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It is a vascular noise.

Module 4 midterm

Question 1

How should you determine whether a murmur is systolic or diastolic?

Palpate the carotid pulse

Palpate the radial pulse

Judge the relative length of systole and diastole by auscultation

Correlate the murmur with a bedside heart monitor

Question 2

Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except _________________.

changes in weight

fatigue and weakness


fever and chills

Question 3

Mrs. Anderson presents with an itchy rash which is raised, and which appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash?

Insect bite

Urticaria or hives



Question 4

Steve has just seen a 5-year-old girl who wheezes when exposed to cats. The patient s family history is positive for asthma. You think the child most likely has asthma. What have you accomplished?

You have tested your hypothesis

You have developed a plan

You have established a working diagnosis

You have created a hypothesis

Question 5

You note a painful ulcerative lesion near the medial malleolus, with accompanying hyperpigmentation. Which of the following etiologies is most likely?

Arterial insufficiency

Neuropathic ulcer

Venous insufficiency


Question 6

You notice a strong pulse and then a weak pulse. The pattern continues. Which of the following is most likely?


Asthma exacerbation

Severe left heart failure

Cardiac tamponade

Question 7

Where is the point of maximal impulse (PMI) normally located?

In the left intercostal space, 7 to 9 cm lateral to the sternum

In the 5th intercostal space, 10 to 12 cm lateral to the sternum

In the 5th intercostal space, in the anterior axillary line

In the 5th intercostal space, in the mid-axillary line

Question 8

Sudden, painful unilateral loss of vision may be caused by which of the following conditions?

Vitreous hemorrhage

Central retinal artery occlusion

Macular degeneration

Optic neuritis

Question 9

Which of the following lists the proper sequence of examination for the abdomen?

Auscultation, inspection, palpation, percussion

Inspection, percussion, palpation, auscultation

Inspection, auscultation, percussion, palpation

Auscultation, percussion, inspection, palpation

Question 10

Which valve lesion typically produces a murmur of equal intensity throughout systole?

Aortic stenosis

Mitral insufficiency

Pulmonic stenosis

Aortic insufficiency

Question 11

You are performing a thorough cardiac examination. Which of the following chambers of the heart can you assess by palpation?

Left atrium

Right atrium

Right ventricle

Sinus node

Question 12

You are palpating the apical impulse in a patient with heart disease and find that the amplitude is diffuse and increased. Which of the following conditions could be a potential cause of an increase in the amplitude of the impulse?


Aortic stenosis, with pressure overload of the left ventricle

Mitral stenosis, with volume overload of the left atrium


Question 13

Which of the following may be missed unless the patient is placed in the left lateral decubitus position and auscultated with the bell of the stethoscope?

Mitral stenosis murmur

Opening sap of the mitral valve

S3 and S4 gallops

All the above

Question 14

You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure that they can distinguish between jugular venous pulsations and the carotid pulse. Which one of the following characteristics is typical of the carotid pulse?


Soft, rapid, undulating quality

Pulsation eliminated by light pressure on the vessel

Level of pulsation changes with changes in position

Question 15

Which area of the fundus is the central focal point for incoming images?

The fovea

The macula

The optic disk

The physiologic cup

Question 16

Asymmetric blood pressure results (left versus right sides of the body) are seen in which of the following conditions?

Coronary Artery Disease

Congenital narrowing of the aorta

Diffuse atherosclerosis

Vasculitis as seen in systemic lupus erythematosus

Question 17

Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration, and with expiration being longer than inspiration?





Question 18

Which of the following is true of a grade 4-intensity murmur?

It is moderately loud.

It can be heard with the stethoscope off the chest

It can be heard with the stethoscope partially off the chest

It is associated with a “thrill”

Question 19

What is responsible for the inspiratory splitting of S2?

Closure of aortic and then the pulmonic valves

Closure of mitral and then the tricuspid valves

Closure of aortic and then the tricuspid valves

Closure of mitral and then the pulmonic valves

Question 20

Which of the following events occurs at the start of diastole?

Closure of the tricuspid valve

Opening of the pulmonic valve

Closure of the aortic valve

Production of the first heart sound S1

Question 21

Which of the following is consistent with good percussion technique?

Allow all of the fingers to touch the chest while performing percussion

Maintain a stiff wrist

Leave the plexor finger on the pleximeter after each strike

Strike the pleximeter over the distal interphalangeal joint

Question 22

Which of the following is consistent with the obturator sign?

Pain distant from the site used to check rebound tenderness

Right hypogastric pain with the right hip and knee flexed and the hip internally rotated

Pain with extension of the right thigh while the patient is on her left side or while pressing her knee against your hand with thigh flexion

Pain that stops inhalation in the right upper quadrant

Question 23

A patient presents for evaluation of a sharp aching chest pain which increases with breathing. Which anatomic area would you localize the symptoms to?





Question 24

Which of the following occurs in respiratory distress?

Speaking in sentences of 10 to 20 words

Skin between the ribs moves inward with inspiration

Neck muscles relaxed

Patient torso leans posteriorly

Question 25

Which of the following conditions would produce a hyperresonant percussion note?

Large pneumothorax

Lobar pneumonia

Pleural effusion


Question 26

The components of the health history include all of the following except which one?

Review of systems

Thorax and lungs

Present illness

Personal and social items

Question 27

A patient comes to the emergency room for evaluation of shortness of breath. To which anatomical region would you assign symptoms?





Question 28

You ask a patient to draw a clock. He fills in all the numbers on the right half of the circle. What do you suspect?



Oppositional defiant disorder


Question 29

Cody is a teenager with a history of leukemia and an enlarged spleen. Today, he presents with fairly significant left-upper quadrant pain. On examination of this area, a rough grating noise is heard. What is this sound?

It is a splenic rub.

It is a type of bowel noise.

It represents borborygmi.

It is a vascular noise.

Question 30

Which of the following is a “red flag” regarding patients presenting with headache?

Unilateral headache

Pain over the sinuses

Age over 50

Phonophobia and photophobia

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