CVS 2

Question 1

Loud S1 (3)

Answer 1

Short PR-interval
Mild mitral stenosis
Hyperdynamic states

Question 2

Soft S1

Answer 2

Long PR-interval
Severe mitral stenosis
LBBB
COPD
Obesity
Pericardial effusion

Question 3

Variable S1

Answer 3

AV dissociation
Atrial fibrillation
Large pericardial effusion
Severe LV dysfunction

Question 4

During expiration S2 is

Answer 4

single

Question 5

During inspiration: S2 is

Answer 5

split

Question 6

Pathologic split: occurs during

Answer 6

expiration

Question 7

Wide S2 split:

Answer 7

RBBB, Pulmonic stenosis

Mitral regurgitation

Question 8

Fixed splitting:

Answer 8

ASD
RV failure
Pulmonary HTN

Question 9

Paradoxical S2 split:

Answer 9

LBBB, Aortic stenosis

Question 10

Single S2

Answer 10

Severe aortic stenosis/ aortic regurgitation

Question 11

Loud A2

Answer 11

Systemic HTN

Dilated aortic root

Question 12

Soft or Absent A2

Answer 12

Calcified aortic stenosis

Question 13

Loud P2

Answer 13

Pulmonary HTN

ASD

Question 14

Soft or Absent P2

Answer 14

Pulmonic stenosis

COPD, aging

Question 15

S3

Answer 15

LVF (apex)
Volume overloading: MR/TR
Decreased myocardial contractility

Question 16

S4

Answer 16

never present in atrial fibrillation

L-sided S4: apex
Systemic HTN, aortic stenosis, hypertrophic cardiomyopathy
Ongoing myocardial ischemia
Aging

R-sided S4: LSB
Pulmonary HTN, pulmonic stenosis

Question 17

Systolic

Answer 17

Systolic: starts after S1 and ends before S2
‘Flow’ murmurs: Hyperdynamic states, anemia
Aortic/ pulmonic stenosis
Aortic outflow tract obstruction: HOCM
Mitral/ tricuspid regurgitation
VSD

Question 18

Grade 1 -6

Answer 18

Grade 1: Barely audible
Grade 2: Soft but easily heard
Grade 3: Loud
Grade 4: Loud + palpable thrill**
Grade 5: Loud with minimal contact between stethoscope and chest + thrill**
Grade 6: Loud with no contact between stethoscope and chest + thrill**

Question 19

Squatting/ Valsalva: Release

Answer 19

HOCM
↓ Intensity of murmur

Aortic Stenosis
↑Intensity of murmur

MVP
↓ valve prolapse

CV EFFECT:
↑LVEDV
(from ↑ venous return)
↑SV

Question 20

Standing/ Valsalva: Strain

Answer 20

HOCM
↑Intensity of murmur

AS
↓ Intensity of murmur

MVP
↑valve prolapse

Question 21

Aortic Stenosis

Answer 21

ejection click w/crescendo- decrescendo
paradoxical split 
LV>>>>aortic pressure
radiate to neck/carotid
SYNCOPE
ANGINA
DYSPNEA ON EXERTION
Calcifications in >60 yo or on young w/ bicupisid aortic valve 
palsus parvus et tardus

Question 22

Mitral regurgitation

Answer 22

high pitched blowing 
post MI, MVP, LV dialation 
holo/pansystolic 
radiates to axilia 
wide split 
hyperdamic conditions

Question 23

MVP

Answer 23

non ejection click midstystolic click w/ late systolic murmur
b/c chordinae tensing

predipose to infective endocarditis
common in rhematic fever, marfan/ehlers danos pts

s/s: chest pain, anxious, dizziness

Question 24

AR

Answer 24

autin flint murmur 
hears at erbs point 
high pitched blowing 
head bobbing - severe 
due to bicupsid aortic valve or endocarditis 
bounding carotid pulse 
quincke pulse 
heard best at left sternal border

Question 25

MS

Answer 25

NO S3/S4 sound 
LA>>>LV pressure
OS w/ mid diasystolic rumble 
a-fib common 
s/s: hempotysis, hoarseness (ortner)

Question 26

Decrescendo-Crescendo

Diastolic (presystolic accentuation)

Answer 26

MS

Question 27

Decrescendo

Diastolic:

Answer 27

AR

Question 28

Crescendo-Decrescendo

Systolic:

Answer 28

AS, flow murmurs

Question 29

Uniform (plateau): holosystolic

Systolic:

Answer 29

MR

Question 30

Musical, vibratory

Common in 80% of children

Answer 30

innocent murmur

Question 31

PDA

Answer 31

machine-like

Question 32

Increases with valsalva strain/standing;
decreases with squatting

S4

Answer 32

Hypertrophic cardiomyopathy