murmurs

Question 1

underlying RHD
fatigue, exertional dyspnea, orthopnea
hoarseness (partners syndrome)
edema, ascites with pulmonary HTN
A fib, systemic thromboembolism

Answer 1

Hx MS

Question 2

malar flush 
precordial bulge 
RV heave with pulmonary HTN
Loud S1
opening snap following S2

Answer 2

MS

Question 3

apical mid diastolic rumble
decrescendo-cresendo
presynaptic accentuation

best heard after exercise, using bell at apex with the pt on left lateral position

Answer 3

MS

Question 4

terminal component missing in A fib and also A wave and S4

Answer 4

MS

Question 5

aortic root dilation: marfans and syphilis
post infection: RHD, inf endocarditis
structural: bicuspid aortic valve (age <65) and aortic dissection

Answer 5

AR

Question 6

heart failure

acute: rapidly developing HF
chronic: long standing asymptomatic; chronic volume overload - LV dysfxn

Answer 6

AR

Question 7

S1 normal or diminished

S3

Answer 7

AR

Question 8

decrescendo
diastolic
loudest alond Erb point when leaning forward on full expiration

Answer 8

AR

Question 9

low pitched mid diastolic apical
“fxn MS”
anterior leaflet of MV vibrates at same time as blood jets from left atrium and the aorta

Answer 9

Austin flint murmur

Question 10

water hammer quick to rise and collapse

Answer 10

corrigans

Question 11

visible pulsations of retinal arterioles and pupils

Answer 11

beckers

Question 12

head bobbing synchronous with heartbeat

Answer 12

de Mussets

Question 13

systolic and diastolic bruit when femoral artery is compressed

Answer 13

duroziez

Question 14

popliteal cuff systolic pressure > brachial pressure by 40 mmHg

Answer 14

hills

Question 15

pulsatile nailbeds

pink white pink white

Answer 15

quinckes

Question 16

congenital bicuspid aortic valve less than 65 yo

degenerative or senile calcific AS over 65 yo

Answer 16

AS

Question 17

risk factors: HTN, hypercholesterolemia, smoking

Hx: syncope, angina, dyspnea on exertion

Answer 17

AS

Question 18

sustained, powerful, heaving PMI to left and slightly below MCL
delayed and diminished carotid pulse (pulses parvus et tardus)

Answer 18

AS

Question 19

paradoxical split S2
single/soft S2
S4
Ej. click: bicuspid AV or flexible stenosis

Answer 19

AS

Question 20

harsh, systolic, ej. type (diamond)

R 2nd ICS (heard best) parasternal with radiation to carotids

Answer 20

AS

Question 21

passive leg raising increase murmur

standing decrease murmur

Answer 21

AS

Question 22

increase in after load
incomplete emptying of LA
LV hypertrophy
decrease CO
RV strain 
pulmonary congestion

Answer 22

AS

Question 23

acute: abrupt increase LA pressure
chronic: LA enlarges progressively

Answer 23

MR

Question 24

widely split S2

S3 indicates severity

Answer 24

MR

Question 25

holosystolic, blowing, high pitched loudest over apex

radiates to L axilla

Answer 25

MR

Question 26

myxomatous degeneration of MV

1) malcoaptation of MV leaflets during systole - regurg
2) young pmts - gross redundancy of both the anterior and posterior leaflets and chordal apparatus
3) older pts - fibroelastic def

connective tissue dz

1) marfans, Ehlers danlo, osteo imperfecta
2) ASD

Answer 26

MVP

Question 27

apical systolic (non ej) click followed by a MR murmur (heard best at apex)

Answer 27

MVP

Question 28

1) passive leg raising/squatting
increase VR - increase LV size and volume - click = later

2) after sudden standing/ valsalva
decrease VR - decrease LV size and volume - clicks = earlier

Answer 28

MVP