Which of the following physical examination findings are found in patients with primary pulmo-nary hypertension? 1. Cyanosis 2. Diastolic heart murmur 3. Digital clubbing 4. Loud second heart sound (P2)

a. 2 and 4 only
b. 1 and 3 only
c. 1, 2, and 4 only
d. 2, 3, and 4 only

ANS: C
Physical findings associated with idiopathic pulmonary artery hypertension (IPAH) include a loud second heart sound and a right-sided third or fourth heart sound. Other common signs are a palpable right ventricular heave and impulse of the pulmonary artery and both pulmonary ejection and pulmonary tricuspid regurgitation murmurs. Signs of right ventricular failure are common. Cyanosis often is present as a result of low cardiac output or the presence of an intracardiac right-to-left shunt that occurs as cor pulmonale develops. Clubbing does not occur in IPAH.