A 52-Year-Old Man Comes to the Office with Concerns About

question 117

Multiple Choice

A 52-year-old man comes to the office with concerns about a "heart problem."  Three years ago, the patient was told during a routine physical examination that he had a heart murmur.  Currently, he has no specific complaints, but he mentions that he has become tired more easily in the past year.  He has no chest pain or lower extremity swelling or significant medical history.  The patient was healthy as a child and received all his childhood vaccinations.  Blood pressure is 145/90 mm Hg and pulse is 80/min and regular.  Physical examination reveals a holosystolic murmur best heard at the apex of the heart that radiates to the axilla.  The lungs are clear on auscultation and abdominal examination is unremarkable.  Which of the following is the best indicator of the severity of this patient's valve disease?

• A)Presence of audible S3
• B)Presence of audible S4
• C)Presence of mid-systolic click
• D)S2-to-opening snap time interval
• E)Splitting of S2 accentuated by inspiration

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Definitions:

Independent Contractor

A person who is hired to perform a task for another but who is not the other’s employee.

Employee

An individual who works for an employer and is entitled to receive compensation in exchange for their labor or services.

Independent Contractor

An individual who provides services to another entity under terms specified in a contract or within a verbal agreement, unlike an employee who works regularly for a single employer.

Supervision

The act of overseeing or managing activities and personnel to ensure that tasks are performed correctly, safely, and efficiently.