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Quizzes > Health & Medicine > Human Anatomy & Medicine

Take the Free Cardiac Auscultation Quiz

Ready to Identify Heart Sounds? Start the S1 - S4 Quiz!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art heart and stethoscope for cardiac auscultation quiz identify S1-S4 boost accuracy on coral background

Ready to sharpen your skills? Our free cardiac auscultation quiz challenges you to distinguish S1 - S4 heart sounds and refine your diagnostic ear. This heart sound identification quiz will boost your auscultation accuracy and help you tackle cardiac respiratory exam questions with confidence. Whether you're taking the heart sounds quiz or the S1 S2 S3 S4 quiz, you'll get instant feedback and tips to level up. Then, explore our heart murmur quiz or check our optimal valve auscultation guide to keep progressing. Dive in and start listening now!

Which heart sound corresponds to the closure of the mitral and tricuspid valves?
S1
S2
S4
S3
S1 is produced by the closure of the atrioventricular (mitral and tricuspid) valves at the onset of ventricular systole. It signifies the beginning of systole and is best heard at the cardiac apex. S1 is louder when these valves close forcefully. source
Which heart sound corresponds to the closure of the aortic and pulmonary valves?
S2
S3
S1
S4
S2 results from the closure of the semilunar valves (aortic and pulmonary) marking the end of ventricular systole. It is best heard at the upper left and right sternal borders. Splitting of S2 can vary with respiration. source
A physiologic split of S2 is best heard at which auscultation site?
Apex
Left midclavicular line
Left upper sternal border
Right lower sternal border
Physiologic splitting of S2 occurs when A2 and P2 are heard separately during inspiration and is best auscultated at the left upper sternal border (pulmonic area). The split narrows or disappears during expiration. This finding is normal in healthy individuals. source
Which heart sound may be normal in children but often indicates heart failure in older adults?
S3
S1
S2
S4
An S3 gallop is common in young children and pregnant women due to increased flow but in older adults often signifies volume overload and heart failure. It occurs early in diastole during rapid ventricular filling. It is best heard at the apex with the bell of the stethoscope. source
Which heart sound is associated with atrial contraction and best heard with the bell at the apex?
S1
S2
S4
S3
The S4 heart sound is due to atrial contraction against a stiff ventricle and occurs late in diastole, just before S1. It is best heard at the apex with the patient in the left lateral decubitus position using the bell. An S4 often indicates decreased ventricular compliance. source
S1 is loudest at which auscultation area on the chest?
Second intercostal space
Right upper sternal border
Apex
Left lower sternal border
S1, produced by the closure of the mitral and tricuspid valves, is typically loudest at the cardiac apex. The intensity of S1 correlates with the velocity of valve closure and the distance between valve leaflets at the onset of systole. source
Where is the mitral valve area located for auscultation?
Fourth intercostal space at left sternal border
Third intercostal space at left sternal border
Second intercostal space at right sternal border
Fifth intercostal space at midclavicular line
The mitral valve area is best auscultated at the fifth intercostal space in the midclavicular line (the apex). This location allows for optimal hearing of both S1 and any diastolic murmurs due to mitral pathologies. source
Which statement about S1 is correct?
It marks the onset of systole
It marks the onset of diastole
It is caused by semilunar valve closure
It is best heard at the right upper sternal border
S1 corresponds to the closure of the mitral and tricuspid valves at the beginning of ventricular systole. It is best heard at the apex and signifies the start of systolic ejection. Semilunar valve closure produces S2, not S1. source
A fixed wide split of S2 that does not vary with respiration suggests which condition?
Ventricular septal defect
Aortic stenosis
Atrial septal defect
Mitral regurgitation
A fixed, wide splitting of S2 that persists through the respiratory cycle is characteristic of an atrial septal defect. The left-to-right shunt increases right ventricular volume and delays P2 consistently. This physiology does not change with inspiration. source
A holosystolic murmur heard best at the left lower sternal border that radiates to the right lower sternal border is most consistent with which diagnosis?
Mitral regurgitation
Pulmonic stenosis
Tricuspid regurgitation
Ventricular septal defect
A holosystolic, harsh murmur best heard at the left lower sternal border that radiates across that border suggests a ventricular septal defect. The high-pressure gradient between the left and right ventricles during systole causes this characteristic sound. source
A harsh crescendo-decrescendo systolic murmur heard at the right second intercostal space radiating to the carotids is most indicative of?
Hypertrophic cardiomyopathy
Aortic regurgitation
Ventricular septal defect
Aortic stenosis
A harsh, crescendo-decrescendo murmur at the right upper sternal border radiating to the carotids is classic for aortic stenosis. It peaks in mid-systole and its intensity correlates with valve area reduction. source
A high-pitched decrescendo diastolic murmur heard at the left sternal border is characteristic of?
Mitral stenosis
Aortic regurgitation
Pulmonic regurgitation
Tricuspid regurgitation
A high-pitched, decrescendo diastolic murmur best heard at the left sternal border is typical of aortic regurgitation. It results from blood flowing back into the left ventricle during diastole. Patient position leaning forward accentuates this murmur. source
A low-pitched rumbling diastolic murmur with an opening snap at the apex suggests?
Aortic stenosis
Tricuspid stenosis
Ventricular septal defect
Mitral stenosis
Mitral stenosis produces a low-frequency, rumbling diastolic murmur preceded by an opening snap due to the stiff mitral valve leaflets. It is best heard at the apex with the patient in the left lateral decubitus position. The interval between S2 and the opening snap correlates with severity. source
Which condition is commonly associated with the presence of an S3 gallop?
Heart failure
Pericarditis
Mitral regurgitation
Aortic stenosis
An S3 gallop reflects rapid ventricular filling and increased diastolic volume, commonly seen in systolic heart failure. It can also occur in volume overload states. It is low-pitched and best heard at the apex with the bell. source
In an adult over 40, the presence of an S3 gallop is most likely:
Pathological
Physiological
A normal variant in athletes
An incidental finding
In adults over 40, an S3 is almost always pathological, often indicating heart failure or increased filling pressures. In younger individuals it may be physiological due to faster filling. Persistent S3 in older adults warrants evaluation for ventricular dysfunction. source
Which maneuver increases the intensity of the systolic murmur in hypertrophic obstructive cardiomyopathy?
Valsalva maneuver
Handgrip
Squatting
Leg elevation
The Valsalva maneuver decreases venous return and left ventricular volume, which exaggerates the outflow tract obstruction in hypertrophic cardiomyopathy, increasing murmur intensity. Squatting and handgrip increase preload or afterload, decreasing the murmur. source
How does inspiration affect heart murmurs?
No change in murmur intensity
Increases intensity of left-sided murmurs
Decreases intensity of right-sided murmurs
Increases intensity of right-sided murmurs
Inspiration increases venous return to the right heart, enhancing right-sided murmurs (e.g., tricuspid regurgitation). Conversely, left-sided murmurs diminish slightly. This single-breath maneuver helps distinguish murmur origin. source
The ability to distinguish pulmonic from aortic murmurs by respiration relies on what principle?
Right-sided sounds accentuate with expiration
Left-sided sounds accentuate with inspiration
Right-sided sounds accentuate with inspiration
Murmur intensity is unaffected by respiration
Respiration changes intrathoracic pressures; inspiration increases right heart filling and accentuates right-sided murmurs (pulmonic). This helps differentiate pulmonic from aortic murmurs which do not increase with inspiration. source
A pericardial knock heard shortly after S2 is most characteristic of which condition?
Pericardial effusion
Acute myocardial infarction
Constrictive pericarditis
Restrictive cardiomyopathy
A pericardial knock is an early diastolic sound occurring after S2 in constrictive pericarditis due to sudden cessation of ventricular filling. It is higher pitched than an S3 and best heard at the left lower sternal border. source
A loud P2 component of S2 suggests which of the following?
Mitral regurgitation
Pulmonary hypertension
Systemic hypertension
Aortic stenosis
A prominently loud P2 is associated with pulmonary hypertension because increased pressure in the pulmonary artery causes forceful closure of the pulmonic valve. It is best heard at the left upper sternal border. source
Paradoxical splitting of S2 occurs in which scenario?
Left bundle branch block
Pulmonary embolism
Atrial septal defect
Right bundle branch block
Paradoxical or reversed splitting of S2 occurs when A2 is delayed and follows P2, as seen in left bundle branch block or severe aortic stenosis. The split narrows on inspiration. source
How can you differentiate an S4 from an early systolic ejection click based on timing?
S4 occurs just before S1 during late diastole
S4 occurs immediately after S1
Ejection click occurs in mid-diastole
Ejection click occurs after S2
An S4 gallop is a late diastolic sound just before S1, whereas an ejection click occurs early in systole, shortly after S1. Timing within the cardiac cycle distinguishes these sounds. source
Which maneuver decreases the intensity of a mitral regurgitation murmur?
Squatting
Handgrip
Valsalva maneuver
Passive leg raise
The Valsalva maneuver reduces venous return and left ventricular volume, decreasing regurgitant flow and murmur intensity in mitral regurgitation. Squatting and passive leg raise increase preload, intensifying the murmur. source
In left bundle branch block, why is the splitting of S2 paradoxical?
It only occurs during expiration
Both semilunar valves close simultaneously
Increased right ventricular pressure delays P2
Delayed aortic valve closure causes A2 to occur after P2
Left bundle branch block delays left ventricular activation and prolongs aortic valve closure (A2), causing it to occur after P2. This reversal of the normal sequence results in paradoxical splitting that narrows on inspiration. source
What defines a summation gallop and how is it distinguished from separate S3 and S4?
A loud S1 and S2 merging in tachycardia
Timing of sounds after S2 only
Presence of S3 only in diastole
Fusion of S3 and S4 at high heart rates producing a single low-frequency sound
A summation gallop occurs when tachycardia shortens diastole so that S3 and S4 overlap, producing one combined low-frequency sound. It is distinguished by the absence of two discrete diastolic sounds and is best heard with the bell at the apex. source
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Study Outcomes

  1. Identify Heart Sounds S1 - S4 -

    Learn to recognize and label the first through fourth heart sounds by their distinct timing and acoustic characteristics.

  2. Understand Physiological Origins -

    Gain insight into the mechanical events and valve movements that generate each heart sound during the cardiac cycle.

  3. Distinguish Normal from Abnormal Sounds -

    Differentiate between typical heart sounds and pathological findings, such as gallops or murmurs, to improve diagnostic precision.

  4. Apply Systematic Auscultation Techniques -

    Master a stepwise approach to stethoscope placement and listening sequences for accurate cardiac assessment.

  5. Enhance Exam Readiness -

    Boost your confidence and performance on cardiac respiratory exam questions through targeted quiz practice.

Cheat Sheet

  1. Key timing and origins of S1 vs S2 -

    Review how S1 arises from mitral and tricuspid valve closure at the onset of ventricular systole, while S2 marks aortic and pulmonic valve closure at the start of diastole. Note that S1 is loudest at the apex and S2 at the base, and using carotid pulse palpation helps correlate each sound with the cardiac cycle (Harrison's Principles of Internal Medicine).

  2. Mnemonic for gallop rhythms (S3 & S4) -

    Use the phrases "Ken-tuck-y" for S3 and "Ten-nes-see" for S4 to remember timing: S3 falls after S2 in early diastole ("Ken - ") and S4 just before S1 in late diastole (" - see"). Both are low-frequency sounds best heard with the bell at the apex and may indicate heart failure (American Heart Association).

  3. Optimal auscultation sites and techniques -

    Follow the APE To Man mnemonic - Aortic (2nd right ICS), Pulmonic (2nd left ICS), Erb's point (3rd left ICS), Tricuspid (4th left ICS), Mitral (5th ICS, midclavicular line) - switch between diaphragm for high-pitch sounds and bell for low-pitch gallops. Incorporate maneuvers like left lateral decubitus or Valsalva to accentuate S3/S4 and boost your confidence during the cardiac auscultation quiz (University of Washington School of Medicine).

  4. Physiological vs pathological splitting -

    Understand that normal splitting of S2 occurs during inspiration due to delayed pulmonic valve closure, whereas fixed or paradoxical splitting suggests pathology such as atrial septal defect or left bundle branch block. Practice listening for changes in split duration across respiratory phases to ace the cardiac auscultation quiz (Brigham and Women's Hospital guidelines).

  5. Phonocardiogram cross-referencing -

    After listening, review phonocardiogram tracings to visualize sound waveforms and intervals; for example, S1 correlates with the QRS upstroke and S2 with the end of the T-wave. This dual sensory approach reinforces recognition and boosts accuracy in cardiac auscultation quizzes (Stanford School of Medicine research).

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