Bates question bank - Cardiovascular
A 55-year-old actress sustains a heart attack and the follow-up electrocardiogram demonstrates a left bundle branch block. What would be the likely duration of the QRS complex? - 95 milliseconds - 90 milliseconds - 100 milliseconds - 75 milliseconds - 125 milliseconds
125 milliseconds - The QRS complex is the duration of ventricular depolarization and is normally less than 100 milliseconds. Therefore, a left bundle branch block would extend ventricular depolarization and cause lengthening of the QRS complex and its duration.
A 45-year-old physician is placed on a beta-blocker for hypertension. Prior to medication administration, the patient's heart rate is 75 bpm with a cardiac output of 5 liters per minute. Following initiation of the medication, the heart rate decreases to 60 bpm without a change in stroke volume. What would be the expected new cardiac output? - 5 liters per minute - 10 liters per minute - 3 liters per minute - 6 liters per minute - 4 liters per minute
4 liters per minute - Cardiac output is the product of heart rate and stroke volume. Therefore, if the heart rate decreases by 20%, the cardiac output would decrease by 20% if the stroke volume did not change.
A 77-year-old man is experiencing progressive shortness of breath and dizziness. The patient undergoes cardiac catheterization, and the systolic blood pressure measured in the left ventricle is 180 mmHg, while the systolic blood pressure measured in the aorta is 140 mmHg. The patient is most likely experiencing symptoms related to what valvular condition? - Aortic insufficiency - Aortic stenosis - Pulmonic stenosis - Mitral stenosis - Mitral regurgitation
Aortic stenosis - Patients with aortic stenosis often experience dyspnea with exertion, chest pain, or dizziness. The calcification of the aortic valve and narrowing of the aortic valve area effectively decreases the blood flow from the left ventricle to the aorta. Given the obstruction created from the narrowing of the aortic valve, the pressure within the left ventricle is often higher than that seen in the aorta.
A 20-year-old college student is experiencing dyspnea on exertion and palpitations. On cardiac auscultation, the second heart sound is split and fixed on both inspiration and expiration. What is the most likely cardiac condition associated with this finding? - Tricuspid stenosis - Right bundle branch block - Pulmonic stenosis - Left bundle branch block - Atrial septal defect
Atrial septal defect - often experience dyspnea as well as atrial arrhythmias. Fixed splitting of the second heart sound occurs in ASD and right heart failure and does not vary with respiration.
On routine physical examination, a 40 year-old teacher is found to have a single second heart sound. The most likely explanation for this finding is what? - The patient has a right bundle branch block. - The patient has a left bundle branch block. - The patient has pulmonic stenosis. - Auscultation occurred during expiration. - Auscultation occurred during inspiration.
Auscultation occurred during expiration - during expiration, the components of S2, A2, and P2 fuse into a single sound.
T/F: Tricuspid stenosis does affect the second heart sound as it is a component of S2
False - Tricuspid stenosis would not usually affect the second heart sound as it is a component of S1
A first year medical student is examining a standardized patient with a structurally normal heart. The student is having difficulty auscultating the splitting sound of the second heart sound. At what area on the patient's chest would the student have the best opportunity of hearing this sound? - Apex - Lower left sternal border - Left second and third interspace - Right second interspace - Midsternum
Left second and third interspace - the pulmonic area is close to the sternum.
Name the locations for: mitral area, aortic valve, tricuspid space, and midsternum. (sorry this part of the question doesn't really make sense but it was in Bates)
Mitral area = apex Aortic valve = Right second interspace tricuspid space = lower left sternal border midsternum = does not correspond to the anatomic location of any of the four cardiac valves; however, it is important to remember that murmurs radiate and must be interpreted in the clinical scenario
What is Mitral stenosis involved with compared to mitral regurgitation?
Mitral stenosis is narrowing of the valve between the left atrium and left ventricle while mitral regurgitation involves the flow of blood from the left ventricle to the left atrium during systole when the mitral valve is normally closed
A 55-year-old truck driver with obstructive sleep apnea has diastolic heart failure. An echocardiogram demonstrates significant biatrial enlargement. What portion of his electrocardiogram would likely be abnormal? - S wave - R wave - QRS complex - T wave - P wave
P wave - is the result of atrial depolarization and would therefore have changes associated with atrial enlargement.
An elderly patient with a history of smoking two packs of cigarettes a day for 50 years complains to her physician of progressive shortness of breath. On cardiac exam, the physician feels the most prominent palpable impulse to be in the xiphoid area. This is most likely a result of what condition? - Hypertension - Mitral regurgitation - Aortic stenosis - Hypertrophic cardiomyopathy - Pulmonary hypertension
Pulmonary hypertension - may arise from underlying lung disease from smoking such as emphysema or COPD. Pulmonary hypertension often results in right ventricular hypertrophy.
A new born baby has an embryologic defect affecting the aortic valve. What other cardiac valve is most likely to be affected? - Tricuspid valve - Eustachian tube - Pyloric valve - Pulmonic valve - Mitral valve
Pulmonic valve - the pulmonic and aortic valves are semilunar valves and have similar embryologic origin. The tricuspid and mitral valves are atrioventricular valves. The pyloric valve is located between the stomach and small intestine. The Eustachian valve lies at the junction of the inferior vena cava and right atrium.
Match QRS complex, T wave, S wave, and R wave with either ventricular depolarization or ventricular repolarization.
QRS complex, R wave, and S wave are a result of ventricular depolarization T wave is a result of ventricular repolarization
A 70-year-old retired business executive presents to the ED with progressive shortness of breath and two-pillow orthopnea. On P/E, the blood pressure is 145/90 mmHg, there is jugular venous distension, lower extremitiy pitting edema to the knee, and a blowing holosystolic murmur heard best at the lower left sternal border. No other murmurs or thrills are auscultated on physical exam. Which of the following interventions is most likely to improve the patient's symptoms? - Replacement of the aortic valve - Replacement of the mitral valve - Decrease in blood pressure - Removal of intravascular volume with diuresis - Repair of a ventricular septal defect
Removal of intravascular volume with diuresis - This patient is in heart failure based upon the symptoms and P/E findings. The murmur is consistent with tricuspid regurgitation that may be the result of ventricular dilation and failure of the valve to completely close. Symptoms often improve with diuresis.
What kind of murmur would a ventricular septal defect cause?
a holosystolic murmur heard within the left third to fifth interspaces, but is often associated with a thrill.
What do right bundle branch block and pulmonic stenosis do to the heart sounds?
a wide splitting of the second heart sound is secondary to a delayed closure of the pulmonic valve and is often found in RBBBs and pulmonic stenosis
What is Aortic insufficiency is associated with?
blood flow from the aorta to the left ventricle during diastole and is often not associated with differences in systolic blood pressure
What does a left bundle branch block do?
delays the A2 component and cause paradoxical splitting.
Aortic stenosis, hypertrophic cardiomyopathy, and hypertension all cause what?
left ventricular hypertrophy and would displace the PMI lateral to the midclavicular line. Mitral regurgitation is often not associated with ventricular hypertrophy
What does a left bundle branch block cause?
paradoxical splitting secondary to the delayed closure of the aortic valve.
What happens when auscultation occurs during inspiration?
the right heart filling time is increased thereby delaying closure of the pulmonic valve and splitting S2 into two audible components.
What do pulmonic stenosis and a right bundle branch block have in common?
they delay the P2 component and cause fixed splitting of S2.
What is Pulmonic stenosis involved with?
valvular obstruction between the right ventricle and pulmonary artery.
