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 Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Aortic stenosis, WBRKeyword::crescendo decrescendo murmur
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