[MCQs] Physical Examination of the Cardiovascular System - Part 5

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Physical Examination of the Cardiovascular System- Part 5

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Congratulations - you have completed Physical Examination of the Cardiovascular System- Part 5. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Causes of early systolic murmurs include all except ?

A	Large VSD with pulmonary hypertension
B	Small muscular VSD
C	TR with pulmonary hypertension
D	Acute mitral regurgitation

Question 1 Explanation:

Early systolic murmurs begin with S1 and end in midsystole. Examples include large VSD with pulmonary hypertension, small muscular VSD, TR without pulmonary hypertension and acute MR.

Question 2

Late systolic murmurs are best heard at ?

A	Apex
B	Base
C	Left parasternal
D	Xiphoid

Question 2 Explanation:

Late systolic murmurs high-pitched apical murmurs that start after S1 & do not mask S1 or S2

Question 3

Frequent cause of late systolic murmurs is ?

A	Mitral valvulitis
B	Papillary muscle dysfunction
C	AV ring dilatation
D	All of the above

Question 3 Explanation:

Late systolic murmurs are frequently caused by papillary muscle dysfunction due to myocardial infarction or ischemia. MR in MVPS produces late systolic murmurs following midsystolic clicks

Question 4

Which of the following is false about early diastolic murmur of aortic regurgitation ?

A	Low pitched
B	Decrescendo
C	Best heard over left midsternal border
D	Best heard with patient sitting & leaning forward

Question 4 Explanation:

Murmur of AR is high-pitched, decrescendo, best heard over left midsternal border when patient sits leaning forward & holds breath in full expiration

Question 5

Which of the following is false about early diastolic murmur of aortic regurgitation ?

A	Low pitched
B	Decrescendo
C	Best heard over left midsternal border
D	Best heard with patient sitting & leaning forward

Question 5 Explanation:

Murmur of AR is high-pitched, decrescendo, best heard over left midsternal border when patient sits leaning forward & holds breath in full expiration

Question 6

Which of the following murmurs is low-pitched ?

A	Aortic regurgitation
B	Mitral regurgitation
C	Mitral stenosis
D	Pulmonic regurgitation due to pulmonary hypertension

Question 6 Explanation:

Middiastolic murmur of mitral stenosis is low-pitched. Early diastolic murmurs of AR and PR due to pulmonary hypertension are high pitched. Holosystolic murmur of MR is high pitched

Question 7

By Doppler studies, trivial mitral regurgitation (MR) can be detected in what percentage of normal individuals ?

A	10 %
B	25 %
C	45 %
D	75 %

Question 8

By Doppler studies, trivial tricuspid regurgitation (TR) can be detected in what percentage of normal individuals ?

A	10 %
B	25 %
C	45 %
D	70 %

Question 9

By Doppler studies, trivial pulmonic regurgitation (PR) can be detected in what percentage of normal individuals ?

A	10 %
B	22 %
C	65 %
D	88 %

Question 9 Explanation:

Trivial mitral regurgitation can be detected by 2D echocardiography & Doppler studies in ~ 45% of normal individuals, tricuspid regurgitation in ~ 70% and pulmonic regurgitation in ~ 88%

Question 10

By Doppler studies, which of the following is least detected in normal individuals ?

A	Mitral regurgitation
B	Tricuspid regurgitation
C	Aortic regurgitation
D	Pulmonic regurgitation

Question 10 Explanation:

Aortic regurgitation is encountered much less frequently in normal persons, and its incidence increases with advancing age

Question 11

2D Echocardiography is always recommended in an asymptomatic person with which of the following murmur ?

A	Holosystolic
B	Diastolic
C	Continuous
D	All of the above

Question 11 Explanation:

2D Doppler echocardiography is indicated in patients with loud systolic murmurs (grades >=III/VI), especially those that are holosystolic or late systolic & in those with diastolic or continuous murmurs.

Question 12

In mitral stenosis, which of the following is more reliable as an index of severity of valve obstruction ?

A	Loudness of S1
B	Character of murmur
C	Duration of murmur
D	Intensity of murmur

Question 12 Explanation:

In mitral stenosis, the duration of murmur is more reliable than its intensity as an index of the severity of valve obstruction.

Question 13

Middiastolic murmurs may be generated across mitral valve by all except ?

A	Mitral regurgitation
B	Patent ductus arteriosus
C	Atrial septal defect
D	Ventricular septal defect

Question 13 Explanation:

Middiastolic murmurs are generated across mitral valve in MR, PDA or VSD, and across the tricuspid valve in TR or ASD due to rapid flow across AV valve

Question 14

Which of the following statements about Carey-Coombs murmur is false ?

A	Soft
B	Middiastolic murmur
C	Heard in patients with acute rheumatic fever
D	None of the above

Question 14 Explanation:

Carey-Coombs murmur is a soft, middiastolic, low pitched murmur, heard best at the apex. It is heard in patients with acute rheumatic fever due to inflammation of mitral valve cusps. Carey Coombs murmur does not have an opening snap, presystolic accentuation, or a loud first sound, but may follow an S3 gallop.

Question 15

Dock’s murmur is best related to ?

A	Dock’s murmur is best related to ?
B	Stenosis of the left anterior descending artery
C	Pericarditis
D	Endocarditis

Question 15 Explanation:

Dock’s murmur is due to stenosis of left anterior descending artery. It is likened to that of the bruits heard over stenosed renal and hepatic arteries. Dock’s murmur is a continuous diastolic murmur, with a presystolic peak, a pattern consistent with blood flow through the coronary arteries. It may be in a sharply localized area, 4 cm left of the sternum in the third intercostal space, detectable only when the patient is sitting upright.

Question 16

In sinus rhythm, presystolic murmur is most typical of ?

A	Aortic regurgitation
B	Aortic regurgitation
C	Tricuspid stenosis
D	Aortic stenosis

Question 16 Explanation:

Crescendo presystolic murmur follows atrial contraction that fills the ventricules in sinus rhythm in AV valve stenosis. It is most characteristic of tricuspid stenosis with sinus rhythm

Question 17

All of the following cause continuous murmur over precordium except ?

A	Mammary souffle
B	Aortopulmonary septal defect
C	Coarctation of aorta
D	Proximal coronary artery stenosis

Question 17 Explanation:

Continuous murmur in the “back” may be present in coarctation of the aorta

Question 18

All are true about cervical venous hum except ?

A	Audible in healthy children and young adults
B	Audible in right supraclavicular fossa
C	Abolished by compression over internal jugular vein
D	Systolic louder than diastolic component

Question 18 Explanation:

Systolic louder than diastolic component

Question 19

All are true about cervical venous hum except ?

A	Audible in healthy children and young adults
B	Audible in right supraclavicular fossa
C	Abolished by compression over internal jugular vein
D	Systolic louder than diastolic component

Question 19 Explanation:

Systolic louder than diastolic component

Question 20

All of the following are true about mammary souffle except ?

A	Represents augmented venous flow through engorged breasts
B	Represents augmented venous flow through engorged breasts
C	Firm pressure with diaphragm of stethoscope can eliminate the diastolic portion of murmur
D	Firm pressure with diaphragm of stethoscope can eliminate the diastolic portion of murmur

Question 20 Explanation:

Firm pressure with diaphragm of stethoscope can eliminate the diastolic portion of murmur

Question 21

Transient external compression of both arms to levels above peak SBP augments murmurs of ?

A	MR
B	VSD
C	AR
D	All of the above

Question 21 Explanation:

Transient external compression of both arms by bilateral cuff inflation to 20 mm Hg over peak systolic pressure augments murmurs of MR, VSD & AR

Question 22

Roth’s spots are a feature of ?

A	Leukemia
B	SABE
C	Diabetes mellitus
D	All of the above

Question 22 Explanation:

Roth’s spots are white centered retinal hemorrhages pathognomonic for subacute bacterial endocarditis. They also appear in leukemia & diabetes.

Question 23

Which of the following statements about ‘Means-Lerman scratch’ is false ?

A	Systolic scratchy sound
B	Heard best at left 2nd intercostal space in expiration
C	Found in hypothyroidism
D	Result from rubbing of pericardium against pleura

Question 23 Explanation:

In hyperthyroid patients, a systolic pleuropericardial friction rub (Means-Lerman scratch) may be heard at left 2nd intercostal space during expiration due to hyperdynamic cardiac motion.

Question 24

Which of the following is best heard with the diaphragm of a stetoscope ?

A	S3
B	S4
C	Opening snap
D	MS rumble

Question 24 Explanation:

MS rumble

Question 25

A patient should be examined in the left lateral decubitus position to bring out findings at the apex of ?

A	S3
B	OS
C	MS
D	All of the above

Question 25 Explanation:

Patient should be examined in the left lateral decubitus position to bring out findings at the apex of S3, OS and MS.

Question 26

Top of the head is auscultated for ?

A	Mitral regurgitation
B	Aortic regurgitation
C	Venous hum
D	Right ventricular sounds

Question 26 Explanation:

It is important to remember to auscultate areas such as left axilla and back (MR), subxiphoid (RV sounds), supraclavicular (venous hums), and top of the head (if AR is suspected)

Question 27

Intensity of murmurs is described using which grading scale ?

A	Lennaec
B	Theodore
C	Levine
D	McCuine

Question 27 Explanation:

McCuine

Question 28

Splitting of S1 may be due to ?

A	RBBB
B	Ebstein’s anomaly
C	Ventricular arrhythmias
D	All of the above

Question 28 Explanation:

Splitting of S1 may be normal or may be associated with RBBB, Ebstein’s anomaly (due to abnormality of the tricuspid valve), or ventricular arrhythmias.

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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

1.Causes of early systolic murmurs include all except ?
A. Large VSD with pulmonary hypertension
B. Small muscular VSD
C. TR with pulmonary hypertension
D. Acute mitral regurgitation

2. Late systolic murmurs are best heard at ?
A. Apex
B. Base
C. Left parasternal
D. Xiphoid

3. Frequent cause of late systolic murmurs is ?

A. Mitral valvulitis
B. Papillary muscle dysfunction
C. AV ring dilatation
D. All of the above

4. Which of the following is false about early diastolic murmur of aortic regurgitation ?
A. Low pitched
B. Decrescendo
C. Best heard over left midsternal border
D. Best heard with patient sitting & leaning forward

5. Which of the following murmurs is low-pitched ?
A. Aortic regurgitation
B. Mitral regurgitation
C. Mitral stenosis
D. Pulmonic regurgitation due to pulmonary hypertension

4. By Doppler studies, trivial mitral regurgitation (MR) can be detected in what percentage of normal individuals ?
A. 10 %
B. 25 %
C. 45 %
D. 75 %

5. By Doppler studies, trivial tricuspid regurgitation (TR) can be detected in what percentage of normal individuals ?
A. 10 %
B. 25 %
C. 45 %
D. 70 %
6. By Doppler studies, trivial pulmonic regurgitation (PR) can be detected in what percentage of normal individuals ?
A. 10 %
B. 22 %
C. 65 %
D. 88 %

7. By Doppler studies, which of the following is least detected in normal individuals ?
A. Mitral regurgitation
B. Tricuspid regurgitation

C. Aortic regurgitation
D. Pulmonic regurgitation

8. 2D Echocardiography is always recommended in an asymptomatic person with which of the following murmur ?
A. Holosystolic
B. Diastolic
C. Continuous
D. All of the above

9. In mitral stenosis, which of the following is more reliable as an index of severity of valve obstruction ?
A. Loudness of S1
B. Character of murmur
C. Duration of murmur
D. Intensity of murmur

10. Middiastolic murmurs may be generated across mitral valve by all except ?
A. Mitral regurgitation
B. Patent ductus arteriosus
C. Atrial septal defect
D. Ventricular septal defect

11. Which of the following statements about Carey-Coombs murmur is false ?
A. Soft
B. Middiastolic murmur
C. Heard in patients with acute rheumatic fever
D. None of the above

12. Dock’s murmur is best related to ?
A. Rupture of sinus of Valsalva
B. Stenosis of the left anterior descending artery
C. Pericarditis
D. Endocarditis

13. In sinus rhythm, presystolic murmur is most typical of ?
A. Aortic regurgitation
B. Mitral regurgitation
C. Tricuspid stenosis
D. Aortic stenosis

14. All of the following cause continuous murmur over precordium except ?
A. Mammary souffle
B. Aortopulmonary septal defect
C. Coarctation of aorta
D. Proximal coronary artery stenosis

15. All are true about cervical venous hum except ?
A. Audible in healthy children and young adults
B. Audible in right supraclavicular fossa
C. Abolished by compression over internal jugular vein
D. Systolic louder than diastolic component

16. All of the following are true about mammary souffle except ?
A. Represents augmented venous flow through engorged breasts
B. Becomes audible during the late pregnancy
C. Firm pressure with diaphragm of stethoscope can
eliminate the diastolic portion of murmur
D. Heard in second to sixth anterior intercostal spaces

17. Transient external compression of both arms to levels above peak SBP augments murmurs of ?
A. MR
B. VSD
C. AR
D. All of the above

18. Roth’s spots are a feature of ?
A. Leukemia
B. SABE
C. Diabetes mellitus
D. All of the above

19. Which of the following statements about ‘Means-Lerman scratch’ is false ?
A. Systolic scratchy sound
B. Heard best at left 2nd intercostal space in expiration
C. Found in hypothyroidism
D. Result from rubbing of pericardium against pleura

20. Which of the following is best heard with the diaphragm of a stetoscope ?
A. S3
B. S4
C. Opening snap
D. MS rumble

21. A patient should be examined in the left lateral decubitus position to bring out findings at the apex of ?
A. S3
B. OS
C. MS
D. All of the above

22. Top of the head is auscultated for ?
A. Mitral regurgitation
B. Aortic regurgitation
C. Venous hum
D. Right ventricular sounds

23. Intensity of murmurs is described using which grading scale ?
A. Lennaec
B. Theodore
C. Levine
D. McCuine

24. Splitting of S1 may be due to ?
A. RBBB
B. Ebstein’s anomaly
C. Ventricular arrhythmias
D. All of the above

Physical Examination of the Cardiovascular System

[MCQs] Physical Examination of the Cardiovascular System – Part 5

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Physical Examination of the Cardiovascular System- Part 5

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