In mitral stenosis, the murmur can be best heard with the patient in the:

The answer to question 1  ANS: C
Mitral stenosis results from thickening and stiffening of the mitral valve, usually secondary to rheumatic fever. The murmur is generally grade I to IV and low pitched; therefore, it is heard better with the bell at the apex in the left lateral recumbent position. The first heart sound (S1) is loud, followed by S2 and a loud opening snap that precedes the murmur.

The answer to question 2  ANS: A
The tricuspid valve is best heard over the fourth intercostal space left sternal border. Erb's point is where all valves can be heard equally well. Erb's point is located over the third intercostal space left sternal border. The mitral valve is best heard over the fifth intercostal space in the mid-clavicular line. The aortic valve is best heard over the second intercostal space right sternal border. The pulmonic valve is best heard over the second intercostal space left sternal border.

The answer to question 3  ANS: D
An innocent murmur is a type of systolic murmur that results from turbulent blood flow and is not associated with heart disease. Innocent murmurs occur commonly in children and young adults and reflect the contractile force of the heart, resulting in greater velocity of flow during early systole. They are heard best in the second and third left interspaces along the left sternal border or at the apex.

The answer to question 4  ANS: B
Mitral stenosis results from thickening and stiffening of the mitral valve, usually secondary to rheumatic fever. The murmur is generally grade I to IV and low pitched; therefore, it is heard better with the bell at the apex in the left lateral recumbent position. The first heart sound (S1) is loud, followed by S2 and a loud opening snap that precedes the murmur.

The answer to question 5  ANS: C
The tricuspid valve is best heard over the fourth intercostal space left sternal border. Erb's point is located over the third intercostal space left sternal border. The mitral valve is best heard over the fifth intercostal space in the mid-clavicular line. The aortic valve is best heard over the second intercostal space right sternal border. The pulmonic valve is best heard over the second intercostal space left sternal border.

The answer to question 6  ANS: A
In mitral valve prolapse (MVP), a portion of the mitral valve flops open up into the left atrium, giving rise to a classic mid-systolic click followed by a soft grade I murmur that crescendos up to S2. It is high pitched and is heard best at the apex or left sternal border.

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