BLBK691-c01 BLBK691-Pai-241-167 October 23, 2017 22:17 Printer Name: Trim: 241mm × 167mm History and Physical Examination .. A 25-year-old woman has a 2/6 ejection systolic murmur best heard in the second left intercostal space with normal S1. The S2 is split during inspiration, and P2 intensity is normal. No apical or parasternal heave. The murmur diminishes during expiration and standing up. What is the murmur likely due to? A. Physiological or normal B. Atrial septal defect (ASD) C. Bicuspid aortic valve D. Hypertrophic obstructive cardiomyopathy (HOCM) .. A 29-year-old pregnant woman was found to a have a systolic murmur best heard in the second left intercostal space. It is rough and there was a palpable thrill in the same area and in the suprasternal notch. Patient is asymptomatic and has normal exercise tolerance. What is the likely explanation of the murmur? A. Pulmonary stenosis (PS) B. Normal flow murmur due to increased cardiac output C. Posterior mitral leaflet prolapse causing an interiorly directed jet D. Mammary souffle´ .. A 22-year-old patient has a hypoplastic radial side of the forearm and fingerized thumb. What this may be associated with? A. ASD C. Coarctation of aorta B. Tetralogy of Fallot D. Ebstein’s anomaly .. A 28-year-old man presented with a history of shortness of breath on exertion. On examination, the pulse rate was 76 bpm and blood pressure (BP) 126/80 mmHg. The left ventricular apex was prominent and forceful. The S1 and S2 were normal, buttherewasa2/6ejectionsystolicmurmurbestheardinthethirdrightinter- costal space. There was no appreciable variation with respiration, but there was an increase in intensity with the Valsalva maneuver and standing up. It seemed to be less prominentCOPYRIGHTED on squatting. There was MATERIAL no audible click. What is the murmur likely due to? A. Valvular aortic stenosis C. Mitral valve prolapse (MVP) B. HOCM D. Innocent murmur .. A 36-year-old asymptomatic woman was found to have a systolic murmur best heard in the apex, but also in the aortic area. It was mid to late systolic and was associated with a sharp systolic sound. What is the likely cause of the murmur? A. Posterior mitral leaflet prolapse C. Valvular aortic stenosis B. Anterior mitral leaflet prolapse D. Aortic subvalvular membrane .. A 78-year-old man with hypertension and diabetes mellitus presented with exer- tional shortness of breath of 6 months’ duration. Examination revealed a 4/6 crescendo–decrescendo murmur best heard in the second right intercostal space. Cardiology Board Review, First Edition. Ramdas G. Pai, Padmini Varadarajan and Sudha M. Pai. © 2018 John Wiley & Sons, Ltd. Published 2018 by John Wiley & Sons, Ltd. BLBK691-c01 BLBK691-Pai-241-167 October 23, 2017 22:17 Printer Name: Trim: 241mm × 167mm Cardiology Board Review The first component of the second sound was soft. The murmur was also heard Chapter 1 along the right carotid artery. What is this patient likely to have? A. Mild aortic stenosis C. Pulmonary stenosis B. Moderate or severe aortic stenosis D. MR .. A thrill and a continuous machinery murmur in the left infraclavicular area is indicative of what? A. Patent ductus arteriosus (PDA) B. Increased flow due to left arm arteriovenous (AV) fistula for dialysis C. Venous hum D. Pulmonary AV fistula .. Which of the following is not a feature of aortic coarctation? A. A continuous murmur on the back B. Lower blood pressure in legs compared with arm C. Radiofemoral delay D. Pistol shot sounds on femoral arteries .. A 22-year-old newly immigrant woman was referred to high-risk pregnancy clinic because of clubbing and cyanosis. Examination in addition revealed a paraster- nal heave, 4/6 ejection systolic murmur in the third left intercostal space, normal jugular venous pressure (JVP), and oxygen saturation of 75%. What will you rec- ommend after confirmation of the diagnosis? A. Continue pregnancy with sodium restriction B. Continue pregnancy, but deliver at 28 weeks C. Advise termination of pregnancy D. Perform percutaneous ASD closure and continue pregnancy .. What is the murmur of ASD? A. Continuous due to flow across the defect B. Ejection systolic due to increased flow across the pulmonary valve C. Mid-diastolic due to increased flow across the tricuspid valve D. Continuous over lung fields due to increased flow in lungs .. What is a systolic click that disappears on inspiration likely due to? A. Pulmonary valvular stenosis C. MVP B. Bicuspid aortic valve D. Pulmonary hypertension .. A 36-year-old woman presented with an 8-month history of progressive exer- tional dyspnea. Physical examination revealed heart rate of 74 bpm, regular, BP 126/78 mmHg, no pedal edema. JVP and carotid upstroke were normal. Cardiac auscultation revealed normal S1, an accentuated P2 with narrow splitting of S2, an ejection click, and a 2/6 ejection systolic murmur. What is the likely diagnosis? A. Pulmonary hypertension C. Aortic stenosis B. PS D. ASD .. Causes of prominent “a” wave in jugular venous pulsations include all of the fol- lowing except which option? A. PS D. Aortic stenosis B. Pulmonary hypertension E. ASD C. Tricuspid stenosis BLBK691-c01 BLBK691-Pai-241-167 October 23, 2017 22:17 Printer Name: Trim: 241mm × 167mm 1 History and Physical Examination .. What is a 6-year-old Amish boy in Pennsylvania with short stature, polydactyly, Chapter 1 short limbs, absent upper incisor teeth with dysplasia of other teeth, and a systolic murmur most likely to have? A. ASD C. Aortic coarctation B. Ventricular septal defect D. PS .. Which of the following describes ventricular septal defect murmur? A. Holosystolic C. Systolico-diastolic B. Ejection systolic D. None of the above .. Clubbing and cyanosis in lower limbs, but not upper limbs, is indicative of which of the following? A. PDAwithcoarctationofaorta B. PDA with pulmonary hypertension C. Ventricular septal defect Eisenmenger’s D. ASD Eisenmenger’s with coarctation of aorta .. A 46-year-old man presented with progressive fatigue and leg swelling. He had no significant past medical history except a front-on collision in a car he was driving. Examination revealed 2+ edema, raised JVP, and an enlarged liver, which seemed to expand during systole. What is the likely diagnosis? A. Severe tricuspid stenosis C. Constrictive pericarditis B. Severe tricuspid regurgitation (TR) D. Restrictive cardiomyopathy .. A 23-year-old has a mid-diastolic rumble and sharp early diastolic sound. What is the likely explanation? A. Mitral stenosis C. Restriction B. Constriction D. Bicuspid aortic valve .. A 28-year-old man has history of progressive fatigue and exertional shortness of breath over the last 6 months. Examination revealed raised JVP that seemed to increase with inspiration and a sharp precordial sound in early diastole. What is themostlikelydiagnosis? A. Right ventricular infarct C. Constrictive pericarditis B. Tricuspid stenosis D. Restrictive cardiomyopathy .. A 66-year-old woman with left breast cancer post mastectomy, radiation, and chemotherapy was admitted with shortness of breath, heart rate of 120 bpm, and BP of 90/60 mmHg. On slow cuff deflation during BP measurement, Korotkoff’s sounds started at 90 mmHg during expiration only and throughout the respiratory cycle at a cuff pressure of 70 mmHg. An echocardiogram was obtained. What is this likely to show? A. Akinesis of left anterior descending area B. Thick pericardium C. Large pericardial effusion D. Large, globally hypokinetic left ventricle. .. Features of restrictive cardiomyopathy may include all of the following except which option? A. Raised JVP B. Loud S3 C. Kussmaul’s sign D. A diastolic knock in pulmonary area BLBK691-c01 BLBK691-Pai-241-167 October 23, 2017 22:17 Printer Name: Trim: 241mm × 167mm Cardiology Board Review .. Pulsus paradoxus despite tamponade may not be present in which of the following? Chapter 1 A. ASD C. Mitral stenosis B. Aortic stenosis D. Old age .. Pulsus paradoxus may occur in all of the following except which option? A. Tamponade C. Pulmonary embolism B. Status asthmaticus D. Aortic stenosis .. Square sign during Valsalva maneuver occurs in which of the following? A. HOCM C. Aortic stenosis B. MVP D. Congestive heart failure .. An abnormal Schamroth’s test may be found in all of the following except which option? A. Tetralogy of Fallot C. Left atrial myxoma B. Subacute bacterial endocarditis D. Aortic stenosis 1.26–1.31. For the jugular vein or RA pressure tracings shown in Figures 1.26–1.31, match with an appropriate clinical scenario from the following choices: Q26 Q29 mmHg mmHg 10 10 5 5 0 0 Q27 Q30 mmHg mmHg 10 10 5 5 0 0 Q28 Q31 mmHg mmHg (mean) 10 10 5 5 Inspiration 0 0 Figures .–. BLBK691-c01 BLBK691-Pai-241-167 October 23, 2017 22:17 Printer Name: Trim: 241mm × 167mm 1 History and Physical Examination A. Normal F. TR Chapter 1 B. Pericardial constriction G. Cardiac tamponade C. Restrictive cardiomyopathy H. Superior vena cava syndrome D. ASD I. Heart failure E. Tricuspid stenosis J. PS 1.32–1.37. For the jugular vein or RA pressure tracings shown in Figures 1.32–1.37, match with an appropriate clinical scenario from the following choices: A. Normal G. Cardiac tamponade B. Pericardial constriction H. Superior vena cava syndrome C. Restrictive cardiomyopathy I. Heart failure D. ASD J. PS E. Tricuspid stenosis K. Complete heart block F. TR Q32 Q35 mmHg mmHg (mean) 10 10 Inspiration 5 5 0 0 Q33 Q36 mmHg a v a v mmHg (mean) 10 20 5 10 Inspiration 0 0 Q34 Q37 mmHg mmHg (mean) 10 20 5 10 Inspiration 0 0 Figures .–. 1.38–1.45. For the carotid pulse or arterial pressure tracings shown in Figures 1.38– 1.45, match with an appropriate clinical scenario from the following choices: A.