General Exam Questions

Question 1

Causes Loud S1

Answer 1

Metal valve

Short PR

Mild mitral stenosis

Hyperdynamic states

Question 2

Causes Soft S1

Answer 2

Long PR interval

Severe Mitral Stenosis

LBBB

COPD

Obesity

Pericardial effusion

Question 3

Causes variable S1 intensity

Answer 3

AV dissociation

AF

Large pericardial effusion

Severe LV dysfunction

Question 4

Causes wide S2 split

Answer 4

RBBB

WPW

Pulm HTN

Massive PE

Severe MR

constrictive pericarditis

Question 5

Causes fixed S2 split

Answer 5

ASD

Severe RV failure

Question 6

Causes reversed S2 split

Answer 6

LBBB

AS

AR

LV outflow obstruction

Question 7

Causes fixed S2

Answer 7

VSD with eisenmenger syndrome

Single ventricle

Question 8

What is an S3

Answer 8

Low pitched early diastolic sound

Easiest to hear Apex with pt in left lateral decubitus

Occasional heared in young people, pathological in over 40 indicating LV failure

Mechanism for sound not known, but probably an abrupt stop of ventricular filling

Question 9

What is an S4 sound

Answer 9

low pitched diastolic sound

Always pathological

Caused by atrial contraction into a stiff and non-compliant vertricle

Question 10

Causes of a split S1

Answer 10

S1 is actually split (RBBB, pre=excitation, idioventricular rhythm)

It is actually an S4

Second component is an aortic ejection click.

Question 11

What is an Austin flint murmor

Answer 11

an Austin Flint murmur is a low-pitched rumbling heart murmur which is best heard at the cardiac apex. It is associated with severe aortic regurgitation,

Question 12

Associated conditions with dextra cardia

Answer 12

o Kartagener’s syndrome – a type of immotile ciliary syndrome with Triad of:

• Bronchiectasis
• Sinusitis, otitis media and dysplasia of the frontal sinuses
• Infertility

o Turner’s syndrome
o Asplenia – PBF may show Heinz bodies and Howell-Juoly bodies