Question 1

The procedure for locating the second intercostal space (ICS)is to first locate

Accepted Answer

To locate the second ICS,first locate the angle of Louis.Lightly place your finger on this angle.Then move your finger laterally to the right of the sternum to the rib.This is the second rib.Move your finger down beneath the second rib to the ICS which is the second intercostal space.You would first locate Erb's point in order to locate the third ICS.The apical impulse,which used to be called the point of maximum impulse,is a pulsation created as the left ventricle rotates against the chest wall during systole.When visible,it occupies the fourth or fifth ICS,inside the midclavicular line.

Question 2

A patient with mitral stenosis may also have an opening snap caused by the opening of a diseased valve.This sound

Accepted Answer

An opening snap is an early diastolic sound that is high pitched and is abnormal.An opening snap is caused by the opening of a diseased valve and can be auscultated in mitral stenosis.The sound does not vary with respirations and can radiate throughout the chest.It follows S₂ and can be differentiated from an S₃ because it occurs earlier than an S₃.Because the sound is high pitched,it is best auscultated with the diaphragm of the stethoscope.

Question 3

A visible,systolic pulsation in the tricuspid area is most likely caused by increased stroke volume resulting in

Accepted Answer

A visible,systolic pulsation in the tricuspid area is abnormal.It can result from right ventricular enlargement secondary to an increased stroke volume.Anxiety,hyperthyroidism,fever,and pregnancy are clinical situations that produce an increased stroke volume.

Question 4

A normal pulsation palpated in the mitral area is the apical impulse,which

Accepted Answer

The apical impulse is palpable in approximately half of the adult population.It is felt as a light,localized tap that is 1 to 2 cm in diameter.The amplitude is small,and it can be felt immediately after the first heart sound,lasting for about one-half of systole.This impulse may be exaggerated in young patients.The apical impulse is often easier to palpate with the patient turned to the left side.This position facilitates palpation because the heart shifts closer to the chest wall.

Question 5

S₁ is loudest,and therefore best heard,in the:

Accepted Answer

S₁ is loudest,and therefore best heard,in the mitral area.S₁ is heard the loudest in the mitral area and is caused by the closure of the mitral and tricuspid valves.S₁ corresponds to the “lub” sound in the phonetic “lub-dub” representation of heart sounds.S₁ is louder than S₂ at this landmark.S₁ in the tricuspid area is softer than S₁ auscultated in the mitral area because the pressure in the left side of the heart is greater than that in the right.S₁ is louder than S₂ at this landmark.The midprecordial area is where both aortic and pulmonic murmurs can be auscultated.S₂ is louder than S₁ at the aortic area.

Question 6

When palpating the cardiac landmarks,you should examine for the presence of a thrill,which is best examined using the

Accepted Answer

Using the palmar surface of the hand at the base of the fingers (also known as the ball of the hand),locate the cardiac landmark and palpate the area for thrills.A thrill is a palpable vibration that feels like the throat of a purring cat.The finger pads of all five fingers are used to examine for pulsations.Neither the ulnar aspect of a closed fist nor the fingertips along with a stethoscope as a guide is used to palpate the cardiac landmarks.

Question 7

When auscultating a patient’s heart at the pulmonic area,you hear a split S₂ with the louder A₂ component occurring slightly before the P₂ component during inspiration.You recognize that this finding most likely is

Accepted Answer

There is a normal physiological splitting of S₂ that is heard best at the pulmonic area.The components of a split S₂ are A₂ (aortic)and P₂ (pulmonic).The aortic component occurs slightly before the pulmonic component during inspiration.The physiology of a split S₂ is that during inspiration,because of the more negative intrathoracic pressure,the venous return to the right side of the heart increases.Thus,pulmonic closure is delayed because of the extra time needed for the increased blood volume to pass through the valve.Normally,the A₂ component of the split S₂ is louder than the P₂ component because of the greater pressures in the left side of the heart.A fixed split is unaffected by respiration; the split is always there.

Question 8

An S₃ originating from the right ventricle is best heard with the

Accepted Answer

Auscultation of the mitral and tricuspid areas is performed for low-pitched sounds,specifically an S₃ (otherwise known as a ventricular diastolic gallop or extra heart sound).Because S₃ is a low-pitched sound,it is best heard with the bell.An S₃ is an early diastolic filling sound that originates in the ventricles and is thus heard best at the apex of the heart.An S₃ originating from the right ventricle is best heard by placing the bell over the third or fourth ICS at the left sternal border.An S₃ originating from the left ventricle is best heard by placing the bell over the fifth ICS at the midclavicular line.

Question 9

An S₄ is best described as

Accepted Answer

The S₄ heart sound is a low-frequency vibration caused by atrial contraction.It precedes S₁ of the next cycle and is known as atrial diastolic gallop.An S₄ heart sound is a late diastolic filling sound.An S₃ is an early diastolic filling sound associated with rapid ventricular filling.A holosystolic heart murmur is a rumbling or blowing sound heard throughout systole.An opening snap is a high-pitched clicking sound occurring early in diastole.

Question 10

The diaphragm of the stethoscope is used in the cardiac examination to auscultate

Accepted Answer

The diaphragm of the stethoscope is used in the cardiac examination to auscultate high-frequency or high-pitched sounds.The bell of the stethoscope is used to examine for bruits.The bell is for relatively low-pitched sounds.The diaphragm is used to auscultate for murmurs in the aortic,pulmonic,mitral,and tricuspid areas.

Question 11

Discovered upon inspection,a pulsation or systolic bulge found at the third intercostal space,left sternal border,is considered

Accepted Answer

A pulsation or systolic bulge found at the third intercostal space,left sternal border (in the midprecordial area),is considered abnormal.A left ventricular aneurysm can produce a midprecordial pulsation.Ventricular aneurysms can develop several weeks following an acute MI.With an MI,the hydraulic stress on the infarcted area can cause the damaged ventricular wall to bulge and become extremely thin during systole.Pericardial disease can produce retractions in the midprecordial area.

Question 12

When auscultating the tricuspid area,you hear a split S₁.You determine that the split is wider than usual during inspiration and is still heard during expiration.An abnormally split S₁ is commonly heard in mitral stenosis because the

Accepted Answer

A split S₁ with an abnormally wide split is pathological.The split is wider than usual during inspiration and is still heard on expiration.In mitral stenosis,the tricuspid valve can close before the mitral valve closes because of calcification of the diseased mitral valve.If the mitral valve closes before the tricuspid valve,it is caused by greater pressure in the left side of the heart.An abnormally split S₁ is not related to the sound of the mitral valve as it closes or opens.

Question 13

A pulsation in the aortic area,discovered upon inspection,is considered

Accepted Answer

No pulsation should be visible in the aortic area.If it is visible,it is abnormal and is possibly caused by the presence of an aortic root aneurysm.A visible systolic pulsation in the tricuspid area is abnormal and can result from a right ventricular enlargement or hypertrophy.Aortic regurgitation can cause a pulsation or thrill palpable in the aortic area.

Question 14

You detect the presence of a heave,which is best described as

Accepted Answer

A heave is a lifting of the cardiac area secondary to an increased workload and force of left ventricular contraction.A heave is also referred to as a lift.A pulsating mass is a pulsation.A thrill is a vibration similar to that felt when your hand is placed on a purring cat.

Question 15

Hypokinetic pulsations in the mitral area can be caused by

Accepted Answer

Hypokinetic (decreased movement)pulsations in the mitral area can be caused by the presence of fluid between the left ventricle and the chest wall.Two causes of hypokinetic pulsations in the mitral area are pericardial effusion and cardiac tamponade; however,absent pulsations are normal in half of the adult population.In obesity,the excess subcutaneous tissue dampens the apical pulse.Low output states such as shock produce a less palpable apical impulse from the reduced blood volume and decreased myocardial contractility.High-output states such as mitral regurgitation,thyrotoxicosis,severe anemia,and left-to-right heart shunts are potential causes of hyperkinetic pulsations.

Question 16

A summation gallop is the sound heard when the following heart sounds are present

Accepted Answer

When both the pathologic S₃ and S₄ are present,quadruple rhythm is heard.Often,in cases of cardiac stress,one response is tachycardia.During rapid rates,the diastolic filling time shortens and the S₃ and S₄ move closer together.They sound superimposed in mid-diastole,and you hear one loud,prolonged,summated sound,often louder than either S₁ or S₂.This is called a summation gallop which is represented as S₁,S₂,S₃–₄.

Question 17

After auscultating the aortic area,you determine that a patient has a diminished A₂ and an ejection click.The most likely cause of these two findings is

Accepted Answer

The second heart sound (S₂)is associated with the closure of the semilunar valves.You can hear it with the diaphragm on the aortic landmark.The components of S₂ are A₂ (aortic)and P₂ (pulmonic).A greatly intensified or diminished A₂ is considered abnormal.A diminished A₂ can be caused by aortic stenosis where the aortic valve is calcified or thickened.The ejection click occurs early in systole at the start of ejection because it results from the opening of the semilunar valves.Normally,the semilunar valves open silently,but in the presence of aortic stenosis their openings make a sound.It is short and high pitched,with a click quality.A greatly intensified A₂ can be the result of arterial hypertension that increases the pressure in the aorta.

Question 18

When palpating the aortic area,you detect the presence of a thrill,which is an abnormal finding related to aortic stenosis and aortic regurgitation resulting in turbulent blood flow in the

Accepted Answer

Aortic stenosis and aortic regurgitation create turbulent blood flow in the left ventricle which can be palpated as a thrill.Pulmonic stenosis and pulmonic regurgitation create turbulent blood flow in the right ventricle that may be palpated as a thrill.

Question 19

You are unable to distinguish S₁ from S₂,so you proceed by placing the diaphragm of your stethoscope over the mitral area while

Accepted Answer

To identify S₁, place the diaphragm of the stethoscope over the mitral area.If you are unable to distinguish S₁ from S₂,palpate the carotid artery with the hand closest to the head while auscultating the mitral landmark.You will hear S₁ with each carotid pulse beat.The patient holding his breath or taking a deep breath is not going to help you differentiate S₁ from S₂.

Question 20

You are auscultating a patient's heart during a routine physical examination.You should position the patient

Accepted Answer

During a routine physical examination,the patient should be positioned flat,supine,or sitting for you to auscultate the heart.For a more thorough auscultation of the heart,the patient may need to be in positions other than flat,supine,or sitting.The murmur of mitral stenosis and S? and S? sometimes can be heard only when the patient is on the left side.Murmur of aortic regurgitation can sometimes be heard only when the patient is leaning forward in the sitting position.The patient would not be on his back with the bed raised 45° for auscultation of the heart.

Quiz 16: Heart

The procedure for locating the second intercostal space (ICS) is to first locate

A patient with mitral stenosis may also have an opening snap caused by the opening of a diseased valve.This sound

A visible,systolic pulsation in the tricuspid area is most likely caused by increased stroke volume resulting in

A normal pulsation palpated in the mitral area is the apical impulse,which

S₁ is loudest,and therefore best heard,in the:

When palpating the cardiac landmarks,you should examine for the presence of a thrill,which is best examined using the

When auscultating a patient’s heart at the pulmonic area,you hear a split S₂ with the louder A₂ component occurring slightly before the P₂ component during inspiration.You recognize that this finding most likely is

An S₃ originating from the right ventricle is best heard with the

An S₄ is best described as

The diaphragm of the stethoscope is used in the cardiac examination to auscultate

Discovered upon inspection,a pulsation or systolic bulge found at the third intercostal space,left sternal border,is considered

When auscultating the tricuspid area,you hear a split S₁.You determine that the split is wider than usual during inspiration and is still heard during expiration.An abnormally split S₁ is commonly heard in mitral stenosis because the

A pulsation in the aortic area,discovered upon inspection,is considered

You detect the presence of a heave,which is best described as

Hypokinetic pulsations in the mitral area can be caused by

A summation gallop is the sound heard when the following heart sounds are present

After auscultating the aortic area,you determine that a patient has a diminished A₂ and an ejection click.The most likely cause of these two findings is

When palpating the aortic area,you detect the presence of a thrill,which is an abnormal finding related to aortic stenosis and aortic regurgitation resulting in turbulent blood flow in the

You are unable to distinguish S₁ from S₂,so you proceed by placing the diaphragm of your stethoscope over the mitral area while

You are auscultating a patient's heart during a routine physical examination.You should position the patient

Quiz 16: Heart

The procedure for locating the second intercostal space (ICS) is to first locate

A patient with mitral stenosis may also have an opening snap caused by the opening of a diseased valve.This sound

A visible,systolic pulsation in the tricuspid area is most likely caused by increased stroke volume resulting in

A normal pulsation palpated in the mitral area is the apical impulse,which

S1 is loudest,and therefore best heard,in the:

When palpating the cardiac landmarks,you should examine for the presence of a thrill,which is best examined using the

When auscultating a patient’s heart at the pulmonic area,you hear a split S2 with the louder A2 component occurring slightly before the P2 component during inspiration.You recognize that this finding most likely is

An S3 originating from the right ventricle is best heard with the

An S4 is best described as

The diaphragm of the stethoscope is used in the cardiac examination to auscultate

Discovered upon inspection,a pulsation or systolic bulge found at the third intercostal space,left sternal border,is considered

When auscultating the tricuspid area,you hear a split S1.You determine that the split is wider than usual during inspiration and is still heard during expiration.An abnormally split S1 is commonly heard in mitral stenosis because the

A pulsation in the aortic area,discovered upon inspection,is considered

You detect the presence of a heave,which is best described as

Hypokinetic pulsations in the mitral area can be caused by

A summation gallop is the sound heard when the following heart sounds are present

After auscultating the aortic area,you determine that a patient has a diminished A2 and an ejection click.The most likely cause of these two findings is

When palpating the aortic area,you detect the presence of a thrill,which is an abnormal finding related to aortic stenosis and aortic regurgitation resulting in turbulent blood flow in the

You are unable to distinguish S1 from S2,so you proceed by placing the diaphragm of your stethoscope over the mitral area while

You are auscultating a patient's heart during a routine physical examination.You should position the patient

S₁ is loudest,and therefore best heard,in the:

When auscultating a patient’s heart at the pulmonic area,you hear a split S₂ with the louder A₂ component occurring slightly before the P₂ component during inspiration.You recognize that this finding most likely is

An S₃ originating from the right ventricle is best heard with the

An S₄ is best described as

When auscultating the tricuspid area,you hear a split S₁.You determine that the split is wider than usual during inspiration and is still heard during expiration.An abnormally split S₁ is commonly heard in mitral stenosis because the

After auscultating the aortic area,you determine that a patient has a diminished A₂ and an ejection click.The most likely cause of these two findings is

You are unable to distinguish S₁ from S₂,so you proceed by placing the diaphragm of your stethoscope over the mitral area while