[MCQs] Physical Examination of the Cardiovascular System- Part 4

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Physical Examination of the Cardiovascular System- Part 4

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Question 1

Which of the following about Still’s murmur ?

A	Benign grade 2 murmur
B	Vibratory mid-systolic murmur
C	At lower left sternal border
D	In elderly

Question 1 Explanation:

Still’s murmur refers to a benign grade 2, vibratory mid-systolic murmur at the lower left sternal border in normal children and adolescents

Question 2

Which of the following produces a cardiac murmur that is plateau in configuration ?

A	ASD
B	ASD
C	Chronic MR
D	Chronic MR

Question 2 Explanation:

Holosystolic murmur of chronic MR is high pitched & plateau in configuration because of wide difference between LV & LA pressure throughout systole

Question 3

“Maladie de Roger” relates to ?

A	ASD
B	PDA
C	Congenital AS
D	Small, restrictive VSDs

Question 3 Explanation:

Small, restrictive VSDs (maladie de Roger) produces a very loud murmur due to significant & sustained systolic pressure gradient between LV & RV. Maladie de Roger describes patients with asymptomatic ventricular septal defects. Patients with symptomatic ventricular septal defects, which cause cyanosis and progressive pulmonary hypertension, have Eisenmenger’s syndrome

Question 4

“Maladie de Roger” relates to ?

A	ASD
B	PDA
C	Congenital AS
D	Small, restrictive VSDs

Question 4 Explanation:

Question 5

Gibson’s murmur is best heard at ?

A	Left upper sternal border
B	Left lower sternal border
C	Apex
D	Left interscapular region

Question 5 Explanation:

Gibson’s continuous murmur may be audible from the back, at the left interscapular region, or cranial to the scapular spine. Although the murmur is audible over the entire base of the heart, Gibson’s murmur is best heard at the left upper sternal border

Question 6

Which of the following is false about Gibson’s murmur ?

A	Caused by a persistent patent ductus arteriosus
B	Begins after the first heart sound
C	Grows louder as the child ages
D	None of the above

Question 7

Graham Steell murmur is best heard at ?

A	Left upper sternal border
B	Left lower sternal border
C	Apex
D	Apex

Question 7 Explanation:

Graham Steell murmur is a soft, blowing, decrescendo diastolic murmur running off of an accentuated second sound that mimics the murmur of aortic insufficiency. The Graham Steell murmur is best heard in a localized area at the left upper sternal border

Question 8

Key - Hodgkin murmur is best related to ?

A	Aortic stenosis
B	Aortic regurgitation
C	Pericarditis
D	Endocarditis

Question 8 Explanation:

Key - Hodgkin murmur is a diastolic murmur of aortic regurgitation. It has a raspy quality, similar to the sound of a saw cutting through wood

Question 9

Which of the following is best heard at left upper sternal border ?

A	Graham Steell murmur
B	Gibson’s murmur
C	Roger’s murmur
D	All of the above

Question 10

Who, from the following, was from Scotland ?

A	Henri-Louis Roger
B	George Frederic Still
C	Graham Steell
D	George Gibson

Question 10 Explanation:

Scottish cardiologist Graham Steell was an avid horseman and iconoclast.

Question 11

Who, from the following, is called father of British pediatrics ?

A	Henri-Louis Roger
B	George Frederic Still
C	George Frederic Still
D	George Gibson

Question 11 Explanation:

English physician George Frederic Still, the father of British pediatrics, is best known for his eponymous rheumatic disorders: a juvenile febrile arthritis and a more typhoidal illness in adults, both called Still’s disease.

Question 12

Which of the following is false about Still’s murmur ?

A	Most often seen in children
B	Systolic ejection murmur with a musical quality
C	Heard at the left lower sternal border and apex
D	None of the above

Question 13

Still’s murmur increases in intensity with ?

A	Fever
B	Anxiety
C	Exercise
D	All of the above

Question 13 Explanation:

Most often seen in children, Still’s murmur is a benign, medium-to-long systolic ejection murmur with a musical quality; it is heard at the left lower sternal border and apex. It increases in intensity with fever, anxiety, or exercise. Its cause is unknown.

Question 14

Which of the following is true for holosystolic murmurs ?

A	Begin before S1 and end before S2
B	Begin after S1 and end before S2
C	Begin with S1 and end with S2
D	Begin with S1 and end after S2

Question 14 Explanation:

Holosystolic murmurs (MR, TR, VSD) at the area of maximal intensity begin with S1 & end after S2

Question 15

Acute, severe MR occurs in ?

A	Papillary muscle rupture in acute myocardial infarction
B	Rupture of chordae tendineae in MVP
C	Infective endocarditis
D	All of the above

Question 15 Explanation:

Clinical settings in which acute, severe MR occurs include papillary muscle rupture complicating acute MI, rupture of chordae tendineae in myxomatous mitral valve disease (MVP), infective endocarditis & blunt chest wall trauma

Question 16

Acute, severe MR from papillary muscle rupture accompanies which MI ?

A	Inferior MI
B	Posterior MI
C	Lateral MI
D	Any of the above

Question 16 Explanation:

Acute, severe MR from papillary muscle rupture usually accompanies an inferior, posterior, or lateral MI and occurs 2 - 7 days after presentation.

Question 17

Majority of heart murmurs are ?

A	Early systolic
B	Midsystolic
C	Late systolic
D	Holosystolic

Question 17 Explanation:

Majority of heart murmurs are midsystolic and soft (grades I to II/VI)

Question 18

Most benign, functional murmurs originate from ?

A	Most benign, functional murmurs originate from ?
B	Pulmonary outflow tract
C	Mitral valve
D	Tricuspid valve

Question 19

Most benign, functional murmurs are ?

A	Presystolic
B	Early systolic
C	Midsystolic
D	Late systolic

Question 19 Explanation:

Most benign, functional murmurs are midsystolic and originate from the pulmonary outflow tract

Question 20

Systolic ejection murmur is the name given to ?

A	Early systolic murmurs
B	Midsystolic murmurs
C	Late systolic murmurs
D	Any of the above

Question 20 Explanation:

Midsystolic murmurs are also called systolic ejection murmurs. They are crescendo-decrescendo in shape, occur across aortic or pulmonic outflow tracts. Murmur starts shortly after S1 and ends before the closure of aortic or pulmonic leaflets.

Question 21

Auscultatory findings of severe AS include all except ?

A	Soft or absent A2
B	Paradoxical splitting of S2
C	Apical S4
D	Early-peaking systolic murmur

Question 21 Explanation:

Auscultatory findings of severe AS include a soft or absent A2, paradoxical splitting of S2, apical S 4 and a late-peaking systolic murmur.

Question 22

Which of the following lesions produce midsystolic murmur with disproportionate radiation into right carotid artery ?

A	Hypertrophic cardiomyopathy
B	Valvular aortic stenosis
C	Supravalvular aortic stenosis
D	All of the above

Question 23

Which of the following lesions produce midsystolic murmur with little radiation into carotid arteries ?

A	Hypertrophic cardiomyopathy
B	Valvular aortic stenosis
C	Supravalvular aortic stenosis
D	All of the above

Question 23 Explanation:

In valvular AS, murmur is maximal in 2nd right ICS, with radiation into neck. In supravalvular AS, murmur radiates disproportionately into right carotid artery. In HOCM, midsystolic murmur originates in LV cavity & is maximal at lower left sternal edge & apex, with relatively little radiation to carotids.

Question 24

Midsystolic murmur occuring in mitral regurgitation suggests ?

A	Mitral valvulitis
B	Papillary muscle dysfunction
C	AV ring dilatation
D	Mitral valve prolapse

Question 24 Explanation:

Midsystolic murmur can occur in mitral regurgitation resulting from papillary muscle dysfunction

Question 25

Early systolic murmurs end in ?

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

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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.Which of the following about Still’s murmur ?
A. Benign grade 2 murmur
B. Vibratory mid-systolic murmur
C. At lower left sternal border
D. In elderly

2. Which of the following produces a cardiac murmur that is plateau in configuration ?
A. ASD
B. MVP
C. Chronic MR
D. VSD

3. “Maladie de Roger” relates to ?
A. ASD
B. PDA
C. Congenital AS
D. Small, restrictive VSDs

4. Gibson’s murmur is best heard at ?
A. Left upper sternal border
B. Left lower sternal border
C. Apex
D. Left interscapular region

5. Which of the following is false about Gibson’s murmur ?

A. Caused by a persistent patent ductus arteriosus
B. Begins after the first heart sound
C. Grows louder as the child ages
D. None of the above

6. Graham Steell murmur is best heard at ?
N Engl J Med 2010;363:22
A. Left upper sternal border
B. Left lower sternal border
C. Apex
D. Left interscapular region

7. Key – Hodgkin murmur is best related to ?
A. Aortic stenosis
B. Aortic regurgitation
C. Pericarditis

D. Endocarditis

8. Which of the following is best heard at left upper sternal border ?
A. Graham Steell murmur
B. Gibson’s murmur
C. Roger’s murmur
D. All of the above

9. Who, from the following, was from Scotland ?
A. Henri-Louis Roger
B. George Frederic Still
C. Graham Steell
D. George Gibson

10. Who, from the following, is called father of British pediatrics ?
A. Henri-Louis Roger
B. George Frederic Still
C. Graham Steell
D. George Gibson

11. Which of the following is false about Still’s murmur ?
A. Most often seen in children
B. Systolic ejection murmur with a musical quality
C. Heard at the left lower sternal border and apex
D. None of the above

12. Still’s murmur increases in intensity with ?
A. Fever
B. Anxiety
C. Exercise
D. All of the above

13. Which of the following is true for holosystolic murmurs ?
A. Begin before S1 and end before S2
B. Begin after S1 and end before S2
C. Begin with S1 and end with S2
D. Begin with S1 and end after S2

14. Acute, severe MR occurs in ?
A. Papillary muscle rupture in acute myocardial infarction

B. Rupture of chordae tendineae in MVP
C. Infective endocarditis
D. All of the above

15. Acute, severe MR from papillary muscle rupture accompanies which MI ?
A. Inferior MI
B. Posterior MI
C. Lateral MI
D. Any of the above

16. Majority of heart murmurs are ?
A. Early systolic
B. Midsystolic
C. Late systolic
D. Holosystolic

17. Most benign, functional murmurs originate from ?
A. Aortic outflow tract
B. Pulmonary outflow tract
C. Mitral valve
D. Tricuspid valve

18. Most benign, functional murmurs are ?
A. Presystolic
B. Early systolic
C. Midsystolic
D. Late systolic

19. Systolic ejection murmur is the name given to ?
A. Early systolic murmurs
B. Midsystolic murmurs
C. Late systolic murmurs
D. Any of the above

20. Auscultatory findings of severe AS include all except ?
A. Soft or absent A
2
B. Paradoxical splitting of S2
C. Apical S4
D. Early-peaking systolic murmur

21. Which of the following lesions produce midsystolic murmur with disproportionate radiation into right carotid artery ?
A. Hypertrophic cardiomyopathy
B. Valvular aortic stenosis
C. Supravalvular aortic stenosis
D. All of the above

22. Which of the following lesions produce midsystolic murmur with little radiation into carotid arteries ?
A. Hypertrophic cardiomyopathy
B. Valvular aortic stenosis
C. Supravalvular aortic stenosis
D. All of the above

23. Midsystolic murmur occuring in mitral regurgitation suggests ?
A. Mitral valvulitis
B. Papillary muscle dysfunction
C. AV ring dilatation
D. Mitral valve prolapse

24. Early systolic murmurs end in ?
A. Early systole
B. Midsystole
C. Late systole
D. Any of the above

Physical Examination of the Cardiovascular System

[MCQs] Physical Examination of the Cardiovascular System- Part 4

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

Physical Examination of the Cardiovascular System- Part 4

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