Exam (elaborations)

USMLE Problem set study Exam Questions and Correct Answers Guaranteed Success 2024/2025

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Uploaded on October 8, 2024
Number of pages 66
Written in 2024/2025
Type Exam (elaborations)
Contains Questions & answers

what is the most common cause of heart failure in
when do we most commonly or typically for step 1
when does s3 heart sound happen correct answer
how do we best auscultate an s3 gallop correct

Institution USMLE
Course USMLE

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USMLE Problem set study Exam
Questions and Correct Answers
Guaranteed Success 2024/2025

What is the most common cause of heart failure in developed
countries? - correct answer repeated bouts of myocardial
ischemia

When do we most commonly (or typically for Step 1) hear an S3
ventricular gallop? - correct answer in patients with left
ventricular systolic failure or restrictive cardiomyopathy

When does S3 heart sound happen? - correct answer
immediately following S2 during phase of rapid passive
ventricular filling

How do we best auscultate an S3 gallop? - correct answer with
the bell of the stethoscope at the ventricular apex

What 2 physical examination maneuvers can help bring out an S3
more audibly? - correct answer (1) lying the patient in a left
lateral decubitus position

(2) ask the patient to exhale completely while in that position by
decreasing the volume of the lungs and bringing heart closer to
the chest wall

Summarize the key facts of the S3 sound or S3 gallop. - correct
answer An S3 sound is a low frequency sound that can be

,physiologic in younger individuals, but typically pathologic in
older adults. In older adults, it results from left ventricular
systolic failure or restrictive cardiomyopathy. The S3 sound can
be accentuated by having the patient lie in the left lateral
decubitus position and fully exhale.

What are the characteristic ECG findings of a patient in A-fib? -
correct answer (1) absent P waves replaced with chaotic f
(fibrillatory) waves
(2) irregularly irregular R-R intervals
(3) narrow QRS complexes

What causes ventricular contraction rate in a patient in atrial
fibrillation? - correct answer Atrial fibrillation occurs due to
irregular, chaotic electrical activity within the atria

Some of the atrial impulses are transmitted to the ventricles, but
most are not.

This is due to the AV nodal refractory period.

What three pathologies do we associate a holosytolic murmur
with? - correct answer (1) tricuspid regurgitation
(2) mitral regurgitation
(3) ventricular septal defect

Does more or less blood return to the right heart during
inspiration? Why? - correct answer More blood returns

,because during inspiration intrathoracic pressure drops, allowing
more blood to return to the right heart

How do we differentiate a holosystolic murmur? I.e., how do we
know if it's tricuspid valve regurgitation vs. Mitral regurgitation
vs. Ventricular septal defect? - correct answer A tricuspid
regurgitation murmur would be expected to increase in intensity
during inspiraiton, while the other two would not

Summarize the cardiac findings in a patient with a tricuspid
valve regurgitation. - correct answer A holosystolic murmur
that increase in intensity on inspiration most likely represents
tricuspid regurgitaiton.

How do arterial baroreceptors monitor systemic blood pressure?
- correct answer Baroreceptors sense arterial wall stretch,
which is an indicator of systemic pressure in arterial circulation.
When stimulated by:
(1) stretch: nerves innvervating those baroreceptors increase
firing --> blood pressure decrease through peripheral
vasodilation and decreased cardiac output
(2) hypotension: decreased baroreceptor signaling --> releases
inhibition of vasoconstrictor center and increases blood pressure

Which two nerves monitor the baroreceptors in the neck? -
correct answer Glossopharyngeal nerve (IX) & Vagus nerve (X)

Which two anatomical landmarks are important loctaions of
barroreceptors that are especially important in blood pressure
control? - correct answer (1) the carotid sinus [located just
above the bifurcation of the common carotid artery]

, (2) the aortic arch

Which nerve innervates the baroreceptors of the aortic arch? -
correct answer the vagus nerve; fibers from the baroreceptors
run within the vagus nerve (X)

Which nerve is more associated with the carotid sinus? How is it
associated, and what is the name of the actual nerve / who is that
nerve a branch of? - correct answer (1) glossopharyngeal
nerve
(2) afferent fibers from the carotid sinus stretch receptors form a
small carotid sinus nerve called HERING'S NERVE, which is a
branch of the glossopharyngeal nerve

Where do all of our important baroreceptor nerves terminate?
I.e., fibers from the aortic arch baroreceptors and the carotid
sinus baroreceptors send their fibers to what brain structure? -
correct answer the solitary nucleus of the medulla

Describe the net impact on Mean Arterial Pressure (MAP) of
exercise on exercising muscle. - correct answer There is only a
modest blood pressure increase! This is because of peripheral
vasodilation to skeletal muscle within the muscle significantly
decreases the total systemic vascular resistance.

In what condition do where hear a "snap" followed by a rumbling
diastolic murmur, best heard over the cardiac apex? - correct
answer Mitral Stenosis

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