Ped: Cardiac

Front 1

1. The condition in which a patient's heart is either rotated or displaced to the right or is situated as a mirror image of the expected position is called

A. amyloidosis.

B. cardiomyopathy.

C. dextrocardia.

D. situs inversus.

E. coarctation.

Back 1

C. dextrocardia.

Front 2

2. Heart position can vary depending on body habitus. In a short, stocky individual, you would expect the heart to be located

A. more to the right and hanging more vertically.

B. more to the left and lying more horizontally.

C. riding higher in the chest and pushed anteriorly.

D. hanging lower in the chest and riding more vertically.

E. more to the right and lying more horizontally.

Back 2

B. more to the left and lying more horizontally.

Front 3

3. Thin-walled reservoirs of the heart are the

A. atria.

B. pericardia.

C. sinuses.

D. ventricles.

E. septa.

Back 3

A. atria.

Front 4

4. Which cardiac structure is responsible for the heart's pumping action?

A. Pericardium

B. Epicardium

C. Myocardium

D. Endocardium

E. Atria

Back 4

C. Myocardium

Front 5

5. Which two heart structures are most anterior in the chest?

A. Both atria

B. Both ventricles

C. The right atrium and ventricle

D. The left atrium and ventricle

E. Superior and inferior venae cavae

Back 5

B. Both ventricles

Front 6

6. Contraction of the ventricles causes

A. closure of the atrioventricular valves.

B. closure of the pulmonic and aortic valves.

C. opening of the mitral valve and closure of the tricuspid valve.

D. opening of the mitral and tricuspid valves.

E. opening of the auricular septa.

Back 6

A. closure of the atrioventricular valves.

Front 7

7. Which two structures together form the primary muscle mass of the heart?

A. Right atria and left ventricle

B. Left ventricle and the aorta

C. Right and left atria

D. Left atrium and the pulmonary vein

E. Right and left ventricles

Back 7

E. Right and left ventricles

Front 8

8. The major heart sounds are normally created by

A. valves opening.

B. valves closing.

C. the rapid movement of blood.

D. rubbing together of the cardiac walls.

E. pulmonic veins.

Back 8

B. valves closing.

Front 9

9. Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the

A. P wave.

B. PR interval.

C. QRS complex.

D. ST segment.

E. T wave.

Back 9

A. P wave.

Front 10

10. A third heart sound is created by

A. atrial contraction.

B. ventricular contraction.

C. diastolic filling.

D. regurgitation between the right and left ventricles.

E. blood in the pericardium.

Back 10

C. diastolic filling.

Front 11

11. The "pacing" structure of the heart's electrical activity is the

A. atrioventricular (AV) node.

B. bundle of His.

C. Purkinje fibers.

D. coronary sinus.

E. sinoatrial (SA) node.

Back 11

E. sinoatrial (SA) node.

Front 12

12. Purkinje fibers are located in the

A. sinoatrial node.

B. atrioventricular node.

C. myocardium.

D. aortic arch.

E. pericardium.

Back 12

C. (ventricular) myocardium.

Front 13

13. The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the

A. P wave.

B. QRS complex.

C. PR interval.

D. T wave.

E. U wave.

Back 13

B. QRS complex.

Front 14

14. In a fetus, the right ventricle primarily pumps blood through the

A. left atrium.

B. ductus arteriosus.

C. lungs.

D. foramen ovale.

E. septum primum.

Back 14

B. ductus arteriosus.

Front 15

15. In what group are the right and left ventricles equal in weight and muscle mass?

A. Newborns

B. School-age children

C. Adolescents

D. Older adults

E. Pregnant women

Back 15

A. Newborns

Front 16

16. Closure of the ductus arteriosus usually occurs

A. just before the initiation of labor.

B. 24 to 48 hours after birth.

C. after 7 days of life.

D. between the second and third months of life. E. during the toddler stage.

Back 16

B. 24 to 48 hours after birth.

Front 17

17. The apex of a 2-month-old baby's heart typically lies closest to the

A. left midsternal area.

B. fourth left intercostal space.

C. midthoracic spinal area.

D. sixth left intercostal space.

E. right midsternal area.

Back 17

B. fourth left intercostal space.

Front 18

18. Normal cardiac changes that occur during pregnancy include

A. decreased cardiac output.

B. increased thickness and mass of the left ventricle.

C. decreased heart rate.

D. dilation of the ventricles.

E. heart is shifted more vertical.

Back 18

B. increased thickness and mass of the left ventricle.

Front 19

19. Which ECG change would indicate the ventricle has lost the rhythm of its expected response?A. First-degree block

B. Bundle branch block

C. Left ventricular hypertrophy

D. Ventricular fibrillation

E. Atrial fibrillation

Back 19

D. Ventricular fibrillation

Front 20

20. Mr. O, age 50 years, comes for his yearly health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O mentions that he routinely engages in light exercise. At this time, you should

A. ask if he makes his own bed daily.

B. have the patient describe his exercise.

C. make a note that he walks each day.

D. record "light exercise" in the history.

E. record "questionable exercise" in the history.

Back 20

B. have the patient describe his exercise.

Front 21

21. Pleural pain differs from chest discomfort caused by other conditions in that it is

A. precipitated by breathing.

B. eased with deep breathing.

C. usually described as dull in nature.

D. related to the time of day.

E. eased with coughing.

Back 21

A. precipitated by breathing.

Front 22

22. Which of the following information belongs in the past medical history section related to heart and blood vessel assessment?

A. Adolescent inguinal hernia

B. Childhood mumps

C. Past incidence of bee stings

D. Previous unexplained fever

E. Parents with a history of cardiac problems

Back 22

D. Previous unexplained fever

Front 23

23. A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history interview of his family history, he relates that his father died of heart trouble. The most important follow-up question you should pose is which of the following?

A. "Did your father have coronary bypass surgery?"

B. "Did your father's father have heart trouble also?"

C. "What were your father's usual dietary habits?"

D. "What age was your father at the time of his death?"

E. "Did your mother also have heart trouble?"

Back 23

D. "What age was your father at the time of his death?"

Front 24

24. Which one of the following is a common symptom of cardiovascular disorders in an older adult?

A. Fatigue

B. Joint pain

C. Poor night vision

D. Urticaria

E. Fevers

Back 24

A. Fatigue

Front 25

25. In an adult, the apical impulse should be most visible when the patient is in which position?

A. Supine

B. Leaning backward

C. Lithotomy

D. Right lateral recumbent

E. Upright

Back 25

E. Upright

Front 26

26. If the apical impulse is more vigorous than expected to the chest wall, it is called

A. a lift.

B. a thrill.

C. a bruit.

D. a murmur.

E. crepitus.

Back 26

A. a lift.

Front 27

27. A palpable rushing vibration over the base of the heart at the second intercostal space is called a

A. heave.

B. lift.

C. thrill.

D. thrust.

E. murmur.

Back 27

C. thrill.

Front 28

28. An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may indicate

A. decreased cardiac output.

B. dextrocardia.

C. left ventricular hypertrophy.

D. hyperventilation.

E. obesity.

Back 28

C. left ventricular hypertrophy.

Front 29

29. A lift along the left sternal border is most likely the result of

A. aortic stenosis.

B. atrial septal defect.

C. pulmonary hypertension.

D. right ventricular hypertrophy.

E. left ventricular hypertrophy.

Back 29

D. right ventricular hypertrophy.

Front 30

30. To estimate heart size by percussion, you should begin tapping at the

A. apex.

B. left sternal border.

C. midclavicular line.

D. midsternal line.

E. anterior axillary line.

Back 30

E. anterior axillary line.

Front 31

31. Normal heart sounds are best heard

A. directly over the semilunar and bicuspid heart valves.

B. over areas where blood flows after it passes through a valve.

C. near the carotid vessels.

D. over the central sternum.

E. over the ribs.

Back 31

B. over areas where blood flows after it passes through a valve.

Front 32

32. To hear low pitch diastolic heart sounds, you should ask patients to

A. lie on their backs.

B. lie on their left sides.

C. lie on their right sides.

D. sit up and lean forward.

E. lie prone.

Back 32

B. lie on their left sides.

Front 33

33. The carotid pulse should coincide with which heart sound?

A. S1

B. S2

C. S3

D. S4

E. S3-4

Back 33

A. S1

Front 34

34. You are listening to a patient's heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following?

A. S1

B. S2

C. S3

D. S4

E. S3-4

Back 34

B. S2

Front 35

35. During auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split. You should ask the patient to inhale deeply while listening at the _____ area.

A. aortic

B. pulmonic

C. tricuspid

D. mitral

E. apex

Back 35

A. aortic

B. pulmonic

Front 36

36. The bell of the stethoscope placed at the apex is more useful than the diaphragm for hearing

A. the splitting of S2 .

B. high-pitched murmurs.

C. presystolic gallops.

D. systolic ejection sounds.

E. pericardial friction rub.

Back 36

C. presystolic gallops.

Front 37

37. You are conducting an examination of Mr. C's heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is

A. barely discernible.

B. quiet but audible.

C. moderately loud.

D. loud with palpable thrill.

E. very loud without a stethoscope.

Back 37

C. moderately loud.

Front 38

38. A grade I or II murmur, without radiation and of medium pitch, is a common variation found in

A. school-age children.

B. older women.

C. middle-aged men.

D. sedentary individuals.

E. older adults.

Back 38

A. school-age children.

Front 39

39. An example of a functional heart murmur is one that is caused by

A. anemia. - one we should ask about

B. a ventricular septal defect.

C. an atrial septal defect.

D. mitral valve prolapse.

E. a leaking aortic valve.

Back 39

A. anemia.

Functional Heart Murmurs: defects that are due to phsyiologic conditions outside of the heart and not structural defects

Front 40

40. A fixed split second heart sound is

A. abnormal.

B. greatest at the peak of inspiration.

C. heard best after forceful expiration.

D. supposed to disappear with deep inspiration. E. always accompanied by a thrill.

Back 40

A. abnormal.

Front 41

41. The earliest sign of heart failure in an infant is frequently

A. an apical impulse in the fourth intercostal space.

B. moisture in the lungs.

C. enlarged thyroid.

D. clubbing of the fingers.

E. liver enlargement.

Back 41

E. liver enlargement.

Front 42

42. Chest pain in a child with an organic cause is more likely the result of

A. cardiac disease.

B. asthma.

C. esophageal reflux.

D. arthritis.

E. peptic ulcer disease.

Back 42

B. asthma.

Front 43

43. Which dysrhythmia is a physiologic event during childhood?

A. First-degree AV block

B. Mobitz type II

C. Multifocal PVCs

D. Sinus arrhythmia

E. Third-degree AV block

Back 43

D. Sinus arrhythmia

Front 44

44. An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an expected finding in

A. adults under stress.

B. 4-year-old children.

C. pregnant women.

D. older adults.

E. premature infants.

Back 44

B. 4-year-old children.

Front 45

45. A condition that is likely to present with dizziness and fainting is

A. bacterial endocarditis.

B. hypertension.

C. sick sinus syndrome.

D. pericarditis.

E. hyperlipidemia.

Back 45

C. sick sinus syndrome.

Front 46

46. The auscultation of a triphasic friction rub in a patient with acute chest pain should lead you to suspect

A. congestive heart failure.

B. mitral stenosis.

C. endocarditis.

D. cardiac tamponade.

E. pericarditis.

Back 46

E. pericarditis.

Front 47

47. Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of

A. rheumatic fever.

B. cor pulmonale.

C. pericarditis.

D. endocarditis.

E. cardiac tamponade.

Back 47

D. endocarditis.

Front 48

48. Fat deposits in the circulatory system of an older adult can lead to

A. diffuse conduction disturbances.

B. exaggerated contractility.

C. heart failure.

D. thinning of the ventricles.

E. amyloidosis.

Back 48

heart failure?

Front 49

49. A holosystolic murmur in an infant that is best heard along the left sternal border in the third to fifth intercostal spaces and does not radiate to the neck is indicative of

A. a ventricular septal defect.

B. patent ductus arteriosus.

C. pulmonary stenosis.

D. aortic sclerosis.

E. dextrocardia.

Back 49

A. a ventricular septal defect.

Front 50

50. Ms. S. is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On auscultation of her heart, you note murmurs of mitral regurgitation and aortic insufficiency. She reports a recent severe sore throat. You suspect

A. angina.

B. acute rheumatic fever.

C. cardiac amyloidosis.

D. aortic sclerosis.

E. sick sinus syndrome.

Back 50

B. acute rheumatic fever.

Front 51

51. A grade IV mitral regurgitation murmur would

A. be described as a diastolic murmur.

B. not be expected to have a thrill.

C. radiate to the axilla.

D. be heard best at the base.

E. radiate to the neck.

Back 51

C. radiate to the axilla.

Front 52

52. The most helpful finding in determining left-sided heart failure is

A. dyspnea.

B. orthopnea.

C. jugular vein distention.

D. an S4 heart sound.

E. tachycardia.

Back 52

C. jugular vein distention.

Front 53

53. Chest pain that is intensified or provoked by movement, particularly twisting, is long lasting, and is often associated with focal tenderness is most likely

A. cardiac.

B. pleural.

C. esophageal.

D. musculoskeletal.

E. psychoneurotic.

Back 53

D. musculoskeletal.

Front 54

54. An abnormal pulsus paradoxus is usually defined as

A. An inspiratory fall in systolic BP of greater than 10 mmHg

B. An inspiratory fall in diastolic BP of greater than 10 mmHg

C. An expiratory fall in systolic BP of greater than 10 mmHg

D. An expiratory fall in diastolic BP of greater than 10 mmHg

E. An inspiratory fall in systolic BP of greater than 20 mmHg

Back 54

A. An inspiratory fall in systolic BP of greater than 10 mmHg

Front 55

55. On average family practice and internal medicine trainees are able to identify what percentage of 12 important and commonly encountered cardiac events on auscultation.

A. 10%

B. 20%

C. 40%

D. 80%

E. Family practice and internal medicine trainees don’t need to use a stethoscope, since an EKG is the standard.

Back 55

B. 20%

Front 56

56. Percussion dullness of greater than ____ in the 5th left ICS from the MSL accurately discriminates patients with and without cardiomegaly.

A. 8 cm

B. 9 cm

C. 10 cm

D. 10.5 cm

E. 12.5 cm

Back 56

D. 10.5 cm