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Review of Clinical Signs Review Questions

Precordial and Carotid Pulse Palpation

Author: Bernard Karnath, MD

Dr. Karnath is an Assistant Professor of Internal Medicine, University of Texas Medical Branch, Galveston, TX.

1. A 50-year-old man has had progressive exertional dyspnea and chest pain for the past 2 months. Palpation of the carotid arteries reveals a diminished and delayed pulse. Palpation of the precordium reveals a dilated, sustained apical or left ventricular impulse with a presystolic impulse. What is the most likely cause of the patient’s condition?
  1. Aortic stenosis
  2. Hypertrophic cardiomyopathy
  3. Mitral stenosis
  4. Pulmonic stenosis
Click here to compare your answer.


2. A 70-year-old woman has worsening dyspnea. Palpation of the carotid arteries reveals a hyperkinetic bisferious pulse. Palpation of the precordium reveals a dilated left ventricular impulse that is shifted to the left. What is the most likely cause of the patient’s condition?

  1. Aortic regurgitation
  2. Mitral regurgitation
  3. Mitral stenosis
  4. Pulmonic stenosis
Click here to compare your answer.


3. A 50-year-old man has exertional dyspnea. Palpation of the carotid arteries reveals a hyperkinetic bisferious pulse. Palpation of the precordium reveals a hyperkinetic left ventricular impulse that consists of a “triple hump.” What is the most likely cause of the patient’s condition?

  1. Aortic stenosis
  2. Hypertrophic cardiomyopathy
  3. Mitral stenosis
  4. Pulmonic stenosis
Click here to compare your answer.

4. A 40-year-old woman has exertional dyspnea. Palpation of the carotid arteries reveals a hypokinetic pulse. Palpation of the precordium reveals a right ventricular heave and the absence of the left ventricular impulse. What is the most likely cause of the patient’s condition?
  1. Aortic stenosis
  2. Hypertrophic cardiomyopathy
  3. Mitral stenosis
  4. Pulmonic stenosis
Click here to compare your answer.


5. A 60-year-old man has worsening dyspnea. Palpation of the carotid arteries reveals a pulsus alternans. Palpation of the precordium reveals a dilated left ventricular impulse that is shifted to the left. What is the most likely cause of the patient’s condition?

  1. Dilated cardiomyopathy
  2. Hypertrophic cardiomyopathy
  3. Mitral stenosis
  4. Pulmonic stenosis
Click here to compare your answer.




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