Advanced Assessment Final Review
QUESTIONS AND ANSWERS |GRADED A
Which type of abnormal heart sound is best described below?
mid-systolic murmur located R 2nd interspace
radiates into the neck and down L sternal border, even to apex
often loud with medium pitch, harsh quality
best heard it patient it sitting up and leaning forward Correct Answer: aortic
stenosis
Which type of abnormal heart sound is best described below?
best heard in 2nd-4th interspaces between L sternal border and apex of heart
rarely radiates
caused by temporary increase in blood flow (such as in anemia, pregnancy,
hyperthyroid, or fever) Correct Answer: physiologic or functional systolic murmur
Which type of abnormal heart sound is best described below?
located in 2nd-3rd L interspaces
radiates toward L shoulder and neck
soft-to-loud intensity, medium pitch, harsh quality
persist throughout respiratory cycle Correct Answer: pulmonic stenosis
Which type of abnormal heart sound is best described below?
best heard in the 3rd-4th L interspaces
radiates down L sternal border to apex and possibly base of heart
does NOT radiate to neck
medium pitch, harsh quality
decreases with squatting, increases with straining down Correct Answer:
hypertrophic cardiomyopathy
Which type of abnormal heart sound is best described below?
best heard at apex, radiates to L axilla
soft-to-loud intensity with medium-high pitch, blowing quality
does NOT become louder with inspiration Correct Answer: mitral regurgitation
Which type of abnormal heart sound is best described below?
best heard at lower L sternal border
radiates to R of the sternum (xiphoid area), NOT axilla
,variable intensity, medium pitch, blowing quality
intensity increases slightly with inspiration Correct Answer: tricuspid regurgitation
Which type of abnormal heart sound is best described below?located in the 3rd,
4th, and 5th left interspaces
has a wide range of radiation
very loud intensity and high pitch with a harsh quality Correct Answer: ventricular
septal defect
Which type of abnormal heart sound is best heard it patient it sitting up and leaning
forward? Correct Answer: aortic stenosis
Which type of abnormal heart sound is best heard at apex of heart? Correct
Answer: mitral regurgitation
Which type of abnormal heart sound is best heard at lower L sternal border?
Correct Answer: tricuspid regurgitation
Characteristics of carotid pulse in cardiogenic shock. Correct Answer: weak,
thready
Characteristics of carotid pulse in aortic regurgitation Correct Answer: bounding
Characteristics of carotid pulse in aortic stenosis Correct Answer: upstroke is
delayed
thrill Correct Answer: Turbulent blood flow creates vibrations that you can
palpate. Feels like the sensation of a vibration under your hand or even "cat
purring." Caused by a murmur, a dialysis shunt/fistula.
Use of the diaphragm of the Stethoscope during cardiac exam for what? Correct
Answer: for hearing relatively high-pitched heart sounds (S1, S2, most murmurs)
Use of the bell of the Stethoscope during cardiac exam for what? Correct Answer:
for hearing relatively low-pitched heart sounds (S3, S4, and the rumble of mitral
stenosis)
First heart sound (S1) Correct Answer: lub, systole (ventricular contraction)
closing of mitral and tricuspid valve
heard better at apex
, Second heart sound (S2) Correct Answer: dub, diastole (ventricular relaxation)
closing of aortic and pulmonic valve
heard better at base of heart
When would you hear an accentuated S1? Correct Answer: tachycardia
rhythms with short PR interval
high cardiac output states (anemia)
When would you hear a diminished S1? Correct Answer: mitral regurgitation
When would you hear a split S1 Correct Answer: RBBB (delay in inter ventricular
conduction)
When does S1 have varying intensity? Correct Answer: atrial fib
What would be the suspicion with a widely split S2 that persists throughout the
respiratory cycle? Correct Answer: pulmonic stenosis
What would be the suspicion with fixed splitting of S2? Correct Answer: atrial
septal defect
R ventricular failure
What would be the suspicion with paradoxical or reversed S2 split, which occurs
with expiration and disappears through inspiration (the opposite of what you would
expect)? Correct Answer: LBBB
(caused by delayed closure of aortic valve)
What would be the suspicion with a mid-systolic click at the apex of the heart?
Correct Answer: mitral valve prolapse
blood volume during inspiration Correct Answer: moRe blood to R heart, Less
blood to L heart
Grading murmurs Correct Answer: grade on scale of 1-6
1 barely audible
2 readily audible
3 even louder
6 audible without stethoscope
grades 4-6 must have accompanying thrill
QUESTIONS AND ANSWERS |GRADED A
Which type of abnormal heart sound is best described below?
mid-systolic murmur located R 2nd interspace
radiates into the neck and down L sternal border, even to apex
often loud with medium pitch, harsh quality
best heard it patient it sitting up and leaning forward Correct Answer: aortic
stenosis
Which type of abnormal heart sound is best described below?
best heard in 2nd-4th interspaces between L sternal border and apex of heart
rarely radiates
caused by temporary increase in blood flow (such as in anemia, pregnancy,
hyperthyroid, or fever) Correct Answer: physiologic or functional systolic murmur
Which type of abnormal heart sound is best described below?
located in 2nd-3rd L interspaces
radiates toward L shoulder and neck
soft-to-loud intensity, medium pitch, harsh quality
persist throughout respiratory cycle Correct Answer: pulmonic stenosis
Which type of abnormal heart sound is best described below?
best heard in the 3rd-4th L interspaces
radiates down L sternal border to apex and possibly base of heart
does NOT radiate to neck
medium pitch, harsh quality
decreases with squatting, increases with straining down Correct Answer:
hypertrophic cardiomyopathy
Which type of abnormal heart sound is best described below?
best heard at apex, radiates to L axilla
soft-to-loud intensity with medium-high pitch, blowing quality
does NOT become louder with inspiration Correct Answer: mitral regurgitation
Which type of abnormal heart sound is best described below?
best heard at lower L sternal border
radiates to R of the sternum (xiphoid area), NOT axilla
,variable intensity, medium pitch, blowing quality
intensity increases slightly with inspiration Correct Answer: tricuspid regurgitation
Which type of abnormal heart sound is best described below?located in the 3rd,
4th, and 5th left interspaces
has a wide range of radiation
very loud intensity and high pitch with a harsh quality Correct Answer: ventricular
septal defect
Which type of abnormal heart sound is best heard it patient it sitting up and leaning
forward? Correct Answer: aortic stenosis
Which type of abnormal heart sound is best heard at apex of heart? Correct
Answer: mitral regurgitation
Which type of abnormal heart sound is best heard at lower L sternal border?
Correct Answer: tricuspid regurgitation
Characteristics of carotid pulse in cardiogenic shock. Correct Answer: weak,
thready
Characteristics of carotid pulse in aortic regurgitation Correct Answer: bounding
Characteristics of carotid pulse in aortic stenosis Correct Answer: upstroke is
delayed
thrill Correct Answer: Turbulent blood flow creates vibrations that you can
palpate. Feels like the sensation of a vibration under your hand or even "cat
purring." Caused by a murmur, a dialysis shunt/fistula.
Use of the diaphragm of the Stethoscope during cardiac exam for what? Correct
Answer: for hearing relatively high-pitched heart sounds (S1, S2, most murmurs)
Use of the bell of the Stethoscope during cardiac exam for what? Correct Answer:
for hearing relatively low-pitched heart sounds (S3, S4, and the rumble of mitral
stenosis)
First heart sound (S1) Correct Answer: lub, systole (ventricular contraction)
closing of mitral and tricuspid valve
heard better at apex
, Second heart sound (S2) Correct Answer: dub, diastole (ventricular relaxation)
closing of aortic and pulmonic valve
heard better at base of heart
When would you hear an accentuated S1? Correct Answer: tachycardia
rhythms with short PR interval
high cardiac output states (anemia)
When would you hear a diminished S1? Correct Answer: mitral regurgitation
When would you hear a split S1 Correct Answer: RBBB (delay in inter ventricular
conduction)
When does S1 have varying intensity? Correct Answer: atrial fib
What would be the suspicion with a widely split S2 that persists throughout the
respiratory cycle? Correct Answer: pulmonic stenosis
What would be the suspicion with fixed splitting of S2? Correct Answer: atrial
septal defect
R ventricular failure
What would be the suspicion with paradoxical or reversed S2 split, which occurs
with expiration and disappears through inspiration (the opposite of what you would
expect)? Correct Answer: LBBB
(caused by delayed closure of aortic valve)
What would be the suspicion with a mid-systolic click at the apex of the heart?
Correct Answer: mitral valve prolapse
blood volume during inspiration Correct Answer: moRe blood to R heart, Less
blood to L heart
Grading murmurs Correct Answer: grade on scale of 1-6
1 barely audible
2 readily audible
3 even louder
6 audible without stethoscope
grades 4-6 must have accompanying thrill
