This is an evolving issue for the NBME. On mine, I had 2 media questions - both heart sounds - and you could not reliably answer the question based on the vignette alone. You could make an educated guess and probably guess right, but the sound should really help you confirm or refute your suspicion.
Both of mine were fairly difficult -- no straightforward cresc-decresc at the RUSB for me! One was incredibly difficult and took me a long time to figure out what was going on. The sound was actually a very subtle finding that I thought I was just imagining, so I answered based only on the vignette and probability given that info and got it right. The other I can't remember, but don't recall struggling much at all with it.
Don't forget, none of these will be "what sound is this," but rather they'll want you make the diagnosis Tricuspid regurg from the exam, connect that with IVDA, and then the question might ask about other steps in management (HIV test, etc) or other expected clinical findings or most likely organism (staph aureus) etc.
