Transcript HARVEY SIMULATOR QUESTIONS

HARVEY®Simulation Exam
VCU Internal Medicine M3 Clerkship
IMSPE Exam
Harvey Question #1
• A 50 year-old man who hasn’t
seen a physician in 15 years
presents to your office for
establishment of regular care and
to update his health
maintenance. He denies known
medical problems and feels well
overall. His vital signs reveal a
blood pressure of 153/95 mm Hg,
a heart rate of 77/min, a
respiratory rate of 16/min, and a
temperature of 37.2 Celsius. You
auscultate his heart. What is the
abnormal finding and its most
likely cause?
A. Physiologic S3, no underlying
disease
B. S4, due to essential hypertension
C. S3, due to chronic systolic heart
failure
D. Fixed splitting of S2, due to atrial
septal defect
E. S4, due to hypertrophic
obstructive cardiomyopathy
(HOCM)
Harvey Question #2
• A 75 year-old man presents to
your office complaining of
exertional near-syncope over the
past several months, with
progressive worsening. He has no
exertional chest pain or dyspnea,
and otherwise has felt well. He
has a history of well-controlled
hypertension but no diabetes or
known coronary artery disease.
His blood pressue is 128/75 mm
Hg and his heart rate is 84/min.
You auscultate his heart. Identify
the abnormal findings and their
most likely cause.
A. Systolic murmur loudest at the apex
with an S3, due to mitral
regurgitation
B. Diastolic murmur loudest at the apex,
due to mitral stenosis
C. Systolic murmur loudest at the left
lower sternal border, due to
tricuspid regurgitation
D. Systolic murmur loudest at the right
upper sternal border with S4 at the
apex, due to aortic stenosis
E. Diastolic murmur loudest at the right
upper sternal border with S4 at the
apex, due to aortic regurgitation
Harvey Question #3
•
A 65 year-old man with multiple
medical problems presents to the
emergency department complaining
of progressive dyspnea on exertion,
orthopnea, and lower extremity
edema over the past several days. He
has no chest pain. He has poorlycontrolled hypertension and
diabetes, at least partly due to nonadherence to his medications. On
initial examination, his blood
pressure is 148/88 mm Hg, his heart
rate is 112/min, his respiratory rate is
24/min, and his pulse oximetry is
92% on room air. You auscultate his
heart and lungs. Identify the
abnormal findings and match them
with the most likely problem.
A. Holosystolic murmur heard best at the
apex, with S3 and S4; and inspiratory
crackles, due to systolic heart failure
and mitral regurgitation
B. Holosystolic murmur heard best at left
lower sternal border, with S3 and S4,
due to severe pulmonary hypertension
and triscuspid regurgitation
C. Holosystolic murmur heard best at left
lower sternal border and the apex, no S3
or S4, with inspiratory crackles, due to
ventricular septal defect
D. Diastolic murmur heard best at the apex
with an S4, due to mitral stenosis
E. Systolic murmur heard best at the left
upper sternal border due to pulmonic
stenosis
Harvey Question #4
• A 55 year-old woman presents
complaining of several days of
progressively worsening chest
pain that is severe in nature. She
has some mild dyspnea as well
but can’t really tell if it’s any
worse on exertion. She has
hypertension and diabetes, both
of which have been wellcontrolled. She recently had a
productive cough about 2-3
weeks ago that has since
resolved. You auscultate her
heart. What is the most likely
diagnosis based on your findings?
A. Acute mitral regurgitation due to
acute myocardial infarction
B.
Diastolic heart failure due to
long-standing hypertension
C.
Mitral stenosis due to
previously undiagnosed
rheumatic heart disease
D.
Aortic regurgitation due to
endocarditis
E.
Acute pericarditis due to recent
viral infection
Harvey Question #5
•
A 25 year-old man presents to your
office for a physical examination; he
would like to know if it’s safe for him
to begin a strenuous exercise
program. He is not aware of any
medical problems as a child, and he
feels well currently. He has no chest
pain or dyspnea with his current level
of activity (walking several blocks at a
time, climbing 1 flight of stairs). His
blood pressure is 115/75 mm Hg, his
heart rate is 68/min, his respiratory
rate is 15/min, and he appears
generally comfortable and in no
acute distress. You auscultate his
heart. What should you tell him
about your findings?
A.
Normal cardiac auscultation, no
limitations on exercise
B.
Systolic murmur heard at right upper
sternal border, concerning for aortic
stenosis, he should not exercise until an
echocardiogram has been obtained
C.
S4 heard at the apex, concerning for
hypertrophic obstructive
cardiomyopathy, he should not exercise
until an echocardiogram has been
obtained
D.
S3 heard at the apex, no limitations on
exercise
E.
S3 heard at the apex, concerning for left
ventricular dysfunction, he needs to see
a cardiologist prior to beginning any
exercise program
Harvey Question #6
•
A 52 year-old woman presents
complaining of progressively
worsening dyspnea on exertion.
Symptoms have been occurring for
several months. Years ago she was
told she had a heart murmur but was
told she didn’t need to worry about it
because she was feeling well at that
time. Her vital signs are a blood
pressure of 160/65 mm Hg, a heart
rate of 92/min, a respiratory rate of
22/min, and a pulse oximetry of 96%
on room air at rest. You auscultate
her heart. What are the abnormal
findings and the most likely
diagnosis?
A. Diastolic murmur best heard at the apex
due to mitral stenosis from prior
rheumatic heart disease
B . Systolic murmur heard throughout the
chest but loudest at the right upper
sternal border, due to aortic stenosis
C. Systolic murmur at the right upper sternal
border, diastolic murmur heard
throughout the chest but loudest at the
left lower sternal border, due to aortic
regurgitation
D. Systolic murmur best heard at the left lower
sternal border due to tricuspid
regurgitation from severe pulmonary
hypertension
E. Diastolic murmur heard best at the left
upper sternal border to the pulmonic
regurgitation