Auscultatory skills

Question 1

What causes S1?

Answer 1

Closure of the mitral and tricuspid valves

Question 2

What causes S2?

Answer 2

Closure of the semi lunar valves

Question 3

What does S1 signal?

Answer 3

The beginning of systole

Question 4

What does S2 signal?

Answer 4

The beginning of diastole

Question 5

How can you tell if a murmur is systolic or diastolic?

Answer 5

Systolic murmurs coincide with the carotid pulse

Question 6

What is the cause of physiological splitting of the left heart sound?

Answer 6

Inspiration causes a drop in thoracic pressure resulting in increased venous return to the right side of the heart. Increased right ventricular volume increases right ventricular ejection time => pulmonary valve closes after the aortic valve during inspiration

Question 7

Where is physiological splitting of the second heart sound best heard?

Answer 7

Pulmonary area- 2nd intercostal space of the left parasternal edge

Question 8

What causes a third heart sound?

Answer 8

Related to acceleration and deceleration of blood during early passive filling of the ventricle

Question 9

What is a third heart sound?

Answer 9

An early diastolic low frequency filling sound- kentucky

Question 10

Where are 3rd heart sound best heard?

Answer 10

Apex with the bell

Question 11

What is the significance of the third heart sound?

Answer 11

In a healthy person- can be physiological
In an older person with suspect or known heart disease a third heart sound may be due to left ventricular systolic dysfunction

Question 12

What should you do if you suspect a pathological third heart sound?

Answer 12

Refer to echo to assess left ventricular performance

Question 13

What causes a 4th heart sound?

Answer 13

Due to atrial contraction causing rapid blood flow into a ledd complient ventricle

Question 14

What is a 4th heart sound?

Answer 14

Late diastolic low frequency filling sound- Tenasea

Question 15

What are common causes of decreased left ventricular compliance?

Answer 15

Myocardial ischemia, hypertension and aortic stenosis

Question 16

Where is a 4th heart sound best heard?

Answer 16

At the apex with the bell of the stethoscope

Question 17

WHat is the significance of a 4th heart sound?

Answer 17

Almost always pathological

Indicator of severity of hypertension or aortic stenosis

Question 18

What should you do if you find a 4th heart sound?

Answer 18

Refer to echo to assess left ventricular hypertrophy and/or aortic stenosis

Question 19

How do you describe a cardiac murmur?

Answer 19

Timing 
Location 
Character and pitch 
Radiation 
Intensity/Grading

Question 20

What is the innocent cardiac murmur?

Answer 20

Systolic flow murmur causes by turbulence of flow in the right ventricular outflow tract. Normal finding in children and young adults

Question 21

When is an innocent cardiac murmor loudest?

Answer 21

Circulation is hyperdynamic

Fever, pregnancy, anaemia, thyrotoxicosis

Question 22

What are the characteristics of an innocent murmur?

Answer 22

Soft, mid systolic
Usually in pulmonary area
Localised to one auscletatory area => no radiation
No other cardiac abnormalities

Question 23

What causes pathological cardiac murmurs?

Answer 23

Turbulence of blood flow resulting from a structural cardiac abnormality. Systolic or diastolic.

Question 24

What are the characteristics of a pathological murmur?

Answer 24

Diastolic, ejection systolic or pan systolic
Not localises and may radiate
Associated with cardiac abnormalities

Question 25

Describe the murmour of aortic stenosis?

Answer 25

Ejection systolic murmur which may radiate to the carotids. Best heard in the aortic area- 2nd intercostal space right parasternal edge

Question 26

Describe the murmur of aortic regurgitation?

Answer 26

Decrescendo diastolic murmur best heard in the aortic region by may radiate to the tricuspid area. Position the patient upright, leaning forward and holding breath and listen with the diaphragm

Question 27

Describe the murmur of mirtal regurgitation?

Answer 27

Pan systolic rumbling murmur best heard at the apex beat but may radiate to the axilla

Question 28

Describe the murmur of mirtal stenosis?

Answer 28

Decrescendo diastolic murmur best heard at the apex. Position the patient on their left side and listen with the bell at the apex beat