Valvular Heart Disease USMLE Step 1 Practice Question
A 76 year old man presents with several months of exertional chest pain and two episodes of near syncope while climbing stairs. He has a history of hyperlipidemia and smoking. Blood pressure is 132/78 mm Hg. Cardiac examination shows a harsh crescendo decrescendo systolic murmur at the right upper sternal border that radiates to both carotids. The carotid upstroke is delayed and diminished. Which of the following is the most likely underlying cause of this patient's condition?
Answer choices
- AImmune mediated destruction of the aortic media
- BFibroelastic thickening from chronic hypertension alone
- CDystrophic calcification of a degenerating tricuspid aortic valveCorrect answer
- DMyxomatous degeneration of the mitral valve
- ECongenital failure of endocardial cushion fusion
- FRheumatic fever causing commissural fusion of aortic valve leaflets
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