Valvular Heart Disease USMLE Step 1 Practice Question
A 72-year-old man with a 15-year history of hypertension (currently on amlodipine) presents to clinic with progressive dyspnea on exertion over 3 months. He denies orthopnea or paroxysmal nocturnal dyspnea. On physical examination, blood pressure is 158/92 mmHg, heart rate is 78/min and regular. Cardiac auscultation reveals a late-peaking systolic murmur at the right upper sternal border that decreases with Valsalva maneuver and handgrip but increases with squatting. Transthoracic echocardiography shows concentric left ventricular hypertrophy, an aortic valve area of 0.8 cm² (normal >1.0 cm²), peak aortic valve gradient of 65 mmHg, and a small amount of aortic regurgitation. Which of the following is the most likely diagnosis?
Answer choices
- AHypertrophic cardiomyopathy with left ventricular outflow tract obstruction
- BAortic stenosis secondary to valve calcificationCorrect answer
- CAortic regurgitation from chronic hypertension-induced aortic root dilation
- DMitral regurgitation with secondary left ventricular hypertrophy
- ERestrictive cardiomyopathy with impaired diastolic function
- FPulmonary stenosis with right ventricular outflow tract obstruction
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.