An 82-Year-Old Woman Is Brought to the Emergency Department After

question 170

Multiple Choice

An 82-year-old woman is brought to the emergency department after 2 episodes of large bloody bowel movements.  She has no abdominal pain or vomiting.  Her past medical history is significant for paroxysmal atrial fibrillation and hypertension.  She takes daily low-dose aspirin.
Her blood pressure is 130/80 mm Hg, pulse is 88/min, and respirations are 14/min.  Abdominal examination reveals no tenderness or organomegaly.
Laboratory results are as follows:

While in the emergency department, the patient has another bloody bowel movement accompanied by transient dizziness and diaphoresis.  Upper gastrointestinal endoscopy and colonoscopy reveal no source of bleeding.
Which of the following is the most likely additional physical finding on chest examination?

• A)Ejection-type mid-systolic murmur
• B)Holosystolic murmur
• C)Late diastolic decrescendo murmur
• D)Low-pitched mid-diastolic rumble
• E)Pericardial knock

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