02-27-2007, 02:41 PM
i have no answer for it
Previously healthy 42 year old woman comes to the physician becos of a 6 month history of shortness of breath with moderate exertion and pulsatile tinnitus in her left ear. She has had to decrease her daily running from 40 mts to 20 mts. at a slower pace. She takes no medications. Her last menstrual period was 5 weeks ago. She is sexually active and uses a diaphragm for contraception. She appears well. Her BP is 130/60 mm Hg, pulse is 96/min and respirations are 16/min. A bruit is heard over the left ear. The lungs are clear to auscultation. A grade 2/6, early systolic murmur is heard at the left sternal border. The cardiac apex is laterally displaced and enlarged. Peripheral pulses are bounding. An ECG shows no abnormalities except for left ventricular hypertrophy. Echocardiography shows a left ventricular ejection fraction of 50% and an increased left ventricular end-diastolic volume. Which of the following is the most likely diagnosis?
A. Aortic stenosis
B. Arteriovenous malformation
C. Hypertrophic cardiomyopathy
D. Osteitis deformans (Paget™s disease)
E. Pregnancy
F. Vitamin B (thiamine) deficiency
Previously healthy 42 year old woman comes to the physician becos of a 6 month history of shortness of breath with moderate exertion and pulsatile tinnitus in her left ear. She has had to decrease her daily running from 40 mts to 20 mts. at a slower pace. She takes no medications. Her last menstrual period was 5 weeks ago. She is sexually active and uses a diaphragm for contraception. She appears well. Her BP is 130/60 mm Hg, pulse is 96/min and respirations are 16/min. A bruit is heard over the left ear. The lungs are clear to auscultation. A grade 2/6, early systolic murmur is heard at the left sternal border. The cardiac apex is laterally displaced and enlarged. Peripheral pulses are bounding. An ECG shows no abnormalities except for left ventricular hypertrophy. Echocardiography shows a left ventricular ejection fraction of 50% and an increased left ventricular end-diastolic volume. Which of the following is the most likely diagnosis?
A. Aortic stenosis
B. Arteriovenous malformation
C. Hypertrophic cardiomyopathy
D. Osteitis deformans (Paget™s disease)
E. Pregnancy
F. Vitamin B (thiamine) deficiency