[MCQs] Physical Examination of the Cardiovascular System- Part 3

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Physical Examination of the Cardiovascular System- Part 3

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Congratulations - you have completed Physical Examination of the Cardiovascular System- Part 3. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

S1 is louder in which of the following conditions ?

A	Tachycardia
B	Mitral stenosis
C	Short PR interval
D	All of the above

Question 1 Explanation:

Loudness of S1 depends upon the position of mitral leaflets at the beginning of ventricular systole. The farther apart they are at this time, louder will be the sound of S1. This occurs in tachycardia, MS and short PR interval.

Question 2

Hangout time is related to ?

A	Resistance to pulmonary vascular bed
B	Resistance to right ventricular filling
C	Resistance to left ventricular outflow
D	Resistance to left ventricular filling

Question 2 Explanation:

P 2 is coincident with incisura of PA pressure curve, which is separated from RV pressure tracing by an interval called hangout time. Absolute value of this interval reflects the resistance to pulmonary vascular bed.

Question 3

In pulmonary hypertension, splitting of S2 may be ?

A	Diminished
B	Normal
C	Normal
D	Any of the above

Question 3 Explanation:

In pulmonary hypertension, P2 component of S2 is loud. As the severity of pulmonary hypertension increases, the splitting of S2 may vary from normal, increased to decreased

Question 4

Fixed splitting of second heart sound diagnostic of ?

A	ASD
B	VSD
C	PDA
D	Tetralogy of Fallot

Question 4 Explanation:

Due to volume and duration of right ventricular ejection remaining the same during inspiration and expiration, there is little inspiratory exaggeration of the splitting of S2 in ASD.

Question 5

Abnormal splitting of S2 is best heard in which area ?

A	Abnormal splitting of S2 is best heard in which area ?
B	Pulmonic area
C	Aortic 1 area
D	Tricuspid area

Question 5 Explanation:

Splitting of S2 that persists with expiration when the patient is in the upright position is heard best at the pulmonic area

Question 6

Early aortic valve closure (A2), occurs in ?

A	Mitral regurgitation
B	VSD
C	Constrictive pericarditis
D	All of the above

Question 6 Explanation:

Aortic valve closes early in mitral regurgitation, ventricular septal defect and constrictive pericarditis. The S2 splitting persists during expiration

Question 7

Reversed (paradoxic) splitting of S2 is seen in ?

A	Reversed (paradoxic) splitting of S2 is seen in ?
B	Right ventricular ectopic beat
C	Severe aortic outflow obstruction
D	All of the above

Question 7 Explanation:

In reversed or paradoxical splitting of S2, P2 precedes A2. Splitting is maximal in expiration and decreases during inspiration. Events that delay closure of aortic valves paradoxical S2 splitting

Question 8

On cardiac auscultation, P2 louder than A2 suggests pulmonary hypertension except in patients with ?

A	VSD
B	ASD
C	MR
D	MS

Question 8 Explanation:

P2 is normally softer than A2 in 2nd left intercostal space. P2 that is greater than A2 in this area suggests pulmonary hypertension, except in patients with atrial septal defect

Question 9

Which of the following right-sided acoustical event is heard better during expiration ?

A	Opening snap
B	Pulmonary ejection sound
C	S3
D	S4

Question 9 Explanation:

Question 10

The timing of ejection sounds is ?

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

Question 10 Explanation:

Ejection sound is a sharp, high-pitched event in early systole, closely following S1. They occur in presence of semilunar valve stenosis & with dilation of aorta or pulmonary artery.

Question 11

Which of the following statements about “nonejection clicks” is false ?

A	Heard in mitral valve prolapse
B	Heard best in pulmonary area
C	May be single or multiple
D	May occur at any time in systole

Question 11 Explanation:

Nonejection or midsystolic clicks are due to prolapse of mitral valve leaflets. They are best heard along the lower left sternal border & at left ventricular apex. They may be single or multiple & may occur at any time in systole but usually later than systolic ejection sound.

Question 12

What is the character of opening snap (OS)

A	Low-pitched
B	High-pitched
C	Variable-pitched
D	Any of the above

Question 12 Explanation:

Opening snap (OS) is a high-pitched, early diastolic sound, usually due to mitral stenosis. It is generally heard best at the lower left sternal border and radiates well to the base of the heart

Question 13

The normal A2-OS interval is ?

A	0.04 to 0.06 seconds
B	0.04 to 0.08 seconds
C	0.04 to 0.10 seconds
D	0.04 to 0.12 seconds

Question 13 Explanation:

A2-OS interval is inversely related to height of mean LA pressure & ranges from 0.04 - 0.12 seconds

Question 14

What duration after A2 is the third heart sound (S3) heard ?

A	0.04 to 0.08 seconds
B	0.08 to 0.12 seconds
C	0.08 to 0.12 seconds
D	0.14 to 0.16 seconds

Question 14 Explanation:

S3 is a low-pitched sound produced in ventricle, 0.14 - 0.16 seconds after A2 at the termination of rapid filling

Question 15

S3 is normally heard in ?

A	In normal children
B	Pregnancy
C	Anemia
D	All of the above

Question 15 Explanation:

S3 is frequent in normal children & in patients with high cardiac output. In individuals >40 years S3 usually indicates impairment of ventricular function

Question 16

Which of the following may radiate to subclavian and carotid arteries ?

A	S1
B	S2
C	S3
D	OS

Question 16 Explanation:

Both left-sided S3 & S4 sounds increase with isometric exercise and both may radiate to the subclavian & carotid arteries

Question 17

Pericardial knock is a variant of ?

A	S1
B	S2
C	S3
D	S4

Question 17 Explanation:

S3 that is earlier (0.10 - 0.12 seconds after A2) & higher-pitched than normal occurs in patients with constrictive pericarditis and is called pericardial knock.

Question 18

All of the following are heard best at the left ventricular apex except ?

A	Aortic ejection sound
B	Opening snap (OS)
C	Third heart sound (S3)
D	Fourth heart sound (S4)

Question 18 Explanation:

Aortic ejection sound, S3, and S4 are heard best at the left ventricular apex. OS is heard best at the lower left sternal border and radiates to the base of the heart.

Question 19

S₄ is frequently present in ?

A	Systemic hypertension
B	Aortic stenosis
C	Hypertrophic cardiomyopathy
D	All of the above

Question 19 Explanation:

S4 is frequent in systemic hypertension, AS, HOCM, IHD and acute MR.

Question 20

Loudness of cardiac murmurs is graded from ?

A	0 to V
B	0 to V
C	0 to V
D	1 to VI

Question 21

If thrill is palpable, cardiac murmur is of which grade ?

A	I
B	II
C	III
D	IV

Question 21 Explanation:

Loudness of cardiac murmurs is graded from I to VI. Grade I murmur is heard only with special effort, grade IV murmur is accompanied by a thrill while grade VI murmur is audible with the stethoscope removed from contact with the chest

Question 22

Murmur of HOCM becomes louder with ?

A	Standing
B	Squatting
C	Passive leg raising
D	All of the above

Question 22 Explanation:

With standing, most cardiac murmurs diminish, but those of HOCM & MVP becomes louder. With squatting & passive leg raising, most murmurs become louder, but those of HOCM & MVP soften & may disappear

Question 23

Murmur of HOCM becomes louder with ?

A	Valsalva maneuver
B	Squatting
C	Passive leg raising
D	Exercise

Question 23 Explanation:

In Valsalva maneuver, most murmurs decrease in intensity. Systolic murmur of HOCM & MVP becomes louder. Murmur of HOCM decreases with exercise.

Question 24

Which of the following about murmur of HCM is false ?

A	With exercise, murmur of HCM decreases
B	With Valsalva maneuver, HCM murmur becomes louder
C	With standing, murmur of HCM becomes louder
D	None of the above

Question 25

Which of the following about HOCM is false ?

A	Murmur is produced by LV outflow obstruction & MR
B	Murmur intensity does not exceed grade 3
C	Murmur increases with reduction in preload / afterload
D	Murmur decreases with augmentation of contractility

Question 25 Explanation:

Murmur of HOCM increase in intensity with maneuvers that result in increasing degrees of outflow tract obstruction, such as a reduction in preload or afterload (Valsalva, standing, vasodilators) or to an augmentation of contractility (inotropic stimulation). Maneuvers that increase preload (squatting, passive leg raising, volume administration) or afterload (squatting, vasopressors) or that reduce contractility (beta blockers) decrease intensity of murmur.

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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. S1 is louder in which of the following conditions ?
A. Tachycardia
B. Mitral stenosis
C. Short PR interval
D. All of the above

2. Hangout time is related to ?
A. Resistance to pulmonary vascular bed
B. Resistance to right ventricular filling
C. Resistance to left ventricular outflow

D. Resistance to left ventricular filling

3. In pulmonary hypertension, splitting of S2 may be ?
A. Diminished
B. Normal
C. Accentuated
D. Any of the above

4. Fixed splitting of second heart sound diagnostic of ?
A. ASD
B. VSD
C. PDA
D. Tetralogy of Fallot
.
5. Abnormal splitting of S2 is best heard in which area ?
A. Apex
B. Pulmonic area
C. Aortic 1 area
D. Tricuspid area

6. Early aortic valve closure (A2), occurs in ?
A. Mitral regurgitation
B. VSD
C. Constrictive pericarditis
D. All of the above

7. Reversed (paradoxic) splitting of S2 is seen in ?
A. Left bundle branch block
B. Right ventricular ectopic beat
C. Severe aortic outflow obstruction
D. All of the above

8. On cardiac auscultation, P2 louder than A2 suggests pulmonary hypertension except in patients with ?
A. VSD
B. ASD
C. MR

D. MS

9. Which of the following right-sided acoustical event is heard better during expiration ?
A. Opening snap
B. Pulmonary ejection sound
C. S3
D. S4
.
10. The timing of ejection sounds is ?
A. Early systole
B. Mid systole
C. Late systole
D. Any of the above

11. Which of the following statements about “nonejection clicks” is false ?
A. Heard in mitral valve prolapse
B. Heard best in pulmonary area
C. May be single or multiple
D. May occur at any time in systole

12. What is the character of opening snap (OS) ?
A. Low-pitched
B. High-pitched
C. Variable-pitched
D. Any of the above

13. The normal A2-OS interval is ?
Harrison’s 17th Ed. 1386
A. 0.04 to 0.06 seconds
B. 0.04 to 0.08 seconds
C. 0.04 to 0.10 seconds
D. 0.04 to 0.12 seconds

14. What duration after A2 is the third heart sound (S3) heard ?
A. 0.04 to 0.08 seconds
B. 0.08 to 0.12 seconds

C. 0.12 to 0.14 seconds
D. 0.14 to 0.16 seconds

15. S3 is normally heard in ?
A. In normal children
B. Pregnancy
C. Anemia
D. All of the above

16. Which of the following may radiate to subclavian and carotid arteries ?
A. S1
B. S2
C. S3
D. OS

17. Pericardial knock is a variant of ?
A. S1
B. S2
C. S3
D. S4

18. All of the following are heard best at the left ventricular apex except ?
A. Aortic ejection sound
B. Opening snap (OS)
C. Third heart sound (S3)
D. Fourth heart sound (S4)

19. S4 is frequently present in ?
A. Systemic hypertension
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. All of the above

20. Loudness of cardiac murmurs is graded from ?
A. 0 to V
B. 0 to VI
C. 1 to V

D. 1 to VI

21. If thrill is palpable, cardiac murmur is of which grade ?
A. I
B. II
C. III
D. IV

22. Murmur of HOCM becomes louder with ?
A. Standing
B. Squatting
C. Passive leg raising
D. All of the above

23. Murmur of HOCM becomes louder with ?
A. Valsalva maneuver
B. Squatting
C. Passive leg raising
D. Exercise

24. Which of the following about murmur of HCM is false ?
A. With exercise, murmur of HCM decreases
B. With Valsalva maneuver, HCM murmur becomes louder
C. With standing, murmur of HCM becomes louder
D. None of the above

25. Which of the following about HOCM is false ?
A. Murmur is produced by LV outflow obstruction & MR
B. Murmur intensity does not exceed grade 3
C. Murmur increases with reduction in preload / afterload
D. Murmur decreases with augmentation of contractility

Physical Examination of the Cardiovascular System

[MCQs] Physical Examination of the Cardiovascular System- Part 3

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

Physical Examination of the Cardiovascular System- Part 3

II. Preview all questions below:

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