WBR0831
| Author | PageAuthor::Neeraja Danda M.B.B.S |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 60-year-old male presents to the physician for several episodes of fainting in the last 4 weeks. His past medical history is significant for hypertension and diabetes mellitus. His current medications are glibenclamide , atorvastatin , losartan and multivitamins. On physical examination, his vital signs show a heart rate of 75 bpm with weak peripheral pulses, and a blood pressure measuring 110/80 mmHg. Cardiac auscultation reveals a crescendo decrescendo systolic ejection murmur that increase in intensity with elevation of the legs. What is the most likely diagnosis?]] |
| Answer A | AnswerA::Aortic regurgitation |
| Answer A Explanation | AnswerAExp::'''Incorrect''' Aortic regurgitation causes a decrescendo diastolic murmur and presents with shortness of breath and fatigue |
| Answer B | AnswerB::Mitral regurgitation |
| Answer B Explanation | AnswerBExp::'''Incorrect''' Mitral regurgitation is characterized by a holosystolic murmur at the cardiac apex. Dyspnea on exertion is the most common presentation |
| Answer C | AnswerC::Mitral stenosis |
| Answer C Explanation | AnswerCExp::'''Incorrect''' A diastolic murmur after an opening snap is characteristic of mitral stenosis. |
| Answer D | AnswerD::Aortic stenosis |
| Answer D Explanation | AnswerDExp::A crescendo decrescendo systolic ejection murmur that increases in intensity with elevation of the legs, and squatting, but decreases in intensity on valsalva maneuver, standing and handgrip is characteristic of aortic stenosis |
| Answer E | AnswerE::Mitral valve prolapse |
| Answer E Explanation | AnswerEExp::'''Incorrect''' Mitral valve prolapse is usually characterized by a mid-systolic click. In severe cases, it can be associated with a regurgitation murmur. |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::Angina is the most common presentation of aortic stenosis, but it can also present as syncope or heart failure. A crescendo decrescendo systolic ejection murmur is characteristic of aortic stenosis. The murmur increases in intensity with elevation of the legs, and squatting, but decreases in intensity on valsalva maneuver, standing and handgrip. Delayed carotid upstroke is also seen in aortic stenosis. Transthoracic echocardiogram is the best initial diagnostic test and diuretics are the preferred initial therapy. Definitive therapy is valve replacement.
Educational Objective: A crescendo decrescendo systolic ejection murmur is characteristic of aortic stenosis. References: Page 63, 64 Master the boards step 3 2009 edition, Page 86,87,88,89,90,91,92 Master the boards step 2 CK second edition |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Aortic stenosis, WBRKeyword::crescendo decrescendo murmur |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |