A 48-year-old woman presents with dyspnea. She has a history of dyspnea for the past several years and has worsened over the last 6 months. There is associated orthopnea and lee swelling, She has no past medical history and does not use alcohol or recreational drugs On physical examination: Cardiac examination reveals an increased S1 with an opening snap and a soft diastolic murmur at the apex. There is also a systolic murmur over the anterior left sternal border. The ECG shows a sinus tachycardia with a right bundle branch block A chest X-ray shows pulmonary congestion. What is the most likely diagnosis?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: D. Mitral stenosis
Loud S1 + opening snap + apical diastolic murmur, with pulmonary congestion, orthopnea and leg swelling = mitral stenosis. The systolic murmur at the left sternal border and the RBBB fit right-heart strain (secondary TR / pulmonary hypertension). MR and MVP are systolic murmurs, and AS/HOCM are ejection murmurs.
ليش كل خيار صح أو غلط
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A
ليش غلط
Aortic stenosis is a harsh crescendo-decrescendo systolic murmur radiating to the carotids, not a loud S1 with an opening snap and apical diastolic murmur.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 3 -
B
ليش غلط
Mitral regurgitation gives a holosystolic murmur at the apex radiating to the axilla, a systolic murmur rather than an opening snap with a diastolic rumble.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 6 -
C
ليش غلط
HOCM gives a crescendo-decrescendo systolic murmur from LV outflow obstruction, heard at Erb's point with no ejection click; it does not give an opening snap or loud S1.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 5 -
D
ليش صح
Mitral stenosis gives a loud S1, an opening snap and a low-pitched diastolic rumble, and long-standing disease causes pulmonary hypertension and right ventricular failure.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 1 -
E
ليش غلط
Mitral valve prolapse has an ejection click (buckling of the valve) with a holosystolic murmur at the apex, not an opening snap with a diastolic murmur.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 6
- المصدر
- Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 1
Valvular disease ...pdf · p. 8 - المحاضرة
- Valvular Heart Disease · Cardiology · Module B
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- Cardio bank