352.A 36-year-old male office worker comes to the clinic complaining of
general weakness and shortness of breath. He also relates a rapid, throb-
bing pulse after climbing a flight of stairs. Cardiac auscultation reveals a
diastolic rumbling murmur attributable to the mitral valve. The mitral
valve is best heard where?
a. Left side adjacent to the sternum in the second intercostal space
b. Left side adjacent to the sternum in the fifth intercostal space
c. Left side in the midclavicular line in the fifth intercostal space
d. Right side adjacent to the sternum in the second intercostal space
e. Right side adjacent to the sternum in the fourth intercostal space
353.A 62-year-old woman comes into your office complaining of a cough
and chest cold that she just can’t get rid of. While listening to her lungs,
which do sound congested, you also listen to her heart. While three of the
valves sound normal the valve sound at the second intercostal space just to
the right of the sternum sounds stenotic. You order a PA and lateral chest
film to evaluate the extent of her pneumonia, you also note that the aortic
arch/knob is enlarged, as is the left border of the heart. In addition to mild
pneumonia, which one of the following other conditions should be further
evaluated for potential treatment?
a. Pneumothorax
b. Ventricular septal defect
c. Aortic valve stenosis
d. Pulmonary valve stenosis
e. Mitral valve prolapse
354.A 6-year-old girl is brought to your pediatric office by her mother. The
girl has just joined a recreational soccer team for the first time and she is not
as fast as most of the girls her age and both of her legs hurt all over during
and after soccer practices. The nurse checked her blood pressure upon
arrival and was shocked at how high it was, 150/90. Upon physical exam,
you reconfirm the hypertension in both arms and feel a weak femoral pulse
just below her inguinal ligament. Her leg blood pressure was 85/55. You
order a PA chest film to look for which of the following?
a. A patent ductus arteriosus
b. Tetralogy of Fallot
c. Transposition of the great arteries
d. Grooving of the inferior surface of the ribs
e. An enlarged right heart border
470 Anatomy, Histology, and Cell Biology