Turn the sound on: Use headphones in a quiet room and begin at a low volume. These are synthetic educational simulations, not patient recordings and not a substitute for supervised clinical auscultation.
How to use the sound lab
- Listen once with your eyes closed and identify S1 and S2.
- Decide whether the added sound is systolic or diastolic.
- Describe its shape: crescendo–decrescendo, holosystolic, decrescendo or rumbling.
- State the best auscultation location, radiation and the maneuver that makes it easier to hear.
- Replay the segment and compare your description with the answer table.
| Sound | OSCE description | Best location and maneuver |
|---|---|---|
| Normal S1–S2 | Regular first and second heart sounds with no added sound or murmur in this simulation. | Use as the timing reference before classifying an added sound. |
| Aortic stenosis | Harsh systolic crescendo–decrescendo murmur. | Right upper sternal border, commonly radiating to the carotids. Assess carotids one at a time. |
| Mitral regurgitation | Blowing holosystolic or pansystolic murmur extending from S1 to S2. | Apex, commonly radiating toward the axilla; left lateral positioning may improve apical sounds when tolerated. |
| Aortic regurgitation | High-pitched early diastolic decrescendo murmur after S2. | Left sternal border with the patient leaning forward during held expiration, if clinically safe. |
| Mitral stenosis | Opening snap followed by a low-pitched mid-diastolic rumble. | Bell at the apex in the left lateral position, if tolerated. |
Exact examiner presentation framework
“On auscultation, S1 and S2 are present. There is a grade __/6 [systolic/diastolic] [shape and quality] murmur, maximal at the [location], radiating to the [site]. It is best heard with the [diaphragm/bell] and [increases/decreases] with [maneuver]. I would correlate this with the pulse, JVP, apex, peripheral signs and echocardiography.”
Self-check
Which murmur is heard throughout systole at the apex and radiates to the axilla?
Mitral regurgitation. Describe it as holosystolic or pansystolic rather than simply “systolic.”
Which murmur is an early diastolic decrescendo best heard leaning forward?
Aortic regurgitation. State that the maneuver is used only if the patient can tolerate it.
Which murmur is a systolic crescendo–decrescendo at the right upper sternal border?
Aortic stenosis. Radiation to the carotids supports the pattern.
Which murmur has an opening snap and low-pitched diastolic rumble?
Mitral stenosis. Use the bell at the apex in the left lateral position.
Clinical safety: A recording cannot establish a diagnosis. In a real station, integrate the sound with stability, symptoms, pulse character, JVP, precordial findings, lungs and peripheral signs. Escalate immediately for chest pain, syncope, severe dyspnea, hypoxemia, hypotension, altered mentation or poor perfusion.