A 35-Year-Old African American Woman Comes to the Clinic Due

question 1485

Multiple Choice

A 35-year-old African American woman comes to the clinic due to exertional shortness of breath.  The patient's exercise tolerance a year ago was walking 7 blocks but now she walks less than a block before becoming short of breath.  She also feels lightheaded when she forces herself "to go on."  The patient denies any episodes of syncope, chest pain, cough, wheezing, orthopnea, nausea, or lower extremity edema.  She has been treated for Raynaud phenomenon and fingertip ulcerations for the last 2 years.  She also suffers from severe heartburn controlled with high-dose pantoprazole.  Family history is not significant.  She does not smoke cigarettes or consume alcohol.  Blood pressure is 112/72 mm Hg and pulse is 94/min.  Pulse oximetry shows 95% on room air.  BMI is 23 kg/m².
Which of the following would be the most expected finding on physical examination?

• A)Delayed femoral pulses bilaterally
• B)Ejection-type systolic murmur radiating to the carotids
• C)Right ventricular heave
• D)Third heart sound at the apex on end-expiration
• E)Wide and fixed splitting of the second heart sound

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Definitions:

Oxygen

A chemical element (O) essential for most forms of life on Earth, critical for cellular respiration in organisms.

Zinc

A chemical element with symbol Zn and atomic number 30, it is a necessary mineral for human health, involved in various biochemical processes.

Iron

A chemical element with symbol Fe and atomic number 26, known for its metallic properties and crucial role in biological processes like oxygen transport in hemoglobin.

Hydrogen Bonds

Weak bonds between partially positive hydrogen atoms and partially negative atoms, such as oxygen or nitrogen, important in the structure of water and biological molecules.