Sounds

Question 1

S1

Answer 1

Mitral and tricuspid valve closure:

Loudest at mitral area

Question 2

S2

Answer 2

Aortic and pulmonary valve closure:

Loudest at left sternal border

Question 3

S3

Answer 3

In early diastole during rapid ventricular filling

Associated with high filling pressure (mitral regurg, CHF) More common in dilated ventricles (but normal in children and pregnant women)

Question 4

S4

Answer 4

“Atrial kick”

In late diastole,
high atrial pressure, associated with ventricular hypertrophy; left atrium must push against stiff LV wall.

Question 5

Jugular venous pulse (JVP):

a wave

Answer 5

Atrial contraction

Question 6

Jugular venous pulse (JVP):

c wave

Answer 6

RV contraction (closed tricuspid valve bulging into atrium)

Question 7

Jugular venous pulse (JVP):

x descent

Answer 7

Atrial relaxation and downward displacement of closed tricuspid valve during ventricular contraction

Question 8

Jugular venous pulse (JVP):

v wave

Answer 8

Increased right atrial pressure due to filling against closed tricuspid Valve

Question 9

Jugular venous pulse (JVP):

y descent

Answer 9

blood flow from RA to RV

Question 10

Order of JVP

Answer 10

A-CX-VY