A 58-year-old female presents to her primary care physician with complaints of chest pain and palpitations. A thorough past medical history reveals a diagnosis of rheumatic fever during childhood. Echocardiography is conducted and shows enlargement of the left atrium and narrowing of the mitral valve opening. Which of the following should the physician expect to hear on cardiac auscultation?
AContinuous, machine-like murmur
BHolosystolic murmur that radiates to the axilla
COpening snap following S2
DHigh-pitched, blowing decrescendo murmur in early diastole
EMid-systolic click
A previously healthy 19-year-old man is brought to the emergency department by his girlfriend after briefly losing consciousness. He passed out while moving furniture into her apartment. She said that he was unresponsive for a minute but regained consciousness and was not confused. The patient did not have any chest pain, palpitations, or difficulty breathing before or after the episode. He has had episodes of dizziness when exercising at the gym. His blood pressure is 125/75 mm Hg while supine and 120/70 mm Hg while standing. Pulse is 70/min while supine and 75/min while standing. On examination, there is a grade 3/6 systolic murmur at the left lower sternal border and a systolic murmur at the apex, both of which disappear with passive leg elevation. Which of the following is the most likely cause?
AProlonged QT interval
BHypertrophic cardiomyopathy
CMitral valve stenosis
DMitral valve prolapse
EBicuspid aortic valve
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
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