Cardiovascular & Lymphatic System – APEA
Cardiovascular & Lymphatic System – APEA Practice Questions with Answers
Lymphatic System
Q: The lymphatic ducts drain into the: A: Venous system. Lymphatic ducts return fluid to circulation via the venous system, not arteries or capillary beds.
Q: The right lymph duct drains all areas EXCEPT: A: Right leg. The right lymph duct covers the right upper quadrant — right head/neck, right thorax, and right upper limb. The legs drain via the thoracic duct.
Q: The thoracic duct drains all areas EXCEPT: A: Right upper thorax. The thoracic duct drains most of the body. The right upper thorax (plus right head/neck and right arm) drains via the right lymph duct.
Q: Preauricular nodes drain: A: Palpebral conjunctiva and skin adjacent to the ear in the temporal region.
Q: Posterior auricular nodes drain: A: Posterior part of the temporoparietal region.
Q: Facial lymph nodes (infraorbital/maxillary, buccinator, supramandibular) drain: A: Eyelids, conjunctiva, skin and mucous membranes of the nose and cheek.
Q: Tonsillar, submandibular, and submental nodes drain: A: Mouth, throat, and face.
Q: Deep cervical lymph nodes drain: A: Head and neck (all lymphatic fluid).
Q: Supraclavicular nodes are located: A: Deep in the angle formed by the clavicle and sternomastoid muscle. Enlargement here suggests possible metastasis from thoracic or abdominal malignancy.
Q: Anterior cervical lymph node chain is located: A: Anterior and superficial to the sternomastoid muscle.
Q: External iliac nodes drain: A: Umbilicus, urinary bladder, prostate or uterus, upper vagina — NOT the gluteal region.
Q: Internal iliac nodes drain: A: All pelvic viscera, deep perineum, and gluteal region.
Q: Sacral lymph nodes drain: A: Prostate or cervix, rectum, urinary bladder, posterior pelvic wall — NOT the gluteal region.
Q: Horizontal superficial inguinal nodes drain: A: Lower abdomen, buttock, external genitalia (not testes), anal canal, lower vagina.
Q: Superior and inferior mesenteric nodes drain: A: Small and large intestines.
Q: Hepatic chain (glands) drain: A: Stomach, duodenum, liver, gallbladder, and pancreas.
Q: Anterior mediastinal nodes drain: A: Thymus, thyroid, and anterior pericardium.
Q: Posterior mediastinal nodes drain: A: Esophagus and posterior pericardium.
Q: Subscapular nodes drain: A: Posterior chest wall and portions of the upper arms.
Q: Axillary nodes drain: A: Breasts, upper abdominal wall, upper back, pectoral region, upper limbs — NOT anterior chest wall directly (that’s anterior pectoral nodes).
Q: Tonsillar node is located: A: At the angle of the mandible.
Q: Preauricular node is located: A: In front of the ear.
Q: Occipital node is located: A: At the base of the skull posteriorly.
Q: Posterior auricular node is located: A: Superficial to the mastoid process.
Q: Submandibular nodes are located: A: Midway between the angle and tip of the mandible.
Q: Enlarged/tender lymph nodes most often suggest: A: Infection in a nearby drainage area. Hard/fixed nodes suggest malignancy. Mobile, enlarged, nontender nodes suggest benign tumors.
Q: An inflamed lymph node finding: A: Tender and movable. Shotty (small, mobile, nontender) nodes are normal. Hard and fixed nodes suggest malignancy.
Cardiac Auscultation — Adult
Valve listening points:
| Valve | Location |
|---|---|
| Aortic | 2nd–3rd ICS, right upper sternal border (RUSB) |
| Pulmonic | 2nd–3rd ICS, left sternal border (LUSB) |
| Tricuspid | 3rd–6th ICS, left lower sternal border (LLSB) |
| Mitral (apex) | 5th–6th ICS, midclavicular line |
Q: To assess PMI (apex), ask patient to: A: Turn to the left side (left lateral decubitus position).
Q: To assess aortic insufficiency, ask patient to: A: Sit up, lean forward, and exhale.
Q: PMI displaced >10 cm lateral to the midsternal line suggests: A: Left ventricular hypertrophy.
Heart Sounds
Q: S1 signifies: A: Closure of mitral and tricuspid valves (“lub,” heard at apex).
Q: S2 signifies: A: Closure of aortic and pulmonic valves (“dub,” heard at base).
Q: S3 in adults over 40 suggests: A: Ventricular failure or volume overload (e.g., mitral regurgitation). Normal in children and pregnant women.
Q: S3 in older adults specifically suggests: A: Heart failure (left ventricular dilation/cardiomyopathy).
Q: S4 suggests: A: Hypertension (atria contracting against a non-compliant ventricle; always abnormal; also called “atrial gallop”).
Q: Pericardial friction rub: A: Scratchy, continuous, high-pitched murmur during atrial systole, ventricular systole, and diastole. Heard best with diaphragm.
Murmurs
| Murmur | Location | Character | Radiation |
|---|---|---|---|
| Mitral regurgitation | Apex | Pansystolic, harsh | Left axilla |
| Tricuspid regurgitation | Left sternal border | Pansystolic, blowing; increases with inspiration | Right sternal border, xiphoid, left MCL |
| Aortic stenosis | Right 2nd ICS | Crescendo-decrescendo; loud with thrill | Carotids, down left sternal border |
| Pulmonic stenosis | 2nd–3rd left ICS | Soft, crescendo-decrescendo | Left shoulder and neck |
| VSD | Throughout | High-pitched, throughout systole | — |
| Innocent murmur | 2nd–4th ICS, between LSB and apex | Mid-systolic; decreases/disappears when sitting | — |
Q: Physiologic murmur: Caused by temporary metabolic changes (fever, anemia, pregnancy, hyperthyroidism). Resolves when condition resolves.
Q: Innocent murmur: No detectable physiologic or structural abnormality.
Q: Organic murmur: Anatomic cardiac defect present (e.g., congenital heart defect).
Chest Pain Differentiation
| Condition | Description |
|---|---|
| Angina pectoris | Exertional; relieved by rest; may feel like indigestion |
| Myocardial infarction | Pressing, squeezing, tight, heavy; radiates to neck, jaw, left arm |
| Aortic dissection | Sudden, sharp, tearing; radiates to back or neck |
| Pericarditis | Sharp, knife-like; radiates to shoulder tip and neck |
| Costochondritis | Stabbing, dull, aching; worsens with coughing or deep breathing |
Peripheral Vascular Disease
Q: Ankle-brachial index screens for: A: Peripheral artery disease (PAD). Low index = narrowing or blockage.
Q: Risk factor for PAD: A: Smoking (nicotine causes vasoconstriction).
Q: Intermittent claudication: A: Pain/cramping with exertion, relieved by rest. Usually in calves but can be buttock, hip, thigh, foot.
Q: Raynaud’s disease: A: Numbness/tingling in distal fingers aggravated by cold or emotional stress.
Q: DVT: A: Tight, bursting calf pain; may have swelling and tenderness.
Q: Thromboangiitis obliterans (Buerger’s disease): A: Occurs in smokers; arch of foot claudication; pain at rest in toes/fingers.
Q: Chronic venous insufficiency: A: Brown pigmentation just above malleolus; warm feet; persistent pain even at rest.
Q: Chronic arterial insufficiency: A: Pale on elevation, dusky red on dependency; cool skin; intermittent claudication.
Q: Orthostatic hypotension: Symptoms: lightheadedness, weakness, unsteadiness, visual blurring, syncope in 20–30%. Causes: medications, autonomic disorders, diabetes, prolonged bed rest, volume depletion, cardiovascular disorders — NOT impaired visual acuity (that is a result, not a cause).
Q: Pulse amplitude in cardiogenic shock: A: Thready/weak (correlates with low pulse pressure). Bounding pulse = aortic insufficiency.
Q: Great saphenous vein enters deep system via: A: Femoral vein.
Q: To assess varicosities: A: Have patient stand — allows veins to fill with blood.
Q: Right atrial pressure assessed via: A: Right internal jugular vein pulsations (jugular venous pressure).
Pediatric Cardiovascular
Q: Apical pulse location by age:
| Age | Location |
|---|---|
| Infant/child <7 years | 3rd–4th ICS, left of midclavicular line |
| 13-month-old | 3rd–4th ICS, left midclavicular line |
| Child >7 years / adults | 5th ICS, left midclavicular line |
Q: Sinus arrhythmia in a 2-year-old: A: Normal finding. Rate increases with inspiration, decreases with expiration.
Q: Coarctation of the aorta: A: Disparity between brachial and femoral pulses (narrowing of descending aorta reduces lower extremity blood flow).
Q: Tetralogy of Fallot (4 defects): A: VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy.
Q: Decreased pulmonary blood flow defects (cyanotic): TOF, pulmonary atresia, tricuspid atresia. Signs: cyanosis, capillary refill >3 seconds, low O2 sats (sometimes 80s), poor feeding.
Q: Right-to-left shunting defects: Hypoplastic left heart, truncus arteriosus, transposition of great arteries, TAPVR. Signs: cyanosis, decreased cardiac output, desaturated systemic blood flow.
Q: Heart failure in children with CHD — most common cause: A: Volume and pressure overload resulting in decreased cardiac output.
Q: Compensatory response to chronic hypoxia: A: Polycythemia — HCT of 55–60%, increased RBC production to improve O2 carrying capacity.
Q: Patent ductus arteriosus treatment with indomethacin: A: Causes ductal constriction, reducing pulmonary fluid overload and redirecting oxygenated blood to systemic circulation.
Q: Kawasaki disease — diagnosed with fever ≥5 days PLUS 4 of 5: Bilateral non-purulent conjunctivitis, cervical lymphadenopathy, macular rash, hand/foot edema, strawberry tongue.
Q: Rheumatic heart disease signs: Erythema marginatum, chorea, murmur, joint pain, shortness of breath — preceded by Group A strep infection.
Q: Physiologic vs. organic murmur in children:
- Fever or anemia present → non-organic/physiologic
- Anatomic defect present → organic
- No fever, no anatomic defect → innocent
Neonatal Assessment
Q: Acrocyanosis: A: Bluish color of hands, feet, and perioral area — normal in first 24–48 hours. Tongue and mucous membranes remain pink.
Q: Cutis marmorata: A: Generalized lacy, reticulated blue skin discoloration in newborn — caused by immature vascular/neurologic systems.
Q: Newborn requiring further evaluation: A: Dusky and cyanotic when crying — indicates poor cardiovascular adaptation. Acrocyanosis alone is normal.
Q: Normal newborn glucose: A: 40–60 mg/dL.
Q: APGAR scoring: Activity (muscle tone), Pulse, Grimace, Appearance (color), Respiration — each 0–2 points. Score ≥7 = normal. Score 0–3 = immediate resuscitation needed.
Example from question: Irregular respirations (1) + HR 105 (2) + grimace (1) + pink body/blue extremities (1) + moving all limbs (2) = Score: 7
Other
Q: Bruit in epigastric area with systolic AND diastolic components: A: Renal artery stenosis.
Q: Portal hypertension indicator: A: Splenomegaly (also ascites and collateral venous channels).
Q: Aortic pulsations with carotid obstruction — assess via: A: Brachial artery.
Q: Pacemaker failure symptom: A: Hiccoughs (also dizziness, lightheadedness, sudden heart rate changes). Chest pain is usually absent.
Q: Furosemide (Lasix) effect: A: Loop diuretic — decreases potassium levels (hypokalemia).
Q: Widened pulse pressure: A: SBP minus DBP. PP ≥60 in older adults = risk for cardiovascular disease, stroke, and renal disease.
Q: Orthopnea: A: Dyspnea when lying down, relieved by sitting — seen in obstructive lung disease, mitral stenosis, heart failure.
Q: Paroxysmal nocturnal dyspnea: A: Sudden dyspnea waking patient from sleep — must sit, walk, or stand to resolve; may have coughing and wheezing.
Q: Thrills palpated using: A: Ball (thenar/hypothenar area) of the hand — detects buzzing/vibratory sensation from vascular turbulence.
Complete this comprehensive cardio APEA review covering over 70 practice questions and detailed rationales across lymphatic drainage, cardiac auscultation, murmur differentiation, peripheral vascular disease, pediatric heart defects, and neonatal cardiovascular assessment — structured to help NP students master high-yield board content fast.
Study this 6-to-8-page cardio APEA answer guide covering heart sounds, valve auscultation points, murmur characteristics, lymph node drainage pathways, PAD versus venous disease, congenital heart defects, and pediatric cardiovascular findings — with full explanations and correct answers for every question.
Review cardio APEA questions and rationales covering lymphatic system drainage, cardiac murmurs, aortic and mitral valve assessment, peripheral artery disease, Tetralogy of Fallot, Kawasaki disease, neonatal APGAR scoring, and nurse practitioner board exam cardiovascular essentials — answers and explanations included.