having right-sided chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medical history is unremarkable. He doesn't smoke but drinks several beers on the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an honors student and is on the basketball team. His parents are both in good health. He denies any recent weight gain, weight loss, fever, or night sweats. On examination you see a tall, thin young man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the right upper lobe. What disorder of the thorax or lung best describes his symptoms? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia 4. A 62-year-old construction worker presents to your clinic, complaining of almost a year of chronic cough and occasional shortness of breath. Although he has had worsening of symptoms occasionally with a cold, his symptoms have stayed about the same. The cough has occasional mucous drainage but never any blood. He denies any chest pain. He has had no weight gain, weight loss, fever, or night sweats. His past medical history is significant for high blood pressure and arthritis. He has smoked two packs a day for the past 45 years. He drinks occasionally but denies any illegal drug use. He is married and has two children. He denies any foreign travel. His father died of a heart attack and his mother died of Alzheimer's disease. On examination you see a man looking slightly older than his stated age. His blood pressure is 130/80 and his pulse is 88. He is breathing comfortably with respirations of 12. His head, eyes, ears, nose, and throat examinations are unremarkable. His cardiac examination is normal. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung fields. There is no area of dullness and no increased or decreased fremitus. What thorax or lung disorder is most likely causing his symptoms? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia 5. A 36-year-old teacher presents to your clinic, complaining of sharp, knifelike pain on the left side of her chest for the last 2 days. Breathing and lying down make the pain worse, while sitting forward helps her pain. Tylenol and ibuprofen have not helped. Her pain does not radiate to any other area. She denies any upper respiratory or gastrointestinal symptoms. Her past medical history consists of systemic lupus. She is divorced and has one child. She denies any tobacco, alcohol, or drug use. Her mother has hypothyroidism and her father has high blood pressure. On examination you find her to be distressed, leaning over and holding her left arm and hand to her left chest. Her blood pressure is 130/70, her respirations are 12, and her pulse is 90. On auscultation her lung fields have normal breath sounds with no rhonchi, wheezes, or crackles. Percussion and palpation are unremarkable. Auscultation of the heart has an S1 and S2 with no S3 or S4. A scratching noise is heard at the lower left sternal border, coincident with systole; leaning forward relieves some of her pain. She is nontender with palpation of the chest wall. What disorder of the chest best describes this disorder? A) Angina pectoris B) Pericarditis C) Dissecting aortic aneurysm D) Pleural pain 6. A 68-year-old retired postman presents to your clinic, complaining of dull, intermittent left-sided chest pain over the last few weeks. The pain occurs after he mows his lawn or chops wood. He says that the pain radiates to the left side of his jaw but nowhere else. He has felt light-headed and nauseated with the pain but has had no other symptoms. He states when he sits down for several minutes the pain goes away. Ibuprofen, Tylenol, and antacids have not improved his symptoms. He reports no recent weight gain, weight loss, fever, or night sweats. He has a past medical history of high blood pressure and arthritis. He quit smoking 10 years ago after smoking one pack a day for 40 years. He denies any recent alcohol use and reports no drug use. He is married and has two healthy children. His mother died of breast cancer and his father died of a stroke. His younger brother has had bypass surgery. On examination you find him healthy-appearing and breathing comfortably. His blood pressure is 140/90 and he has a pulse of 80. His head, eyes, ears, nose, and throat examinations are unremarkable. His lungs have normal breath sounds and there are no abnormalities with percussion and palpation of the chest. His heart has a normal S1 and S2 and no S3 or S4. Further workup is pending. Which disorder of the chest best describes these symptoms? A) Angina pectoris B) Pericarditis C) Dissecting aortic aneurysm D) Pleural pain 7. A 75-year-old retired teacher presents to your clinic, complaining of severe, unrelenting anterior chest pain radiating to her back. She describes it as if someone is “ripping out her heart.” It began less than an hour ago. She states she is feeling very nauseated and may pass out. She denies any trauma or recent illnesses. She states she has never had pain like this before. Nothing seems to make the pain better or worse. Her medical history consists of difficult-to-control hypertension and coronary artery disease requiring two stents in the past. She is a widow. She denies any alcohol, tobacco, or illegal drug use. Her mother died of a stroke and her father died of a heart attack. She has one younger brother who has had bypass surgery. On examination you see an elderly female in a great deal of distress. She is lying on the table, curled up, holding her left and right arms against her chest and is restless, trying to find a comfortable position. Her blood pressure is 180/110 in the right arm and 130/60 in the left arm, and her pulse is 120. Her right carotid pulse is bounding but the left carotid pulse is weak. She is afebrile but her respirations are 24 times a minute. On auscultation her lungs are clear and her cardiac examination is unremarkable. You call EMS and have her taken to the hospital's ER for further evaluation. What disorder of the chest best describes her symptoms? A) Angina pectoris B) Pericarditis C) Dissecting aortic aneurysm D) Pleural pain 8. A 25-year-old accountant presents to your clinic, complaining of intermittent lower right-sided chest pain for several days. He describes it as knifelike and states it only lasts for 3 to 5 seconds, taking his breath away. He states he feels like he has to breathe shallowly to keep it from recurring. The only thing that makes it better is lying quietly on his right side. It is much worse when he takes a deep breath. He has taken some Tylenol and put a heating pad on his side but neither has helped. He remembers that 2 weeks ago he had an upper respiratory infection with a severe hacking cough. He denies any recent trauma. His past medical history is unremarkable. His parents and siblings are in good health. He has recently married, and his wife has a baby due in 2 months. He denies any smoking or illegal drug use. He drinks two to three beers once a month. He states that he eats a healthy diet and runs regularly, but not since his recent illness. He denies any cardiac, gastrointestinal, or musculoskeletal symptoms. On examination he is lying on his right side but appears quite comfortable. His temperature, blood pressure, pulse, and respirations are unremarkable. His chest has normal breath sounds on auscultation. Percussion of the chest is unremarkable. During palpation the ribs are nontender. What disorder of the chest best describes his symptoms? A) Pericarditis B) Chest wall pain C) Pleural pain D) Angina pectoralis 9. A 60-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can't do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination she is in no acute distress. Her blood pressure is 160/100 and her pulse is 100. She is afebrile and her respiratory rate is 16. With auscultation she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination the S1 and S2 are distant and an S3 is heard over the apex. What disorder of the chest best describes her symptoms? A) Pneumonia B) Chronic obstructive pulmonary disease (COPD) C) Pleural pain D) Left-sided heart failure 10. A grandmother brings her 13-year-old grandson to you for evaluation. She noticed last week when he took off his shirt that his breastbone seemed collapsed. He seems embarrassed and tells you that it has been that way for quite awhile. He states he has no symptoms from it and he just tries not to take off his shirt in front of anyone. He denies any shortness of breath, chest pain, or lightheadedness on exertion. His past medical history is unremarkable. He is in sixth grade and just moved in with his grandmother after his father was deployed to the Middle East. His mother died several years ago in a car accident. He states that he does not smoke and has never touched alcohol. On examination you see a teenage boy appearing his stated age. On visual examination of his chest you see that the lower portion of the sternum is depressed. Auscultation of the lungs and heart are unremarkable. What disorder of the thorax best describes your findings? A) Barrel chest B) Funnel chest (pectus excavatum) C) Pigeon chest (pectus carinatum) D) Thoracic kyphoscoliosis 11. Which of the following anatomic landmark associations is correct? A) 2nd intercostal space for needle insertion in tension pneumothorax B) T6 for lower margin of endotracheal tube C) Sternal angle marks the 4th rib D) 5th intercostal space for chest tube insertion 12. A 55–year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture? A) Bronchitis B) Costochondritis C) Pericarditis D) Angina pectoris 13. A 62-year-old smoker complains of “coughing up small amounts of blood,” so you consider hemoptysis. Which of the following should you also consider? A) Intestinal bleeding B) Hematoma of the nasal septum C) Epistaxis D) Bruising of the tongue 14. Which of the following occurs in respiratory distress? A) Speaking in sentences of 10–20 words B) Skin between the ribs moves inward with inspiration C) Neck muscles are relaxed D) Patient torso leans posteriorly 15. Which of the following is consistent with good percussion technique? A) Allow all of the fingers to touch the chest while performing percussion. B) Maintain a stiff wrist and hand. C) Leave the plexor finger on the pleximeter after each strike. D) Strike the pleximeter over the distal interphalangeal joint. 16. Which of the following percussion notes would you obtain over the gastric bubble? A) Resonance B) Tympany C) Hyperresonance D) Flatness 17. Which of the following conditions would produce a hyperresonant percussion note? A) Large pneumothorax B) Lobar pneumonia C) Pleural effusion D) Empyema 18. Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration? A) Bronchovesicular B) Vesicular C) Bronchial D) Tracheal 19. A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these? A) Asthma B) COPD C) Bronchiectasis D) Heart failure 20. When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology? A) Bronchitis B) Simple asthma C) Cystic fibrosis D) Heart failure 21. A patient with longstanding COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next? A) Percuss the lower border of the liver B) Measure the span of the liver C) Order a hepatitis panel D) Obtain an ultrasound of the liver 22. You are at your family reunion playing football when your uncle takes a hit to his right lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very remote area. What would your next step be? A) Call a medevac helicopter B) Drive him to the city (4 hours away) C) Press on his sternum and spine simultaneously D) Examine him for tenderness over the injured area Cardiac and Peripheral Vascular System (Goolsby & Grubbs) 57 Questions ____ 1. The first heart sound (S1) occurs because of the closure of the: A. Aortic and mitral valves B. Mitral and tricuspid valves C. Pulmonic valve D. Aortic valve ____ 2. The second heart sound (S2) occurs because of the closure of the: A. Aortic valve B. Tricuspid valve C. Aortic and pulmonic valve D. A and B ____ 3. To distinguish a physiologic split S2 heart sound, it is best to listen with the stethoscope at: A. Left fifth intercostal space midclavicular line B. Fourth intercostal space left sternal border with patient holding his or her breath C. Second intercostal space left sternal border with inspiration D. Fourth intercostal space right sternal border with expiration ____ 4. An S3 gallop is commonly heard in: A. Children with fever B. Adults with heart failure C. Children with aortic stenosis D. Adults with hypertension ____ 5. An S4 sound is commonly heard in: A. Children with fever B. Adults with atrial fibrillation C. Adults with hypertension D. Children with pulmonic stenosis ____ 6. Which of the following heart sounds is commonly heard after myocardial infarction? A. Friction rub B. S4 C. S3 D. Opening snap ____ 7. Which of the following is the most important question to ask during cardiovascular health history? A. Number of offspring B. Last physical examination C. Sudden death of a family member D. Use of caffeine ____ 8. Cardiovascular disease risk increase in women after age: A. 30 B. 40 C. 45 D. 55 ____ 9. Which of the following blood pressure measurements is categorized as prehypertension? A. 110/78 B. 129/85 C. 142/80 D. 145/92 ____ 10. Xanthelasma is a skin condition that should alert the clinician to ____ in a patient. A. Familial hyperlipidemia B. Type 2 diabetes C. Congenital heart disease D. Peripheral arterial disease ____ 11. When palpating the chest, you find the point of maximal impulse (PMI) in the left mid-axillary region. This can be indicative of: A. Normal PMI B. Congenital heart disease C. Ventricular hypertrophy D. Hypertension ____ 12. Upon inspecting the patient, you find jugular venous distension. This is a sign of: A. Left ventricular hypertrophy B. Right ventricular failure C. Hypertension D. Valve disease ____ 13. On an electrocardiogram, you see a deepened Q wave that is greater than one-third the height of the QRS complex. This is indicative of: A. Acute myocardial infarction B. Acute myocardial ischemia C. Left ventricular hypertrophy D. Past myocardial infarction ____ 14. Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of: A. Anemia B. Anxiety C. Hyperthyroidism D. All of the above ____ 15. A pulse rate of 56 beats per minute can be normal in: A. Elderly patients B. Newborns C. Athletic individuals D. Hypertensive patients ____ 16. Your patient has a dysrhythmia and has been on a diuretic for 2 months. Which of the following should be suspected? A. Potassium imbalance B. Sodium deficit C. Calcium imbalance D. Insufficient diuretic ____ 17. Your patient has suffered an inferior wall myocardial infarction. This is most commonly due to an obstruction in the: A. Posterior branch of the right coronary artery B. Circumflex branch of the left coronary artery C. Right main coronary artery D. Left main coronary artery ____ 18. Cardiac chest pain is most often described as: A. Stabbing, piercing pain B. Pain with inhalation C. Crushing, squeezing pain D. Burning, gnawing pain ____ 19. On an electrocardiogram (ECG), an anterior wall myocardial infarction is demonstrated on leads: A. II, III, AVR B. II, III, AVF C. V1, V2, V3, V4 D. I, AVL, V5, V6 ____ 20. Which is the most specific and sensitive test for validating a myocardial infarction? A. 12-lead EKG B. Troponin C. CK-MB D. CT scan ____ 21. It is important for clinicians to recognize that individuals with ____ often sustain silent myocardial infarction. A. Diabetes mellitus B. Hypertension C. Valvular disorders D. Congenital heart defects ____ 22. The pain associated with pericarditis is ____. A. Crushing and squeezing B. Constant C. Worse with inspiration D. Only present with fever ____ 23. Pain associated with a dissecting thoracic aortic aneurysm is commonly described as: A. Retrosternal crushing and squeezing B. Chest stabbing and sharp C. Ripping and tearing in the chest or thoracic back D. Worse with inspiration ____ 24. The pain of ____ can frequently be mistaken for cardiac chest pain. A. Gastroesophageal reflux disease (GERD) B. Peptic ulcer disease (PUD) C. Cholecystitis D. All of the above ____ 25. The pain of pancreatitis is described as: A. Abdominal sharp and piercing pain in the left upper quadrant B. Dull and cramping pain in the right upper quadrant C. Severe, epigastric pain radiating straight into the back D. Sharp pain radiating to the shoulder ____ 26. The pain of costochondritis typically ____. A. Mimics cardiac crushing and squeezing pain B. Worsens with movement and full inspiration C. Radiates from epigastrium into the back D. Is a tearing and ripping pain ____ 27. The medical record of your patient lists a grade III systolic murmur. This indicates the patient has a heart murmur that is: A. Soft and after S2 B. Loud and crescendo in quality C. Moderately loud and after S1 D. Loud and after S2 ____ 28. The radiation of a mitral valve murmur is commonly heard in the: A. Carotid arteries B. Left mid-axillary line C. Base of the heart D. Left mid-clavicular line ____ 29. The murmur of aortic stenosis is best heard in the: A. Left second intercostal space left sternal border B. Left fifth intercostal space mid-clavicular line C. Right fourth intercostal space right sternal border D. Right second intercostal space right sternal border ____ 30. The pulmonary valve is best heard over the: A. left second intercostal space left sternal border B. left fifth intercostal space mid-clavicular line C. right fourth intercostal space right sternal border D. right second intercostal space right sternal border ____ 31. The key sign(s) of aortic stenosis are: A. Syncope B. Dyspnea C. Angina D. All of the above ____ 32. Classically in mitral valve prolapse, the clinician can hear a(n) ____. A. Mid-systolic click followed by a grade I murmur that crescendos up to S2 B. Opening snap followed by a grade III holosystolic murmur C. Crescendo-decrescendo grade I diastolic murmur after S2 D. Rough grade III holosystolic murmur that obscures S1 and S2 ____ 33. The best diagnostic test that allows analysis of a heart murmur is: A. CT scan B. Echocardiogram C. MRI D. ECG ____ 34. The most common cause of tricuspid regurgitation is: A. Left ventricular hypertrophy B. Left atrial enlargement C. Aortic stenosis D. Pulmonary hypertension ____ 35. The tricuspid valve is best heard over the: A. Third intercostal space left sternal border B. Fifth intercostal space right sternal border C. Fourth intercostal space left sternal border D. Third intercostal space right sternal border ____ 36. From Erb’s point, all the heart valves can be heard equally. Erb’s point is located over the: A. Third intercostal space left sternal border B. Fifth intercostal space right sternal border C. Fourth intercostal space left sternal border D. Third intercostal space right sternal border ____ 37. Upon examination of a child, an innocent systolic murmur is heard at the second intercostal space left sternal border. This is usually due to: A. Atrial septal defect B. Patent foramen ovale C. Low flow velocity D. High flow turbulence ____ 38. In mitral stenosis, the murmur occurs: A. From S1 through S2 as a holosystolic murmur B. After an opening snap that is heard after S2 during diastole C. As a soft mid-systolic click D. A loud crescendo-decrescendo systolic murmur ____ 39. In mitral stenosis, the murmur can be best heard with the patient in the: A. Squatting position B. Seated position C. Left lateral recumbent D. Supine position ____ 40. Due to increased left atrial pressure, a patient with mitral stenosis often suffers from: A. Pulmonary congestion B. Hepatomegaly C. Jugular venous distension D. Ventricular tachycardia ____ 41. In aortic stenosis, the patient’s point of maximal impulse is commonly located at the: A. Fifth intercostal space mid-clavicular line B. Fifth intercostal space mid-axillary line C. Second intercostal space left sternal border D. Second intercostal space right sternal border ____ 42. Aortic regurgitation occurs after S2 during ____ because there is turbulent flow that refluxes into the left ventricle after the aortic valve closes. A. Early diastole B. Late diastole C. Early systole D. Mid-systole ____ 43. The murmur of a ventricular septal defect (VSD) occurs when the ventricle contracts and blood flows from the left ventricle into the right ventricle. This creates a ____ heart murmur. A. Holodiastolic B. Early diastolic C. Holosystolic D. Late systolic ____ 44. An atrial septal defect (ASD) causes a left to right shunt, which enlarges the right atrium. Because of this effect, which of the following conditions often occur with ASD? A. Asthma B. Jugular venous distension C. Atrial fibrillation D. B & C ____ 45. A patient with hypertension who has hyperlipidemia should aim for LDL measurement to be: A. 130 mg/dL or less B. 40 mg/dL or less C. 100 mg/dL or less D. 60mg/dL or less ____ 46. Your 47-year-old female patient has a waist to hip ratio of 1. In terms of cardiovascular disease risk, this is considered: A. Ideal B. Greater than acceptable limits C. Less than acceptable limits D. Within acceptable limits ____ 47. Which of the following conditions is/are part of metabolic syndrome? A. Hypertension B. Hyperlipidemia C. Insulin resistance D. All of the above ____ 48. The target body mass index for women is: A. 27 kg/m2 B. 25 kg/m2 C. 22 kg/m2 D. 16 kg/m2 ____ 49. Dyspnea, cough, and pulmonary crackles are symptoms that can occur in left ventricular failure and respiratory disorders, such as pneumonia. Which of the blood tests below can be used to differentiate cardiovascular from pulmonary disease? A. B type natriuretic peptide (BNP) B. Pulse oximetry C. Arterial blood gases D. High sensitivity C reactive protein (hs-CRP) ____ 50. When an examiner presses on the liver and elicits hepato-jugular reflux, which of the following conditions is likely? A. Left ventricular failure B. Right ventricular failure C. Hepatomegaly D. Pulmonary edema ____ 51. Your patient has had hypertension for 10 years, a myocardial infarction 5 years ago, and now complains of dyspnea on exertion, cough, and 3-pillow orthopnea. Which of the following conditions is likely? A. Right ventricular failure B. Pulmonary embolism C. Cor pulmonale D. Left ventricular failure ____ 52. Your patient complains of worsening ankle edema and weight gain over the last week. On physical examination, you note jugular venous distension, ascites, hepatomegaly, and splenomegaly. These conditions are indicative of: A. Left ventricular failure B. Pulmonary embolism C. Right ventricular failure D. Myocardial infarction ____ 53. A 23-year-old patient presents the emergency department with high fever, chills, extreme fatigue, and arthralgias. Your physical examination reveals grade II heart murmur heard loudest over the fourth intercostal space left sternal border. The arms of the patient reveal past intravenous drug abuse. The clinician should recognize these are signs and symptoms of: A. Pulmonary embolism B. Right ventricular failure C. Functional heart murmur D. Bacterial endocarditis ____ 54. A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, 1 dorsalis pedis pulse in the right foot, and 2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms? A. Arterial insufficiency B. Femoral vein thrombus C. Venous insufficiency D. Peripheral neuropathy ____ 55. Which of the following ankle-brachial index measurements require a referral to a vascular consultant? A. ABI 1.2 B. ABI 1 C. ABI 0.9 D. ABI 0.5 ____ 56. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? A. Femoral vein thrombosis B. Femoral artery thrombus C. Venous insufficiency D. Musculoskeletal injury ____ 57. After multiple pregnancies, the following vascular disorder is common: A. Deep venous thrombosis B. Varicose veins C. Peripheral arterial disease D. Aortic aneurysm