Cardiology PACKRAT Questions And Complete
Solutions 2025/26
History & Physical/Cardiology
Which of the following conditions would cause a positive Kussmaul's sign on physical
examination?
Answers
A. Left ventricular failure
B. Pulmonary edema
C. Coarctation of the aorta
D. Constrictive pericarditis - Correct Answer Explanations
(u) A. Left ventricular failure results in the back-up of blood into the left atrium and then the
pulmonary system so it would not be associated with Kussmaul's sign.
(u) B. Pulmonary edema primarily results in increased pulmonary pressures rather than having
effects on the venous inflow into the heart.
(u) C. Coarctation of the aorta primarily affects outflow from the heart due to the stenosis
resulting in delayed and decreased femoral pulses; it has no effect on causing Kussmaul's sign.
(c) D. Kussmaul's sign is an increase rather than the normal decrease in the CVP during
inspiration. It is most often caused by severe right-sided heart failure; it is a frequent finding in
patients with constrictive pericarditis or right ventricular infarction.
History & Physical/Cardiology
Anginal chest pain is most commonly described as which of the following?
Answers
A. Pain changing with position or respiration
B. A sensation of discomfort
C. Tearing pain radiating to the back
D. Pain lasting for several hours - Correct Answer Explanations
,(u) A. Pain changing with position or respiration is suggestive of pericarditis.
(c) B. Myocardial ischemia is often experienced as a sensation of discomfort lasting 5-15
minutes, described as dull, aching or pressure.
(u) C. Tearing pain with radiation to the back represents aortic dissection.
(u) D. Chest pain lasting for several hours is more suggestive for myocardial infarction.
History & Physical/Cardiology
Eliciting a history from a patient presenting with dyspnea due to early heart failure the severity
of the dyspnea should be quantified by
Answers
A. amount of activity that precipitates it.
B. how many pillows they sleep on at night.
C. how long it takes the dyspnea to resolve.
D. any associated comorbidities. - Correct Answer Explanations
(c) A. The amount of activity that precipitates dyspnea should be quantified in the history.
(u) B. Orthopnea or paroxysmal nocturnal dyspnea can be quantified by how many pillows a
patient needs to sleep on to be comfortable.
(u) C. How long dyspnea takes to resolve or associated comorbidities has no bearing on
quantifying the severity of dyspnea.
(u) D. See answer C above.
History & Physical/Cardiology
A 25 year-old female presents with a three-day history of chest pain aggravated by coughing
and relieved by sitting. She is febrile and a CBC with differential reveals leukocytosis. Which of
the following physical exam signs is characteristic of her problem?
Answers
A. Pulsus paradoxus
B. Localized crackles
,C. Pericardial friction rub
D. Wheezing - Correct Answer Explanations
(u) A. Pulsus paradoxus is a classic finding for cardiac tamponade.
(u) B. Localized crackles are associated with pneumonia and consolidation, not pericarditis.
(c) C. Pericardial friction rub is characteristic of an inflammatory pericarditis.
(u) D. Wheezing is characteristic for pulmonary disorders, such as asthma.
History & Physical/Cardiology
A 65 year-old white female presents with dilated tortuous veins on the medial aspect of her
lower extremities. Which of the following would be the most common initial complaint?
Answers
A. Pain in the calf with ambulation
B. Dull aching heaviness brought on by periods of standing
C. Brownish pigmentation above the ankle
D. Edema in the lower extremities - Correct Answer Explanations
(u) A. Patients with deep venous thrombosis (DVT) may present with complaints of pain in the
calf with ambulation. Secondary varicosities may result from DVT's.
(c) B. Dull aching heaviness or a feeling of fatigue brought on by periods of standing is the most
common complaint of patients presenting initially with varicosities.
(u) C. Stasis Dermatitis and edema are most suggestive of chronic venous insufficiency.
(u) D. See C for explanation.
History & Physical/Cardiology
A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial
tamponade is strongly supported by the presence of
Answers
A. pulmonary edema.
, B. wide pulse pressure.
C. distended neck veins.
D. an early diastolic murmur. - Correct Answer Explanations
(u) A. Pulmonary edema may result with low output states as seen with myocardial contusions,
but it is not strongly suggestive of tamponade.
(u) B. Wide pulse pressure is seen in conditions of high stroke volume such as aortic
insufficiency or hyperthyroidism. Narrow pulse pressure is seen with cardiac tamponade.
(c) C. Cardiac compression will manifest with distended neck veins and cold clammy skin.
(u) D. The onset of diastolic murmur is suggestive of valvular disease, not tamponade.
Diagnostic Studies/Cardiology
Cardiac nuclear scanning is done to detect
Answers
A. electrical conduction abnormalities.
B. valvular abnormalities.
C. ventricular wall dysfunction.
D. coronary artery patency/occlusion. - Correct Answer Explanations
(u) A. An EKG is used to determine electrical conduction abnormalities.
(u) B. An echocardiogram is a non-invasive test used to determine valvular abnormalities and
wall motion.
(c) C. Visualization of the cardiac wall can be done with cardiac nuclear scanning. This is done to
determine hypokinetic areas from akinetic areas.
(u) D. Patency or occlusion is assessed with cardiac catheterization (invasive).
Diagnostic Studies/Cardiology
A 72 year-old male with a new diagnosis of congestive heart failure and atrial fibrillation,
develops episodes of hemodynamic compromise secondary to increased ventricular rate. A
Solutions 2025/26
History & Physical/Cardiology
Which of the following conditions would cause a positive Kussmaul's sign on physical
examination?
Answers
A. Left ventricular failure
B. Pulmonary edema
C. Coarctation of the aorta
D. Constrictive pericarditis - Correct Answer Explanations
(u) A. Left ventricular failure results in the back-up of blood into the left atrium and then the
pulmonary system so it would not be associated with Kussmaul's sign.
(u) B. Pulmonary edema primarily results in increased pulmonary pressures rather than having
effects on the venous inflow into the heart.
(u) C. Coarctation of the aorta primarily affects outflow from the heart due to the stenosis
resulting in delayed and decreased femoral pulses; it has no effect on causing Kussmaul's sign.
(c) D. Kussmaul's sign is an increase rather than the normal decrease in the CVP during
inspiration. It is most often caused by severe right-sided heart failure; it is a frequent finding in
patients with constrictive pericarditis or right ventricular infarction.
History & Physical/Cardiology
Anginal chest pain is most commonly described as which of the following?
Answers
A. Pain changing with position or respiration
B. A sensation of discomfort
C. Tearing pain radiating to the back
D. Pain lasting for several hours - Correct Answer Explanations
,(u) A. Pain changing with position or respiration is suggestive of pericarditis.
(c) B. Myocardial ischemia is often experienced as a sensation of discomfort lasting 5-15
minutes, described as dull, aching or pressure.
(u) C. Tearing pain with radiation to the back represents aortic dissection.
(u) D. Chest pain lasting for several hours is more suggestive for myocardial infarction.
History & Physical/Cardiology
Eliciting a history from a patient presenting with dyspnea due to early heart failure the severity
of the dyspnea should be quantified by
Answers
A. amount of activity that precipitates it.
B. how many pillows they sleep on at night.
C. how long it takes the dyspnea to resolve.
D. any associated comorbidities. - Correct Answer Explanations
(c) A. The amount of activity that precipitates dyspnea should be quantified in the history.
(u) B. Orthopnea or paroxysmal nocturnal dyspnea can be quantified by how many pillows a
patient needs to sleep on to be comfortable.
(u) C. How long dyspnea takes to resolve or associated comorbidities has no bearing on
quantifying the severity of dyspnea.
(u) D. See answer C above.
History & Physical/Cardiology
A 25 year-old female presents with a three-day history of chest pain aggravated by coughing
and relieved by sitting. She is febrile and a CBC with differential reveals leukocytosis. Which of
the following physical exam signs is characteristic of her problem?
Answers
A. Pulsus paradoxus
B. Localized crackles
,C. Pericardial friction rub
D. Wheezing - Correct Answer Explanations
(u) A. Pulsus paradoxus is a classic finding for cardiac tamponade.
(u) B. Localized crackles are associated with pneumonia and consolidation, not pericarditis.
(c) C. Pericardial friction rub is characteristic of an inflammatory pericarditis.
(u) D. Wheezing is characteristic for pulmonary disorders, such as asthma.
History & Physical/Cardiology
A 65 year-old white female presents with dilated tortuous veins on the medial aspect of her
lower extremities. Which of the following would be the most common initial complaint?
Answers
A. Pain in the calf with ambulation
B. Dull aching heaviness brought on by periods of standing
C. Brownish pigmentation above the ankle
D. Edema in the lower extremities - Correct Answer Explanations
(u) A. Patients with deep venous thrombosis (DVT) may present with complaints of pain in the
calf with ambulation. Secondary varicosities may result from DVT's.
(c) B. Dull aching heaviness or a feeling of fatigue brought on by periods of standing is the most
common complaint of patients presenting initially with varicosities.
(u) C. Stasis Dermatitis and edema are most suggestive of chronic venous insufficiency.
(u) D. See C for explanation.
History & Physical/Cardiology
A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial
tamponade is strongly supported by the presence of
Answers
A. pulmonary edema.
, B. wide pulse pressure.
C. distended neck veins.
D. an early diastolic murmur. - Correct Answer Explanations
(u) A. Pulmonary edema may result with low output states as seen with myocardial contusions,
but it is not strongly suggestive of tamponade.
(u) B. Wide pulse pressure is seen in conditions of high stroke volume such as aortic
insufficiency or hyperthyroidism. Narrow pulse pressure is seen with cardiac tamponade.
(c) C. Cardiac compression will manifest with distended neck veins and cold clammy skin.
(u) D. The onset of diastolic murmur is suggestive of valvular disease, not tamponade.
Diagnostic Studies/Cardiology
Cardiac nuclear scanning is done to detect
Answers
A. electrical conduction abnormalities.
B. valvular abnormalities.
C. ventricular wall dysfunction.
D. coronary artery patency/occlusion. - Correct Answer Explanations
(u) A. An EKG is used to determine electrical conduction abnormalities.
(u) B. An echocardiogram is a non-invasive test used to determine valvular abnormalities and
wall motion.
(c) C. Visualization of the cardiac wall can be done with cardiac nuclear scanning. This is done to
determine hypokinetic areas from akinetic areas.
(u) D. Patency or occlusion is assessed with cardiac catheterization (invasive).
Diagnostic Studies/Cardiology
A 72 year-old male with a new diagnosis of congestive heart failure and atrial fibrillation,
develops episodes of hemodynamic compromise secondary to increased ventricular rate. A
