A 42-Year-Old Woman Comes to the Clinic for a Routine

question 136

Multiple Choice

A 42-year-old woman comes to the clinic for a routine physical examination.  She has no specific concerns, but on review of systems acknowledges that she has recently been getting tired easily.  The patient also informs the physician of occasional palpitations, which she describes as a "fast heartbeat."  Family history is significant for hypertension and type 2 diabetes mellitus.  She is a lifetime nonsmoker.  The patient does not drink alcohol or use illicit drugs.  Vital signs are normal.  She was told in the past that she has "a heart problem" that she thinks is mitral valve prolapse.  The patient was advised to follow-up with a cardiologist, but she says she had been feeling well and did not see a doctor.  Which of the following physical findings would be most consistent with this diagnosis?

• A)Ejection click followed by a crescendo-decrescendo systolic murmur
• B)Harsh holosystolic murmur with the thrill at the left sternal border
• C)Holosystolic murmur at the lower sternum that increases with inspiration
• D)Loud S1 and low-pitched diastolic murmur loudest at apex
• E)Nonejection click and murmur that vary in timing depending on body position

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Definitions:

Portfolio

A collection of various investments held by an individual, company, or financial institution.

Risky Bond Portfolio

A collection of bonds with higher default risk, which may offer higher yields in compensation for the increased risk of loss.

Standard Deviation

A statistical measure of the dispersion or variability of a set of values, representing how spread out the numbers are from the mean.

Correlation

A statistical measure that describes the extent to which two variables move in relation to each other, indicating the strength and direction of their relationship.