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kabu
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11/09/05 - 06:24 PM

A 55-year-old man presents for evaluation of exertional dyspnea and chest pain. His medical history is unremarkable. His carotid pulses are delayed and diminished. His point of maximal intensity is hyperdynamic but not displaced. He has a harsh crescendo-decrescendo murmur along the left sternal border that peaks late in systole. The aortic component of S2 is not heard. His ECG demonstrates left ventricular hypertrophy with strain pattern. His chest x-ray film shows a normal-sized heart and clear lung fields.
The cause of his problem is most likely

Myxomatous valve degeneration
Bicuspid aortic valve
Rheumatic aortic stenosis
Senile calcific aortic stenosis

DrS
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11/09/05 - 07:57 PM

Bicuspid aortic valve

phuluong2k
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11/10/05 - 01:27 AM

Senile calcific aortic stenosis

nisha
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11/10/05 - 01:45 AM

just read it again, yes i agree with senile calcification

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ARJ
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11/10/05 - 02:37 AM

Age of onset-- young...Middle age
Bicuspid aortic valve

Age of onset latter in life
Senile calcific aortic stenosis

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dr.arabnia
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11/10/05 - 02:52 AM

I think he is too young for senil calcification and i think the predisposing factor is bicuspid aortic valve

DrS
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11/10/05 - 04:57 AM

Yes thats what I thought, doesent' senile calcification occur in those >65?

popillon
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11/10/05 - 06:19 AM

Hello

I need a partner in Dallas to practicing for step 2CK in november ending

abreo17@yahoo.com

phuluong2k
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11/10/05 - 10:35 AM

What is the answer kabu ?

So exactly above at what age we can conclude senile calcification ? Any preference ?

nisha
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11/10/05 - 01:21 PM

#10

generally its said that if bicuspid aortic valve were to cause stenosis it would have by 2nd-3rd decade, after that senile calcification becomes more likely

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DrS
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11/10/05 - 05:07 PM

#11

Nisha, Could you please tel me your source?

kabu
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11/10/05 - 05:27 PM

#12

Answer: B
Explanation: In a 55-year-old man, bicuspid aortic valve is most likely. Senile calcific aortic stenosis develops in the seventh and eighth decades. There was no history of rheumatic fever to suggest rheumatic aortic stenosis. Myxomatous degeneration does not cause aortic stenosis. (Cecil, Ch. 72)

nisha
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11/10/05 - 07:59 PM

#13

my source was my cousin (an int med doc) but i guess things r diff in theory! which book is cecil?

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kabu
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11/11/05 - 03:04 PM

#14

Cecils textbook of Medicine -used more in India/UK.

I did'nt look up the reference though - it came with the answer. If anyone has access to a Cecils , they can confirm it?

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