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Cases | Cardiothoracic | Chatfield

Henry Chatfield: Physical Examination

General

Slender, youthful looking 72 year-old man.

Vital signs

Temp 98 degrees; pulse 84 and regular; BP 136/84.

HEENT

Normal.

Neck

Deformity of the left mid-clavicle.

Chest

Resonant, breath sounds clear.

Heart

PMI wide and 3cm left of the mcl; 1st sound barely audible, 5/6 holosystolic plateau-shaped blowing murmur best heard at the apex radiating to the left axilla.

Abdomen

Soft and non-tender; no organomegaly or mass.

Rectal exam

No masses; prostate 3 plus in size, smooth, firm.

Extremities

Pulses all palpable, no edema.

Self-assessment question:

The murmur described is most compatible with which of the following?

a. Aortic stenosis
b. Aortic insufficiency
c. Mitral stenosis
d. Mitral insufficiency

The correct answer is d. Mitral insufficiency results in a holosystolic plateau shaped murmur best heard at the apex and radiating to the left axilla.

Next: Test results

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Last modified: Monday, 09-Jan-2006 15:40:26 EST. (PL)

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