PCCN FINAL PAPER 2026 ACTUAL EXAM
QUESTIONS WITH CORRECT ANSWERS
◉ A definitive diagnosis of myocarditis can be made via? Answer:
ENDOMYOCARDIAL BIOPSY
A biopsy is the ONLY definitive way to diagnose myocarditis.
◉ The volume of fluid required to cause a pericardial tamponade is?
Answer: 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? Answer: 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 Answer: 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, what you expect to see on a
CXR? Answer: 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? Answer: 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 what condition? Answer: 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? Answer: 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 about CK-MB
isoenzymes and troponins? Answer: 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.
◉ 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 Answer: II, a VF - inferior heart
I, aVL - lateral wall
V1 - V2 --septal wall
V5 - V6 - apical area
QUESTIONS WITH CORRECT ANSWERS
◉ A definitive diagnosis of myocarditis can be made via? Answer:
ENDOMYOCARDIAL BIOPSY
A biopsy is the ONLY definitive way to diagnose myocarditis.
◉ The volume of fluid required to cause a pericardial tamponade is?
Answer: 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? Answer: 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 Answer: 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, what you expect to see on a
CXR? Answer: 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? Answer: 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 what condition? Answer: 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? Answer: 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 about CK-MB
isoenzymes and troponins? Answer: 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.
◉ 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 Answer: II, a VF - inferior heart
I, aVL - lateral wall
V1 - V2 --septal wall
V5 - V6 - apical area
