Cedrick
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A 55 year old with a 10 year old history of poorly controlled hypertension has had increasing dysnea for the past 3 days
last night he slept sitting in a chair
vital signs are
pulse 110/min
resp 30/min and regular
blood pressure,sitting 120/80 Hg
The apical impulse is felt 2 cm lateral to the midclavicular line in the sixth intercostal space
Over the apex,there is an early diastolic low frequency sound after S2
this sound is most likely
a.-a midsystolic click
b.-an opening snap
c.-a pericardial rub
d.-a splitting of S2
e.-an S3
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| Cedrick
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E
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| Cedrick
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| robin082006
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E
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| rn
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can u plz explain why e?
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| sridevibandaru24
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E
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| young_doc
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Explanation:
a.-a midsystolic click...this is NOT diastolic
b.-an opening snap...this is NOT diastolic
c.-a pericardial rub...is not a low frequency sound after S2 in the apex of the heart!
d.-a splitting of S2...this would be heard over the pulmonic valve
e.-an S3...heard right after S2, as blood starts gushing into the ventricle.
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| pocas
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for sure E
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| what to do
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i donno about this qs for sure but mid systolic click appears in mitral prolapse and OPEING SNAP is a diastolic event, so young doc, u got the second one wrong, cuz Mitral stenosis is a mid-daistolic murmur followed by a opening snap. no offense. can someone give me the diagnosis of this qs stem? i need to know the diagnosis to get through E (the answer)
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| Ancylostoma
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You should look at three clues, one that he has pulmonary edema- hearfailure, 2nd, his apex beat is in the 6th intercostal space - hypertrophy,-heartfailure. And you have to know that diastolic filling in a volume loaded vetricle will cause an s3. Since he has hypertrophy he probably has an s4 as well.
the answer is e
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