Cardiovascular - Auscultation of Heart Sounds

Question 1

S1 is diminished with

Answer 1

1st degree heartblock
Left bundle branch block 
Myocardial infarction 
-Due to weak ventricular contraction. 
Acute aortic regurgitation

Question 2

Aortic stenosis

Answer 2

S2 diminished

Question 3

S2 physiologically splits into 2 components on

Answer 3

Inspiration

Question 4

The S2 splitting of the heart sound is

(1) L sided, which valve closes?
(2) R sided, which valve closes?

Answer 4

(1) Aortic

(2) Pulmonic

Question 5

S1 heart sound is when which 2 valves close?

Answer 5

Mitral and Tricuspid

Question 6

S2 heart sound is when which 2 valves close?

Answer 6

Aortic and pulmonic

Question 7

S1 is heard loudest at

Answer 7

Apex

Question 8

S2 is heard loudest at

Answer 8

Base

Question 9

What is “inching” your stethoscope and what does it help with?

Answer 9

Helps clarify the timing of S1 and S2. Return to a
place on the chest, typically the base, where it is easy to identify S1 and S2. Get their rhythm clearly in mind. Then inch your stethoscope down the left sternal
border in steps until you hear changes in the sounds.

Question 10

Which area should you auscultate for S2?

Answer 10

Pulmonic area (2nd intercostal space, L side)

Question 11

During expiration, S2 split should be heard upon

Answer 11

1. Expiration: (Normal sound) Dub
2. Inspiration: Drrub
   S2 splits on inspiration = normal physiological response.

Question 12

Sound for wide S2 split

Answer 12

1. Expiration: Drrub

2. Inspiration: Drrrrrub (more pronounced during inspiration)

Question 13

Sound for fixed S2 split

Answer 13

1. Expiration: Drrrrrub
2. Inspiration: Drrrrrub
   No degree of splitting difference

Question 14

Sound for paradoxical splitting (reverse splitting)

Answer 14

1. Expiration: (aortic valve closure is delayed) A2 appears after P2 (instead of before P2). Drrub
2. Inspiration: Single heart sound. Dub

Question 15

Begin auscultation with

Answer 15

Bell, Mitral area (apex). Then diaphragm. Work backwards. Palpate the carotid pulse to time the heart sounds with cardiac cycle.

Question 16

After auscultating normal heart sounds, have the patient roll

Answer 16

Left lateral position and auscultate with the bell in the mitral area to listen for S3 heart sound and mitral stenosis.

Question 17

After patient rolls to left lateral position, have the patient sit upright and lean forward and have the patient take breath in, then out, and stop. Then auscultate with the diaphragm in the aortic area and LLS for

Answer 17

Early diagnostic murmur of aortic regurgitation

Question 18

Where is S1 best heard? Normal splitting is detectable along

Answer 18

Apex, lower left sternal border

Question 19

Because murmurs may be loudest in other areas, chart murmurs

Answer 19

Anatomical position

Question 20

Where should you hear the splitting of the S2

Answer 20

2nd and 3rd interspaces

Question 21

Where is S1 heard the loudest? How about the softer tricuspid component split?

Answer 21

Apex, Lower Left Sternal Border

Question 22

Unlike the splitting of S2, the splitting of S1

Answer 22

Does not vary with respiration

Question 23

S4 (atrial sound, atrial gallop) occurs

Answer 23

Before S1. Dull, low in pitch. Heard at the apex with the bell. Normal in athletes and older age groups. Due to ventricular hypertrophy.

Question 24

Diastolic murmurs can be quiet and difficult to hear.
Rolling the patient onto their left-hand side brings the
apex of the heart into contact with the chest wall and
may make the murmur

Answer 24

of mitral stenosis audible.

Question 25

If a systolic murmur is heard, the _____ and ____ arteries should be

Answer 25

the axilla and the carotid
arteries should be auscultated with the diaphragm
of the stethoscope for radiation. The murmur of mitral
regurgitation often radiates to the axilla and the murmur
of aortic stenosis classically radiates to the carotid
arteries, although it can also sometimes be heard in the
axilla

Question 26

A murmur of aortic regurgitation can be

heard better at the left sternal edge.

Answer 26

By asking the patient to sit forward and hold their breath

in expiration,

Question 27

Diastolic murmurs mnemonic

Answer 27

ARMS and PaRTS
Aortic Regurgitation 
Mitral Stenosis opening snap
Mitral Stenosis 
Pulmonary Regurgitation 
Triscupid Stenosis

Question 28

Features of benign/innocent murmurs

Answer 28

• Soft, early systolic
• Young
• Conditions with increased cardiac output (anemia, thyrotoxicosis, hypertension, pregnancy)

Question 29

Why should you palpate the liver if there are signs of heart failure?

Answer 29

In R HF, an enlarged liver can be due to venous congestion

Question 30

Inspect the hands for

Answer 30

Clubbing, peripheral cyanosis, nicotine staining, splinter hemorrhages, Janeway lesions, Osler’s nodes

Question 31

Inspect the face for

Answer 31

Corneal arcus, malar flush, conjunctival pallor, xanthelasma, central cyanosis

Question 32

Murmurs that arise on the right side of the heart become louder during

Answer 32

Inspiration (because venous return increases). Expiration has the opposite effect

Question 33

To evaluate for aortic regurgitation,

Answer 33

Have the patient lean forward in full expiration and listen at the base of the heart.

Question 34

Transgender patients may use torso binders. What should you do?

Answer 34

They may not want to remove the binder. Explain to patients what it is important.

Question 35

Older patients have a higher chance of developing a CVA.

Answer 35

Routine carotid artery evaluations