Cardiac Physical Exam and Murmurs

Question 1

JVD

Answer 1

JVP > 7cm above sternal angle

Question 2

Kussmaul’s sign

Answer 2

Increased JVD upon respiration

-can signify right heart MI, post-op tamponade, restrictive pericarditis, tricuspid regurgitation

Question 3

Harsh, systolic ejection murmur that radiates to the carotids

Answer 3

Aortic stenosis

Question 4

Holosystolic murmur that radiates to the axilla or to the carotids

Answer 4

Mitral regurgitation

Question 5

Midsystolic or late systolic murmur with preceding click

Answer 5

MVP

Question 6

Early decrescendo diastolic murmur

Answer 6

Aortic regurgitation

Question 7

Mid-to late diastolic, low-pitched murmur

Answer 7

Mitral stenosis

Question 8

S3 gallop

Answer 8

Dilated cardiomyopathy (sloshing in) ie a floppy ventricle
Mitral valve disease
Often normal in younger patients or in high-output states

Question 9

S4 gallop

Answer 9

A stiff heart
LV hypertrophy
HTN
Diastolic dysfunction (a stiff ventricle)
Aortic stenosis

Question 10

Increased peripheral pulses

Answer 10

Compensated aortic regurgitation, coarctation, PDA

Question 11

Pulsus paradoxus

Answer 11

Decreased SBP with inspiration (it normally increases)
pericardial tamponade
asthma
COPD
Tension pneumothorax

Question 12

Pulsus alterans

Answer 12

Alternating weak and strong pulses
Cardiac tamponade
Imaired LV systolic function

Question 13

Pulsus parvus et tardus

Answer 13

Weak and delayed carotid upstroke

Aortic stenosis

Question 14

Single or paradoxical split S2

Answer 14

Aortic stenosis

Question 15

Systolic murmur radiating to carotids

Answer 15

Aortic stenosis

Question 16

Blowing diastolic murmur at LSB

Answer 16

Aortic regurgitation

Question 17

Mid-diastolic rumble

Answer 17

aka Austin Flint rumble

Aortic regurgitation

Question 18

Midsystolic apical murmur

Answer 18

Aortic regurgitation

Question 19

de Musset’s sign

Answer 19

head bob with heartbeat

2/2 widened pulse pressure seen in aortic regurgitation

Question 20

Water-hammer pulse

Answer 20

Seen in aortic regurgitation

caused by widened pulse pressure

Question 21

Femoral bruit

Answer 21

Seen in aortic regurgitation caused by widened pulse pressure

Question 22

Opening snap + mid diastolic murmur at apex

Answer 22

Mitral valve stenosis

Question 23

Holosystolic murmur radiating to axilla

Answer 23

MItral regurgitation