The apical impulse is the visible, palpable, pushing force against the chest wall that is caused by left ventricular contraction and is associated with the S1 sound
True
False
True
Cor pulmonale is a pulmonary pathology due to heart failure
True
False
False
- It is caused by lung pressure
- Associated conditions are:
o Tachypnea
o Precordial heaving
o Emphysema
o Right ventricular hypertrophy
In angina pectoris there is an elevation of serum specific enzymes
True
False
False
- No serum change
- Serum change is seen with left ventricular hypertrophy, total failure or RVH
Rheumatic heart may lead most often to mitral valve lesions
True
False
True
- ONLY CAUSE of mitral valve lesions/ stenosis is rheumatic fever
- Usually comes from repeated exposure to strep throat
The character of cardiac (coronary) pain is usually stabbing
True
False
False
- The character is usually crushing
- Excessive pressure on chest
o Elephant on chest
o Heaviness
o Restriction
o Rock on chest
Under normal conditions the valves of the heart open silently and they close with a sound
True
False
True
Chest pain that is exacerbated by exercise and is relieved by rest is most likely due to coronary ischemia
True
False
True
Palpitations means awareness of the heart beats
True
False
True
- Irregular rhythm
- Palpitations refers to the awareness
o COULD indicate arrhythmia
Subacute bacterial endocarditis is associated with splinter hemorrhage of the fingernails
True
False
True
The third heart sound occurs physiologically due to aortic and pulmonic valves closure
True
False
False
- Heart sounds
o S1- Mitral/tricuspid
o S2- Aortic/pulmonic
o S3- Passive filling of heart with 70% of blood
o S4- At end of diastole, active filling of ventricle. 30%
The apex beat is normally located at the anterior axillary line
True
False
False
- The apex is located at midclavicular line
Systemic hypertension may lead to left ventricle enlargement
True
False
True
Elevated HDL is a cardiac risk factor:
True
False
False
- Elevated LDL is a cardiac risk factor
The causative organism for rheumatic fever is beta hemolytic streptococci group A
True
False
True
All are true concerning the vital signs except:
A. Blood pressure is 120/80 B. Pulse pressure is 60 to 90 normally 72 C. Respiratory rate is 12 to 20 D. Temperature is 98.6 F E. All of the above are true
B. Pulse pressure is 60 to 90 normally 72
o Pulse pressure • The difference between systole and diastole • Normally 40-50 • Should not exceed 50 • Causes of exceeding 50: o Hypertension o Atherosclerosis • Systole & disastole are normal in their respective ranges • But pulse pressure will be +50 o Aortic valve incompetency o Pulse RATE is 60 to 90 normally 72
A 10 year old girl presents with a four-day history of pain in the knees, hips, shoulders and wrists. The joints are not swollen, red or tender. Her temperature is 102F. Her mother states that her daughter’s only recent illness was a sore throat one month ago. Auscultation of the chest reveals an apical systolic murmur. Which of the following statements are true:
A. She may be suffering from rheumatic fever
B. She could be suffering from rheumatoid arthritis
C. Aortic valve is the most common valve involved in this problem
D. Gastrointestinal manifestation is a common complication of this problem
A. She may be suffering from rheumatic fever
o Classic presentation
o Socioeconomic problem/ overabundance disease
o Patient will experience migratory/fleeting arthritis
• But joints are normal
o RE: C. Aortic valve is the most common valve involved
• MITRAL valve is most commonly involved, the valve associated with the sound heard at the apex.
Aortic valve stenosis may lead to?
A. Right atrium enlargement
B. Left atrium enlargement
C. Right ventricle enlargement
D. Left ventricle enlargement
D. Left ventricle enlargement
Night fever and night sweats are characteristic of?
A. Pneumonia
B. TB
C. Bronchial asthma
D. Emphysema
B. TB
Which of the following chest conditions is associated with hemoptysis?
A. Bronchial asthma
B. Acute bronchitis
C. TB
D. Peptic ulcer
C. TB
o Hemoptysis
• P: Pulmonary origin
Pleurisy is most likely to cause which type of pain?
A. Crushing
B. Stabbing
C. Burning
D. Radiating
B. Stabbing
The most significant fault in the Tetrology of Fallot that causes cyanosis at birth is…
A. Pulmonary stenosis
B. Aortic valve overriding on both ventricles
C. Atrial septal defect
D. Right ventricular hypertrophy
B. Aortic valve overriding on both ventricles
Tetrology of Fallot is combination of 4 faults:
• Ventricular Septal Defect
• Pulmonary stenosis
• Aorta overriding both ventricles
• Right ventricular hypertrophy
• Leads to low oxygen levels in the blood and fingers and toes looking cyanotic
Non- Cyanotic heart disease • VSD • most common, frequently asymptomatic • 60% spontaneously close in 2-4 years • ASD • Patent ductus arteriosis • The aorta (coming from left ventricle with oxygenated blood) feeds into the pulmonary artery (coming from right ventricle with deoxygenated blood going to the lungs)
Myocardial infarction can be differentiated from angina pectoris based on the ____ of the pain.
A. Location
B. Duration
C. Character
D. Intensity
B. Duration
o Angina
• Transitional, acute pain
• Goes away
• Eventually multiple episodes will lead to MI
o Heart attack is most common cause of death
o Duration
• Angina: 2-5 minutes
• MI: constant
o Character is constricting in both angina and MI
o Intensity is worse in MI
All of the following are associated with bronchial asthma except:
A. Flaring of the alae
B. Chest wheezing
C. Tachypnea
D. Increased respiratory excursion
D. Increased respiratory excursion
Examination of a 60-year-old male with chest and midthoracic pain reveals clubbing of the nails, cyanosis of the lips and oral mucosa, and hypertrophy of both SCM muscles. Based on this information, the most commonly involved system is the ____ system.
A. Vascular
B. Respiratory
C. Cardiac
D. Endocrine
B. Respiratory
- Constant accessory muscle use
Which of the following blood changes usually accompanies emphysema?
A. Increased RBC number
B. Increased WBC number
C. Increased platelet number
D. Pancytopenia
A. Increased RBC Number
- Nothing increases RBC except:
o Emphysema
• Hypoxia leads to short temper/aggitation
o High altitude
Precordial heaving is a sign associated with which of the following:
A. Cor-pulmonale
B. Systemic hypertension
C. TB
D. Bronchial asthma
A. Cor-pulmonale
o Epigastric pulsations
While taking X-ray, which of the following pathologies necessitates a reduction in exposure technique?
A. Acromegaly
B. Obese patient
C. Pleural effusion
D. Emphysema
D. Emphysema
- AKA which pathology has a LACK of substance
Which of the five percussive notes is the only one that is pathological?
A. Tympanic B. Resonant C. Hyperresonant D. Dull E. Flat
C. Hyperresonant
Tympanic- Gastric air bubble Resonant- Normal lung Hyperresonant- Emphysema, sometimes pneumothorax Dull- organ Flat- bone
Cor pulmonale is:
A. Pulmonary pathology due to heart failure
B. Right ventricular failure/hypertrophy in response to pulmonary pathology
C. Bilateral ventricular enlargement due to pulmonary pathology
D. A congenital cyanotic heart disease
B. Right ventricular failure/hypertrophy in response to pulmonary pathology
“OPQRST” falls under which major patient history category?
A. Family history
B. Past medical history
C. Present problem
D. Social history
C. Present problem
The proper protocol for physical exam is: inspection, palpation, percussion, ausculatation except for the:
A. Heart
B. Lung
C. Abdomen
C. Abdomen
The sound that is normally heard over the trachea and the main bronchi of the lung during auscultation of the chest is described as:
A. Bronchovesicular
B. Bronchial (also acceptable)
C. Vesicular
D. Resonant
A. Bronchovesicular
Systemic hypertension may lead to:
A. Right atrium enlargement
B. Left atrium enlargement
C. Right ventricular enlargement
D. Left ventricular enlargement
D. Left ventricular enlargement
All of the following usually accompany emphysema except:
A. Clubbing of the fingernails
B. Hyperresonant note upon percussion
C. Decreased tactile fremitius
D. Increased respiratory excursion
D. Increased respiratory excursion
The nature of asthma is:
A. Infectious B. Immune C. Traumatic D. Neoplastic E. Degenerative
B. Immune
Infectious- pneumonia, Hepatitis C, TB, shingles Immune- Lupus, RA Traumatic- Broken bones, laceration Neoplastic- Cancers Degenerative- DJD, OA, Amnesia
o Metabolic
• Gout
• Diabetes
MATCHING
Pneumothorax
A. Air in the pleural space B. Inflammation of the alveoli C. Coughing of blood D. Occurs due to compression fracture of a thoracic vertebra E. Awareness of heart beats
Pneumonia- Inflammation of the alveoli Hemoptysis- Coughing of blood Gibbus deformity- Occurs due to compression fracture of a thoracic vertebra - 3 Causes of Gibbus o TB o Osteoporosis (primary cause) o Multiple myeloma Palpitations- Awareness of heart beats
Pneumothorax- Air in the pleural space
MATCHING
Pneumonia
A. Air in the pleural space B. Inflammation of the alveoli C. Coughing of blood D. Occurs due to compression fracture of a thoracic vertebra E. Awareness of heart beats
Hemoptysis- Coughing of blood Gibbus deformity- Occurs due to compression fracture of a thoracic vertebra - 3 Causes of Gibbus o TB o Osteoporosis (primary cause) o Multiple myeloma Palpitations- Awareness of heart beats
Pneumonia- Inflammation of the alveoli
MATCHING
Hemoptysis
A. Air in the pleural space B. Inflammation of the alveoli C. Coughing of blood D. Occurs due to compression fracture of a thoracic vertebra E. Awareness of heart beats
Gibbus deformity- Occurs due to compression fracture of a thoracic vertebra - 3 Causes of Gibbus o TB o Osteoporosis (primary cause) o Multiple myeloma Palpitations- Awareness of heart beats
Hemoptysis- Coughing of blood
MATCHING
Gibbus Deformity
A. Air in the pleural space B. Inflammation of the alveoli C. Coughing of blood D. Occurs due to compression fracture of a thoracic vertebra E. Awareness of heart beats
Palpitations- Awareness of heart beats
Gibbus deformity- Occurs due to compression fracture of a thoracic vertebra - 3 Causes of Gibbus o TB o Osteoporosis (primary cause) o Multiple myeloma
MATCHING
Palpitations
A. Air in the pleural space B. Inflammation of the alveoli C. Coughing of blood D. Occurs due to compression fracture of a thoracic vertebra E. Awareness of heart beats
Palpitations- Awareness of heart beats
56-year-old male presented with acute chest pain. The condition started one week ago, no trauma, and steady course. The pain is rated 7-8/10, retrosternal and at the front chest area and left sternal margin. Patient is a smoker for 25 years and smokes up to a pack per day
The pain is associated with cough productive associated with mucopurulent sputum that started one week ago.
Entry data:
- Pulse: 90 bpm
- Blood pressure: 140/90
- Respiration: 22/min
- Oral temperature: 101 F
What is the most appropriate clinical impression:
A. Asthma B. Angina C. Costochondritis D. Myocardial infarction E. Pneumonia
E. Pneumonia
- Due to the increase in temperature the correct answer is pneumonia
- Impressions associated with increased temperature
o Pneumonia
o Tonsilitis
o Nephritis
Which of the following skin tumors have the least tendency to metastasize?
A. Melanoma
B. Kaposi Sarcoma
C. Rodent Ulcer
D. Squamous cell carcinoma
C. Rodent ulcer
Melanoma- metastasize via blood
Kaposi Sarcoma – HIV/AIDS, immunocompromised
Rodent Ulcer – hardly ever metastasize, most common in humans, creates an area of carcinoma insitu
Squamous cell carcinoma – metastasize via lymph
All of the following are true regarding percussion except:
A. The heart and the liver are dull
B. The normal lung tissue is resonant
C. The gastric air bubble will by tympanic
D. All statements are true
D. All of the statements are true
All of the following usually accompany emphysema except:
A. Clubbing of the fingernails
B. Hyperresonant note upon percussion
C. Decreased red blood cells
D. Decreased residual volume
C. Decreased red blood cells
D. Decreased residual volume
Structural abnormalities of the chest may be associated with:
A. Pneumonia
B. Asthma
C. Bronchial asthma
D. Emphysema
D. Emphysema
- Congenital o Pectus excavatum - Acquired o Musculoskeletal (ie. Scoliosis) o TB o Emphysema
Which respect to the chief complaint; the “O” stands for:
A. How did the condition start
B. What makes it better or worse
C. Where is the pain
D. Is the pain an electric shock type pain, muscle ache, etc
A. How did the condition start
The classic sequence for case history is _____?
A. Chief complaint, past medical history, present illness
B. Chief complaint, present illness, past medical history
C. Present illness, chief complaint, past medical history
D. Chief complaint, social history, past medical history
B. Chief complaint, present illness, past medical history
Case: A 63-year-old male presents with shortness of breath, and cough productive small amounts of blood in the sputum. This condition occurs intermittently through the last several months
These symptoms may be suggestive of the following (Choose 2)
A. Emphysema B. TB C. Bronchogenic carcinoma D. Asthmatic bronchitis E. Pneumonia
B. TB
C. Bronchogenic carcinoma
For central cyanosis to occur there must be a blood shunt in which of the following directions
A. Right ventricle to left ventricle
B. Left ventricle to right ventricle
C. Both
D. None
A. Right ventricle to left ventricle
- Eisenmenger Syndrome
o VSD with reverse shunt
o Acute case of cyanosis after 6-8 years
The Erb’s point for cardiac auscultation is located in the…
A. Second intercostal space to the left of the sternum
B. Second intercostal space to the right of the sternum
C. Third intercostal space to the left of the sternum
D. Fourth intercostal space to the left of the sternum
E. Fifth intercostal space to the left of the sternum
C. Third intercostal space to the left of the sternum
Second intercostal space to the left of the sternum – Aortic
Second intercostal space to the right of the sternum – Pulmonic
Fourth intercostal space to the left of the sternum - Tricuspid
Fifth intercostal space to the left of the sternum – Mitral
Postive egophony, bronchophony, & whispered pectoriloquy during auscultation of the lung indicate:
A. Asthma
B. Emphysma
C. Lung consolidation
D. Pleurisy
C. Lung consolidation
The sound that is normally heard over the periphery of the lung during auscultation of an asthmatic patient is _____:
A. Bronchial B. Bronchovesicular C. Vesicular D. Localized wheezing E. Generalized wheezing
E. Generalized wheezing – entire bronchial tree is in spasm all over
With respect to the chief complaint the “O” stands for:
A. How did this condition occur
B. What makes it better or worse
C. Where is the pain
D. Is the pain an electric shock type pain, muscle ache, etc
A. How did this condition occur
The part of the heart that occupies most of the anterior surface is:
A. Right ventricle
B. Left ventricle
C. Right atrium
D. Left atrium
A. Right ventricle
For central cyanosis to occur there must be a blood shunt in which of the following directions:
A. Right ventricle to left ventricle
B. Left ventricle to right ventricle
A. Right ventricle to left ventricle
Which of the following valvular lesions can cause drop attacks (blackouts)?
A. Mitral stenosis
B. Aortic stenosis
C. Tricuspid stenosis
D. Pulmonic stenosis
B. Aortic stenosis
Ruptured spleen that is compensated by hypotension, and tachycardia is categorized under which of the following reflexes?
A. Viscero-somatic reflex
B. Somato-visceral reflex
C. Viscero-visceral reflex
D. Somato-somatic reflex
C. Viscero-visceral reflex
Choose A if all statements 1,2,3,4 are true
Choose B if statements 1 and 3 only are true
Choose C if statements 2 and 4 only are true
Choose D if statements 1,2 and 3 only are true
Choose E if all statements are false
Regarding ventricular septal defect
- It s the most common congenital heart defect (true)
- May cause cyanosis at birth (true)
- 70% of cases close spontaneously within 2 years (true)
- Responsible for the majority of infantile morbidity (true)
A. 1,2,3,4 are all true
Choose A if all statements 1,2,3,4 are true
Choose B if statements 1 and 3 only are true
Choose C if statements 2 and 4 only are true
Choose D if statements 1,2 and 3 only are true
Choose E if all statements are false
Regarding cardiac examination
- The apex beat is normally located at mid-axillary line (false)
- The apex beat is formed by left ventricular contraction (true)
- Precordial heaving is associated with left ventricular contraction (false)
- The apex beat is normally located at the fifth left intercostal space (true)
- C. STATEMENTS 2 AND 4 ARE TRUE
- The apex beat is normally located at mid clavicular line
- Precordial heaving is associated with right ventricular hypertrophy
Choose A if all statements 1,2,3,4 are true
Choose B if statements 1 and 3 only are true
Choose C if statements 2 and 4 only are true
Choose D if statements 1,2 and 3 only are true
Choose E if all statements are false
Regarding abdominal exam:
- The superficial mass will be less palpable upon abdominal crunch (false)
- The gall bladder is examined by palpation at the mid-axillary line (false)
- The abdominal aorta is palpated above and right of the umbilicus (false)
- Rebound tenderness indicates nephritis (false)
E- All statements are false