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That the murmur would best be heard in the lateral left decubitus position
7%
18/259
The character of the murmur would be machine-like
2%
5/259
The murmur would also have a mid-systolic click loudest before S2
11%
29/259
The murmur would also have an opening snap
10%
27/259
Palpation of the carotid pulse would be weak and late relative to the patient’s heart sounds
68%
177/259
Select Answer to see Preferred Response
The patient presents with syncope and has physical exam findings of aortic stenosis. This condition is associated with a weak and late carotid pulse, also known as pulsus parvus et tardus. Aortic stenosis most often occurs in the elderly and results from mechanical wear and tear of the aortic valve resulting in dystrophic calcification. Another potential cause of aortic stenosis is chronic rheumatic fever, though rheumatic fever more often affects the mitral valve. In younger patients presenting with signs and symptoms of aortic stenosis, the underlying cause is often a unicuspid or bicuspid valve. Aortic stenosis is often asymptomatic until very advanced but once symptomatic, patients may progress rapidly and experience angina, syncope with exercise, and concentric left ventricular hypertrophy leading to congestive heart failure. Illustration A shows a calcified aortic valve. Incorrect Answers: Answer 1: This a characteristic of the murmur of mitral valve stenosis. Answer 2: The is a characteristic of the murmur of patent ductus arteriosus. Answer 3: This is a characteristic of the murmur of mitral valve prolapse. Answer 4: This is a characteristic of the murmur of mitral stenosis.
3.7
(6)
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