Bates’ Guide to Physical Examination and History Taking, 11th Edition
Chapter 9: The Cardiovascular System
Multiple Choice
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
Ans: C
Chapter: 09
Page and Header: 323, Anatomy and Physiology
Feedback: The right ventricle occupies most of the anterior cardiac surface and is easily
accessible to palpation. The other structures are less likely to have findings on palpation and the
sinus node is an intracardiac structure. You may be able to diagnose abnormal rhythms caused
by the sinus node indirectly by palpation, but this is less obvious.
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
Ans: A
Chapter: 09
Page and Header: 323, Anatomy and Physiology
Feedback: During inspiration, the closure of the aortic valve and the closure of the pulmonic
valve separate slightly, and this may be heard as two audible components, instead of a single
sound. Current explanations of inspiratory splitting include increased capacitance in the
pulmonary vascular bed during inspiration, which prolongs ejection of blood from the right
ventricle, delaying closure of the pulmonic valve. Because the pulmonic component is soft, you
may not hear it away from the left second intercostal space. Because it is a low-pitched sound,
, you may not hear it unless you use the bell of your stethoscope. It is generally easy to hear in
school-aged children, and it is easy to notice the respiratory variation of the splitting.
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
Ans: A
Chapter: 09
Page and Header: 323, Anatomy and Physiology
Feedback: Mitral valve sounds are usually heard best at and around the cardiac apex.
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
Ans: B
Chapter: 09
Page and Header: 337, The Health History
Feedback: Orthopnea, which is dyspnea that occurs when the patient is lying down and
improves when the patient sits up, is part of the cardiovascular review of systems and, if positive,
may indicate congestive heart failure.
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
Chapter 9: The Cardiovascular System
Multiple Choice
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
Ans: C
Chapter: 09
Page and Header: 323, Anatomy and Physiology
Feedback: The right ventricle occupies most of the anterior cardiac surface and is easily
accessible to palpation. The other structures are less likely to have findings on palpation and the
sinus node is an intracardiac structure. You may be able to diagnose abnormal rhythms caused
by the sinus node indirectly by palpation, but this is less obvious.
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
Ans: A
Chapter: 09
Page and Header: 323, Anatomy and Physiology
Feedback: During inspiration, the closure of the aortic valve and the closure of the pulmonic
valve separate slightly, and this may be heard as two audible components, instead of a single
sound. Current explanations of inspiratory splitting include increased capacitance in the
pulmonary vascular bed during inspiration, which prolongs ejection of blood from the right
ventricle, delaying closure of the pulmonic valve. Because the pulmonic component is soft, you
may not hear it away from the left second intercostal space. Because it is a low-pitched sound,
, you may not hear it unless you use the bell of your stethoscope. It is generally easy to hear in
school-aged children, and it is easy to notice the respiratory variation of the splitting.
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
Ans: A
Chapter: 09
Page and Header: 323, Anatomy and Physiology
Feedback: Mitral valve sounds are usually heard best at and around the cardiac apex.
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
Ans: B
Chapter: 09
Page and Header: 337, The Health History
Feedback: Orthopnea, which is dyspnea that occurs when the patient is lying down and
improves when the patient sits up, is part of the cardiovascular review of systems and, if positive,
may indicate congestive heart failure.
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
