WBR0533
| Author | [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathophysiology |
| Sub Category | SubCategory::Cardiology |
| Prompt | [[Prompt::A 62-year-old male presents to the emergency room with complaints of progressive shortness of breath at rest. Vital signs demonstrate a temperature of 37 °C, heart rate of 90 bpm, blood pressure of 110/70 mmHg, and respiratory rate of 30 breaths/min. Physical examination reveals an extra heart sound in early diastole, prominent jugular vein, and pitting edema in the lower extremities. Which of the following statements is most likely true regarding the patient's extra heart sound?]] |
| Answer A | AnswerA::The patient's extra heart sound is a result of atrial contraction against a stiff ventricle. |
| Answer A Explanation | AnswerAExp::S3 manifests due to the increased filling pressure in a dilated ventricle. S4 is characterized by atrial contraction against a stiff ventricle. |
| Answer B | AnswerB::The manifestation of an extra heart sound is indicative of poor prognostic outcomes. |
| Answer B Explanation | AnswerBExp::The manifestation of S3 carries poor prognostic implications in patients with heart failure. |
| Answer C | AnswerC::The patient's symptoms are consistent with isolated left ventricular dysfunction |
| Answer C Explanation | [[AnswerCExp::The patient's syndrome, characterized by shortness of breath, JVD, S3 on cardiac auscultation, and pitting edema is consistent with heart failure of both the left and the right sides. JVD and pitting edema implicate involvement of the right side of the heart.]] |
| Answer D | AnswerD::Aortic stenosis is another pathologic state that is frequently characterized by the same type of extra heart sound |
| Answer D Explanation | AnswerDExp::The extra heart sound that frequently manifests in aortic stenosis is S4. |
| Answer E | AnswerE::The patient's extra heart sound is best heard at the base of the heart |
| Answer E Explanation | AnswerEExp::S3 is best heard at the apex of the heart; whereas S4 is best heard at the base of the heart. |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::The patient presents with symptoms suggestive of heart failure. Physical examination of the patient reveals an extra heart sound (S3), which is described as an early diastolic heart sound occurring due to increased filling pressure in dilated ventricle.
Findings upon physical examination are associated with poor prognosis in patients with heart failure. Elevated jugular venous pressure (JVP) and third heart sound (S3) are cardinal features in the determination of likely prognosis in patients with heart failure. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::heart failure, WBRKeyword::cardiac, WBRKeyword::jugular venous distention, WBRKeyword::JVD, WBRKeyword::pitting edema, WBRKeyword::third heart sound, WBRKeyword::S3, WBRKeyword::shortness of breath, WBRKeyword::ventricle, WBRKeyword::dilated, WBRKeyword::cardiology, WBRKeyword::respiratory system, WBRKeyword::cardiovascular system |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |