NBME Form 1 - Heart Sound

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NBME Form 1 - Heart Sound

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humpf!!
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05/17/06 - 05:52 PM

A 50-year-old man has a 10 year history of poorly controlled hypertension. Vital signs are

Pulse 96/min

Respirations 16/min

Blood pressure

Left arm 226/120 mm Hg

Right arm 218/118mmHg

With the patient in the left lateral decubitus position, a late diastolic sound is heard best with the bell at the apex. Which of the following is the most likely explanation for this auscultatory finding?

A) Aortic insufficiency

B) Aortic stenosis

C) Mitral insufficiency

D) Mitral stenosis

E) Opening snap

F) Pulmonic insufficiency

G) Pulmonic stenosis

H)S3

I) S4
J) Tricuspid insufficiency

robin082006
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05/17/06 - 10:06 PM

A

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qts
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05/17/06 - 10:35 PM

I (S4). here's my xplanation
in this case due to long standing hypertension ventricular hypertrophy develops which gives rise to S4...
nod

robin082006
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05/17/06 - 11:18 PM

oh my God Idid not see S4, I looked for it but not saw. Terrible mastake mad

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Cedrick
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06/29/06 - 02:28 PM

qts wrote:
I (S4). here's my xplanation
in this case due to long standing hypertension ventricular hypertrophy develops which gives rise to S4...
nod

I had other choice S3
but I will change to S4

Choice I

reet
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06/29/06 - 03:06 PM

Ans H-- S3

During diastole there are 2 sounds of ventricular filling: The first is from the atrial walls and the second is from the contraction of the atriums. The third heart sound is caused by vibration of the ventricular walls, resulting from the first rapid filling so it is heard just after S2. The third heart sound is low in frequency and intensity. An S3 is commonly heard in children and young adults. In older adults and the elderly with heart disease, an S3 often means heart failure.

S4
The fourth heart sound occurs during the second phase of ventricular filling: when the atriums contract just before S1. As with S3, the fourth heart sound is thought to be caused by the vibration of valves, supporting structures, and the ventricular walls. An abnormal S4 is heard in people with conditions that increase resistance to ventricular filling, such as a weak left ventricle

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vanshita
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06/29/06 - 04:13 PM

in mitra stenosis also mid diastolic murmur best heard in left lateral decubitus position with bell of stetho

docsrinu
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08/30/06 - 09:36 PM

Both MS & S4 are late diastolic sounds heard with bell in left lateral.

definitely not S3, bcos its early diastolic.

how to differentiate between MS & S4?

tn1kinobe
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09/13/06 - 11:10 PM

Straight out of Bates, 8th edition, pgs 250 and 278. The left lateral decubitus position allows for the left ventricle to be closer to the chest wall to bring out left-sided S3 and S4 and mitral murmers. The vignette telling us it is a LATE DIASTOLIC murmur means it's most likely an S4 murmur. Mitral Stenotic murmurs have a characteristic "diastolic rumble". No such rumble is mentioned in the vignette. Hope this helps!!!

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