#june2020mccqe1
A 60-year-old woman is evaluated for an 18-month history of progressive dyspnea on exertion and a 3-month history of orthopnea. She is otherwise well and takes no medications. On examination, she is afebrile, blood pressure is 110/85 mm Hg, pulse rate is 100/min, and respiration rate is 24/min. The carotid upstroke is diminished and delayed compared with the apical pulsation. Cardiac examination shows a sustained cardiac apex impulse, grade 3/6 late-peaking systolic ejection murmur at the right upper sternal border radiating to the carotid arteries, and an S4. Lungs are clear to auscultation. The remainder of the examination is normal. Which of the following is the most likely diagnosis?
(A) Aortic stenosis
(B) Atrial septal defect
(C) Pulmonary arterial hypertension
(D) Pulmonary valvular stenosis
A 60-year-old woman is evaluated for an 18-month history of progressive dyspnea on exertion and a 3-month history of orthopnea. She is otherwise well and takes no medications. On examination, she is afebrile, blood pressure is 110/85 mm Hg, pulse rate is 100/min, and respiration rate is 24/min. The carotid upstroke is diminished and delayed compared with the apical pulsation. Cardiac examination shows a sustained cardiac apex impulse, grade 3/6 late-peaking systolic ejection murmur at the right upper sternal border radiating to the carotid arteries, and an S4. Lungs are clear to auscultation. The remainder of the examination is normal. Which of the following is the most likely diagnosis?
(A) Aortic stenosis
(B) Atrial septal defect
(C) Pulmonary arterial hypertension
(D) Pulmonary valvular stenosis
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