A 62-year-old man comes to the physician for decreased exercise tolerance. Over the past four months, he has noticed progressively worsening shortness of breath while walking his dog. He also becomes short of breath when lying in bed at night. His temperature is 36.4°C (97.5°F), pulse is 82/min, respirations are 19/min, and blood pressure is 155/53 mm Hg. Cardiac examination shows a high-pitch, decrescendo murmur that occurs immediately after S2 and is heard best along the left sternal border. There is an S3 gallop. Carotid pulses are strong. Which of the following is the most likely diagnosis?
AAortic valve regurgitation
BTricuspid valve regurgitation
CMitral valve prolapse
DMitral valve regurgitation
EMitral valve stenosis
A 76-year-old male with a history of chronic uncontrolled hypertension presents to the emergency room following an episode of syncope. He reports that he felt lightheaded and experienced chest pain while walking his dog earlier in the morning. He notes that he has experienced multiple similar episodes over the past year. A trans-esophageal echocardiogram demonstrates a thickened, calcified aortic valve with left ventricular hypertrophy. Which of the following heart sounds would likely be heard on auscultation of this patient?
ACrescendo-decrescendo murmur radiating to the carotids that is loudest at the right upper sternal border
BDiastolic rumble following an opening snap with an accentuated S1
CEarly diastolic high-pitched blowing decrescendo murmur that is loudest at the left sternal border
DHolosystolic murmur radiating to the axilla that is loudest at the apex
EMidsystolic click that is loudest at the apex
A 65-year-old male with a history of coronary artery disease and myocardial infarction status post coronary artery bypass graft (CABG) surgery presents to his cardiologist for a routine appointment. On physical exam, the cardiologist appreciates a holosystolic, high-pitched blowing murmur heard loudest at the apex and radiating towards the axilla. Which of the following is the best predictor of the severity of this patient's murmur?
AEnhancement with expiration
BPresence of audible S3
CEnhancement with hand grip maneuver
DPresence of audible S4
EEnhancement with inspiration
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