Family Nurse Practitioner Exam

Where is a split S2 best auscultated?

1. The aortic area

2. The pulmonic area

3. The tricuspid area

4. The mitral area

The correct answer is: The pulmonic area

A split S2 is best auscultated in the pulmonic area, which is located at the left second intercostal space, near the sternum. This phenomenon occurs during respiration when the aortic valve and the pulmonic valve close at slightly different times due to variations in intrathoracic pressure. During inspiration, the increased venous return to the right heart causes a delay in the closure of the pulmonic valve, leading to the audible split. In contrast, the other areas listed—the aortic area, tricuspid area, and mitral area—are primarily associated with the sounds generated by other heart valves, and while they may also produce normal heart sounds, they are not optimized for detecting the split S2. This split is a key factor in evaluating cardiac function and is particularly important in understanding normal physiological variations, especially in younger patients or athletes. Being able to accurately identify where to auscultate for a split S2 is essential in clinical practice, making the pulmonic area the correct choice.