IPAP PE 2 WITH ALL QUESTIONS ANSWERED
CORRECTLY!!
1. What causes the S1, "LUB" sound?: Closure of Mitral and Tricuspid valve
(Atrioventricular valves)
-onset of systole
2. What causes the S2, "DUB" sound?: Closure of the Aortic and Pulmonic valves
(2 sounds that
merge into 1)
-onset of diastole
3. What is physiologic splitting related to S2?: closing of the aortic valve precedes
the closing
of the pulmonic valve is normal
4. What causes physiologic splitting of S2?: inspiration causes a delayed closure of
pulmonic
valve due to decreased intra-thoracic pressure
5. Where is S2 splitting heard best?: in the pulmonic region between the second
and third intercostal
spaces at the left sternal border
6. What is fixed splitting of S2?: -occurs in atrial septal defect (ASD).
-Heard on inspiration AND expiration
7. What is paradoxical (reversed) splitting of S2?: -can occur in conditions where
AV closure is
delayed, such as with left bundle branch block or Aortic Stenosis
-can also occur where the PV closes early, such as in Wolff-Parkinson-White
syndrome
,8. Though usually not heard in adults, when might you hear S3?: -During diastole
just
after S2, during rapid filling of the ventricles
-Dull, low-pitched sound
9. What can a pathologic finding with hearing S3 (ventricular gallop) indicate?-
: indicate volume overload - CHF or mitral or tricuspid insufficiency
10. How is the sound of S3 described?: "SLOSH'- ing - in"
S1 - S2 - S3
Or - LUB DUB TUH
11. When can S4 be heard?: Late in diastole, when the atria contract right before
S1 against a stiff
non-compliant ventricle
12. What is indicated by S4 (aka atrial gallop)?: Pressure overload
-Dull, low-pitched, best heard at apex with patient in left lateral decubitus position
13. How is the sound of S4 described?: "a - STIFF' - wall"
S4 - S1 - S2
OR - TUH - LUB - DUB
14. What can cause heart murmurs?: some disruption in the flow of blood through,
or out of the
heart
15. What are the grades of heart murmurs (intensity)?: -Grade I: Barely audible.
-Grade II: Faint but heard immediately upon listening.
-Grades III: Moderately loud without a thrill.
-Grade IV: Loud with a thrill.
, -Grade V: Loud enough to be heard with the stethoscope placed on its edge.
-Grade VI: So loud it can be heard with the stethoscope off the chest.
16. What are the Pansystolic (holosystolic-blowing) murmurs?: -Mitral
Regurgitation
-Tricuspid Regurgitation
-Ventricular Septal Defect (VSD)
17. What causes mitral regurgitation?: -mitral valve fails to close
-(DIAPHRAGM) apex; radiation to left axilla, harsh.
18. What causes tricuspid regurgitation?: -tricuspid valve fails to close
-(DIAPHRAGM) LLSB, radiation to right sternum/xiphoid, blowing.
-Maneuvers: accentuated by inspiration (increases preload).
19. What are the most common kinds of heart murmurs?: Midsystolic murmurs
-very common in children and young adults
20. How can Midsystolic murmurs be classified?: -Innocent: without physiological
or structural
abnormality.
-Physiologic: from changes in body metabolism.
-Pathologic: arising from structural abnormalities.
21. When are Midsystolic murmurs best heard?: Tend to peak near midsystole and
usually stop
just before S2.
22. Where are Innocent Midsystolic murmurs best heard?: 2-4 ICS between LLSB
and
apex, low intensity, usually decreases or disappears with sitting.
CORRECTLY!!
1. What causes the S1, "LUB" sound?: Closure of Mitral and Tricuspid valve
(Atrioventricular valves)
-onset of systole
2. What causes the S2, "DUB" sound?: Closure of the Aortic and Pulmonic valves
(2 sounds that
merge into 1)
-onset of diastole
3. What is physiologic splitting related to S2?: closing of the aortic valve precedes
the closing
of the pulmonic valve is normal
4. What causes physiologic splitting of S2?: inspiration causes a delayed closure of
pulmonic
valve due to decreased intra-thoracic pressure
5. Where is S2 splitting heard best?: in the pulmonic region between the second
and third intercostal
spaces at the left sternal border
6. What is fixed splitting of S2?: -occurs in atrial septal defect (ASD).
-Heard on inspiration AND expiration
7. What is paradoxical (reversed) splitting of S2?: -can occur in conditions where
AV closure is
delayed, such as with left bundle branch block or Aortic Stenosis
-can also occur where the PV closes early, such as in Wolff-Parkinson-White
syndrome
,8. Though usually not heard in adults, when might you hear S3?: -During diastole
just
after S2, during rapid filling of the ventricles
-Dull, low-pitched sound
9. What can a pathologic finding with hearing S3 (ventricular gallop) indicate?-
: indicate volume overload - CHF or mitral or tricuspid insufficiency
10. How is the sound of S3 described?: "SLOSH'- ing - in"
S1 - S2 - S3
Or - LUB DUB TUH
11. When can S4 be heard?: Late in diastole, when the atria contract right before
S1 against a stiff
non-compliant ventricle
12. What is indicated by S4 (aka atrial gallop)?: Pressure overload
-Dull, low-pitched, best heard at apex with patient in left lateral decubitus position
13. How is the sound of S4 described?: "a - STIFF' - wall"
S4 - S1 - S2
OR - TUH - LUB - DUB
14. What can cause heart murmurs?: some disruption in the flow of blood through,
or out of the
heart
15. What are the grades of heart murmurs (intensity)?: -Grade I: Barely audible.
-Grade II: Faint but heard immediately upon listening.
-Grades III: Moderately loud without a thrill.
-Grade IV: Loud with a thrill.
, -Grade V: Loud enough to be heard with the stethoscope placed on its edge.
-Grade VI: So loud it can be heard with the stethoscope off the chest.
16. What are the Pansystolic (holosystolic-blowing) murmurs?: -Mitral
Regurgitation
-Tricuspid Regurgitation
-Ventricular Septal Defect (VSD)
17. What causes mitral regurgitation?: -mitral valve fails to close
-(DIAPHRAGM) apex; radiation to left axilla, harsh.
18. What causes tricuspid regurgitation?: -tricuspid valve fails to close
-(DIAPHRAGM) LLSB, radiation to right sternum/xiphoid, blowing.
-Maneuvers: accentuated by inspiration (increases preload).
19. What are the most common kinds of heart murmurs?: Midsystolic murmurs
-very common in children and young adults
20. How can Midsystolic murmurs be classified?: -Innocent: without physiological
or structural
abnormality.
-Physiologic: from changes in body metabolism.
-Pathologic: arising from structural abnormalities.
21. When are Midsystolic murmurs best heard?: Tend to peak near midsystole and
usually stop
just before S2.
22. Where are Innocent Midsystolic murmurs best heard?: 2-4 ICS between LLSB
and
apex, low intensity, usually decreases or disappears with sitting.
