{"id":1143,"date":"2024-03-06T16:33:00","date_gmt":"2024-03-06T16:33:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1143"},"modified":"2026-01-08T13:19:14","modified_gmt":"2026-01-08T21:19:14","slug":"usmle-step-1-question-of-the-day-systolic-ejection-murmur","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Systolic ejection murmur"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#A\" >A.<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#B\" >B.<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#C\" >C.<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#D\" >D.<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#E\" >E.<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>USMLE\u00ae Step 1 Question of the Day: Systolic ejection murmur Learn about a USMLE\u00ae Step 1 question of the day related to systolic ejection murmur, specifically focusing on aortic stenosis. Discover the characteristics of this murmur and how to recognize it during auscultation.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>66-year-old man<\/strong> presents to a cardiologist for evaluation of a <strong>new heart murmur<\/strong> discovered at a <strong>routine health screening evaluation.<\/strong> The physician reads the report from this evaluation, which states that the patient was found to have a <strong>\u201ccrescendo-decrescendo systolic ejection murmur.\u201d<\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Auscultation at which of the following anatomic locations is <em>most appropriate<\/em> for reproducing this patient\u2019s characteristic murmur?<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"544\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-and-heart.png?w=1024\" alt=\"illustration of the chest and heart with labeled sections related to the question of the day.\n\nA - upper right chest\nB - upper left chest\nC - mid left chest\nD - lower left chest\nE - mid right chest\" class=\"wp-image-1145\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-and-heart.png 1080w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-and-heart.png?resize=300,159 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-and-heart.png?resize=768,408 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/chest-and-heart.png?resize=1024,544 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Scroll down for the correct answer!<\/strong><\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A\"><\/span>A. <span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the <strong>Main Explanation<\/strong>, let&#8217;s look at the <strong>incorrect answer<\/strong> explanations. Skip to the bottom if you want to <strong>see the correct answer<\/strong> right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B\"><\/span>B. <span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Choice B corresponds to the <strong>pulmonic area.<\/strong> This patient\u2019s classic \u201ccrescendo-decrescendo systolic ejection murmur\u201d is most likely from <strong>aortic stenosis,<\/strong> which is best heard over the <strong>aortic area (area A).<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C\"><\/span>C. <span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Choice C corresponds to the <strong>tricuspid area.<\/strong> This patient\u2019s classic \u201ccrescendo-decrescendo systolic ejection murmur\u201d is most likely from <strong>aortic stenosis,<\/strong> which is best heard over the <strong>aortic area (area A).<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D\"><\/span>D. <span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Choice D corresponds to the <strong>mitral area.<\/strong> This patient\u2019s classic \u201ccrescendo-decrescendo systolic ejection murmur\u201d is most likely from <strong>aortic stenosis,<\/strong> which is best heard over the <strong>aortic area (area A).<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E\"><\/span>E. <span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Choice E does not correspond to a <strong>defined auscultatory location.<\/strong> This patient\u2019s classic \u201ccrescendo-decrescendo systolic ejection murmur\u201d is most likely from <strong>aortic stenosis,<\/strong> which is best heard over the <strong>aortic area (area A).<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"562\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/auscultation.png\" alt=\"Title: Ausculiation\n\nA - Correct answer\nP - Pulmonary valve\nAortic valve\nT - Tricuspid valve\nM - Mitral valve\" class=\"wp-image-1144\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/auscultation.png 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/auscultation.png?resize=300,220 300w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">The characteristic <strong>crescendo-decrescendo systolic ejection murmur<\/strong> described in the question stem refers to <strong>aortic stenosis,<\/strong> which is best appreciated over the <strong>second intercostal space along the right sternum.<\/strong> Several <strong>anatomic areas of the chest wall<\/strong> serve as landmarks for auscultation of different <strong>valves of the heart:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Aortic area:<\/strong>&nbsp;Right second intercostal space, parasternal. <strong>Aortic valve murmurs<\/strong> are heard best here, including <strong>aortic stenosis (systolic)<\/strong> and <strong>aortic regurgitation (diastolic).<\/strong>&nbsp;<\/li>\n\n\n\n<li><strong>Pulmonic area:<\/strong>&nbsp;Left second intercostal space, parasternal. <strong>Pulmonic murmurs<\/strong> heard best here, like the <strong>systolic ejection murmur of pulmonic stenosis.<\/strong> Physiologic flow murmurs are also best heard here.<\/li>\n\n\n\n<li><strong>Tricuspid area:<\/strong>&nbsp;Left fourth intercostal space, parasternal. <strong>Diastolic murmurs<\/strong> associated with <strong>tricuspid stenosis<\/strong> or <strong>atrial septal defects<\/strong> can be heard here, as well as <strong>holosystolic murmurs<\/strong> from <strong>tricuspid regurgitation<\/strong> and <strong>ventricular septal defects.<\/strong><\/li>\n\n\n\n<li><strong>Mitral area:<\/strong> Left fifth intercostal space, mid-clavicular. One can hear the <strong>systolic murmurs<\/strong> from <strong>mitral regurgitation<\/strong> or <strong>mitral valve prolapse<\/strong> here, in addition to the <strong>diastolic mitral stenosis murmur.<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Anatomic areas of the chest wall<\/strong> correspond to <strong>different valves of the heart<\/strong> for auscultation. Using this knowledge, one can elicit <strong>murmurs associated with specific cardiac valvular pathology.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hockberger, Robert, Ron Walls, and John Marx. <strong>Rosen\u2019s Emergency Medicine: Concepts and Clinical Practice<\/strong>. Saunders, 2012. Print.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"\" class=\"wp-image-760\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><figcaption class=\"wp-element-caption\"><em><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/em><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 1<\/strong> <strong>practice questions<\/strong>? Try <strong>Osmosis by Elsevier<\/strong> today! Access your\u00a0<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>\u00a0and find out why millions of <strong>current and future clinicians and caregivers<\/strong> love <strong>learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Aortic stenosis produces a classic crescendo-decrescendo systolic ejection murmur best heard at the right second intercostal space. Learn key auscultation sites for cardiac murmurs.<\/p>\n","protected":false},"author":202,"featured_media":1149,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1366,1369,44],"tags":[416,2224,2221,2230,2227,2222,2229,84,2228,2232,2225,2226,2223,664,2231],"class_list":["post-1143","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-questions","category-step-1-questions","category-step-1","tag-aortic-stenosis","tag-aortic-valve","tag-cardiac-auscultation","tag-cardiac-exam","tag-crescendo-decrescendo","tag-heart-murmur","tag-heart-sounds","tag-medical-education","tag-mitral-valve","tag-murmur-recognition","tag-pulmonic-valve","tag-systolic-murmur","tag-tricuspid-valve","tag-usmle-step-1","tag-valvular-disease"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Systolic ejection murmur - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-systolic-ejection-murmur\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Systolic ejection murmur - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Aortic stenosis produces a classic crescendo-decrescendo systolic ejection murmur best heard at the right second intercostal space. 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