Murmurs and Sounds

Question 1

left upper sternal border location

Answer 1

left second intercostal space

Question 2

hear at left upper sternal border

Answer 2

pulmonary valve (to pulmonary trunk)

Question 3

right upper sternal border location

Answer 3

right second intercostal space

Question 4

hear at right upper sternal border

Answer 4

aortic valve (to aorta)

Question 5

lower left sternal border, location

Answer 5

left fifth intercostal space

Question 6

hear at fifth intercostal, medial to left midclavicular line (medial to apex)

Answer 6

mitral valve (to left ventricle)

Question 7

hear at lower left sternal border

Answer 7

tricuspid valve (to right ventricle)

Question 8

S1

Answer 8

mitral and tricupsid valves closing, mitral normally first

Question 9

S2

Answer 9

aortic and pulmonary valves closing, usually aortic first.

Question 10

S3

Answer 10

blood sloshing in ventricle: increased blood volume.

Question 11

detect S3 with

Answer 11

bell (lower frequency) at apex

Question 12

S4

Answer 12

sound of atrium contracting to force blood into a stiff ventricle

Question 13

Wide S2 splitting

Answer 13

RBBB, pulmonic stenosis (P2 as a whole is delayed)

Question 14

Fixed S2 splitting

Answer 14

atrial septal defect (PVR very low: closing is delayed and less affected by change in pressure with inspiration)

Question 15

Paradoxical S2 splitting

Answer 15

LBBB, aortic stenosis (A2 as a whole is delayed)

Question 16

S3 causes

Answer 16

increased, CO (athletes, pregnant), mitral regurgitation, CHF, HCM, tricuspid regurgitation, constrictive pericarditits

Question 17

S4 causes

Answer 17

LVH/RVH caused by HTN/PAH, aortic/pulmonic stenosis, HCM (LA/RA pumping into stiff LV/RV, low frequency)

Question 18

Ejection click

Answer 18

aortic/pulmonic stenosis, Ao/PA dilation, HTN ( from stenotic valve or aortic/pulmonary root stress)

Question 19

midsystolic murmur

Answer 19

aortic/pulmonic stenosis (ejection type: follows rise and fall of ventricular P during systole)

Question 20

Early diastolic decrescendo

Answer 20

aortic/pulmonic regurgitation ( rapid relaxation during diastole)

Question 21

To-and-fro murmur

Answer 21

aortic/pulmonic regurg + stenosis

Question 22

Opening snap

Answer 22

mitral/tricuspid valve stenosis

Question 23

Continuous murmur

Answer 23

mitral/tricuspid stenosis (flow is always Ao to PA, slightly lags behind LVP)

Question 24

Mid-to-late diastolic murmur

Answer 24

mitral/tricuspid stenosis (loudest when ventricle first starts filling)

Question 25

Late systolic murmur

Answer 25

mitral valve prolapse (from turbulent flow)

Question 26

Midsystolic click

Answer 26

mitral valve prolapse (mitral click: later than normal ejection click, in mid-systole)

Question 27

Holosystolic murmur

Answer 27

mitral/tricuspid regurgitation (retrograde flow throughout systole)