American College of Physicians: Internal Medicine — Doctors for Adults ®


The MKSAP Challenge

From the September ACP Observer, copyright © 2005 by the American College of Physicians.

Clinical scenario

A 37-year-old man is evaluated in the office for a first episode of syncope. The event was brief and occurred while he was engaged in light activity. On physical examination, his blood pressure is 110/68 mm Hg, his pulse rate is 70/min and his respiration rate is 12/min. The cardiac apex is displaced laterally. The first and second heart sounds are normal. There is a grade 2/6 midsystolic murmur heard at the left sternal border that decreases when the patient is asked to squat; it increases during a Valsalva maneuver. The murmur does not radiate into the carotid arteries and does not change with respiration.

Which of the following is the most likely diagnosis?

A. Aortic stenosis
B. Atrial septal defect
C. Hypertrophic cardiomyopathy
D. Mitral regurgitation
E. Primary pulmonary hypertension



[PDF] Acrobat PDF format. Download Acrobat Reader software for free from Adobe. Problems with PDFs?

This is a printer-friendly version of this page

Print this page  |  Close the preview



Internist Archives Quick Links

ACP JournalWise

Reviews of the World's Top Medical Journals—FREE to ACP Members!

New CME Option: Internal Medicine 2014 RecordingsACP JournalWiseSM is mobile optimized with optional email alerts! Get access to reviews from over 120 of the world’s top medical journals alerting you to the highest quality, most clinically relevant new articles based on your preferred areas of specialty. ACP Members register your FREE account now!

New CME Option: Internal Medicine 2014 Recordings

New CME Package

New CME Option: Internal Medicine 2014 RecordingsIncludes 75 of the most popular sessions in internal medicine and the subspecialties. Stream the sessions, answer brief quizzes and earn CME credit. See details.