MKSAP: 21-year-old male student is evaluated for a murmur

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old male student is evaluated for a murmur heard during an athletic preparticipation physical examination. He is asymptomatic. His medical and family history is unremarkable and he takes no medications. On physical examination, the patient is afebrile, blood pressure is 118/76 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 18. He wears corrective lenses for myopia. Mild thoracic scoliosis is noted. He has long, thin fingers and a mild pectus excavatum deformity. His height is 188 cm (6 ft 2 in) and arm span is 200 cm from fingertip to fingertip. On cardiac auscultation, a soft early diastolic decrescendo murmur is heard, and is best heard along the left sternal border during expiration with the patient seated and leaning forward slightly. A transthoracic echocardiogram demonstrates dilatation of the aortic root of 6.2 cm. Which of the following is the most appropriate treatment? A: Admit to hospital; begin metoprolol and intravenous sodium nitroprusside B: Begin oral losartan and metoprolol C: Plan urgent surgery D: Repeat echocardiogram in 6 months Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Heart Source Type: blogs