Answer to Question 1
ANS: D
The murmur of tricuspid regurgitation is heard best at the left sternal border and may radiate to the right of the sternum. It is pansystolic, high pitched, and blowing and increases with respiration. Tricuspid regurgitation may be associated with right ventricular hypertrophy resulting in a right parasternal lift. When right ventricular failure occurs, jugular venous distention occurs with a prominent v wave, and liver enlargement may be present. There may be secondary right atrial enlargement owing to backflow into the right atrium. The most common initiator is pulmonary HTN.
Answer to Question 2
ANS: B
A thorough cardiac examination is performed with the patient sitting, leaning forward, lying, and in the left lateral recumbent position. Some murmurs are heard better in different positions. Listen over the carotids for radiation of an aortic or pulmonic murmur, in the left mid-axillary line for radiation of a mitral murmur, and in the epigastric area for a bruit, indicating an aneurysm.
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