Question

Match List I (Clinical signs) with List II (Cardiac disease) and select the correct answer using the codes given below the lists.

List I (Clinical signs)	List II (Cardiac disease)
A. Hill's sign	1. Pericardial effusion
B. Ewart's sign	2. Hypertrophic cardiomyopathy
C. Double systolic impulse	3. Junctional rhythm
D. Cannon waves	4. Aortic regurgitation

Codes:

• A. A - 4, B - 2, C - 1, D - 3
• B. A - 3, B - 1, C - 2, D - 4
• C. A - 4, B - 1, C - 2, D - 3
• D. A - 3, B - 2, C - 1, D - 4

Hint:

Match each sign to its mechanism: pressure gradient, compression, hypertrophy, or timing mismatch.

Answer 1

The Correct Option is C

Step 1: Recall Hill's sign.
Hill's sign is an exaggeration of the normal difference between leg and arm systolic blood pressure, seen when the popliteal cuff pressure is at least 20 mm Hg higher than the brachial pressure. This wide difference is a classic peripheral sign of severe aortic regurgitation, so A matches 4.

Step 2: Recall Ewart's sign.
Ewart's sign is an area of dullness, with bronchial breathing and increased vocal resonance, found below the angle of the left scapula. It appears when a large pericardial effusion compresses the base of the left lung, so B matches 1.

Step 3: Recall the double systolic apical impulse.
A double or bifid systolic impulse at the apex happens when a strong atrial contraction fills a hypertrophied, non-compliant left ventricle just before its main systolic contraction, giving two separate outward pushes felt on the chest wall. This is a well known finding in hypertrophic cardiomyopathy, so C matches 2.

Step 4: Recall cannon waves.
Cannon waves are large, sudden waves seen in the jugular venous pulse when the right atrium contracts against a closed tricuspid valve. This happens when atrial and ventricular contraction lose their normal timing, such as in a junctional rhythm, so D matches 3.

Step 5: Match to the codes.
Putting these together gives A-4, B-1, C-2, D-3, which is code (c).

Step 6: Final answer.
\[ \boxed{A\text{-}4,\ B\text{-}1,\ C\text{-}2,\ D\text{-}3} \]