WBR0534
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| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian and Yazan Daaboul, M.D.)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathophysiology |
| Sub Category | SubCategory::Cardiology |
| Prompt | [[Prompt::A 63-year-old man presents to the physician's office complaining of shortness of breath, rhythmic head nodding, and fatigue. On examination, his temperature is 37 °C (98.7 °F), heart rate is 88/min, and blood pressure is 160/60 mmHg. Cardiac auscultation is significant for a murmur. When the patient is asked to raise his hand above the level of his head, capillary pulsations of the nail beds are noted. Which of the following best describes the murmur present in this patient?]] |
| Answer A | AnswerA::Holosystolic high-pitched blowing murmur that radiates toward the axilla |
| Answer A Explanation | AnswerAExp::Murmur of mitral regurgitation is best described as a holosystolic high-pitched blowing murmur that radiates toward the axilla. |
| Answer B | AnswerB::Crescendo-decrescendo systolic murmur with ejection click |
| Answer B Explanation | [[AnswerBExp::Murmur of aortic stenosis is best described as a crescendo-decrescendo systolic murmur with ejection click that radiates to the carotids. Aortic stenosis usually manifests as a triad of dyspnea, syncope, and angina with narrow pulse pressure on physical examination.]] |
| Answer C | AnswerC::Rumbling late diastolic murmur with opening snap |
| Answer C Explanation | AnswerCExp::Murmur of mitral stenosis is best described as a rumbling late diastolic murmur with opening snap. |
| Answer D | AnswerD::Late systolic crescendo murmur with midsystolic click |
| Answer D Explanation | AnswerDExp::Murmur of mitral valve prolapse (MVP) is best described as a late systolic crescendo murmur with midsystolic click. |
| Answer E | AnswerE::Blowing diastolic decrescendo murmur best heard immediately after S2 |
| Answer E Explanation | AnswerEExp::Murmur of aortic regurgitation (AR) is described as a blowing diastolic decrescendo murmur best heard immediately after S2. The patient's symptoms and findings are consistent with AR. |
| Right Answer | RightAnswer::E |
| Explanation | [[Explanation::The patient in this scenario is most likely presenting with aortic regurgitation (AR). Murmur of AR is best described as a blowing diastolic decrescendo murmur. It is usually caused by aortic root dilation, bicuspid aortic valve, rheumatic heart disease, or endocarditis. Patients with AR often have a widened pulse pressure (PP = SBP - DBP) as observed in this patient. This wide difference between systolic and diastolic pressures causes head bobbing, which is head nodding that accompanies one's heart beat (De Musset's sign). Additionally, patients with AR have positive Quincke's sign, which are pulsations in the capillary beds of the nails. Other signs include a bounding carotid pulse (Corrigan’s pulse), pulsation of the uvula (Muller’s sign), pistol-shot sounds during auscultation of the femoral artery (Traube’s sign), and bruit during compression of the femoral artery (Duroziez sign). Educational Objective: Murmur of AR is best described as a high-pitched diastolic decrescendo murmur. Patients usually present with shortness of breath, fatigue, and head bobbing (De Musset's sign). Physical examination findings include a wide pulse pressure and a positive Quincke's sign. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Aortic regurgitation, WBRKeyword::De Musset's sign, WBRKeyword::Quincke's sign, WBRKeyword::Head bobbing, WBRKeyword::Murmur, WBRKeyword::Aortic insufficiency, WBRKeyword::Wide pulse pressure, WBRKeyword::Physical exam, WBRKeyword::Auscultation |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |