ADVANCED HEALTH ASSESSMENT MIDTERM EXAM
2024 NEWEST EXAM 2 VERSIONS (VERSION A AND B)
COMPLETE 250 QUESTIONS WITH DETAILED VERIFIED
ANSWERS AND RATIONALE /ALREADY GRADED A+
Risk factors cardiovascular disease (5) - ANSWER: HTN, hyperlipidemia, smoking,
obesity, family history
What conditions would you see an abnormal fundoscopic exam? Name 4 - ANSWER:
HTN, diabetes, increased ICP
Describe carotid pulse/auscultation findings - ANSWER: Vigorous upstroke, level of
pulsations not changed by position or respiration
Describe internal jugular pulse/auscultation findings - ANSWER: Rarely palpable, soft,
2 elevations per heart beat, level of pulsations change with position and drops with
inspriration
Normal JVP - ANSWER: 6-8cmH20
Where do you feel for PMI? - ANSWER: 5th ICS slightly medial to MCV (if deviated to
L or >2cm, abnormal)
What are forceful cardiac contractions referred to as? - ANSWER: Lifts, heaves
What are vibrations of loud cardiac murmurs referred to as? - ANSWER: Thrills
What are yellowish plaques/skin lesions caused by the accumulation of fat
macrophage immune cells? - ANSWER: Xanthomas (increased risk coronary artery
disease)
Poor oxygen perfusion to distal tissues of hands and feet results in? - ANSWER:
Clubbing
Poor oxygen delivery to peripheral tissues hands and feet? - ANSWER: Cyanosis
What does LLD position accentuate for heart sounds? - ANSWER: Left-sided S3, S4,
mitral murmurs (stenosis)
What does leaning forward, exhaling completely and holding breath accentuate for
heart sounds? - ANSWER: Aortic murmurs (regurgitation)
What does squatting/handgrip accentuate for heart sounds? - ANSWER: Mitral valve
prolapse (increased afterload and increased ventricular volume)
, What heart sound: closure of mitral and tricuspid valves, heard best at apex with the
bell, immediately precedes carotid upstroke - ANSWER: S1
What heart sound: closure of aortic and pulmonic valves, best heard at base (R and L
2nd ICS) with diaphragm, louder than S1 - ANSWER: S2
Where and when (insp/exp) do you hear splitting of S2? - ANSWER: Pulmonic area
during peak inspiration
What causes splitting of S2? - ANSWER: Delayed closure of pulmonic valve; increased
blood flow
What causes S3 gallop? When does it occur? Where do you listen for it? - ANSWER:
Rapid ventricular filling. The third heart sound is caused by vibration of the
ventricular walls, resulting from the first rapid filling so it is heard just after S2. The
third heart sound is low in frequency and intensity. Sloshing sound. "Ken-tuck-ee".
Occurs in early diastole. Associated dilated cardiomyopathy. Apex with bell in LLD.
What extra heart sound may be physiologic in children and in pregnancy? When is it
considered pathologic? - ANSWER: S3; >40 pathologic
What causes S4? When does it occur? Where do you listen for it? - ANSWER: Atrial
contraction. Atrial sound related to vibrations caused by atrial systole (caused by
increased resistance to LV filling by atrial contraction). Increased atrial resistance.
Occurs late diastole right before S1. Soft, low-pitched sound. Common in HTN
patients. Apex with bell in LLD.
What heart sound is physiologic in infants, small kids, and adults >50 years old? -
ANSWER: S4
Conditions with stiffened L ventricles (from conditions like HTN, aortic stenosis,
hypertrophic cardiomyopathy) would have what extra heart sound? - ANSWER: S4
Systolic extra heart sounds? - ANSWER: Clicks (MVP), Ejection sounds
What sound is associated with MVP? Diastolic or systolic heart sound? - ANSWER:
Click, systolic
Diastolic extra heart sounds? - ANSWER: S3, S4, OS (opening snap-forceful opening
mitral valve after S2)
Grading of systolic murmurs? - ANSWER: 1-6. 3=easily audible, 4=easily audible with
thrill
Grading diastolic murmurs? - ANSWER: 1-4; 2=audible but soft, 3=easily audible
2024 NEWEST EXAM 2 VERSIONS (VERSION A AND B)
COMPLETE 250 QUESTIONS WITH DETAILED VERIFIED
ANSWERS AND RATIONALE /ALREADY GRADED A+
Risk factors cardiovascular disease (5) - ANSWER: HTN, hyperlipidemia, smoking,
obesity, family history
What conditions would you see an abnormal fundoscopic exam? Name 4 - ANSWER:
HTN, diabetes, increased ICP
Describe carotid pulse/auscultation findings - ANSWER: Vigorous upstroke, level of
pulsations not changed by position or respiration
Describe internal jugular pulse/auscultation findings - ANSWER: Rarely palpable, soft,
2 elevations per heart beat, level of pulsations change with position and drops with
inspriration
Normal JVP - ANSWER: 6-8cmH20
Where do you feel for PMI? - ANSWER: 5th ICS slightly medial to MCV (if deviated to
L or >2cm, abnormal)
What are forceful cardiac contractions referred to as? - ANSWER: Lifts, heaves
What are vibrations of loud cardiac murmurs referred to as? - ANSWER: Thrills
What are yellowish plaques/skin lesions caused by the accumulation of fat
macrophage immune cells? - ANSWER: Xanthomas (increased risk coronary artery
disease)
Poor oxygen perfusion to distal tissues of hands and feet results in? - ANSWER:
Clubbing
Poor oxygen delivery to peripheral tissues hands and feet? - ANSWER: Cyanosis
What does LLD position accentuate for heart sounds? - ANSWER: Left-sided S3, S4,
mitral murmurs (stenosis)
What does leaning forward, exhaling completely and holding breath accentuate for
heart sounds? - ANSWER: Aortic murmurs (regurgitation)
What does squatting/handgrip accentuate for heart sounds? - ANSWER: Mitral valve
prolapse (increased afterload and increased ventricular volume)
, What heart sound: closure of mitral and tricuspid valves, heard best at apex with the
bell, immediately precedes carotid upstroke - ANSWER: S1
What heart sound: closure of aortic and pulmonic valves, best heard at base (R and L
2nd ICS) with diaphragm, louder than S1 - ANSWER: S2
Where and when (insp/exp) do you hear splitting of S2? - ANSWER: Pulmonic area
during peak inspiration
What causes splitting of S2? - ANSWER: Delayed closure of pulmonic valve; increased
blood flow
What causes S3 gallop? When does it occur? Where do you listen for it? - ANSWER:
Rapid ventricular filling. The third heart sound is caused by vibration of the
ventricular walls, resulting from the first rapid filling so it is heard just after S2. The
third heart sound is low in frequency and intensity. Sloshing sound. "Ken-tuck-ee".
Occurs in early diastole. Associated dilated cardiomyopathy. Apex with bell in LLD.
What extra heart sound may be physiologic in children and in pregnancy? When is it
considered pathologic? - ANSWER: S3; >40 pathologic
What causes S4? When does it occur? Where do you listen for it? - ANSWER: Atrial
contraction. Atrial sound related to vibrations caused by atrial systole (caused by
increased resistance to LV filling by atrial contraction). Increased atrial resistance.
Occurs late diastole right before S1. Soft, low-pitched sound. Common in HTN
patients. Apex with bell in LLD.
What heart sound is physiologic in infants, small kids, and adults >50 years old? -
ANSWER: S4
Conditions with stiffened L ventricles (from conditions like HTN, aortic stenosis,
hypertrophic cardiomyopathy) would have what extra heart sound? - ANSWER: S4
Systolic extra heart sounds? - ANSWER: Clicks (MVP), Ejection sounds
What sound is associated with MVP? Diastolic or systolic heart sound? - ANSWER:
Click, systolic
Diastolic extra heart sounds? - ANSWER: S3, S4, OS (opening snap-forceful opening
mitral valve after S2)
Grading of systolic murmurs? - ANSWER: 1-6. 3=easily audible, 4=easily audible with
thrill
Grading diastolic murmurs? - ANSWER: 1-4; 2=audible but soft, 3=easily audible
