Murmurs

Question 0

Holosystolic murmur, left lower sternal border

Diastolic rumble

Answer 0

VSD

Question 1

Harsh, systolic ejection murmur at left upper sternal border

Single S2

Answer 1

Pulmonic stenosis

Question 2

High pitched 3/6 systolic murmur best heard at the second right intercostal space

Answer 2

Aortic stenosis

Question 3

Loud first heart sound

Mid diastolic rumble

Answer 3

Mitral stenosis

Question 4

Left lower sternal border

Decreases in intensity with an increase in preload

Answer 4

HOCM

Question 5

Ejection systolic murmur at left lower sternal border that increases with valsalva

Answer 5

HOCM

Question 6

Holosystolic murmur that radiates to the axilla

Answer 6

Mitral regurgitation

Question 7

Holosystolic murmur that radiates to the right sternal border
Enhanced by inspiration

Answer 7

Tricuspid regurgitation

Question 8

Crescendo-decrescendo systolic ejection murmur following an ejection click
Radiates to carotids/heart base

Answer 8

Aortic stenosis

Question 9

Holosystolic harsh murmur
Loudest at tricuspid, left sternal border
Increases with increased afterload

Answer 9

VSD

Question 10

Late systolic crescendo with mid systolic click

Answer 10

MVP

Question 11

Pulsus parvus et tarsus - pulses are weak with delayed peak
Syncope
Angina
Dypsnea 
Paradoxical splitting (p2 closer later)

Answer 11

Aortic stenosis

Question 12

High-pitched blowing diastolic decrescendo murmur

Answer 12

Aortic regurgitation

Question 13

Late rumbling diastolic murmur after opening snap

Answer 13

Mitral stenosis

Question 14

Wide pulse pressure
Bounding pulses
Head bobbing
Pulsating nail bed

Answer 14

Aortic regurgitation

Question 15

Continuous machine-like murmur

Best heard and left infraclavicular area

Answer 15

PDA

Question 16

Chronic rheumatic fever

Answer 16

Mitral stenosis

Question 17

Atrial fibrillation

Answer 17

Mitral stenosis due to LA dilation

Question 18

CHF

Answer 18

Mitral regurgitation

Question 19

Aortic dissection

Answer 19

Aortic regurgitation

Question 20

Young black male

Answer 20

Auto-Dom HOCM

Question 21

Early diastolic murmur that starts with S2 and ends before S1
Decrescendo
Increases in intensity with inspiration
Heard best at left sternal border

Answer 21

Pulmonic regurgitation

Question 22

Pulmonary congestion
Pulmonary HTN
A-fib

Answer 22

Mitral stenosis

Question 23

Can hear your heartbeat when lying down at night

May have pounding in head

Answer 23

Aortic regurgitation

Question 24

Normal splitting

Answer 24

Inspiration: drop in intrathoracic pressure and increased venous return to right heart --> increased right heart stroke volume --> delayed closure of pulmonic

Question 25

Wide splitting

Answer 25

Seen in conditions that delay RV emptying (pulmonic stenosis, tricuspid regurgitation, ASD, TOF) Pulmonic closes much longer after aortic

Question 26

Fixed splitting

Answer 26

Seen in ASD due to increase volumes in RA, left to right shunting and increased flow through the pulmonic

Question 27

Paradoxical splitting

Answer 27

Due to delayed emptying of LV (aortic stenosis, left bundle branch block, coarctation) P closes later than A

Question 28

Pulsus paradoxus

Answer 28

Seen in patients with impaired cardiac filling. Increased RV volume pushes the intventricular septum over and causes a reduction in LV EDV and SV resulting in a decrease n BP during inspiration. Defined as a decrease in systolic BP of over 10 mmHg during inspiration. Korotkoff sounds are heard first during expiration then throughout

Question 29

What conditions will you see pulsus paradoxus?

Answer 29

``` Restrictive cardiomyopathy HOCM Pericarditis Tamponade Obstructive lung disease ```

Question 30

Best heard at apex with patient lateral recumbent

Answer 30

s4

Question 31

Due to an atrium contracting against a ventricle that has reached compliance

Answer 31

S4

Question 32

Early diastole sound due to rapid ventricular filling

Answer 32

S3

Question 33

Heard in late diastole | Right before S1

Answer 33

s4

Question 34

Early diastolic murmur best heard along the left sternal border between 3rd and 4th intercostal spaces

Answer 34

Aortic regurgitation due to valvular disease

Question 35

Early diastolic murmur best heard along the right sternal border

Answer 35

Aortic regurgitation due to aortic root dilatation

Question 36

Displaced apical impulse Holosystolic murmur Third heart sound

Answer 36

Mitral regurgitation

Question 37

What is the most common cause of mitral regurgitation in developed countries?

Answer 37

MVP due to myxomatous degeneration of the valve leaflets and chordae

Question 38

Exertional dypsnea Dry cough Holosystolic murmur Fatigue

Answer 38

Mitral regurgitation

Question 39

Prolonged pr interval | Prolonged QRS

Answer 39

Bradyarrythmia

Question 40

Harsh systolic ejection murmur + single S2

Answer 40

TOF

Question 41

Short systolic murmur that disappears with squatting

Answer 41

MVP

Question 42

Systolic/diastolic murmur over right upper sternal border that is silenced when turning the head

Answer 42

Venous hum

Question 43

2/6 mid systolic murmur that radiates to the back and axilla in a child

Answer 43

Peripheral pulmonic stenosis

Question 44

2/6 early systolic murmur with vibratory character at left mid sternal border with normal splitting

Answer 44

Still's murmur

Question 45

Soften S1 | Pan systolic murmur loudest at apex

Answer 45

Mitral regurgitation

Question 46

Pansystolic murmur best heard at left sternal border with a thrill

Answer 46

Ventricular septal rupture

Question 47

Loud, palpable S2 A flow murmur S4 Para sternal heave

Answer 47

Pulmonary HTN

Question 48

Jugular A wave | Loud P2

Answer 48

Pulmonary embolism

Question 49

Late systolic murmurs in a patient with UE HTN

Answer 49

Coarctation of the aorta with collateralz

Question 50

Hum or bruit at costovertebral angle

Answer 50

Renal artery stenosis from fibromuscular dysplasia