A 74-Year-Old Man Comes to the Office for a Follow-Up

question 784

Multiple Choice

A 74-year-old man comes to the office for a follow-up visit for hypertension.  His last visit was a year ago.  He has no chest pain, shortness of breath, leg swelling, or dizziness.  The patient is compliant with his medications and can tolerate a moderate level of physical activity.  Blood pressure is 145/75 mm Hg and pulse is 67/min and regular.  Auscultation findings at the base of the heart are depicted in the exhibit below. Which of the following is the most likely cause of this patient's physical findings?

• A)Ankylosing spondylitis
• B)Chordal rupture
• C)Coronary artery disease
• D)Cystic medial necrosis
• E)Infective endocarditis
• F)Rheumatic fever
• G)Right ventricular failure
• H)Valvular calcification

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