Week 4: Midweek Comprehension Quiz

Question 1

According to the lesson, heart failure can be assessed using the Framingham criteria. Which of the following findings are major criteria suggestive of heart failure? (Select all that apply)

• Orthopnea
• S3 gallop
• Neck-vein distention

Explanation:For establishing a diagnosis of CHF using the modified Framingham Criteria, 2 major criteria or 1 major and 2 minor criteria must be present. Major criteria include:

• Paroxysmal nocturnal dyspnea or orthopnea
• Neck-vein distention
• Rales
• Cardiomegaly
• Acute pulmonary edema
• S3 gallop
• Increased venous pressure >16 cm of water
• Hepatojugular reflux

Question 2

According to the lesson, the JVP is best assessed from pulsations in the right internal jugular vein, which is directly in line with the superior vena cava and right atrium?

• True

Explanation:Estimating the JVP is one of the most important and frequently used skills of physical examination. The JVP closely parallels pressure in the right atrium, or central venous pressure, related primarily to volume in the venous system. The JVP is best assessed from pulsations in the right internal jugular vein, which is directly in line with the superior vena cava and right atrium.

Question 3

According to the Bates’ Visual Guide video 10.9 Auscultation of Heart Sounds, splitting of S2 is best heard during inspiration over which area on the chest wall?

• Pulmonic

Explanation:A split S2 is best heard at the pulmonic valve listening post, as P2 is much softer than A2. Like the S1 heart sound, the S2 sound is described regarding splitting and intensity.

Question 4

According to the lesson, the border of the myocardium is generally located about 3 cm lateral to the left of the sternum?

• False

Explanation:The border of the myocardium is generally located about 6 cm (not 3 cm) lateral to the left of the sternum.

Question 5

According to the lesson, low-pitched sounds of S3 and S4 and the murmur of mitral stenosis are best heard using what?

• The bell of the stethoscope

Explanation:Listen throughout the precordium with the diaphragm, pressing it firmly against the chest. The bell is more sensitive to the low-pitched sounds of S3 and S4 and the murmur of mitral stenosis. Apply the bell lightly, with just enough pressure to produce an air seal with its full rim. Use the bell at the apex, then move medially along the lower sternal border. Resting the heel of your hand on the chest like a fulcrum may help you to maintain light pressure.