Pulmonic stenosis in exam vignettes is best described as which murmur and physiologic feature?

• A. Sounds like mitral stenosis
• B. Sounds like tricuspid regurgitation, left-sided
• C. It is best heard at the apex with radiation
• D. Sounds like aortic stenosis (midsystolic) and increases with inspiration

Answer: (D)

Pulmonic stenosis produces a midsystolic, harsh ejection murmur that is best heard at the left upper sternal border (second left intercostal space) and tends to increase with inspiration because the right ventricle experiences more venous return during inspiration. Describing it as a midsystolic murmur like aortic stenosis and noting that it intensifies with inspiration fits the neurovascular pattern of a right‑sided outflow obstruction. The other descriptors would point to different valvular lesions—for example, mitral stenosis is a diastolic murmur at the apex, and tricuspid regurgitation is a holosystolic murmur best heard along the left lower sternal border.