Match List I with List II and select the correct answer using the code given below the lists:
List I (Auscultatory findings) List II (Cardiac condition) A Wide fixed split in the second heart sound 1 Pulmonary hypertension B Continuous machinery murmur 2 Atrial septal defect C Muffled heart sounds 3 Patent ductus arteriousus D Wide variable split in the second heart sound 4 Pericardial effusion
| A | B | C | D |
| 2 | 3 | 4 | 1 |
Cardiac Auscultation Findings Explained
This solution details the correct matching of specific auscultatory findings (List I) with their corresponding cardiac conditions (List II) to identify distinct cardiac pathologies.
Understanding the Cardiovascular Sound Matches
- Finding A: Wide fixed split in the second heart sound corresponds to Condition 2: Atrial Septal Defect (ASD). The fixed split occurs because the increased right atrial volume in ASD equalizes right ventricular and pulmonary artery pressures, delaying pulmonic valve closure consistently across respiratory cycles.
- Finding B: Continuous machinery murmur is characteristic of Condition 3: Patent Ductus Arteriosus (PDA). This murmur is heard throughout systole and diastole due to the continuous pressure gradient between the aorta and the pulmonary artery, allowing blood to shunt from the aorta to the pulmonary artery.
- Finding C: Muffled heart sounds relates to Condition 4: Pericardial Effusion. Excess fluid in the pericardial sac dampens the transmission of heart sounds, making S1 and S2 less distinct and quieter.
- Finding D: Wide variable split in the second heart sound is associated with Condition 1: Pulmonary Hypertension. Increased pulmonary artery pressure can prolong right ventricular systole, leading to delayed pulmonic valve closure and a split S2 that varies with respiration.
Summary of Correct Pairings
| List I Auscultatory Finding | List II Cardiac Condition |
| A: Wide fixed split S2 | 2: Atrial Septal Defect |
| B: Continuous machinery murmur | 3: Patent Ductus Arteriosus |
| C: Muffled heart sounds | 4: Pericardial Effusion |
| D: Wide variable split S2 | 1: Pulmonary Hypertension |
The correct matching derived from the analysis is A-2, B-3, C-4, and D-1.
Important Questions from General Clinical Conditions
- The height of the Jugular Venous Pulse is determined by :
- The SA node is situated at the junction of:
- Reverse splitting of second heart sound is most commonly seen in :
- A 70-year-old man with dyspnoea on exertion has been found to have a single second heart sound and a loud diamond-shaped, rough quality systolic murmur best heard at the right $2^{nd}$ intercostal space, radiating to the right carotid artery. Which one of the following is the likely diagnosis ?
Consider the following statements with regard to pulmonary embolism :
1. Unexplained breathlessness is the most common symptom.
2. When congestive heart failure or pneumonia fail to improve despite standard medical treatment, occult pulmonary embolism should be considered.
3. Patients with high clinical likelihood of venous thromboembolism should first undergo D-dimer testing alone without obligatory imaging tests.
Which of the statements given above are correct?
