Family Nurse Practitioner Exam

A medium-pitched harsh mid-systolic murmur best heard at the right second ICS that radiates into the neck is indicative of?

1. Aortic stenosis

2. Pulmonic stenosis

3. Aortic regurgitation

4. Mitral stenosis

The correct answer is: Aortic stenosis

The presence of a medium-pitched harsh mid-systolic murmur best heard at the right second intercostal space (ICS) and radiating into the neck is characteristic of aortic stenosis. This type of murmur occurs due to the turbulent blood flow across a narrowed aortic valve during ventricular systole. The location of the murmur is significant; aortic stenosis is typically best heard in the right second ICS, as the aortic valve is located in that area. Additionally, the radiation of the murmur into the neck is a classic feature of aortic stenosis, often referred to as "radiation to the carotids." This phenomenon occurs because the sound waves travel along the carotid arteries due to the proximity of the aortic valve to the vascular structures of the neck. In contrast, the other conditions listed would present differently: pulmonic stenosis would typically have a murmur best heard at the left second ICS, aortic regurgitation commonly has a diastolic murmur rather than a systolic one, and mitral stenosis generally produces a rumbling diastolic murmur that is not mid-systolic and is best heard at the apex of the heart. Understanding the distinguishing features of