Instructions: After reading the patient summary, click on the stethoscope head to listen to the heart sound. Then click on the diagram that best matches what you hear.
A 64-year-old business man is seen because of the recent onset of exertional chest discomfort which is classic for angina pectoris. No other symptoms. PMH. Negative. FH. Positive for CAD (brother has had CAB). SH. Discontinued cigarette smoking 5 years ago (40 pack-years). Physical Examination: BP 126/70, P 70, R 12, Ht. 5'11", Wt. 171. General physical examination normal for age. Carotid and jugular pulses normal. No cardiac enlargement. Apex impulse normal. The following was heard on auscultation.
APEX, BELL (Supine)
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CORRECT
This is trochaic metre.
Play the phono and then, if you wish, click on the incorrect diagrams to compare heart sounds.
Move on.
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INCORRECT
S2 is not louder than S1. The heart sound matching this diagram is playing now. Please try again.
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INCORRECT
The patient does not have an S4. The heart sound matching this diagram is playing now. Please try again.