[MCQs] Physical Examination of the Cardiovascular System- Part 2

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Physical Examination of the Cardiovascular System- Part 2

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Question 1

The wave produced due to atrial relaxation is ?

A	a
B	v
C	x
D	y

Question 2

Which of the following wave is produced at the time of right ventricular isovolumetric systole ?

A	a
B	c
C	v
D	y

Question 2 Explanation:

a” wave is a positive presystolic dominant wave in JVP due to right atrial contraction. “c” wave is a positive wave due to bulging of tricuspid valve into RA during RV isovolumetric systole & by impact of carotid artery adjacent to jugular vein. “v” wave is a positive late systolic due to increasing volume of blood in RA during ventricular systole. “x” descent (negative wave) is due to atrial relaxation and to downward displacement of tricuspid valve during ventricular systole. “y” descent (negative wave) is due to opening of tricuspid valve and rapid inflow of blood into RV.

Question 3

Which of the following wave is dominant wave in JVP during inspiration ?

A	a
B	c
C	x
D	y

Question 4

“Cannon” “a” waves may occur regularly in which of the following conditions ?

A	During junctional rhythm
B	AV dissociation with V
C	Complete heart block
D	All of the above

Question 4 Explanation:

All of the above

Question 5

Large “a” waves may occur is all of the following conditions except ?

A	Atrial fibrillation
B	Tricuspid stenosis
C	Pulmonary hypertension
D	Pulmonic stenosis

Question 5 Explanation:

Large “a” waves indicate that RA is contracting against increased resistance as in TS, pulmonary hypertension or PS. “a” wave is absent in atrial fibrillation due to ineffective contraction of atria

Question 6

Cause of increased delay between “a” & “c” wave in JVP is ?

A	1º heart block
B	2º heart block
C	3º heart block
D	All of the above

Question 6 Explanation:

Increased delay occurs between “a” wave and carotid arterial pulse or “c” wave in patients with first-degree atrioventricular block

Question 7

Which of the following is seen in tricuspid regurgitation ?

A	Obliteration of “x” descent
B	Prominent “v” wave
C	Rapid, deep “y” descent in early diastole
D	All of the above

Question 7 Explanation:

Tricuspid regurgitation (TR) causes the v wave to be more prominent. When TR becomes severe, combination of a prominent v wave & obliteration of x descent results in a single large positive systolic wave. A rapid, deep y descent in early diastole occurs with severe TR

Question 8

In JVP, which of the following is seen in constrictive pericarditis ?

A	Sharp “y” descent
B	Sharp “y” descent
C	Rapid ascent to baseline
D	All of the above

Question 8 Explanation:

A venous pulse characterized by a sharp y descent, a deep y trough, and a rapid ascent to the baseline is seen in patients with constrictive pericarditis or with severe right-sided heart failure and a high venous pressure.

Question 9

In JVP, which of the following is a typical feature of tricuspid stenosis ?

A	Prominent “v” wave
B	Slow “y” descent
C	Obliteration of “x” descent
D	Deep “y” trough

Question 9 Explanation:

A slow “y” descent in JVP suggests an obstruction to right ventricular filling as occurs with tricuspid stenosis or right atrial myxoma. Prominent “v” wave & obliteration of “x” descent is seen in Tricuspid regurgitation. Deep “y” trough is seen in constrictive pericarditis.

Question 10

Center of right atrium lies ~5 cm. below sternal angle in which position of the patient ?

A	Supine
B	30º recline
C	45º recline
D	Any of the above

Question 10 Explanation:

Right internal jugular is the best vein for accurate estimation of CVP. Center of RA lies ~5 cm. below sternal angle “regardless of body position”.

Question 11

CVP is normally expressed as ?

A	Millimeter of Mercury
B	Centimeter of Mercury
C	Millimeter of blood
D	Centimeter of blood

Question 11 Explanation:

Vertical distance between top of the oscillating jugular venous column and the level of sternal angle is expressed in centimeters of blood. (1.36 cmH2O = 1.0 mmHg)

Question 12

Most common cause of a high jugular venous pressure is ?

A	Elevated right atrial diastolic pressure
B	Elevated right atrial systolic pressure
C	Elevated right ventricular diastolic pressure
D	Elevated right ventricular systolic pressure

Question 12 Explanation:

Most common cause of a high jugular venous pressure is elevated right ventricular diastolic pressure.

Question 13

Which of the following statements about abdominojugular test is false ?

A	Firm pressure over midabdomen for >30 seconds
B	In normal persons, does not alter JVP significantly
C	Rapid drop of 4 cm on release of compression
D	Most common cause is right-sided heart failure

Question 13 Explanation:

Positive test is best defined as increase in JVP during 10 seconds of firm midabdominal compression followed by a rapid drop in pressure of 4 cm blood on release of the compression

Question 14

Which of the following about Kussmaul’s sign is false ?

A	Increase in CVP during inspiration
B	Caused by severe right-sided heart failure
C	Frequent in constrictive pericarditis
D	Frequent in left ventricular infarction

Question 14 Explanation:

Kussmaul’s sign refers to an increase in CVP during inspiration. It’s causes include severe right-sided heart failure, constrictive pericarditis and right ventricular infarction.

Question 15

The normal left ventricular apex impulse is ?

A	Early systolic
B	Mid systolic
C	Late systolic
D	Any of the above

Question 16

Normal location of left ventricular apex impulse is ?

A	III or IV ICS
B	IV or V ICS
C	V or VI ICS
D	Any of the above

Question 16 Explanation:

Best felt with fingertips, normal left ventricular apex impulse is located at or medial to left midclavicular line in 4th or 5th intercostal space with a tapping character & early systolic timing

Question 17

Normal diameter of left ventricular apex impulse is about ?

A	2.5 cm
B	3.0 cm
C	3.5 cm
D	4.0 cm

Question 17 Explanation:

Early systolic outward thrust of left ventricular apex impulse is localized & the usual diameter is less than 2.5 cm.

Question 18

Abnormal systolic precordial pulsations in patients with left ventricular dyssynergy are most commonly felt in ?

A	Apex
B	Left midprecordium
C	Base of the heart
D	Left lower sternal border

Question 18 Explanation:

Abnormal precordial pulsations occur during systole in patients with left ventricular dyssynergy due to IHD, most commonly in left midprecordium one or two interspaces above and/or 1 to 2 cm medial to left ventricular apex.

Question 19

Which of the following statements about left parasternal lift is false ?

A	Frequent in patients with severe mitral regurgitation
B	Synchronous with ‘v’ wave in left atrial pressure curve
C	Occurs simultaneously with LV apical impulse
D	Due to anterior displacement of RV by expanding LA

Question 19 Explanation:

Typical left parasternal lift is seen in severe mitral regurgitation. This pulsation occurs distinctly "later" than the LV apical impulse, is synchronous with the v wave in left atrial pressure curve. It is due to anterior displacement of right ventricle by an enlarged, expanding left atrium.

Question 20

Pulsation of right sternoclavicular joint may indicate ?

A	Aneurysmal dilation of ascending aorta
B	Pulmonary artery pulsation
C	Tricuspid stenosis
D	Tricuspid regurgitation

Question 20 Explanation:

Tricuspid regurgitation

Question 21

Which of the following is false about hypertrophic cardiomyopathy ?

A	Double systolic apical impulse
B	Double systolic apical impulse
C	Sustained handgrip exercise diminishes systolic murmur
D	None of the above

Question 21 Explanation:

Bisferiens pulse has 2 systolic peaks & is characteristic of HOCM. Sustained handgrip exercise, squatting diminishes & Valsalva maneuver, standing increases systolic murmur of HOCM.

Question 22

Which of the following is not true about ‘Thrills’ ?

A	Palpable
B	High-frequency vibrations
C	Associated with heart murmurs
D	Better felt with the palm of hand

Question 22 Explanation:

Thrills are palpable “low-frequency” vibrations associated with heart murmurs. In MR, thrill is felt at the cardiac apex, while in VSD, it is felt in III & IV ICS near left sternal border. When palm of hand is placed over precordium, thrill of AS crosses palm toward right side of neck, while thrill of pulmonic stenosis radiates more to left side of the neck.

Question 23

Normal splitting of two components of S1 is by ?

A	5 to 10 milliseconds
B	8 to 15 milliseconds
C	10 to 30 milliseconds
D	25 to 40 milliseconds

Question 23 Explanation:

Normally, two high-pitched components of S1 are split by 10 - 30 milliseconds. First component of S1 is mitral valve closure and the second is due to tricuspid valve closure.

Question 24

Reversed splitting of S1 may be present in patients with ?

A	Severe mitral stenosis
B	Left atrial myxoma
C	Left bundle branch block
D	All of the above

Question 24 Explanation:

Widening of S1 is due to complete right bundle branch block. Reversed splitting of S1, where the mitral sound follows tricuspid sound, is heard in severe mitral stenosis, left atrial myxoma and left bundle branch block

Question 25

Intensity of the first heart sound is influenced by all except ?

A	Position of mitral leaflets at onset of ventricular systole
B	Rate of rise of left ventricular pressure pulse
C	Left ventricular end diastolic pressure
D	Structural disease of mitral valve

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See all quizzes of the Physical Examination of the Cardiovascular System at here:

Physical Examination of the Cardiovascular System Part 1 | Physical Examination of the Cardiovascular System Part 2 |Physical Examination of the Cardiovascular System Part 3 | Physical Examination of the Cardiovascular System Part 4 | Physical Examination of the Cardiovascular System Part 5

II. Preview all questions below:

1.The wave produced due to atrial relaxation is ?
A. a
B. v
C. x
D. y
2. Which of the following wave is produced at the time of right ventricular isovolumetric systole ?
A. a
B. c
C. v
D. y

3. Which of the following wave is dominant wave in JVP during inspiration ?
A. a
B. c
C. x
D. y

4. “Cannon” “a” waves may occur regularly in which of the following conditions ?
A. During junctional rhythm
B. AV dissociation with VT
C. Complete heart block
D. All of the above

5. Large “a” waves may occur is all of the following conditions except ?
A. Atrial fibrillation
B. Tricuspid stenosis
C. Pulmonary hypertension
D. Pulmonic stenosis

6. Cause of increased delay between “a” & “c” wave in JVP is ?
A. 1º heart block
B. 2º heart block
C. 3º heart block
D. All of the above

7. Which of the following is seen in tricuspid regurgitation ?
A. Obliteration of “x” descent
B. Prominent “v” wave
C. Rapid, deep “y” descent in early diastole
D. All of the above

8. In JVP, which of the following is seen in constrictive pericarditis ?
A. Sharp “y” descent
B. Deep “y” trough
C. Rapid ascent to baseline
D. All of the above

9. In JVP, which of the following is a typical feature of tricuspid stenosis ?
A. Prominent “v” wave
B. Slow “y” descent
C. Obliteration of “x” descent

D. Deep “y” trough

10 Center of right atrium lies ~5 cm. below sternal angle in which position of the patient ?
A. Supine
B. 30º recline
C. 45º recline
D. Any of the above

11 CVP is normally expressed as ?
A. Millimeter of Mercury
B. Centimeter of Mercury
C. Millimeter of blood
D. Centimeter of blood

12 Most common cause of a high jugular venous pressure is ?
A. Elevated right atrial diastolic pressure
B. Elevated right atrial systolic pressure
C. Elevated right ventricular diastolic pressure
D. Elevated right ventricular systolic pressure

13 Which of the following statements about abdominojugular test is false ?
A. Firm pressure over midabdomen for >30 seconds
B. In normal persons, does not alter JVP significantly
C. Rapid drop of 4 cm on release of compression
D. Most common cause is right-sided heart failure

14. Which of the following about Kussmaul’s sign is false ?
A. Increase in CVP during inspiration
B. Caused by severe right-sided heart failure
C. Frequent in constrictive pericarditis
D. Frequent in left ventricular infarction

15. The normal left ventricular apex impulse is ?
Harrison’s 16th Ed. 1306
A. Early systolic
B. Mid systolic

C. Late systolic
D. Any of the above

16. Normal location of left ventricular apex impulse is ?
A. III or IV ICS
B. IV or V ICS
C. V or VI ICS
D. Any of the above

17. Normal diameter of left ventricular apex impulse is about ?
A. 2.5 cm
B. 3.0 cm
C. 3.5 cm
D. 4.0 cm

18. Abnormal systolic precordial pulsations in patients with left ventricular dyssynergy are most commonly felt in ?
A. Apex
B. Left midprecordium
C. Base of the heart
D. Left lower sternal border

19. Which of the following statements about left parasternal lift is false ?
A. Frequent in patients with severe mitral regurgitation
B. Synchronous with ‘v’ wave in left atrial pressure curve
C. Occurs simultaneously with LV apical impulse
D. Due to anterior displacement of RV by expanding LA

20. Pulsation of right sternoclavicular joint may indicate ?
A. Aneurysmal dilation of ascending aorta
B. Pulmonary artery pulsation
C. Tricuspid stenosis
D. Tricuspid regurgitation

21. Which of the following is false about hypertrophic cardiomyopathy ?

A. Double systolic apical impulse
B. Bisferiens pulse

C. Sustained handgrip exercise diminishes systolic murmur
D. None of the above

22. Which of the following is not true about ‘Thrills’ ?
A. Palpable
B. High-frequency vibrations
C. Associated with heart murmurs
D. Better felt with the palm of hand

23. Normal splitting of two components of S1 is by ?
A. 5 to 10 milliseconds
B. 8 to 15 milliseconds
C. 10 to 30 milliseconds
D. 25 to 40 milliseconds

116 Reversed splitting of S1 may be present in patients with ?
A. Severe mitral stenosis
B. Left atrial myxoma
C. Left bundle branch block
D. All of the above

Physical Examination of the Cardiovascular System

[MCQs] Physical Examination of the Cardiovascular System- Part 2

I. Start the exam by click the “Start” button

Physical Examination of the Cardiovascular System- Part 2

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