WBR0002

Author	PageAuthor::Raviteja Reddy Guddeti
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 68 year old man presents to the Emergency Room after losing consciousness while climbing stairs. He denies any pre-syncopal symptoms, or any past history of neurologic conditions. However, the patient reports having experienced increasing dyspnea and chest pain on exertion over the past 3 years. Which carotid pulse pattern is most likely to be seen in this patient?]]
Answer A	AnswerA::Pulsus bisferiens
Answer A Explanation	AnswerAExp::Pulsus bisferiens is a pulse characterized by two strong systolic peaks separated by a midsystolic dip, most commonly occurring in pure aortic regurgitation with stenosis.
Answer B	AnswerB::Pulsus paradoxus
Answer B Explanation	AnswerBExp::Pulsus paradoxus is the hallmark of tamponade. It is defined as drop in systolic blood pressure by more than 10 mm Hg during inspiration. It is also seen in asthma and COPD.
Answer C	AnswerC::Pulsus parvus et tardus
Answer C Explanation	AnswerCExp::See explanation
Answer D	AnswerD::Pulsus alternans
Answer D Explanation	AnswerDExp::Pulsus alternans refers to a pulse showing alternating strong and weak beats. It is observed in congestive heart failure and its presence carries a poor prognosis.
Answer E	AnswerE::Pulsus bigeminus
Answer E Explanation	AnswerEExp::Pulsus bigeminus refers to a “bigeminal” pulse: a pulse characterized by two beats occur in rapid succession, the groups of two being separated by a longer interval. It is seen in hypertrophic cardiomyopathy.
Right Answer	RightAnswer::C
Explanation	[[Explanation::The patient in this vignette is likely to have aortic stenosis. Aortic stenosis most commonly develops as an age related calcification of a three-leafed aortic valve in the elderly population (late 60s to 80s). Calcification leading to stenosis occurs earlier in patients with bicuspid valves, often in their 40s to 50s. Aortic stenosis causes pulsus parvus et tardus, a pulse which is weak/small (parvus), and late (tardus) relative to its expected character due to outflow obstruction at the aortic valve. Educational Objective: References: ]]
Approved	Approved::No
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