MEDICAL DIAGNOSIS COMPREHENSIVE EXAM 2025/2026
QUESTIONS AND ANSWERS GRADED A++
✔✔Large bounding causes - ✔✔Increased stroke volume, Decreased peripheral
resistance, Fever, Anemia, Hyperthyroidism, Aortic Regurgitation, Arteriovenous
fistulas, patent ductus arteriosus, bradycardia, complete heart block, atherosclerosis
✔✔Bisferiens pulse - ✔✔increased arterial pulse with a double systolic peak
✔✔Pulsus alternans - ✔✔regular rhythm, but force of pulse varies with alternating
strong and weak beats. Indicates sever left ventricular failure
✔✔Bigeminal pulse - ✔✔normal beat alternating with premature contraction
✔✔Paradoxical pulse - ✔✔palpable decrease in pulse amplitude on quiet inspiration
Pulse decreases >10-12 mm hg
Caused by pericardial tamponade, constrictive pericarditis, exacerbations of asthma
and COPD
✔✔In a healthy heart, the left ventricular impulse is - ✔✔the PMI
✔✔The right ventricular pulse is usually - ✔✔not palpable beyond infancy
✔✔Location of PMI - ✔✔4th or 5th intercostal space, midclavicular line
✔✔PMI Amplitude - ✔✔brisk and tapping
✔✔PMI duration - ✔✔less than or equal to 2/3 of systole
✔✔Transiently increased stroke volume - ✔✔Hyperkinetic ventricular impulse
✔✔Sustained ventricular impulse of ventricular hypertrophy from chronic pressure load -
✔✔Increased afterload
✔✔Diffuse ventricular impulse of ventricular dilation from chronic overload -
✔✔increased afterload
✔✔Left Ventricular Impulse (hyperkinetic) causes - ✔✔Anxiety, Hyperthyroidism, severe
anemia
✔✔Left Ventricular Impulse (hyperkinetic) - ✔✔More forceful tapping
< 2/3 systole
, ✔✔Left Ventricular Impulse (Pressure overload) causes - ✔✔Aortic stenosis,
hypertension
✔✔Left ventricular impulse (pressure overload) - ✔✔More forceful tapping
Sustained up to S2
✔✔Left Ventricular Impulse (Volume overload) - ✔✔Loc: displace to left and downward
Dia: >2cm
Amp: diffuse
Dur: often slightly sustained
Causes: aortic or mitral regurgitation
✔✔Right Ventricular Impulse (hyperkinetic) - ✔✔Loc: L 3rd, 4th, 5th intercoastal spaces
Dia: not useful
Amp: slightly more forceful
Dur: normal
Causes: anxiety, hyperthyroidism, severe anemia
✔✔Right Ventricular Impulse (Pressure overload) - ✔✔Loc: L 3rd-5th intercoastal
spaces, subxiphoid area
Dia: not useful
Amp: more forceful
Dur: sustained
Causes: pulmonic stenosis, pulmonary HTN
✔✔Right Ventricular Impulse (Volume Overload) - ✔✔Loc: Left sternal boarder
extending to L cardiac border, subxiphoid area
Dia: not useful
Amp: slightly to more forceful
Dur: normal to slightly sustained
Causes: atrial septal defect
✔✔Normal variations - ✔✔S1 is softer than S2 at the base (2nd R/L intercoastal
spaces)
S1 is often but not always louder than S2 at the apex
✔✔Accentuated S1 - ✔✔tachycardia, rhythms with a short PR interval, and high cardiac
output state, mitral stenosis
✔✔Diminished S1 - ✔✔1st degree heart block, left bundle branch block, MI, Early mitral
valve closure occurring before ventricular contraction also causes a soft S1, seen in
severe aortic regurgitation
QUESTIONS AND ANSWERS GRADED A++
✔✔Large bounding causes - ✔✔Increased stroke volume, Decreased peripheral
resistance, Fever, Anemia, Hyperthyroidism, Aortic Regurgitation, Arteriovenous
fistulas, patent ductus arteriosus, bradycardia, complete heart block, atherosclerosis
✔✔Bisferiens pulse - ✔✔increased arterial pulse with a double systolic peak
✔✔Pulsus alternans - ✔✔regular rhythm, but force of pulse varies with alternating
strong and weak beats. Indicates sever left ventricular failure
✔✔Bigeminal pulse - ✔✔normal beat alternating with premature contraction
✔✔Paradoxical pulse - ✔✔palpable decrease in pulse amplitude on quiet inspiration
Pulse decreases >10-12 mm hg
Caused by pericardial tamponade, constrictive pericarditis, exacerbations of asthma
and COPD
✔✔In a healthy heart, the left ventricular impulse is - ✔✔the PMI
✔✔The right ventricular pulse is usually - ✔✔not palpable beyond infancy
✔✔Location of PMI - ✔✔4th or 5th intercostal space, midclavicular line
✔✔PMI Amplitude - ✔✔brisk and tapping
✔✔PMI duration - ✔✔less than or equal to 2/3 of systole
✔✔Transiently increased stroke volume - ✔✔Hyperkinetic ventricular impulse
✔✔Sustained ventricular impulse of ventricular hypertrophy from chronic pressure load -
✔✔Increased afterload
✔✔Diffuse ventricular impulse of ventricular dilation from chronic overload -
✔✔increased afterload
✔✔Left Ventricular Impulse (hyperkinetic) causes - ✔✔Anxiety, Hyperthyroidism, severe
anemia
✔✔Left Ventricular Impulse (hyperkinetic) - ✔✔More forceful tapping
< 2/3 systole
, ✔✔Left Ventricular Impulse (Pressure overload) causes - ✔✔Aortic stenosis,
hypertension
✔✔Left ventricular impulse (pressure overload) - ✔✔More forceful tapping
Sustained up to S2
✔✔Left Ventricular Impulse (Volume overload) - ✔✔Loc: displace to left and downward
Dia: >2cm
Amp: diffuse
Dur: often slightly sustained
Causes: aortic or mitral regurgitation
✔✔Right Ventricular Impulse (hyperkinetic) - ✔✔Loc: L 3rd, 4th, 5th intercoastal spaces
Dia: not useful
Amp: slightly more forceful
Dur: normal
Causes: anxiety, hyperthyroidism, severe anemia
✔✔Right Ventricular Impulse (Pressure overload) - ✔✔Loc: L 3rd-5th intercoastal
spaces, subxiphoid area
Dia: not useful
Amp: more forceful
Dur: sustained
Causes: pulmonic stenosis, pulmonary HTN
✔✔Right Ventricular Impulse (Volume Overload) - ✔✔Loc: Left sternal boarder
extending to L cardiac border, subxiphoid area
Dia: not useful
Amp: slightly to more forceful
Dur: normal to slightly sustained
Causes: atrial septal defect
✔✔Normal variations - ✔✔S1 is softer than S2 at the base (2nd R/L intercoastal
spaces)
S1 is often but not always louder than S2 at the apex
✔✔Accentuated S1 - ✔✔tachycardia, rhythms with a short PR interval, and high cardiac
output state, mitral stenosis
✔✔Diminished S1 - ✔✔1st degree heart block, left bundle branch block, MI, Early mitral
valve closure occurring before ventricular contraction also causes a soft S1, seen in
severe aortic regurgitation
