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CE Exam 2

front 1	back 1 cyanosis
front 2 [central/peripheral] cyanosis can be seen in the lips, tongue, and cheeks	back 2 central
front 3 [central/peripheral] cyanosis can be seen in the fingers and indicates diminshed blood flow to the local area	back 3 peripheral
front 4	back 4 xanthelasma

front 5	back 5 xanthomas
front 6	back 6 roth spots
front 7	back 7 splinter hemorrhages
front 8	back 8 normal aortic stenosis aortic stenosis mixed w mitral regurgitation

front 9 A patient has a 28 mm Hg systolic BP difference between arms on repeated measurements. Which finding is most likely being suggested? A) Normal adult variation B) Perioral cyanosis C) Retinal embolization D) Vascular abnormality	back 9 D. Vascular abnormality
front 10 During a cardiovascular exam, a patient has an abnormal respiratory rate. Which paired interpretation is most appropriate? A) Cardiac decompensation or lung disorder B) Normal finding in all adults C) Specific for infective endocarditis D) Diagnostic of aortic regurgitation	back 10 A. Cardiac decompensation or lung disorder
front 11 A 2-month-old is evaluated for suspected congenital aortic narrowing. Which bedside comparison is most important? A) Eye plaques and extensor nodules B) Palms and soles for hemorrhages C) Arm-leg pulses and blood pressures D) Right-left pupillary light reflexes	back 11 C. Arm-leg pulses and blood pressures
front 12 In infants and children, comparing pulses and blood pressure between the arms and legs is most useful for diagnosing which condition? A) Coarctation of the aorta B) Familial hypercholesterolemia C) Infective endocarditis D) Aortic regurgitation	back 12 A. Coarctation of the aorta

front 13 A newborn has bluish discoloration around the lips but otherwise appears well. Which statement best applies? A) Always indicates endocarditis B) Always indicates aortic stenosis C) Confirms systemic hypoxemia D) Can be normal in infants	back 13 D. Can be normal in infants
front 14 A clinician suspects digital clubbing and asks the patient to oppose the dorsal surfaces of corresponding fingernails. Which test is being used? A) Allen test B) Schamroth window test C) Homan sign D) Pulsus parvus test	back 14 B. Schamroth window test
front 15 Soft yellow plaques around a patient’s eyelids are noted during inspection. Which term best describes this finding? A) Janeway lesions B) Roth spots C) Xanthelasma D) Osler nodes	back 15 C. Xanthelasma
front 16 Xanthelasma is best described as which lesion-location pairing A) Soft yellow plaques; around eyes B) Painful nodules; digit tips C) Painless macules; palms and soles D) Hemorrhages; beneath fingernails	back 16 A. Soft yellow plaques; around eyes

front 17 A patient has hard yellow-orange eruptive lesions of varying size over extensor surfaces. Which lesion is most likely? A) Xanthelasma B) Janeway lesion C) Osler node D) Xanthoma	back 17 D. Xanthoma
front 18 Which description best matches xanthomas rather than xanthelasma? A) Soft plaques around eyelids B) Hard eruptive extensor lesions C) Retinal lesions with white centers D) Painless hemorrhagic palm lesions	back 18 B. Hard eruptive extensor lesions
front 19 A patient with familial hypercholesterolemia has hard yellow-orange lesions over extensor joints. Which finding is being described? A) Xanthomas B) Osler nodes C) Roth spots D) Splinter hemorrhages	back 19 A. Xanthomas
front 20 Which lipid-associated lesion is commonly found around the eyes as soft yellow macules or plaques? A) Xanthoma B) Osler node C) Xanthelasma D) Janeway lesion	back 20 C. Xanthelasma

front 21 Which set contains classic peripheral or ocular signs of infective endocarditis? A) Xanthomas, xanthelasma, clubbing, cyanosis B) Roth spots, splinters, Osler, Janeway C) Parvus, tardus, bounding, bisferiens D) Coarctation, cyanosis, clubbing, xanthomas	back 21 B. Roth spots, splinters, Osler, Janeway
front 22 A patient with suspected infective endocarditis has fundoscopic round hemorrhagic retinal lesions with pale centers. Which finding is present? A) Roth spots B) Janeway lesions C) Osler nodes D) Xanthelasma	back 22 A. Roth spots
front 23 Roth spots in infective endocarditis are best described as which finding? A) Painless hemorrhages on soles B) Painful nodules on digits C) Yellow lipid plaques near eyes D) Retinal hemorrhages with white centers	back 23 D. Retinal hemorrhages with white centers
front 24 A patient with infective endocarditis has painful erythematous subcutaneous nodules on the fingertips. Which lesion is being described? A) Janeway lesions B) Roth spots C) Osler nodes D) Xanthomas	back 24 C. Osler nodes

front 25 A patient with infective endocarditis has painless hemorrhagic macules on the soles. Which lesion is most likely? A) Janeway lesions B) Osler nodes C) Xanthomas D) Roth spots	back 25 A. Janeway lesions
front 26 Which finding is classified as a sign of infective endocarditis rather than lipid deposition? A) Xanthelasma B) Splinter hemorrhages C) Xanthomas D) Schamroth window	back 26 B. Splinter hemorrhages
front 27 A patient has a small, delayed, slow-rising carotid upstroke. Which valve lesion is most classically associated? A) Aortic stenosis B) Aortic regurgitation C) Mitral stenosis D) Tricuspid regurgitation	back 27 A. Aortic stenosis
front 28 The carotid pulse of aortic stenosis is classically described by which phrase? A) Pulsus bisferiens B) Bounding pulse C) Corrigan pulse D) Pulsus parvus et tardus	back 28 D. Pulsus parvus et tardus

front 29 Aortic stenosis produces which carotid pulse contour? A) Large and bounding B) Painless and hemorrhagic C) Small, delayed, slow-rising D) Double positive upstroke	back 29 C. Small, delayed, slow-rising
front 30 A patient has a large, bounding carotid pulse on exam. Which lesion best matches this pulse finding? A) Aortic stenosis B) Aortic regurgitation C) Coarctation of aorta D) Infective endocarditis	back 30 B. Aortic regurgitation
front 31 Which carotid pulse finding best matches aortic regurgitation A) Large and bounding B) Small and delayed C) Two narrowly spaced waves D) Absent femoral pulse	back 31 A. Large and bounding
front 32 A patient has mixed aortic stenosis and regurgitation. Which carotid pulse is expected? A) Pulsus paradoxus B) Pulsus alternans C) Pulsus parvus D) Pulsus bisferiens	back 32 D. Pulsus bisferiens

front 33 Pulsus bisferiens is best described as which carotid pulse pattern? A) Slow single delayed wave B) Weak collapsing upstroke C) Two narrowly spaced positive waves D) Normal pulse with respiratory variation	back 33 C. Two narrowly spaced positive waves
front 34 Which condition has pulsus bisferiens as a cardinal finding? A) Aortic stenosis only B) Hypertrophic cardiomyopathy C) Pulmonary valve stenosis D) Mitral regurgitation	back 34 B. Hypertrophic cardiomyopathy
front 35 A patient has two narrowly spaced positive carotid waves. Which term best describes this pulse? A) Pulsus bisferiens B) Pulsus parvus C) Pulsus tardus D) Pulsus paradoxus	back 35 A. Pulsus bisferiens
front 36 A public health researcher stratifies heart disease mortality by sex. Which pattern is most consistent with epidemiologic data A) Equal deaths in both sexes B) More than half in males C) Mostly pediatric female deaths D) Predominantly young female deaths	back 36 B. More than half in males

front 37 A 58-year-old smoker with uncontrolled hypertension and elevated LDL asks which modifiable factors most strongly increase heart disease risk. Which set is most appropriate? A) HTN, LDL, smoking B) HDL, exercise, estrogen C) Fever, anemia, obesity D) Bradycardia, vagal tone, age	back 37 A. HTN, LDL, smoking
front 38 A 19-year-old from a resource-limited region develops chronic valvular disease after recurrent untreated pharyngitis. Which acquired heart disease is most common in patients under 25? A) Bacterial endocarditis B) Hypertrophic cardiomyopathy C) Rheumatic heart disease D) Aortic dissection	back 38 C. Rheumatic heart disease
front 39 A global health team studies populations with very high rates of acute renal failure and rheumatic heart disease. Which populations are especially affected? A) Inuit, Scandinavians, Japanese B) Indigenous Australians, Maori, Pacific Islanders C) Central Europeans, Greeks, Koreans D) Ashkenazi Jews, Italians, Russians	back 39 B. Indigenous Australians, Maori, Pacific Islanders
front 40 A clinician wants to focus rheumatic heart disease screening in the region with the highest reported prevalence, including Fiji. Which region is most appropriate? A) Pacific region B) Mediterranean region C) Caribbean region D) Central Europe	back 40 A. Pacific region

front 41 A patient who injects street drugs develops fever and a new murmur. Which diagnosis is most directly associated with this risk factor? A) Rheumatic fever B) Bacterial endocarditis C) Metabolic syndrome D) Viral pericarditis	back 41 B. Bacterial endocarditis
front 42 A patient with bacterial endocarditis develops stroke-like symptoms, renal infarcts, and splenic lesions. Which mechanism best explains these systemic findings? A) Isolated vagal overactivity B) Persistent bacteremia with spread C) Primary phrenic nerve irritation D) Sympathetic ganglion failure	back 42 B. Persistent bacteremia with spread
front 43 Which complication pattern best matches bacterial endocarditis? A) Valvular damage plus metastatic infection B) Isolated pericardial pain C) Pure coronary vasospasm D) Reversible insulin resistance	back 43 A. Valvular damage plus metastatic infection
front 44 A patient with hypertension, hyperglycemia, central obesity, abnormal cholesterol, and abnormal triglycerides is diagnosed with a syndrome that increases CVD, stroke, and type 2 diabetes risk. What is the alternate name? A) Rheumatic syndrome B) Endocarditis syndrome C) Insulin resistance syndrome D) Neurocardiac syndrome	back 44 C. Insulin resistance syndrome

front 45 Which set contains the five defining risk factors of metabolic syndrome? A) HTN, hyperglycemia, central obesity, dyslipidemia B) Fever, murmur, bacteremia, emboli C) Cyanosis, clubbing, dyspnea, syncope D) Bradycardia, hypotension, anemia, edema	back 45 A. HTN, hyperglycemia, central obesity, dyslipidemia
front 46 A patient with acute pericarditis has sharp pain referred to the shoulder. Which pericardial layer and nerve best explain pain transmission? A) Visceral pericardium; vagus nerve B) Parietal pericardium; phrenic nerve C) Epicardium; cervical cardiac nerve D) Myocardium; thoracic splanchnic nerve	back 46 B. Parietal pericardium; phrenic nerve
front 47 During cardiac surgery, manipulation of one pericardial layer produces no pain despite direct contact. Which layer is being manipulated? A) Parietal pericardium B) Fibrous pericardium C) Visceral pericardium D) Pleural pericardium	back 47 C. Visceral pericardium
front 48 A student traces ventricular depolarization through the heart wall. Which direction best describes normal spread of electrical impulses? A) Epicardial to endocardial B) Endocardial to epicardial C) Apex to venous sinus D) Pericardial to pleural space	back 48 B. Endocardial to epicardial

front 49 Which cardiac structures receive both sympathetic and parasympathetic fibers? A) SA and AV nodes B) Papillary muscles C) Coronary valves D) Ventricular myocardium	back 49 A. SA and AV nodes
front 50 A lesion selectively disrupts sympathetic cardiac fibers. Which cardiac region would be most affected because it is predominantly sympathetically innervated? A) Parietal pericardium B) Ventricular musculature C) Tracheal bifurcation D) Visceral pericardium	back 50 B. Ventricular musculature
front 51 A spinal cord lesion from T1 to T5 disrupts which cardiac neural pathway? A) Parasympathetic vagal fibers B) Sympathetic cardiac fibers C) Phrenic pericardial fibers D) Visceral pain fibers	back 51 B. Sympathetic cardiac fibers
front 52 Preganglionic sympathetic fibers to the heart descend to T1-T5 and then synapse where? A) Thoracic and cervical sympathetic ganglia B) Medullary cardiovascular nuclei C) Aortic arch baroreceptors D) Tracheal bifurcation plexuses	back 52 A. Thoracic and cervical sympathetic ganglia

front 53 Postganglionic sympathetic fibers reach the cardiac plexus by traveling through which nerves? A) Vagus nerves B) Phrenic nerves C) Cervical cardiac nerves D) Recurrent laryngeal nerves	back 53 C. Cervical cardiac nerves
front 54 The cardiac plexus is formed by postganglionic sympathetic fibers joining parasympathetic fibers. Where is it located? A) Near renal artery bifurcation B) Near aortic arch and tracheal bifurcation C) Within the pericardial cavity D) Below the diaphragm only	back 54 B. Near aortic arch and tracheal bifurcation
front 55 A brainstem lesion affects areas that normally regulate sympathetic and parasympathetic output to the heart through cardioexcitatory and cardioinhibitory regions. Which structure is involved? A) Medullary cardiovascular center B) Cerebellar vermis C) Hypothalamic thirst center D) Basal ganglia	back 55 A. Medullary cardiovascular center
front 56 A patient has a sudden drop in arterial pressure. Which receptor-location pair first detects this change for rapid cardiovascular reflex control? A) Osmoreceptors; hypothalamus B) Chemoreceptors; renal cortex C) Stretch receptors; aortic arch and carotid sinus D) Pain receptors; parietal pericardium	back 56 C. Stretch receptors; aortic arch/carotid sinus

front 57 A patient becomes acutely hypotensive after blood loss. How do aortic arch and carotid sinus baroreceptors help raise cardiac output? A) Increase impulses to medulla B) Decrease impulses to medulla C) Increase vagal inhibition D) Decrease sympathetic output	back 57 B. Decrease impulses to medulla
front 58 On inspection of the anterior chest, which cardiac chamber forms most of the anterior cardiac surface? A) Right ventricle B) Left ventricle C) Right atrium D) Left atrium	back 58 A. Right ventricle
front 59 During a cardiac exam, where should the normal point of maximal impulse usually be palpated? A) Left 2nd ICS; sternal border B) Right 4th ICS; midclavicular line C) Left 5th ICS; midclavicular line D) Left 3rd ICS; parasternal line	back 59 C. Left 5th ICS; midclavicular line
front 60 A patient’s PMI is displaced laterally and inferiorly from its usual location. Which interpretation is most appropriate? A) Normal athletic variant B) Heart enlargement C) Aortic valve closure D) Reduced venous return	back 60 B. Heart enlargement

front 61 A murmur is difficult to classify as pulmonic versus aortic. Which auscultation site is especially useful for these sounds? A) Apex B) Tricuspid area C) Right 2nd ICS D) Erb point	back 61 D. Erb point
front 62 Erb point is located at which auscultation site? A) Left 3rd intercostal space B) Right 2nd intercostal space C) Left 5th midclavicular space D) Right lower sternal border	back 62 A. Left 3rd intercostal space
front 63 Which valve closure event produces the first heart sound, S1? A) Aortic and pulmonic closure B) Mitral and tricuspid closure C) Mitral and aortic closure D) Tricuspid and pulmonic closure	back 63 B. Mitral and tricuspid closure
front 64 Which valve closure event produces the second heart sound, S2? A) Aortic and pulmonic closure B) Mitral and tricuspid closure C) Mitral and aortic closure D) Tricuspid and pulmonic closure	back 64 A. Aortic and pulmonic closure

front 65 A clinician hears a valve opening sound during auscultation. What does this usually imply about that valve? A) It is physiologically silent B) It is pathologically damaged C) It is normally closing D) It is completely absent	back 65 B. It is pathologically damaged
front 66 A patient with mitral stenosis has an audible sound shortly after S2. Which term best describes opening of a narrowed AV valve A) Ejection click B) Pericardial knock C) Opening snap D) Dicrotic notch	back 66 C. Opening snap
front 67 A patient with aortic stenosis has an audible sound near the start of systole. Which term best describes opening of a damaged semilunar valve? A) Ejection click B) Opening snap C) Third heart sound D) Venous hum	back 67 A. Ejection click
front 68 Which timing best matches an opening snap from a pathologically narrowed AV valve? A) During systole B) During diastole C) During atrial repolarization D) During valve closure	back 68 B. During diastole

front 69 Which timing best matches an ejection click from a pathologically narrowed semilunar valve? A) During diastole B) During passive filling C) During systole D) During isovolumetric relaxation	back 69 C. During systole
front 70 The mitral component of S1, written M1, occurs when which pressure relationship closes the mitral valve? A) LA pressure exceeds LV pressure B) Aortic pressure exceeds LV pressure C) LV pressure exceeds LA pressure D) RV pressure exceeds RA pressure	back 70 C. LV pressure exceeds LA pressure
front 71 The tricuspid component of S1, written T1, occurs when which pressure relationship closes the tricuspid valve? A) RV pressure exceeds RA pressure B) RA pressure exceeds RV pressure C) LV pressure exceeds LA pressure D) Pulmonary pressure exceeds RV pressure	back 71 A. RV pressure exceeds RA pressure
front 72 Which cardiac-cycle interval occurs between AV valve closure and semilunar valve opening? A) Systolic ejection B) Isovolumetric relaxation C) Rapid ventricular filling D) Isovolumetric contraction	back 72 D. Isovolumetric contraction

front 73 The pulmonic valve opens when right ventricular pressure exceeds which pressure? A) Right atrial systolic pressure B) Pulmonary artery diastolic pressure C) Aortic diastolic pressure D) Left atrial pressure	back 73 B. Pulmonary artery diastolic pressure
front 74 The aortic valve opens when left ventricular pressure exceeds which pressure? A) Aortic diastolic pressure B) Left atrial pressure C) Pulmonary diastolic pressure D) Right ventricular pressure	back 74 A. Aortic diastolic pressure
front 75 Which cardiac-cycle period occurs between semilunar valve opening and semilunar valve closing? A) Isovolumetric contraction B) Passive ventricular filling C) Systolic ejection D) Isovolumetric relaxation	back 75 C. Systolic ejection
front 76 On an arterial pressure tracing, ejection ends and the aortic and left ventricular curves separate. What is this point called? A) Opening snap B) Dicrotic notch C) Point of maximal impulse D) Erb point	back 76 B. Dicrotic notch

front 77 The incisura/dicrotic notch occurs simultaneously with which event? A) Mitral valve closure B) Tricuspid valve opening C) Aortic valve closure D) Pulmonic valve opening	back 77 C. Aortic valve closure
front 78 The aortic component of S2 is written A2 and corresponds to closure of which valve? A) Aortic valve B) Pulmonic valve C) Mitral valve D) Tricuspid valve	back 78 A. Aortic valve
front 79 The pulmonic valve closes when right ventricular pressure falls below which pressure? A) Right atrial pressure B) Aortic diastolic pressure C) Left ventricular pressure D) Pulmonary diastolic pressure	back 79 D. Pulmonary diastolic pressure
front 80 The pulmonic component of S2 is commonly written as which abbreviation? A) M1 B) T1 C) A2 D) P2	back 80 D. P2

front 81 Which cardiac-cycle interval occurs between semilunar valve closure and AV valve opening? A) Isovolumetric relaxation B) Isovolumetric contraction C) Systolic ejection D) Rapid ejection	back 81 A. Isovolumetric relaxation
front 82 The tricuspid valve opens when which pressure relationship occurs? A) RV pressure exceeds RA pressure B) RA pressure exceeds RV pressure C) LV pressure exceeds LA pressure D) Aortic pressure exceeds LV pressure	back 82 B. RA pressure exceeds RV pressure
front 83 The mitral valve opens when which pressure relationship occurs? A) LV pressure exceeds LA pressure B) LA pressure exceeds LV pressure C) RV pressure exceeds RA pressure D) Aortic pressure exceeds LV pressure	back 83 B. LA pressure exceeds LV pressure
front 84 A 58-year-old with mitral regurgitation and congestive heart failure has a low-frequency early diastolic sound. Which heart sound is most associated with adult volume overload from regurgitant lesions or CHF? A) S4 B) S3 C) Split S1 D) A2	back 84 B. S3

front 85 A clinician hears a soft sound immediately before S1 during late diastole, when atrial contraction adds the final 10% to 20% of ventricular filling. Which heart sound is this? A) S2 B) S3 C) S4 D) Opening snap	back 85 C. S4
front 86 A 23-year-old healthy adult has an S4, while a 55-year-old with the same sound is suspected of having a stiff ventricle. Which interpretation is most accurate? A) Normal young; abnormal older B) Always pathologic at all ages C) Normal older; abnormal young D) Only caused by regurgitation	back 86 A. Normal young; abnormal older
front 87 A 62-year-old with long-standing hypertension has a noncompliant ventricle and an S4. Which remodeling pattern best explains this finding? A) Eccentric hypertrophy B) Chamber dilation only C) Ventricular wall thinning D) Concentric hypertrophy	back 87 D. Concentric hypertrophy
front 88 Which condition is a major cause of a stiff, noncompliant ventricle associated with S4 in adults older than 30? A) Coronary heart disease B) Isolated pulmonic regurgitation C) Physiologic S2 splitting D) Perioral cyanosis	back 88 A. Coronary heart disease

front 89 A clinician is trying to hear splitting of S1. Which auscultation area is most appropriate? A) Mitral area B) Aortic area C) Pulmonic area D) Tricuspid area	back 89 D. Tricuspid area
front 90 In normal S2 splitting, which valve closure occurs first? A) Aortic valve closure B) Pulmonic valve closure C) Tricuspid valve closure D) Mitral valve closure	back 90 A. Aortic valve closure
front 91 A healthy patient has wider separation between A2 and P2 during inspiration than expiration. Which finding is present? A) Fixed S2 splitting B) Paradoxical S2 splitting C) Physiologic S2 splitting D) Pathologic S1 splitting	back 91 C. Physiologic S2 splitting
front 92 Physiologic splitting of S2 is most prominent during which phase of respiration? A) Forced expiration B) Breath holding C) Valsalva release D) Inspiration	back 92 D. Inspiration

front 93 A healthy person’s heart rate rises slightly during inspiration. Which interpretation is most appropriate? A) Always pathologic B) Normal respiratory variation C) Sign of aortic stenosis D) Evidence of CHF	back 93 B. Normal respiratory variation
front 94 On an arterial waveform, a positive wave immediately follows the dicrotic notch. What is this wave called? A) Dicrotic wave B) Percussion wave C) Tidal wave D) Pulse pressure	back 94 A. Dicrotic wave
front 95 A waveform component occurs during peak velocity of arterial flow and reflects the rate of flow in the artery. Which wave is this? A) Dicrotic wave B) Tidal wave C) Jugular wave D) Percussion wave	back 95 D. Percussion wave
front 96 A waveform component occurs during peak systolic pressure and is related to pressure in the vessel. Which wave is this? A) Dicrotic wave B) Percussion wave C) Tidal wave D) Venous wave	back 96 C. Tidal wave

front 97 Which definition best describes arterial blood pressure? A) Venous pressure near right atrium B) Lateral arterial wall pressure C) Difference between BP values D) Stroke volume entering arteries	back 97 B. Lateral arterial wall pressure
front 98 Systolic blood pressure is best defined as which pressure, and what primarily regulates it? A) Peak pressure; SV and compliance B) Lowest pressure; peripheral resistance C) Mean pressure; venous return D) Pulse difference; arterial recoil	back 98 A. Peak pressure; SV and compliance
front 99 Diastolic blood pressure is best defined by which pairing? A) Peak pressure; stroke volume B) Pulse difference; vessel compliance C) Mean pressure; cardiac output D) Lowest pressure; peripheral resistance	back 99 D. Lowest pressure; peripheral resistance
front 100 A patient has BP 150/90 mm Hg. Which value represents the pulse pressure? A) 40 mm Hg B) 50 mm Hg C) 60 mm Hg D) 90 mm Hg	back 100 C. 60 mm Hg

front 101 A patient lying flat has systolic BP measured in both arms and legs. Which leg-arm systolic difference is normally expected? A) Legs 5 mm Hg lower B) Legs 15–20 mm Hg higher C) Legs equal to arms D) Legs 40 mm Hg higher	back 101 B. Legs 15–20 mm Hg higher
front 102 Jugular venous pulse is clinically useful because the jugular venous system is directly continuous with which chamber? A) Right atrium B) Left atrium C) Right ventricle D) Left ventricle	back 102 A. Right atrium
front 103 Which bedside finding gives direct information about pressures on the right side of the heart? A) Carotid pulse contour B) Point of maximal impulse C) Radial pulse amplitude D) Jugular venous pulse	back 103 D. Jugular venous pulse
front 104 What is the most common cause of right-sided CHF? A) Primary tricuspid stenosis B) Isolated pulmonic stenosis C) Left-sided CHF D) Pericardial cyst	back 104 C. Left-sided CHF

front 105 A patient with coronary heart disease reports exertional substernal chest discomfort relieved by rest. What is the true symptom of CHD? A) Cyanosis B) Angina pectoris C) Xanthelasma D) Pulsus bisferiens	back 105 B. Angina pectoris
front 106 Which pairing correctly matches heart sound location with where it is loudest? A) S1 apex; S2 base B) S1 base; S2 apex	back 106 A. S1 apex; S2 base
front 107 A 62-year-old with exertional substernal chest pressure has myocardial oxygen demand exceeding coronary supply. Which mechanism best explains angina? A) Pericardial stretch without ischemia B) Myocardial hypoxia from supply-demand imbalance C) Pulmonary venous rupture from stenosis D) Cerebral hypoperfusion during standing	back 107 B. Myocardial hypoxia from supply-demand imbalance
front 108 A patient describes chest discomfort by clenching a fist over the sternum. Which classic sign of angina is being demonstrated? A) Levine sign B) Kussmaul sign C) Homan sign D) Schamroth sign	back 108 A. Levine sign

front 109 When chest pain is truly cardiac in origin, which two causes are most common? A) Mitral stenosis and COPD B) PDA and pulmonary embolism C) Coronary atherosclerosis and aortic valvular disease D) Primary biliary cirrhosis and hypertriglyceridemia	back 109 C. Coronary atherosclerosis and aortic valvular disease
front 110 A patient wakes at night gasping for air and also becomes short of breath when lying supine. Which symptom is this? A) Orthopnea B) Platypnea C) Trepopnea D) Paroxysmal nocturnal dyspnea	back 110 D. Paroxysmal nocturnal dyspnea
front 111 A patient reports recurrent nighttime episodes of shortness of breath that force him to sit upright. This symptom is relatively specific for which disease? A) Familial hypercholesterolemia B) Congestive heart failure C) Primary biliary cirrhosis D) Aortic valvular disease	back 111 B. Congestive heart failure
front 112 A patient now sleeps with four pillows because lying flat causes dyspnea. Which symptom is being described? A) Orthopnea B) Trepopnea C) Platypnea D) Posttussive dyspnea	back 112 A. Orthopnea

front 113 A patient has shortness of breath only during activity. Which paired causes best match dyspnea on exertion? A) PDA and tendon xanthomata B) Levine sign and angina C) Chronic CHF and severe pulmonary disease D) Carotid sinus hypersensitivity and micturition	back 113 C. Chronic CHF and severe pulmonary disease
front 114 A patient becomes dyspneic only when lying on the left side but improves on the right side. Which positional dyspnea is this? A) Platypnea B) Trepopnea C) Orthopnea D) Paroxysmal nocturnal dyspnea	back 114 B. Trepopnea
front 115 A patient with chronic congestive heart failure reports trepopnea. Which side do these patients usually prefer lying on? A) Left side B) Supine C) Prone D) Right side	back 115 D. Right side
front 116 A patient is breathless while upright but improves after lying down. Which symptom is being described? A) Platypnea B) Orthopnea C) Trepopnea D) Dyspnea on exertion	back 116 A. Platypnea

front 117 A patient briefly loses consciousness because cerebral blood flow is inadequate, then rapidly recovers. Which term best describes this event? A) Angina B) Cyanosis C) Syncope D) Orthopnea	back 117 C. Syncope
front 118 A patient faints after standing and reports dizziness, blurred vision, and profound weakness beforehand. Which mechanism best fits? A) Bronchial vein rupture B) Peripheral autonomic limitation C) Patent ductus arteriosus shunting D) Tendon lipid deposition	back 118 B. Peripheral autonomic limitation
front 119 Which symptom cluster best matches orthostatic hypotension A) Hemoptysis, cyanosis, clubbing B) PND, orthopnea, edema C) Dizziness, blurred vision, weakness D) Chest pain, Levine sign, xanthomas	back 119 C. Dizziness, blurred vision, weakness
front 120 An older man faints while straining during nighttime urination after heavy alcohol intake. Which syncope type is most likely? A) Vasovagal syncope B) Carotid sinus syncope C) Posttussive syncope D) Micturition syncope	back 120 D. Micturition syncope

front 121 Is the most common fainting type and may be caused during sudden, stressful, or painful experiences such as receiving bad news or seeing blood A) Vasovagal syncope B) Orthostatic syncope C) Micturition syncope D) Posttussive syncope	back 121 A. Vasovagal syncope
front 122 What syncope is associated with a hypersensitive carotid sinus and is most common in older adults? A) Posttussive syncope B) Carotid sinus syncope C) Vasovagal syncope D) Orthostatic hypotension	back 122 B. Carotid sinus syncope
front 123 A patient with carotid sinus hypersensitivity has one subtype causing bradycardia and another causing hypotension without bradycardia. Which pairing is correct? A) Vasodepressor; cardioinhibitory B) Posttussive; orthostatic C) Cardioinhibitory; vasodepressor D) Micturition; vasovagal	back 123 C. Cardioinhibitory; vasodepressor
front 124 A patient with COPD faints after a severe coughing spell. Which syncope type is most likely? A) Carotid sinus syncope B) Micturition syncope C) Orthostatic syncope D) Posttussive syncope	back 124 D. Posttussive syncope

front 125 A patient with congestive heart failure has ankle swelling that is equal bilaterally and worsens throughout the day. Which finding best matches CHF edema? A) Symmetric dependent edema B) Unilateral morning edema C) Painful digital nodules D) Lower-extremity cyanosis only	back 125 A. Symmetric dependent edema
front 126 A patient with mitral stenosis develops hemoptysis. Which mechanism best explains the bleeding? A) Pulmonary artery rupture B) Bronchial vein rupture C) Aortic valve calcification D) Coronary plaque rupture	back 126 B. Bronchial vein rupture
front 127 In mitral stenosis, hemoptysis occurs because bronchial veins are exposed to what abnormal condition? A) Low venous pressure B) Low lymphatic pressure C) High back pressure D) High arterial oxygen	back 127 C. High back pressure
front 128 A child has cyanosis limited to the lower extremities due to a right-to-left shunt through a persistent fetal vessel. Which diagnosis-linked finding is this? A) Orthostatic cyanosis from CHF B) Central cyanosis from COPD C) Perioral cyanosis from infancy D) Differential cyanosis from PDA	back 128 D. Differential cyanosis from PDA

front 129 Differential cyanosis refers to cyanosis isolated to which body region? A) Lower extremities B) Upper extremities C) Face and lips D) Palms and soles	back 129 A. Lower extremities
front 130 Stony-hard, slightly yellowish masses are found on the extensor tendons of the fingers. Which association is most important? A) Infective endocarditis B) Familial hypercholesterolemia C) Preeclampsia D) Mitral stenosis	back 130 B. Familial hypercholesterolemia
front 131 Which locations are common sites for tendon xanthomata besides finger extensor tendons? A) Retina and conjunctiva B) Palms and soles C) Achilles and plantar tendons D) Bronchial and pulmonary veins	back 131 C. Achilles and plantar tendons
front 132 A rare, progressive, often fatal liver disease occurs primarily in females and may be associated with lipid skin findings. Which disease is this? A) Primary biliary cirrhosis B) Rheumatic heart disease C) Bacterial endocarditis D) Congestive heart failure	back 132 A. Primary biliary cirrhosis

front 133 A 54-year-old woman with cholestatic liver disease has positive anti-mitochondrial antibodies. Which diagnosis is most strongly supported by this antibody pattern? A) Infective endocarditis B) Primary biliary cirrhosis C) Acute rheumatic fever D) Familial hypertriglyceridemia	back 133 B. Primary biliary cirrhosis
front 134 A patient with primary biliary cirrhosis and markedly elevated cholesterol has multiple nodular yellow lesions on the hand. Which skin finding is most likely being shown? A) Tuberous xanthomata B) Osler nodes C) Erythema marginatum D) Splinter hemorrhages	back 134 A. Tuberous xanthomata
front 135 A child has sudden crops of yellow papules in the setting of a familial fat metabolism disorder. Which lipid disorder types are classically associated with eruptive xanthomata? A) Types II and III B) Types III and V C) Types I and IV D) Types II and IV	back 135 C. Types I and IV
front 136 A febrile child has disc-shaped erythematous lesions with raised edges after untreated streptococcal pharyngitis. Which diagnosis is suggested? A) Infective endocarditis B) Primary biliary cirrhosis C) Familial hypercholesterolemia D) Acute rheumatic fever	back 136 D. Acute rheumatic fever

front 137 A patient has erythema with reddened disc-shaped areas and raised borders. Which term best describes this rash? A) Janeway lesions B) Erythema marginatum C) Eruptive xanthomata D) Palatal petechiae	back 137 B. Erythema marginatum
front 138 A child with wide-set eyes, strabismus, low-set ears, upturned nose, and mandibular hypoplasia should be evaluated for which cardiac lesion? A) Mitral valve prolapse B) Pulmonic regurgitation C) Coarctation of aorta D) Supravalvular aortic stenosis	back 138 D. Supravalvular aortic stenosis Williams-Beuren Syndrome, often referred to as "elfin facies"
front 139 A child with moon facies and widely spaced eyes is being screened for congenital heart disease. Which lesion is particularly associated? A) Pulmonic stenosis B) Aortic regurgitation C) Mitral stenosis D) Tricuspid stenosis	back 139 A. Pulmonic stenosis Noonan syndrome
front 140 A patient with expressionless facies, puffy eyelids, and loss of the outer third of the eyebrow may develop which cardiac complication? A) Infective endocarditis B) Cardiomyopathy C) Aortic coarctation D) Rheumatic carditis	back 140 B. Cardiomyopathy

front 141 A 62-year-old with an oblique bilateral earlobe crease is found to have significant coronary disease. Which sign is this? A) Levine sign B) Schamroth sign C) Lichstein sign D) Roth sign	back 141 C. Lichstein sign
front 142 A patient has soft yellow plaques on the eyelids. Which associated disorder should be considered, although the finding is less specific than xanthoma? A) Hyperlipoproteinemia B) Acute rheumatic fever C) Cor pulmonale D) Aortic coarctation	back 142 A. Hyperlipoproteinemia
front 143 A 32-year-old has a corneal arcus on eye exam. Which condition should this raise suspicion for? A) Primary biliary cirrhosis B) Hypercholesterolemia C) Pulmonic stenosis D) Infective endocarditis	back 143 B. Hypercholesterolemia
front 144 A clinician notes a bluish ring around an older patient’s cornea. Which term best describes this finding? A) Roth spot B) Xanthelasma C) Arcus senilis D) Hypertelorism	back 144 C. Arcus senilis

front 145 A patient has corneal opacities from sarcoidosis. Which cardiovascular-pulmonary complications should be considered A) Cor pulmonale or myocardial involvement B) Coarctation or aortic dissection C) Rheumatic fever or mitral stenosis D) Endocarditis or palatal petechiae	back 145 A. Cor pulmonale or myocardial involvement
front 146 A tall patient with lens displacement is evaluated for a cardiac murmur. Which syndrome and valve lesion are most associated? A) Turner; coarctation B) Noonan; pulmonic stenosis C) Marfan; aortic regurgitation D) Ehlers-Danlos; mitral stenosis	back 146 C. Marfan; aortic regurgitation
front 147 A patient with fever and a new murmur has conjunctival hemorrhages on exam. Which diagnosis is most strongly suggested? A) Primary biliary cirrhosis B) Infective endocarditis C) Familial hypercholesterolemia D) Hypothyroid cardiomyopathy	back 147 B. Infective endocarditis
front 148 A child with hypertelorism is being screened for congenital heart disease. Which lesions are especially associated? A) MVP and mitral stenosis B) AR and coarctation C) Pulmonic and supravalvular AS D) PDA and tricuspid stenosis	back 148 C. Pulmonic and supravalvular AS

front 149 A patient with a high-arched palate is being evaluated for congenital cardiac abnormalities. Which association is most likely? A) Aortic stenosis B) Mitral valve prolapse C) Pulmonic regurgitation D) Tricuspid atresia	back 149 B. Mitral valve prolapse Marfans
front 150 A patient with fever, new murmur, and small hemorrhagic lesions on the palate is suspected of having which diagnosis? A) Acute rheumatic fever B) Primary biliary cirrhosis C) Infective endocarditis D) Coarctation of aorta	back 150 C. Infective endocarditis
front 151 A girl with short stature and webbed neck is found to have upper-extremity hypertension. Which associated lesion is most likely? A) Pulmonic stenosis B) Mitral valve prolapse C) Aortic regurgitation D) Coarctation of aorta	back 151 D. Coarctation of aorta
front 152 A child with webbed neck but normal female karyotype is suspected of Noonan syndrome. Which cardiac lesion is classically associated? A) Pulmonic stenosis B) Aortic regurgitation C) Mitral stenosis D) Tricuspid regurgitation	back 152 A. Pulmonic stenosis

front 153 A patient with pectus excavatum is evaluated for associated cardiac connective-tissue findings. Which association is most accurate? A) Turner; coarctation B) Marfan; mitral valve prolapse C) Noonan; aortic regurgitation D) PBC; pulmonic stenosis	back 153 B. Marfan; mitral valve prolapse
front 154 A patient with pectus carinatum has features of a connective tissue disorder. Which syndromic association is most accurate A) Marfan and Ehlers-Danlos B) Turner and Noonan C) PBC and sarcoidosis D) Rheumatic fever and CHD	back 154 A. Marfan and Ehlers-Danlos
front 155 A child with a suspected congenital heart defect has an extra phalanx and polydactyly on exam. Which cardiac lesion is most associated with these limb findings? A) Pulmonic stenosis B) Atrial septal defect C) Mitral valve prolapse D) Aortic regurgitation	back 155 B. Atrial septal defect
front 156 A tall patient with long, slender fingers has a diastolic murmur consistent with aortic regurgitation. Which syndrome is most suggested? A) Turner syndrome B) Noonan syndrome C) Down syndrome D) Marfan syndrome	back 156 D. Marfan syndrome

front 157 A girl has short stature, cubitus valgus, and medial deviation of the extended forearm. Which syndrome best matches these findings? A) Turner syndrome B) Marfan syndrome C) Noonan syndrome D) Ehlers-Danlos syndrome	back 157 A. Turner syndrome
front 158 During BP measurement, Korotkoff sounds disappear after initially appearing and then reappear at a lower pressure. What is this silence called? A) Pulse deficit B) Paradoxical pulse C) Auscultatory gap D) Dicrotic notch	back 158 C. Auscultatory gap
front 159 A child has supravalvular aortic stenosis. Which interarm BP pattern may be detected? A) Equal pressures bilaterally B) Right high; left low C) Left high; right low D) Both arms hypotensive	back 159 B. Right high; left low
front 160 A child with coarctation is evaluated for associated congenital cardiac lesions. Which pair is most classically associated? A) ASD and pulmonic stenosis B) MVP and tricuspid stenosis C) PDA and mitral stenosis D) Bicuspid aortic valve and VSD	back 160 D. Bicuspid aortic valve and VSD

front 161 A child has elevated blood pressure in both arms. Which additional measurement is essential to help rule out coarctation of the aorta? A) Jugular venous pressure B) Apical pulse only C) Lower-extremity blood pressure D) Hepatojugular reflex	back 161 C. Lower-extremity blood pressure
front 162 A trauma patient develops pericardial fluid accumulation, impaired diastolic filling, low cardiac output, and shock. Which condition is present? A) Pulmonary hypertension B) Cardiac tamponade C) Cardiomegaly D) Auscultatory gap	back 162 B. Cardiac tamponade
front 163 A patient with suspected cardiac tamponade has an exaggerated inspiratory fall in systolic blood pressure. Which clinical sign is being described? A) Pulse deficit B) Dicrotic wave C) Right ventricular rock D) Paradoxical pulse	back 163 D. Paradoxical pulse
front 164 A patient with an irregularly irregular rhythm has fewer radial pulses than apical beats. What does this difference represent A) Auscultatory gap B) Paradoxical pulse C) Pulse deficit D) Physiologic splitting	back 164 C. Pulse deficit

front 165 The hepatojugular reflex is performed during a cardiac exam to estimate which aspect of cardiac function? A) Left atrial size B) Right ventricular function C) Aortic valve mobility D) Coronary blood flow	back 165 B. Right ventricular function
front 166 A positive hepatojugular reflex correlates best with pulmonary artery wedge pressure and indicates which hemodynamic state? A) Decreased venous return B) Reduced central blood volume C) Increased central blood volume D) Isolated peripheral vasodilation	back 166 C. Increased central blood volume
front 167 A patient’s PMI is laterally displaced and palpable in two interspaces during the same respiratory phase. Which finding is suggested? A) Cardiomegaly B) Pulmonary stenosis C) Atrial septal defect D) Cardiac tamponade	back 167 A. Cardiomegaly
front 168 A clinician compares ventricular apical impulses. Which distinction is most accurate? A) RV localized; LV diffuse B) RV absent; LV diffuse C) RV diffuse; LV localized D) RV systolic; LV diastolic	back 168 C. RV diffuse; LV localized

front 169 A systolic impulse is palpated in the second intercostal space just left of the sternum. Which condition should be suspected? A) Mitral stenosis B) Aortic regurgitation C) Pulmonary hypertension D) Pericardial tamponade	back 169 C. Pulmonary hypertension
front 170 A sustained left parasternal impulse with lateral retraction is described as a right ventricular rock. What does it suggest? A) Enlarged right ventricle B) Small left ventricle C) Aortic valve stenosis D) Normal apical impulse	back 170 A. Enlarged right ventricle
front 171 A systolic murmur is accompanied by a palpable thrill. What minimum murmur grade does this imply on a I–VI scale? A) Grade II or higher B) Grade III or higher C) Grade IV or higher D) Grade VI only	back 171 C. Grade IV or higher
front 172 A murmur becomes louder with inspiration. Which origin is most likely? A) Left-sided heart sound B) Right-sided heart sound C) Pericardial friction rub D) Aortic arch bruit	back 172 B. Right-sided heart sound

front 173 A murmur begins with S1 and continues throughout systole until S2. Which term best describes it? A) Early diastolic murmur B) Systolic ejection murmur C) Holosystolic murmur D) Opening snap	back 173 C. Holosystolic murmur
front 174 Which alternative term is commonly used for a murmur that occurs throughout systole? A) Pansystolic murmur B) Presystolic murmur C) Protodiastolic murmur D) Continuous murmur	back 174 A. Pansystolic murmur
front 175 A murmur begins after S1 and ends immediately before S2 rather than occupying all of systole. Which murmur type is this A) Opening snap B) Systolic ejection murmur C) Holosystolic murmur D) Diastolic rumble	back 175 B. Systolic ejection murmur
front 176 A murmur begins after S2 and persists through the entire diastolic interval until S1. Which term best describes this murmur? A) Holosystolic B) Crescendo-decrescendo C) Holodiastolic D) Midsystolic	back 176 C. Holodiastolic

front 177 A clinician describes a murmur as rumbling, blowing, harsh, musical, machinery-like, or scratchy. Which murmur feature is being characterized? A) Quality B) Timing C) Radiation D) Intensity	back 177 A. Quality
front 178 A clinician suspects a pericardial friction rub. Which maneuver best helps auscultate this sound? A) Supine during inspiration B) Standing after squatting C) Left lateral after exercise D) Sitting, expiration breath-hold	back 178 D. Sitting, expiration breath-hold
front 179 A scratching chest sound disappears when the patient holds their breath in expiration. Which origin is most likely? A) Pericardial B) Pleural C) Valvular D) Carotid	back 179 B. Pleural
front 180 A healthy patient’s A2–P2 separation during inspiration is being evaluated. Where is physiologic S2 splitting best heard? A) Mitral area, sitting forward B) Tricuspid area, standing upright C) Pulmonic area, lying supine D) Aortic area, left lateral	back 180 C. Pulmonic area, lying supine

front 181 Why does lying supine help widen the A2–P2 split during inspiration? A) Increases venous return B) Decreases pulmonary return C) Delays aortic closure D) Shortens right ventricular systole	back 181 A. Increases venous return
front 182 A patient has variable loudness of S1 between beats. Which factor most directly affects S1 intensity? A) Pulmonary artery pressure B) Valve position at contraction C) Aortic wall compliance D) Respiratory phase only	back 182 B. Valve position at contraction
front 183 The angle through which an AV valve closes during ventricular contraction is called what? A) Valve excursion angle B) Annular recoil angle C) Commissural tension angle D) Arc of coaptation	back 183 D. Arc of coaptation
front 184 A patient has systemic hypertension with forceful semilunar valve closure. Which heart sound change is expected? A) Increased S2 intensity B) Decreased S1 intensity C) Fixed S2 splitting D) Opening snap	back 184 A. Increased S2 intensity

front 185 Calcification and fibrosis of aortic and pulmonic valves would most directly produce which auscultatory effect? A) Louder valve opening B) Louder S1 closure C) Softer S2 closure D) Fixed S2 splitting	back 185 C. Softer S2 closure
front 186 A patient with right bundle branch block has delayed right ventricular systole. Which S2 finding is expected? A) Paradoxical splitting B) Widened splitting C) Fixed splitting D) Single S2	back 186 B. Widened splitting
front 187 A condition shortens left ventricular systole so A2 occurs earlier than normal. Which S2 pattern results? A) Fixed splitting B) Single S2 C) Paradoxical splitting D) Wide splitting	back 187 D. Wide splitting
front 188 A patient has delayed left ventricular emptying from severe aortic stenosis. Which S2 splitting pattern is expected? A) Paradoxical splitting B) Fixed splitting C) Physiologic splitting D) Normal wide splitting	back 188 A. Paradoxical splitting

front 189 A child has a fixed split S2 that does not vary with respiration. Which lesion is classically associated? A) Ventricular septal defect B) Atrial septal defect C) Mitral regurgitation D) Aortic stenosis	back 189 B. Atrial septal defect
front 190 A high-pitched sound occurs early in systole at the onset of ejection from a deformed aortic valve. Which sound is this? A) Opening snap B) Midsystolic click C) Pericardial rub D) Ejection click	back 190 D. Ejection click
front 191 Ejection clicks are produced by opening of pathologically deformed valves in which valve class? A) AV valves B) Venous valves C) Semilunar valves D) Coronary valves	back 191 C. Semilunar valves
front 192 A midsystolic click is heard in a patient with valve prolapse. Which valves are most associated with this sound? A) Mitral or tricuspid B) Aortic or pulmonic C) Pulmonic or tricuspid D) Aortic or mitral	back 192 A. Mitral or tricuspid

front 193 A patient with mitral stenosis has a sharp sound shortly after S2 due to abnormal valve opening. Which sound is present? A) Ejection click B) Opening snap C) Dicrotic notch D) Midsystolic click	back 193 B. Opening snap
front 194 An opening snap is best described as which valve event? A) Systolic semilunar closure B) Diastolic semilunar opening C) Systolic AV closure D) Diastolic AV opening	back 194 D. Diastolic AV opening
front 195 A murmur is described as “blowing.” Which hemodynamic pattern most likely produces this quality? A) Large gradient, variable flow B) Small gradient, flow-dependent C) Large gradient, high flow D) Low pressure, no turbulence	back 195 A. Large gradient, variable flow
front 196 A murmur is described as “rumbling.” Which hemodynamic pattern best explains this quality? A) Large gradient, high flow B) Large gradient, variable flow C) Small gradient, flow-dependent D) Semilunar valve ejection	back 196 C. Small gradient, flow-dependent

front 197 A murmur is described as “harsh.” Which hemodynamic pattern best explains this quality? A) Small gradient, slow flow B) Low gradient, low flow C) Variable flow, no gradient D) Large gradient, high flow	back 197 D. Large gradient, high flow
front 198 A crescendo-decrescendo systolic murmur is produced by turbulence across the aortic valve during systole. Which murmur category is this? A) Diastolic AV murmur B) Systolic ejection murmur C) Regurgitant systolic murmur D) Holodiastolic murmur	back 198 B. Systolic ejection murmur
front 199 A patient has mitral regurgitation with retrograde flow from the left ventricle to left atrium during systole. Which murmur type is expected? A) Regurgitant systolic murmur B) Systolic ejection murmur C) Diastolic AV murmur D) Opening snap	back 199 A. Regurgitant systolic murmur
front 200 Regurgitant systolic murmurs such as mitral or tricuspid regurgitation usually have which timing? A) Early diastolic only B) Midsystolic only C) Holosystolic or pansystolic D) Late diastolic only	back 200 C. Holosystolic or pansystolic

front 201

A murmur begins after S2 when a narrowed mitral valve opens during ventricular filling. Which murmur type is this?

A) Systolic ejection murmur

B) Regurgitant systolic murmur

C) Holosystolic murmur

D) Diastolic AV murmur

back 201

D. Diastolic AV murmur

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