Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Continuous, flow murmur best heard in the interscapular region
16%
6/37
Continuous, machine-like murmur best heard in the left subclavicular region
54%
20/37
Holosystolic, harsh-sounding murmur best heard at the left lower sternal border
5%
2/37
Late systolic, crescendo murmur at the apex with mid-systolic click
Systolic ejection murmur best heard at the left upper sternal border
19%
7/37
Select Answer to see Preferred Response
This patient presents with short stature, hypertension, and the physical exam findings of a broad chest, short 4th metacarpals, and kyphosis, which is consistent with a diagnosis of Turner syndrome. Turner syndrome is associated with coarctation of the aorta, which causes a continuous flow murmur best heard in the interscapular region. Turner syndrome (45, XO) classically presents with short stature, increased upper-to-lower segment ratio, webbed neck, broad chest with widely spaced nipples, and kyphosis or scoliosis. Patients are also at risk for cardiac malformations such as coarctation of the aorta and a bicuspid aortic valve. Coarctation of the aorta leads to hypertension of the upper extremities with hypotension of the lower extremities, weak or delayed distal pulses, and symptoms related to poor perfusion such as peripheral claudication. Coarctation typically presents on a cardiac exam as a continuous flow murmur best heard over the upper back, which is caused by flow through the collateral circulation in the intercostal vessels. Morgan reviews the evidence regarding the diagnosis and symptoms associated with Turner syndrome. He discusses how this disease is often associated with congenital heart defects such as coarctation of the aorta. He recommends considering this diagnosis in patients with short stature and primary amenorrhea. Incorrect Answers: Answer 2: A continuous, machine-like murmur best heard in the left subclavicular region reflects patent ductus arteriosus (PDA). PDA is most commonly found in premature infants, although it may also coexist with other congenital cardiac abnormalities. Treatment of a PDA includes medications such as indomethacin as well as surgical interventions such as catheterization. Answer 3: A holosystolic, harsh-sounding murmur at the left lower sternal border reflects a ventricular septal defect (VSD). VSD is most commonly associated with Down syndrome (trisomy 21), which presents with the dysmorphic features of upslanting palpebral fissures, epicanthal folds, a flat nasal bridge, and a single transverse palmar crease. Treatment with surgical correction of the defect is required in symptomatic cases. Answer 4: A late systolic crescendo murmur at the apex with mid-systolic click would suggest mitral valve prolapse, which is associated with Marfan syndrome. Marfan syndrome presents with physical exam findings of tall stature, arachnodactyly, pectus excavatum, and hypermobile joints. Treatment is with valve repair or reconstruction in patients with symptomatic regurgitation. Answer 5: A systolic ejection murmur best heard at the left upper sternal border indicates an atrial septal defect (ASD). ASD is commonly found in Down syndrome (trisomy 21) and also causes fixed splitting of the 2nd heart sound. Asymptomatic patients may not require any treatment but symptomatic patients can have surgical repair of the defective valve. Bullet Summary: Turner syndrome (45, XO) is frequently associated with coarctation of the aorta, which causes a continuous, flow murmur best heard over the interscapular region due to collateral circulation.
5.0
(3)
Please Login to add comment