Harvey Lab, stasio

Question 1

Where is S1 loudest? S2?

Answer 1

S1- apex

S2- base

Question 2

how does inspiration cause split S2

Answer 2

increased blood volume in R ventricle

Question 3

S3 is best heard where

Answer 3

apex with patient lying no the L side

blood hitting non-compliant ventricle

Question 4

what causes the S4 sound

Answer 4

vibrations of L ventricle, mitral valve and L ventricular outlow as result of atrial contraction

Question 5

Waht is best position to hear S4

Answer 5

L lateral decubitus at apex

Question 6

17 y.o has S2 split and an S3 heart sound. rest of exam unremarkable.. should you be worried?

Answer 6

children and young adults have physiologic filling sounds (S3)

Question 7

48 y.o obese man with HTN, HLD, has S4 at mitral post, and left carotid bruit. reason for murmur?

Answer 7

ASHD, noncompliant ventricle.

Question 8

56 y.o with crushing chest pain, dyspnea and diaphoresis. Hx ASHD and angina
dec carotid and peripheral pulses, inspiratory crackles or rales b/l
S3 and S4 present
Dx?

Answer 8

anterior wall MI, S3 indicating significant LV dysfunction

crackles in lungs reflecting acute pulmonary congestion

Question 9

When is an aortic ejection click heard

Answer 9

onset of LV ejection

Question 10

When is a pulmonic ejection click heard

Answer 10

onset of RV ejection

Question 11

When do you hear a mid systolic click? where do you hear it?

Answer 11

mitral valve prolapse

heard at apex in mid or late systole

Question 12

What are the sounds from pericarditis

Answer 12

triphasic scratchy, grating, rasping or squeking

Question 13

causes of pericarditis

Answer 13

infectious, MI, cardiac surgery, uremia, metastatic Ca, TB

Question 14

38 y/o male had recent upper viral infection, leaning forward relieves chest pain
pleural rub with inspiration, normal vesicular breath sounds
has 3 component pericardial firciton rub early and late diastole and mid systolic

Answer 14

acute viral pericarditis

Question 15

how do you describe a heart murmur

Answer 15

timing, location, radiation, shape, intensity, pitch, quality

Question 16

where does mitral regurg usually radiate?

aortic stenosis?

Answer 16

mitral regurg- axilla

aortic stenosis- up the neck

Question 17

which systolic murmur has diamond shape

Answer 17

aortic stenosis

Question 18

which systolic murmur has a holosystolic high pitch blowing sound

Answer 18

mitral regurg

Question 19

what are descriptions of “quality”of a murmur

Answer 19

harsh, blowing, rumbling or musical

Question 20

upon standing or strain phase valsalva what murmurs increase in sound

Answer 20

mitral valve prolapse

HOCM

Question 21

What is effect of standing or valsalva on blood flow in heart

Answer 21

decreased left ventricular volume from dec VR

decreased arterial BP

Question 22

what murmurs get louder with squatting or release of valsalva

Answer 22

aortic stenosis

Question 23

Do you use bell or diaphragm to listen to diastolic events at apex

Answer 23

bell

Question 24

mid systolic click with high frequency 3/6 late systolic crescendo murmur
standing makes murmur louder

Answer 24

mitral valve prolapse

Question 25

high frequency grade 2/6 holosystolic murmur radiating to axilla
S1 obscured by murmur
Dx?

Answer 25

mitral regurg

Question 26

36 y.o male. PMI 6th ICS lateral. carotid pulse bisferiens with brisk upstroke and peripheral pulses bounding
Aortic post:  S1 with ejection sound
short grade 2/6 early systolic murmur
S2 has high frequency 2/6
mitral post: austin flint murmur

Answer 26

severe congenital aortic regurg

Question 27

What is an austin flint murmur

Answer 27

premature closure mitral valve

Question 28

18 y.o with syncope episodes while exercising, hypokinetic pulses, PMI infralaterally with heave
Aortic post: S1 with ejection sound, 3/6 systolic murmur ends before S2
Mitral post: S4 and 1/6 blowing systolic murmur

Answer 28

severe aortic stenosis probably from bicuspid valve

S4 indicates obstruction is severe

Question 29

10 y.o small stature, sports PE
Pumonary post: 1/6 early systolic murmur
tircuspid post: 3/6 high frequencys holosystolic murmur
mitral post: 2/6 transmitted from tricuspid valve

Answer 29

ventricular septal defect

Question 30

30 y.o female with bounding carotid and peripheral pulses
PMI 6th ICS MCL
pulmonic post: high freq 3/6 continuous systolic and diastolic peaks at S2
machine or to and from murmur
mitral post: S3 with short 2/6 diastolic murmur

Answer 30

patent ductus arteriosus