A 16-year-old boy comes to the physician for a routine health maintenance examination. He feels well. He has no history of serious illness. He is at the 60th percentile for height and weight. Vital signs are within normal limits. The lungs are clear to auscultation. A grade 3/6 ejection systolic murmur is heard along the lower left sternal border. The murmur decreases in intensity on rapid squatting and increases in intensity when he performs the Valsalva maneuver. This patient is at increased risk for which of the following complications?
ASudden cardiac death
BPulmonary apoplexy
CInfective endocarditis
DCerebral aneurysm
EAngiodysplasia
A 27-year-old woman, who recently immigrated from Bangladesh, presents to her primary care physician to discuss birth control. During a review of her past medical history, she reports that as a child she had a recurrent sore throat and fever followed by swollen and aching hip and knee joints. These symptoms returned every season and were never treated but went away on their own only to return with the next typhoon season. When asked about any current complaints, the patient says that she sometimes has shortness of breath and palpitations that do not last long. A physical exam is performed. In which of the auscultation sites will a murmur most likely be heard in this patient?
APoint 5
BPoint 4
CPoint 2
DPoint 3
EPoint 1
A 19-year-old man presents to the clinic with a complaint of increasing shortness of breath for the past 2 years. His shortness of breath is associated with mild chest pain and occasional syncopal attacks during strenuous activity. There is no history of significant illness in the past, however, one of his uncles had similar symptoms when he was his age and died while playing basketball a few years later. He denies alcohol use, tobacco consumption, and the use of recreational drugs. On examination, pulse rate is 76/min and is regular and bounding; blood pressure is 130/70 mm Hg. A triple apical impulse is observed on the precordium and a systolic ejection crescendo-decrescendo murmur is audible between the apex and the left sternal border along with a prominent fourth heart sound. The physician then asks the patient to take a deep breath, close his mouth, and pinch his nose and try to breathe out without allowing his cheeks to bulge out. In doing so, the intensity of the murmur increases. Which of the following hemodynamic changes would be observed first during this maneuver?
A↓ Mean Arterial Pressure, ↑ Heart rate, ↑ Baroreceptor activity, ↓ Parasympathetic Outflow
B↑ Mean Arterial Pressure, ↓ Heart rate, ↑ Baroreceptor activity, ↑ Parasympathetic Outflow
C↑ Mean Arterial Pressure, ↓ Heart rate, ↓ Baroreceptor activity, ↑ Parasympathetic Outflow
D↑ Mean Arterial Pressure, ↑ Heart rate, ↓ Baroreceptor activity, ↓ Parasympathetic Outflow
E↑ Mean Arterial Pressure, ↑ Heart rate, ↑ Baroreceptor activity, ↑ Parasympathetic Outflow
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