WBR0652

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 30 year old male patient presents to his primary care physician complaining shortness of breath and fatigue for the last 3 months. Physical examination is significant for a painless ulcer on the penis and painless lymphadenopathy in the inguinal region. Cardiac auscultation reveals a decrescendo diastolic murmur heard best at the left sternal border. He is sexually active with multiple partners both male and female. What is the most likely diagnosis of his heart murmur?]]
Answer A	AnswerA::Reactive arthritis
Answer A Explanation	AnswerAExp::'''Incorrect''' Reactive arthritis can cause aortic regurgitation but is not associated with genital ulcers. It is associated with urethritis , uveitis or conjunctivitis and arthritis.
Answer B	AnswerB::Secondary Syphilis
Answer B Explanation	AnswerBExp::'''Incorrect''' Secondary syphilis is characterized by wart like lesions on the genitals called condylomata lata. Secondary syphilis does not involve the heart.
Answer C	AnswerC::Mitral valve prolapse
Answer C Explanation	AnswerCExp::'''Incorrect''' Mitral valve prolapse is seen in Marfans or Ehlers- Danlos syndrome and is characterized by a mid systolic click on cardiac auscultation
Answer D	AnswerD::Aortic regurgitation
Answer D Explanation	AnswerDExp::Aortic regurgitation is characterize by a diastolic murmur that gradually decreases in intensity (decrescendo murmur)
Answer E	AnswerE::Endocarditis
Answer E Explanation	[[AnswerEExp::Incorrect Endocarditis is often accompanied by fever , and presents as a new murmur or change in an existing murmur. It is diagnosed by blood cultures and vegetations on cardiac valves on echocardiography. The patient in this vignette does not display fever or other acute infective symptoms.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Aortic regurgitation is characterize by a diastolic murmur that gradually decreases in intensity . Aortic regurgitation can be caused by reactive arthritis, ankylosing spondylitis, Marfans syndrome and syphilis. His high degree of sexual activity, painless genital ulcer and lymphadenopathy should raise suspicion for Syphilis as underlying his aortic regurgitation. Cardiac and neural involvement is seen in tertiary syphilis. Tertiary syphilis is treated with intravenous penicillin and desensitization in penicillin sensitive patients Educational Objective: Syphilis in its tertiary phase can involve the aortic valve, thereby causing aortic regurgitation., References: References: Page 17,18,64 Master the boards step 3 2009 edition, Page 91,92 Master the boards Step 2 CK second edition Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Aortic regurgitation, WBRKeyword::Decrescendo murmur, WBRKeyword::tertiary syphilis
Linked Question	Linked::
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