03-07-2010, 05:39 PM
A 78-year-old woman is evaluated for a 1-year history of progressively decreasing exercise tolerance. She has been in good health other than hypertension and osteoarthritis. Physical examination shows a regular pulse of 84/min, a respiration rate of 12/min, and blood pressure of 170/90 mm Hg. Carotid upstrokes are brisk, and her jugular venous pressure is 8 cm H2O. Her lungs are clear to percussion and auscultation. Her S1 is soft, and there is a physiologically split S2. A grade 2/6 mid-systolic murmur is present at the base with radiation to the apex but not to the carotids, and there is a grade 1/6 early diastolic decrescendo murmur at the left sternal border. There is no peripheral edema.
Which of this patient's physical examination findings are the most helpful for excluding severe aortic stenosis?
A Blood pressure
B Carotid upstroke
C Second heart sound
D Loudness of the murmur
E Radiation of the murmur
Which of this patient's physical examination findings are the most helpful for excluding severe aortic stenosis?
A Blood pressure
B Carotid upstroke
C Second heart sound
D Loudness of the murmur
E Radiation of the murmur