Cardio Recalls (February 4, 2013)

Significant Clinical Findings

a. Caravallo’s  sign
b. (+) Hepatojugular reflux
c. Austin-Flint murmur
d. Persistent splitting of S2
e. Paradoxical splitting of S2
1. important physical examination finding in CHF (+) hepatojugular reflux
2. systolic ejection murmur of chronic severe aortic regurgitation is accompanied by which sound Austin-Flint murmur
3. mid-diastolic murmur heard over the pulmonic area in ASD is accompanied by which sound Persistent splitting of S2
4. increased loudness of holosystolic murmur of tricuspid regurgitation upon inspiration Caravallo’s  sign
5. heard in aortic stenosis Paradoxical splitting of S2
Cardiomyopathies
a. RVH
b. Concentric
c. Eccentric
d. LV dilation
e. biventricular hypertrophy
6. apex beat is displaced at the 6th ICS LAAL, (+) parasternal heave, (+) lift Eccentric
7. A 40-year-old female, with apical beat that retracts during systole RVH
8. hardly palpable LV Dilatation
9. A 40-year-old female with chronic HPN complained of chest pain. PE revealed apex beat at 5th ICS
Concentric
LMCL with a (+) apical lift
10. A 52-year-old male with chronic hypertension & DM2 complained of chest pain and SOB. PE
Eccentric
revealed (+) murmur of AR & MR. Apex beat is displaced at 5th ICS left anteroaxillary line with (+) lift.
Abnormal Sounds
a. Loud S1
b. Soft S1
c. Loud A2
d. Loud P2
e. Splitting of S2 on inspiration
f. persistent splitting of S2
g. paradoxical splitting of S2
11. Pulmonary hypertension Loud P2
12. Mitral stenosis Loud S1
13. Atrial fibrillation Soft S1
14. BP 220/120 mmHg Loud S1
15. Pulmonic stenosis Paradoxical Splitting of S2
16. Sinus tachycardia Loud S1
17. Chronic aortic regurgitation Loud A2
18. LBBB Paradoxical Splitting of S2
19. Severe aortic stenosis Loud A1
20. Normal PE findings Splitting of S2 on inspiration
Abnormal Pulses
a. Pulsus parvus et tardus
b. Corrigan’s  pulse
c. Pulsus paradoxus
d. Pulsus bisfiriens
e. Pulsus alternans
21. Chronic aortic regurgitation and aortic stenosis Pulsus bisfiriens
22. Aortic regurgitation Corrigan’s  pulse
23. Constrictive pericarditis Pulsus paradoxus
24. Severe aortic stenosis Pulsus parvus et tardus
25. CHF Pulsus alternans
Case
a. Mitral stenosis
b. Mitral regurgitation
c. Aortic stenosis
d. Aortic regurgitation
e. Tricuspid regurgitation
f. Pulmonic stenosis
g. Pulmonic regurgitation
26. diastolic blowing murmur Aortic regurgitation
27. 4th ICS parasternal line Tricuspid regurgitation
28. Ejection systolic murmur transmitted into the carotids Aortic stenosis
29. A 27 y/o female, worried about ECG finding of RBBB. Auscultation revealed presence of ejection
Pulmonic stenosis
systolic murmur which became louder during forceful expiration.
30. 65 year-old patient with DM, HPN, has a holosystolic murmur displaced to the left axilla, has a
Mitral regurgitation
diminished S1
31. machinery-like murmur
a.  Ebstein’s  anomaly   c. VSD PDA
b. PDA d. ASD
32. Greater BP in the upper extremities compared to the lower extremities
a. VSD c.  Ebstein’s  anomaly Coarctation of aorta
b. ASD d. Coarctation of aorta
33.  Heard  in  Erb’s  point,  transmitted  to  the  left  lower  sternal  border
a. tricuspid regurgitation c. VSD VSD
b. mitral regurgitation d. ASD
34. characteristic pulse in CHF
a. pulsus parvus et tardus c. dicrotic pulse Pulsus alternans
b. pulsus alternans d. pulsus bisfiriens
35. 64 year-old DM hypertensive experienced pain in right calf muscle on walking for 20 mins and
relieved by rest
Intermittent claudications
a. intermittent claudication c. DVT
b. acute ischemia d. osteoarthritis
Areas of Auscultation
a. 2nd ICS LSB
b. 2nd ICS RSB
c. Erb’s  point
d. 4th ICS LSB
e. 5th ICS LMCL
36. Pulmonary stenosis 2nd ICS LSB
37. Mitral stenosis 5th ICS LMCL
38. Opening snap 2nd ICS LSB
39. Mitral valve prolapse 5th ICS LMCL
40. PDA 2nd ICS LSB
41. Aortic stenosis 2nd ICS RSB
42. S3 & S4 5th ICS LMCL
43. Mitral regurgitation 5th ICS LMCL
44. Splitting of S2 2nd ICS LSB
45. Tricuspid regurgitation 4th ICS LSB
Congenital Heart Disease
a. Coarctation of Aorta
b. PDA
c. ASD
d. VSD
e. Ebstein’s  Anomaly
46. Fixed splitting of S2 ASD
47. Holosystolic murmur at the left parasternal area transmitted to the right sternal border VSD
48. sail sound Ebstein’s  Anomaly
49. BP elevated in the upper extremities markedly lower in the lower extremities Coarctation of aorta
50. machinery-like murmur PDA
CARDIO RECALLS

1 important physical examination finding in CHF (+) Hepatojugular reflux

2
3 Mid diastolic murmur heard over the pulmonic area in ASD is accompanied by
what sound? Persistent splitting of S2
4 loudness of holosystolic murmur of tricuspid regurgitation upon inspiration Caravallo's sign
5
6 apex beat is displaced at the 6th ICS LAAL, faint heart sound, (+) parasternal
heave, (+) lift Eccentric hypertrophy
7 40 yr old female, with apical beat that retracts during systole. RVH
8 SOB, apex at 6th ICS left midaxillary line.. faint heart sound, alcoholic and elicit
drug use.. Eccentric
9 40 y/o with chronic HPN complained of chest pain. PE revealed apex beat @
5th ICS LMCL with a (+) apical lift Concentric
10 10 A 52 y/o, Male, chronic hypertension & DM2 complained of chest pain and
SOB. PE revealed (+) murmur of AR & MR. Apex beat is displaced @ 5th ICS left
anteroaxillary line with (+) lift. Eccentric
11 Pulmonary hypertension
Loud P2
12
13 Atrial fibrillation Soft S1
14 BP 220/120 mmHg Loud S1
15
16 Sinus tachycardia Loud S1
17 Chronic aortic regurgitation Soft S1
18 LBBB Paradoxical splitting of S2
19 Severe aortic stenosis Paradoxical splitting of S2
20 Normal PE findings Split S2 on inspiration
21 Chronic aortic regurgitation and aortic stenosis Pulsus bisfiriens
22
23
24 Severe aortic stenosis
25 CHF Pulsus alternans
26
27
28
29 A 27 yo female, worried about ECG finding of RBBB. Auscultation revealed
presence of ejection systolic murmur which became louder during forceful
expiration. Pulmonic stenosis
30 65 year-old patient with DM, HPN, has a holosystolic murmur displaced to the
left axilla, has a diminished S1 Mitral regurgitation
31 Machinery-like murmur PDA
32 Greater BP in the upper extremities compared to the lower extremities Coarctation of aorta
33
34 Characteristic peripheral pulse inn CHF Pulsus alternans
35 DM hypertensive 64y.o experienced pain in right calf muscle on walking for 20
mins and relieved by rest Intermittent claudications
36 Pulmonary stenosis 2nd LICS
CARDIO RECALLS

37
38
39
40 PDA 2nd LICS
41 Aortic stenosis 2nd RICS
42 S3 & S4 5th ICS LMCL
43 Mitral regurgitation
44
45
46 Fixed splitting of S2 ASD
47 Holosystolic murmur at the left parasternal area transmitted to the right sternal
border VSD
48 sail sound Ebstein's Anomaly
49 BP elevated in the upper extremities markedly lower in the lower extremities Coarctation of Aorta
50 machinery-like murmur PDA
 KP
CVS – Post-Test Medicine I a. Mild Mitral Regurgitation
Match the ff PE findings with their corresponding clinical b. Mild Aortic Stenosis
condition: c. Moderate to severe mitral regurgitation
1. A 42-yearold male known hypertensive for 10 d. Moderate to severe aortic stenosis
years with BP 160/110mmHg on both arsms. Apex Matching Type
beat at 5th ICS LMCL but with (-)??? apical lift. LV 11. Mitral Stenosis:
Hypertrophy E- Apical diastolic rumbling murmur
2. A severely dyspneis, orthopneic patient with 12. Aortic Stenosis
distended jugular vein which becomes more D – Ejection systolic murmur at the 2nd ICS RSB
distended upon pressure on the lower area. transmitted to the neck
Hepatojugular Reflex 13. VSD
3. A chronic hypertensive and diabetic patient with A – Holosystolic murmur ar the Erb’s  point  
easy fatigability and orthopnea and bilateral pedal transmitted to the right.
edema. Apex beat is hardly palpable at the 6th ICS 14. Aortic Regurgutation
LMAL. LV Dilatation C – Diastolic  blowing  murmur  at  the  Erb’s  point  
4. A patient diagnosed with pericardial effusion due transmitted to the apex
to long standing SLE. The patient presents 15. Mitral Regurgitation
persistent distention of jugular vein on deep B – Apical holosystolic murmur
inspiration. Kussmaul sign
Mutliple Choice Type: 16. Chronic Hypertension with LVH
5. Persistent splitting of S2 is seen in which of the C – Atrial Gallop
following condition? 17. Congestive Heart Failure
a. ASD B – Ventricular Gallop
b. VSP 18. Chronic Aortic Regurgitation
c. Pulmonic stenosis E – Soft S1
d. Ebstein Anomaly 19. Mitral Stenosis
6. Paradoxical splitting of S2 is seen in which of the A – Loud S1
following condition? 20. Pulmonary Hypertension
a. CRBB D- Loud P2 – S2
b. LV failure
c. Pulmonic stenosis 21. Ebstein Anomaly
d. Tricuspid regurgitation A- Sail Sound
7. Accentuation of A-2 component of S2 is seen in: 22. Coronary Artery Disease
a. Pulmonary Hypertension E – Levine’s  sign
b. Systemic Hypertension 23. Pulmonic Regurgitation 2nd RHD
c. Pulmonic Stenosis D – Graham Steele murmur
d. Tricuspid Stenosis 24. Pulmonic stenosis
8. A ( + ) parasternal lift is seen in which of the C – Expiratory Splitting of S2
following? 25. PDA
a. LVH B – Machinery like murmur
b. RVH
c. VSD
d. ASD
9. A ( + ) apical diastolic thrill is seen in which of the
following?
a. Aortic stenosis
b. Mitral stenosis
c. Mitral Regurgitation
d. Aortic Regurgitation
10. A ( + ) systolic thrill at the base of the heart is seen
in:
CVS Post-Test Medicine 1 - KP; CML Page 1
CLINICAL MEDICINE I !
2012
!
For 1 to 5, choices are: a. Paradoxical
a. concentric d. RVH B. Wide
b. eccentric e. LVH C. Loud
c. LV dilatation D. Negative hepatojugular reflex
!
1. Not palpable in PE
!
36. Mitral stenosis
2. Forceful apical beat but not displaced 37. Hypertensive urgency
3. Markedly displaced at the left axillary line, hardly palpable. 38. Pulmonary hypertension
4. Displaced to axillary line 5th or 6th ICS anterior axillary. 39. Severe aortic stenosis
5. Palpable parasternally but retract in systole. 40. Pulmonary hypertension
!
For 6 to 20, choices are:
!
For 41 to 45, choices are:
a. 2nd LEFT ICS d. 4th ICS PS a. pulsusparvus et tardus d. (-) hepatojugular reflex
b. 2nd RIGHT ICS e. 5th ICS MCL b. Corrigan's pulse e. neck vein distention at 60°
c. Erb's point
!
6. Pulmonic stenosis
c. pulsusbisfiriens
!
41. normal PE finding
7. VSD 42. pulmonary edema
8. 43. aortic stenosis
9 44. combined aortic regurgitation and aortic stenosis
10 45. chronic aortic regurgitation
11. Aortic valve regurgitation
12. Mitral valve regurgitation
!
For 46 to 50, choices are:
13. Mitral prolapse a. ejection systolic murmur best heard at
14. Aortic stenosis b. persistent splitting
15. Mitral stenosis c. diastolic murmur
16. Loud S1 d. rumbling
17. Opening snap e. blowing
18. Loud P2
19. Hypertrophic cardiomyopathy
!
46.
20. LV hypertrophy
! 47. aortic stenosis

!
Multiple choice itona super haba, etoyung summary:
48. mitral stenosis
49. aortic regurgitation
50. pulmonic stenosis
21. mitral stenosis - diastolic rumbling.
22. aortic stenosis - transmitted to the carotid
23. aortic regurgitation - diastolic rumbling murmur
24. VSD - pansystolic
!
For 25 to 30, choices are:
a. Caravallo's d. Gallavardin's
b. Kussmaul's e. Austin-Flint
c. + hepatojugular f. machinery-like
!
25. aortic stenosis
26. tricuspid regurgitation
27. PTA
28. chronic aortic regurgitation
29. CHF
30. constrictive pericarditis
!
For 31 to 35, choices are:
a. loud P2 d. opening snap
b. loud A2 e. ejection click
c. non-ejection sound
!
31. mitral stenosis
32. Mitral valve prolapse
33. Constrictive pericarditis
34. pulmonary hypertension
35 chronic uncontrolled hypertension
!!
!!
!
For 36 to 40, choices are: