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Pain improves with inspiration
4%
14/360
Pain relieved by sitting up and leaning forward
70%
251/360
High-pitched diastolic murmur
11%
38/360
Fixed and split S2
Mid-systolic click
9%
34/360
Select Answer to see Preferred Response
Arthritis, photosensitivity, and facial rash in an African-American woman are consistent with systemic lupus erythematosus (SLE). The most common cardiovascular syndrome associated with SLE is pericarditis. SLE is a multisystem inflammatory disease. Pericarditis is a common manifestation of SLE. Pericarditis presents as severe, constant chest pain radiating to the shoulders, arms, and back. The pain is pleuritic and postural (relieved by sitting up and leaning forward). Auscultation of pericarditis will reveal a pericardial friction rub. Illustration A is an example of a malar rash. Note the sparing of the nasolabial folds. Illustration B is an example of discoid lupus, erythematous raised patches with adherent keratotic scaling. Illustration C is an ECG showing pericarditis. Notice the ST elevation in all leads and PTa depression in the precordial leads (depression between the end of the P-wave and the beginning of the QRS-complex). Incorrect Answers: Answer 1: The pleuritic pain of pericarditis worsens with inspiration. Answer 3: High-pitched diastolic murmur is consistent with aortic regurgitation. Answer 4: Fixed and split S2 is consistent with an atrial septal defect which is not associated with SLE. Answer 5: A mid-systolic click is consistent with mitral valve prolapse.
3.8
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