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
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
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
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,
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, 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
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
D) Stage 2 hypertension
Ans: B
Feedback:
Prehypertension is considered to be a systolic blood pressure from 120 to 139 and a
diastolic BP from 80 to 89. Previously, this was considered normal. JNC 7 recommends
taking action at this point to prevent worsening hypertension. Research shows that this
population is likely to progress to more serious stages of hypertension.
6. You are participating in a health fair and performing cholesterol screens. One person has
a cholesterol of 225. She is concerned about her risk for developing heart disease.
Which of the following factors is used to estimate the 10-year risk of developing
coronary heart disease?
A) Ethnicity
B) Alcohol intake
C) Gender
D) Asthma
Ans: C
Feedback:
Gender is used in the calculation of the 10-year risk for developing coronary heart
disease, because men have a higher risk than women.
7. You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a
history of hypertension, which is well-controlled on his current medications. He does not
smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his
10-year coronary heart disease risk. Which of the following conditions is considered to
be a coronary heart disease risk equivalent?
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of the heart can you assess by palpation?
A) Left atrium
B) Right atrium
C) Right ventricle
D) Sinus node
Ans: C
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
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
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,
Page 1
, 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
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
D) Stage 2 hypertension
Ans: B
Feedback:
Prehypertension is considered to be a systolic blood pressure from 120 to 139 and a
diastolic BP from 80 to 89. Previously, this was considered normal. JNC 7 recommends
taking action at this point to prevent worsening hypertension. Research shows that this
population is likely to progress to more serious stages of hypertension.
6. You are participating in a health fair and performing cholesterol screens. One person has
a cholesterol of 225. She is concerned about her risk for developing heart disease.
Which of the following factors is used to estimate the 10-year risk of developing
coronary heart disease?
A) Ethnicity
B) Alcohol intake
C) Gender
D) Asthma
Ans: C
Feedback:
Gender is used in the calculation of the 10-year risk for developing coronary heart
disease, because men have a higher risk than women.
7. You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a
history of hypertension, which is well-controlled on his current medications. He does not
smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his
10-year coronary heart disease risk. Which of the following conditions is considered to
be a coronary heart disease risk equivalent?
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