Phys 23 Flashcards

What directly produces the first heart sound?

A) Atrial wall stretch

B) AV valve closure vibrations

C) Semilunar valve opening

D) Rapid ventricular filling

The first heart sound is heard at the:

A) Start of diastole

B) End of diastole

C) Mid diastole

D) Beginning of systole

Why does S1 contain audible vibrations?

A) Attempted backflow after contraction

B) Coronary flow entering ventricles

C) Passive atrial emptying only

D) Septal depolarization alone

The second heart sound is most directly associated with:

A) AV valve opening

B) Atrial contraction

C) Semilunar valve closure

D) Rapid ventricular filling

The second heart sound occurs at the:

A) End of systole

B) Middle of systole

C) Beginning of diastole

D) End of atrial systole

In S2, the semilunar valves mainly move by:

A) Opening into arteries

B) Flattening into atria

C) Swinging toward aorta

D) Bulging toward ventricles

Which sound is longer in duration normally?

A) Equal durations

B) S1

C) S2

D) Neither is audible

Why is S2 higher frequency than S1?

A) AV valves are tauter

B) Ventricles are more elastic

C) Semilunars and arteries are tauter

D) Atria vibrate more strongly

A third heart sound is usually heard during the:

A) End of systole

B) End of diastole

C) Atrial kick only

D) Beginning of mid diastole

What is the best proposed mechanism of S3?

A) Blood oscillation between chambers

B) Valve leaflet calcification

C) Papillary muscle tension

D) Arterial recoil alone

Why is S3 not heard earlier in diastole?

A) Atria have not depolarized

B) Semilunars stay closed

C) Ventricles are not full enough

D) AV valves are too taut

In whom can S3 be a normal finding?

A) Older adults with CAD

B) Children and young adults

C) Patients with aortic stenosis

D) Patients with LV hypertrophy

In an older adult, a new S3 most strongly suggests:

A) Systolic heart failure

B) Mitral stenosis

C) Normal aging

D) Acute pericarditis

A fourth heart sound occurs when the:

A) Semilunars close

B) Ventricles eject

C) AV valves close

D) Atria contract

Why is S4 often not heard by routine auscultation?

A) It occurs only in systole

B) It has very low frequency

C) It is masked by S1

D) It requires tachycardia

S4 is most expected in patients with:

A) High-output failure

B) Severe bradycardia alone

C) Increased ventricular compliance

D) Decreased ventricular compliance

Best auscultation point for the tricuspid valve?

A) Left sternal border, 5th ICS

B) Right sternal border, 2nd ICS

C) Left sternal border, 2nd ICS

D) Left midclavicular, 5th ICS

Best auscultation point for the mitral valve?

A) Left sternal border, 5th ICS

B) Right sternal border, 2nd ICS

C) Left sternal border, 2nd ICS

D) Left midclavicular, 5th ICS

Best auscultation point for the pulmonic valve?

A) Right sternal border, 2nd ICS

B) Left midclavicular, 5th ICS

C) Left sternal border, 2nd ICS

D) Left sternal border, 5th ICS

Best auscultation point for the aortic valve?

A) Left sternal border, 2nd ICS

B) Right sternal border, 2nd ICS

C) Left sternal border, 5th ICS

D) Left midclavicular, 5th ICS

The tricuspid area is heard mainly over the:

A) Left atrium

B) Right atrium

C) Left ventricle

D) Right ventricle

The mitral area is heard mainly over the:

A) Apex of left ventricle

B) Base of right ventricle

C) Left atrial appendage

D) Pulmonic outflow tract

Which stenotic lesion usually gives the loudest murmur?

A) Pulmonic stenosis

B) Aortic stenosis

C) Tricuspid stenosis

D) Mitral stenosis

Which stenotic lesion usually gives the weakest murmur?

A) Aortic stenosis

B) Pulmonic stenosis

C) Mitral stenosis

D) Tricuspid stenosis

Which lesion pair causes murmurs heard only during systole?

A) Aortic stenosis and mitral regurgitation

B) Mitral stenosis and aortic regurgitation

C) Patent ductus and aortic stenosis

D) Mitral regurgitation and PDA

Which lesion pair causes murmurs heard only during diastole?

A) Aortic stenosis and mitral regurgitation

B) PDA and mitral stenosis

C) Pulmonic stenosis and MR

D) Aortic regurgitation and mitral stenosis

A murmur from patent ductus arteriosus is heard during:

A) Systole

B) Systole and diastole

C) Middle Diastole

D) Early diastole

Which structures mainly transmit the second heart sound vibrations?

A) Atria

B) Great arteries

C) Ventricles

D) Pericardium

Why is S1 longer than S2?

A) AV valves are tauter

B) Semilunars vibrate longer

C) Semilunars are tauter, shorter

D) Atria add extra resonance

Besides the valves themselves, what also vibrates in S1?

A) Adjacent walls and vessels

B) Coronary sinus

C) Purkinje network

D) Pericardial fat pad

What autoimmune disease causes the greatest number of valvular lesions?

A) Infective endocarditis

B) Rheumatic fever

C) Marfan syndrome

D) Libman-Sacks endocarditis

What best explains autoimmune valvular injury in rheumatic fever?

A) Viral invasion of leaflets

B) Antibody cross-reaction after strep

C) Calcium emboli on cusps

D) Direct toxin digestion

Which prior infection classically precedes rheumatic valvular disease?

A) Staphylococcal cellulitis

B) Streptococcal throat infection

C) Viral myocarditis

D) Fungal pneumonia

In rheumatic valvular disease, severity of valve damage correlates best with:

A) Heart rate at infection and persistence

B) Age at infection and antibody concentration

C) Antibody concentration and persistence

D) Serum calcium level and antibody concentration

Which valve undergoes the greatest turbulent trauma?

A) Tricuspid valve

B) Pulmonic valve

C) Aortic valve

D) Mitral valve

Which valve undergoes the second greatest turbulent trauma?

A) Aortic valve

B) Tricuspid valve

C) Pulmonic valve

D) Mitral valve

Valvular scarring most directly causes the leaflets to:

A) Thin and lengthen

B) Fuse and stiffen

C) Detach from annulus

D) Calcify without fusion

Rheumatic scarring predisposes valves to which two functional problems?

A) Shunting and rupture

B) Regurgitation and stenosis

C) Thrombosis and embolism

D) Hypertrophy and dilation

Aortic stenosis classically produces a murmur during:

A) Systole

B) Diastole

C) Early diastole only

D) Atrial systole

Why is the murmur of aortic stenosis systolic?

A) Blood falls into LV

B) LA empties turbulently

C) LV ejects through narrowed valve

D) Coronaries recoil into aorta

In aortic stenosis, pressure is typically:

A) Low in LV and aorta

B) High in aorta only

C) Equal in LV and aorta

D) High in LV, normal aorta

What directly produces the loud murmur of aortic stenosis?

A) Venous backflow to atrium

B) High-velocity aortic turbulence

C) Mitral leaflet prolapse

D) Pulmonary artery recoil

A palpable upper chest or lower neck vibration in severe aortic stenosis is called:

A) Heave

B) Lift

C) Thrill

D) Knock

Aortic regurgitation classically causes a murmur during:

A) Systole

B) Isovolumic contraction

C) Diastole

D) Atrial contraction

Why is aortic regurgitation heard in diastole?

A) LV ejects through tight valve

B) Blood jets backward into LV

C) LA contracts against resistance

D) RV fills from vena cava

Mitral regurgitation classically causes a murmur during:

A) Early diastole

B) Mid diastole

C) Systole

D) Late diastole

The typical quality of mitral regurgitation is:

A) Harsh scraping murmur

B) High-frequency blowing murmur

C) Low rumbling opening snap

D) Musical midsystolic click

Mitral stenosis classically causes a murmur during:

A) Systole

B) Diastole

C) End systole only

D) Isovolumic relaxation

In mitral stenosis, left atrial pressure is usually:

A) Decreased

B) Unchanged

C) Increased

D) Equal to LV

Why is no murmur usually heard in the first part of diastole in mitral stenosis?

A) Valve is fully open

B) There is little LV blood

C) Atrial systole is absent

D) Aortic recoil masks it

As the ventricle partially fills in mitral stenosis, the murmur appears because:

A) Ventricular stretch permits reverberation

B) Coronary flow suddenly ceases

C) Semilunar valves become taut

D) Papillary muscles contract

What happens to net stroke volume in aortic stenosis?

A) Increases

B) Stays normal

C) Decreases

D) Becomes zero

Why does aortic stenosis decrease net stroke volume?

A) LV empties inadequately

B) RV preload falls

C) LA cannot contract

D) Coronary sinus obstructs flow

What happens to net stroke volume in aortic regurgitation?

A) Increases

B) Decreases

C) Is unchanged

D) Alternates beat to beat

Why does aortic regurgitation reduce net stroke volume?

A) Blood shunts to lungs

B) Blood returns to LA

C) Blood refluxes into LV

D) RV cannot fill

How do chronic aortic stenosis and aortic regurgitation affect blood volume?

A) Decrease blood volume

B) No volume change

C) Increase blood volume

D) Cause plasma loss

Why does blood volume increase in chronic aortic valve disease?

A) To reduce afterload

B) To offset reduced stroke volume

C) To lower LA pressure

D) To improve valve elasticity

Why can aortic stenosis cause ischemia of the myocardium?

A) LV work rises without more coronaries

B) RV hypertrophy compresses LAD

C) Coronary sinus pressure collapses

D) Aortic pressure always falls to zero

In compensated aortic stenosis or regurgitation, the left ventricle initially adapts mainly by:

A) Fibrosing rapidly

B) Reducing blood volume

C) Increasing pump effort

D) Shunting to right heart

Once compensation fails in severe aortic valve disease, the left ventricle first tends to:

A) Become restrictive only

B) Dilate and weaken

C) Shrink concentrically

D) Empty completely

When decompensation occurs in severe aortic stenosis or regurgitation, cardiac output typically:

A) Rises markedly

B) Becomes fixed normal

C) Begins to fall

D) Affects only RV

As left ventricular failure progresses in severe aortic valve disease, pressure backs up into the:

A) Right atrium and vena cava

B) Left atrium then lungs

C) Coronary sinus only

D) Aorta then carotids

The major pulmonary consequence of decompensated aortic stenosis or regurgitation is:

A) Pneumothorax

B) Pulmonary edema

C) Pleural fibrosis

D) Lobar infarction

Which valvular lesion most directly raises left atrial pressure?

A) Aortic stenosis

B) Pulmonic stenosis

C) Mitral stenosis

D) Aortic regurgitation

Mitral stenosis or regurgitation most directly causes which triad?

A) Pulmonary edema, LA enlargement, increased blood volume

B) RV hypertrophy, ascites, decreased blood volume

C) Systemic edema, RA shrinkage, low preload

D) Pulmonary stenosis, LV collapse, hemoconcentration

In mitral valve disease, pulmonary edema develops mainly because pressure backs up into the:

A) Right ventricle

B) Pulmonary veins

C) Coronary sinus

D) Aorta

Left atrial enlargement in mitral stenosis or regurgitation is primarily caused by:

A) Coronary thrombosis

B) Pressure buildup

C) Myocardial rupture

D) Reduced venous tone

In chronic mitral stenosis or regurgitation, blood volume tends to:

A) Decrease markedly

B) Stay unchanged

C) Increase

D) Become zero

Why does left atrial enlargement predispose to atrial fibrillation?

A) Shortens atrial pathways

B) Increases impulse travel distance

C) Blocks AV node directly

D) Eliminates reentry circuits

The arrhythmia most classically promoted by chronic left atrial enlargement is:

A) Ventricular tachycardia

B) Junctional rhythm

C) Atrial fibrillation

D) Complete heart block

In mitral valve disease, enlarged atrial size promotes atrial fibrillation mainly by favoring:

A) SA nodal arrest

B) Circus movement reentry

C) Purkinje fibrosis

D) Ventricular escape beats

Which everyday activity can greatly worsen dynamic abnormalities from valvular disease?

A) Sleeping

B) Exercise

C) Sitting upright

D) Quiet breathing

Coarctation of the aorta usually causes arterial pressure that is:

A) Lower above than below

B) Equal above and below

C) Higher above than below

D) Higher only in legs

In coarctation of the aorta, blood often reaches the lower body through:

A) Coronary arteries

B) Collateral arteries

C) Lymphatic channels

D) Pulmonary veins

Patent ductus arteriosus is classically what type of shunt after birth?

A) Right-to-left

B) Bidirectional only

C) Left-to-right

D) No true shunt

During fetal life, pulmonary arterial pressure is normally:

A) Very low

B) Moderately low

C) High

D) Zero

During fetal life, aortic pressure relative to pulmonary pressure is:

A) Higher

B) Lower

C) Equal

D) Unrelated

Why is fetal pulmonary vascular resistance high?

A) Lungs are overexpanded

B) Alveoli are collapsed

C) Placenta drains lungs

D) Aortic valve is closed

In the fetus, most pulmonary arterial blood flows through the ductus arteriosus into the:

A) Left atrium

B) Right ventricle

C) Pulmonary veins

D) Aorta

The direction of fetal ductus arteriosus flow is mainly determined by:

A) Low pulmonary, high aortic pressure

B) Equal great-vessel pressures

C) High pulmonary, low aortic pressure

D) Coronary sinus pressure gradient

After birth, pulmonary arterial pressure normally:

A) Rises sharply

B) Falls markedly

C) Stays fetal level

D) Becomes higher than aortic

After birth, pulmonary arterial pressure falls mainly because:

A) Ductus closes first

B) Lungs inflate and resistance drops

C) Placenta keeps flowing

D) RV output stops

After birth, aortic pressure rises mainly because:

A) Coronary flow stops

B) Pulmonary veins constrict

C) Placental runoff stops

D) Ductus enlarges

After birth, normal forward flow through the ductus arteriosus ceases because:

A) Pulmonary pressure rises above aortic

B) Pulmonary falls and aortic rises

C) Both pressures become zero

D) LV stops ejecting

Once postnatal pressures reverse, blood through a persistent ductus arteriosus flows from the:

A) Pulmonary artery to aorta

B) RV to left atrium

C) Aorta to pulmonary artery

D) SVC to pulmonary trunk

Failure of ductus arteriosus closure after birth results in:

A) Tetralogy of Fallot

B) Patent ductus arteriosus

C) Tricuspid atresia

D) Coarctation only

Tetralogy of Fallot is classically what kind of shunt?

A) Left-to-right

B) Right-to-left

C) No shunt

D) Atrial-only shunt

The most common cause of a “blue baby” is:

A) Coarctation of aorta

B) Patent ductus arteriosus

C) Tetralogy of Fallot

D) Mitral stenosis

In Tetralogy of Fallot, the aorta characteristically:

A) Arises only from LV

B) Overrides the septal defect

C) Originates from left atrium

D) Drains into pulmonary trunk

Which lesion in Tetralogy of Fallot most directly reduces blood flow to the lungs?

A) Mitral regurgitation

B) Pulmonary stenosis

C) Aortic coarctation

D) Tricuspid prolapse

The septal defect in Tetralogy of Fallot allows blood to move between the:

A) Atrial veins

B) Great arteries

C) Ventricles

D) Pulmonary veins

The right ventricle enlarges in Tetralogy of Fallot mainly because of:

A) High pressure load

B) Mitral inflow obstruction

C) Low venous return

D) Reduced afterload

The main physiologic problem in Tetralogy of Fallot is that a lot of venous blood:

A) Is fully oxygenated twice

B) Bypasses lungs into aorta

C) Returns only to left atrium

D) Pools in pulmonary veins

Which congenital lesion most strongly creates higher upper-body than lower-body pressure?

A) Tetralogy of Fallot

B) Coarctation of aorta

C) Patent ductus arteriosus

D) Mitral stenosis

Which postnatal change normally favors ductus arteriosus closure?

A) Higher pulmonary than aortic pressure

B) Lower systemic resistance

C) Lower pulmonary and higher aortic pressure

D) Increased fetal lung compression

Other than hereditary defects, what is a recognized cause of congenital heart anomalies?

A) Maternal diabetes late pregnancy

B) Maternal viral infection first trimester

C) Paternal smoking before conception

D) Neonatal cyanosis after birth

Cardiac valves normally produce audible heart sounds when they:

A) Open rapidly

B) Begin calcifying

C) Close

D) Prolapse

Why are normal valve opening events usually silent?

A) Opening creates no turbulence

B) Opening does not create audible vibrations

C) Arteries absorb all sound

D) Atria contract simultaneously

A fourth heart sound is also associated with:

A) Increased resistance to filling

B) Reduced atrial contraction

C) Increased coronary flow

D) Decreased afterload

Heart sounds can be amplified and recorded with a:

A) Sphygmomanometer

B) Capnograph

C) Phonocardiogram

D) Spirometer

In rheumatic fever, heart valves are likely to be:

A) Dilated or hypertrophied

B) Damaged or destroyed

C) Only calcified

D) Shortened or duplicated

In rheumatic fever, characteristic valvular lesions are typically:

A) Hemorrhagic and fibrinous

B) Calcified and avascular

C) Fibrotic and smooth

D) Purulent and caseating

The classic rheumatic valvular lesions grow along the:

A) Chordae tendineae

B) Ventricular septum

C) Inflamed valve edges

D) Papillary muscle tips

Rheumatic valvular lesions are also described as:

A) Flat and translucent

B) Bulbous

C) Pedunculated

D) Contractile

A valve whose leaflets adhere so extensively that blood cannot flow normally is called:

A) Regurgitant

B) Stenosed

C) Prolapsed

D) Insufficient

A valve with scarred edges that cannot close during ventricular contraction produces:

A) Stenosis

B) Thrill

C) Regurgitation

D) Cyanosis

In aortic stenosis, blood exiting through the narrowed valve forms a:

A) Low-pressure pool

B) Nozzling jet

C) Venous shunt

D) Laminar wave

The nozzling effect of aortic stenosis causes blood to leave at tremendous:

A) Compliance

B) Resistance

C) Velocity

D) Viscosity

The immediate flow abnormality produced by aortic stenosis is:

A) Severe turbulence

B) Coronary steal

C) Reverse shunting

D) Venous damping

The loud murmur of aortic stenosis is produced when turbulent blood strikes the:

A) Left atrium

B) Aortic walls

C) Pulmonary veins

D) Mitral chordae

The murmur of mitral stenosis is typically:

A) Harsh and high-pitched

B) Weak and low-frequency

C) Loud and blowing

D) Musical and sharp

In both aortic stenosis and aortic regurgitation, the left ventricle typically:

A) Atrophies

B) Fibroses first

C) Hypertrophies

D) Collapses

During exercise, large quantities of what blood are returned to the heart from the periphery?

A) Arterial

B) Capillary

C) Venous

D) Coronary

Even in mild to moderate valvular disease, what declines in proportion to lesion severity?

A) Pulmonary reserve

B) Renal clearance

C) Cardiac reserve

D) Coronary sinus flow

A patient with mild valvular disease becomes symptomatic mainly during exertion because exercise increases:

A) Venous return

B) Aortic elasticity

C) Valve area

D) Diastolic filling time

Which statement best explains why valvular disease worsens during exercise?

A) Less blood returns to heart

B) More blood returns to heart

C) Arterial oxygen falls to zero

D) Coronary flow stops entirely

Which is a major category of congenital cardiovascular anomaly?

A) Right-to-right shunt

B) Left-to-left shunt

C) Stenosis of blood channel

D) Coronary thrombosis

A left-to-right shunt primarily means blood fails to pass normally through the:

A) Lungs

B) Coronary sinus

C) Systemic circulation

D) Right atrium

A right-to-left shunt primarily means blood fails to pass normally through the:

A) Systemic veins

B) Lungs

C) Aorta

D) Left ventricle

Which set lists the three major congenital anomaly categories correctly?

A) Stenosis, left-to-right shunt, right-to-left shunt

B) Regurgitation, stenosis, aneurysm

C) Septal rupture, tamponade, coarctation

D) Cyanosis, edema, hypertrophy

Which lesion combination is matched correctly?

A) Aortic stenosis-diastolic murmur

B) Mitral stenosis-high-frequency loud murmur

C) Mitral regurgitation-systolic backflow

D) Aortic regurgitation-systolic jet

Which lesion is most associated with a weak, low-frequency murmur?

A) Aortic stenosis

B) Mitral stenosis

C) Mitral regurgitation

D) Aortic regurgitation

Which consequence follows increased left atrial pressure from mitral valve disease?

A) Pulmonary edema

B) Aortic aneurysm

C) Right-to-left shunt

D) Cardiac tamponade

A congenital narrowing of the aorta, often near the level of the diaphragm, is called:

A) Patent ductus arteriosus

B) Coarctation of the aorta

C) Tetralogy of Fallot

D) Truncus arteriosus

The fetal vessel connecting the pulmonary artery to the aorta is the:

A) Foramen ovale

B) Ductus venosus

C) Coronary sinus

D) Ductus arteriosus

At birth, forward blood flow through the ductus arteriosus normally:

A) Increases sharply

B) Ceases suddenly

C) Reverses permanently first

D) Becomes turbulent only

Patients with patent ductus arteriosus usually do not become cyanotic until later in life, when the heart fails or the lungs become:

A) Fibrotic

B) Congested

C) Hyperinflated

D) Embolized

The major physiologic reserves reduced in patent ductus arteriosus are:

A) Renal and hepatic

B) Cardiac and respiratory

C) Cerebral and coronary

D) Venous and lymphatic

The murmur of patent ductus arteriosus is most intense during:

A) Diastole

B) Atrial systole

C) Systole

D) Isovolumic relaxation

The murmur of patent ductus arteriosus becomes less intense during:

A) Diastole

B) Systole

C) Atrial contraction

D) Rapid ejection

The waxing and waning murmur of patent ductus arteriosus is classically called a:

A) Blowing murmur

B) Machinery murmur

C) Opening snap

D) Pericardial knock

The standard surgical treatment of patent ductus arteriosus is to:

A) Stent the pulmonary artery

B) Ligate or divide the ductus

C) Replace the aortic valve

D) Create an atrial septal shunt

After dividing a patent ductus arteriosus surgically, the surgeon then:

A) Reopens both ends

B) Closes both ends

C) Inserts a stent

D) Narrows the aorta

Because much blood bypasses the lungs in Tetralogy of Fallot, the aortic blood is predominantly:

A) Oxygen-rich arterial blood

B) Unoxygenated venous blood

C) Lymphatic fluid

D) Coronary venous blood

Which of the following is part of Tetralogy of Fallot?

A) Aorta arises from right ventricle

B) Mitral stenosis

C) Left atrial rupture

D) Coarctation

A major lesion in Tetralogy of Fallot that decreases pulmonary blood flow is:

A) Aortic regurgitation

B) Pulmonary artery stenosis

C) Tricuspid prolapse

D) Patent foramen venosum

In Tetralogy of Fallot, blood from the left ventricle may pass through a septal defect into the:

A) Left atrium

B) Pulmonary vein

C) Right ventricle

D) Coronary sinus

The aorta in Tetralogy of Fallot often overrides a:

A) Mitral annulus

B) Ventricular septal defect

C) Patent ductus

D) Pulmonary vein

The fourth classic abnormality in Tetralogy of Fallot is an:

A) Enlarged right ventricle

B) Enlarged left atrium

C) Enlarged aortic root

D) Enlarged left ventricle

An enlarged right ventricle in Tetralogy of Fallot can be identified by:

A) EEG

B) Angiograms

C) Colonoscopy

D) Sputum culture

Definitive repair of Tetralogy of Fallot includes opening the pulmonary stenosis and:

A) Ligating the coronary sinus

B) Closing the septal defect

C) Enlarging the left atrium

D) Closing the ductus only

Tetralogy of Fallot surgery also aims to:

A) Reconstruct the outflow pathway

B) Close the mitral valve

C) Lower venous return

D) Narrow the aorta

One of the most important mechanisms by which the heart adapts to increased workload is:

A) Atrophy

B) Hypertrophy

C) Fibrillation

D) Embolization

The most common cause of cardiac hypertrophy is:

A) Viral myocarditis

B) Hypertension

C) Mitral prolapse

D) Anemia

Physiological cardiac hypertrophy is best viewed as a:

A) Degenerative lesion

B) Compensatory response

C) Congenital shunt

D) Fibrotic scar