almina
Forum Senior
Topics: 34
Posts: 99
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A 17-year-old Honduran male presents to your office with a complaint of increasing spells of losing attention and falling during exercise. He has also noted feeling some shortness of breath lately. The patient states that he has always suffered such spells, but previously they happened rarely. On further questioning, you find out that a brother, father, paternal aunt, and grandmother all had similar spells. The patient has another brother who is unaffected. The brother who had these spells died when he was 14. One of his father's siblings who did not have these spells died suddenly at age 18 during a soccer game. On physical examination, you would expect to hear which of the following cardiac murmurs?
A. A continuous murmur
B. A crescendo–decrescendo systolic ejection murmur beginning immediately after S1
C. A crescendo–decrescendo systolic ejection murmur beginning well after S1
D. A high-pitched diastolic murmur beginning immediately after S2
E. A high-pitched systolic murmur beginning well after S2, often accompanied with an initial snap
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| Snood
Forum Junior
Topics: 11
Posts: 55
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Im not sure im posting correctly?
Anyway, im guessing B
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| BumbleB
Forum Junior
Topics: 2
Posts: 83
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I'm guessing its AO regurg also, but what about the family history?
Oh...I see you're hinting at Marfan's with an aortic anurysm- does that cause regurg?
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| ELM
Forum Guru
Topics: 28
Posts: 936
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According to the family hystory it seems like Idiopathic Hypertrophic Subaortic Stenosis. ----> septal hypertrophy---> Mitral regurgitation--->so the answer is B ....but the murmur is not due to Aortic stenosis....it's due to MR ( flow murmur).......easly confused with AS!!! In AStenosis murmur accentuated at the end of the systoli whereas here the murmur is laudest in the beginning of systoli.
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ELM
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| Kazem
Forum Elite
Topics: 76
Posts: 296
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answer is C. the murmur happens between S1 and S2.
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| phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
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Almina, what is the right choice ?
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| almina
Forum Senior
Topics: 34
Posts: 99
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the correct answer is C, although I did answer B. (my dg was Hptr subaortic stenosis). Kazem, you answered correectly, what's the right dg?
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| BumbleB
Forum Junior
Topics: 2
Posts: 83
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Coarctation of aorta?
PDA?
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| Kazem
Forum Elite
Topics: 76
Posts: 296
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almina your diagnosis was right. its Idiopathic Hypertrophic Subaortic Stenosis so just remember that the murmur happens well after S1 but before S2.
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| almina
Forum Senior
Topics: 34
Posts: 99
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thanks 
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