Thirty questions on the advanced cardiovascular and peripheral vascular examination. The maneuvers are the block worth getting right, and the deck says why. Valsalva and standing DROP preload; squatting and leg raise RAISE it. Hypertrophic cardiomyopathy gets louder when preload falls and softer when it rises; aortic stenosis does the exact opposite. That one reversal is what separates the two, and the deck flags it in capitals — so you don't sign off incorrectly on a sports physical. Two sounds are easy to swap. S3 is early diastolic with the cadence Ken-TUC-ky, and it is physiologic in children, young adults and late pregnancy but pathologic over 40. S4 is just before S1 with the cadence Ten-nes-SEE, and it runs the other way — normal in trained athletes and older patients. Both are low-pitched and need the bell at the apex in left lateral decubitus. Bell for low, diaphragm for high — S3, S4 and mitral stenosis on the bell, applied lightly; S1, S2, rubs and the regurgitant murmurs on the diaphragm, pressed firmly. One radiation is a discriminator: mitral regurgitation goes to the axilla, tricuspid regurgitation specifically does NOT, and hypertrophic cardiomyopathy never goes to the neck. Covers the cardiac history through chest pain, palpitations, orthopnea, paroxysmal nocturnal dyspnea, edema and syncope; the cardiac cycle and what makes each sound; the apical impulse and the hyperkinetic, sustained and diffuse patterns; auscultation technique; the extra systolic and diastolic sounds; the seven characteristics of a murmur and each named murmur in turn; the maneuvers; and the whole peripheral vascular examination from capillary refill and pulse amplitude through the arterial against venous insufficiency comparison, the pulses, bruits, the Allen test, the ankle brachial index and Homan's sign.
Answers reveal only after you choose. Your score and a breakdown by objective appear at the end, with a review of everything you missed.