Review Material

Question 1

What does Sensitivity mean?

Answer 1

It is the probability that a person with the disease has a positive test.

Question 2

What does specificity mean?

Answer 2

It is the probability that a non-diseased person has a negative test

Question 3

What is a positive predictive value?

Answer 3

It is the probability that a person with a positive test has the disease

Question 4

What causes a split S2 and where is this best heard?

Answer 4

• S2 is composed of 2 components: the aortic valve A2 closing and the pulmonic valve closing P2. Since the aortic valve has higher pressure in the valve due to it carrying arterial blood, it is usually louder.
• To hear the pulmonic valve close during the S2 heart sound, it is best heard between the 2nd & 3rd intercostal spaces AND it is heard only on inspiration

Question 5

What causes an S3 heart sound?

Answer 5

1. S3 sound is produced During ventricular filling when a large amount of blood strikes a very compliant left ventricle
2. After age 40, a third heart sound is usually abnormal and correlates with dysfunction or volume overload of the ventricles.
3. Associated with heart failure and: hypertrophic cardiomyopathy, myocarditis, cor pulmonale, or acute valvular regurgitation

Question 6

What causes an S4 heart sound?

Answer 6

• S4 is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle. This causes abnormal turbulence in the flow of blood that can be detected by a stethoscope.
• It immediately precedes S1 of the next beat and is associated with cardiomyopathy and heart failure

Question 7

What is the diaphragm of your stethoscope used for?

Answer 7

The diaphragm is better for:

• High pitched sounds of S1 and S2
• The murmurs of aortic and mitral regurgitation, and pericardial friction rubs.

Question 8

What is the bell of your stethoscope used for?

Answer 8

• The bell is more sensitive to the low-pitched sounds of S3 and S4
• Is used to detect the murmur of mitral stenosis.

Question 9

What does a grade 1 murmur sound like?

Answer 9

Very faint, heard only after listener has “tuned in”; may not be
heard in all positions

Question 10

What does a grade 2 murmur sound like?

Answer 10

Quiet, but heard immediately after placing the stethoscope on
the chest

Question 11

What does a grade 3 murmur sound like?

Answer 11

Moderately loud

Question 12

What does a grade 4 murmur sound like?

Answer 12

• Loud, with palpable thrill
• **Note that grades 4 through 6 require the added presence of a palpable
  thrill. **

Question 13

What does a grade 5 murmur sound like?

Answer 13

• Very loud, with thrill. May be heard when the stethoscope is partly off the chest
• **Note that grades 4 through 6 require the added presence of a palpable
  thrill. **

Question 14

What does a grade 6 murmur sound like?

Answer 14

• Very loud, with thrill. May be heard with stethoscope entirely off the chest
• **Note that grades 4 through 6 require the added presence of a palpable
  thrill. **